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Interrupting a Nurse Makes Medication Errors More Likely

Distracting an airline pilot during taxi, takeoff or landing could lead to a critical error. Apparently the same is true of nurses who prepare and administer medication to hospital patients.

A new study shows that interrupting nurses while they’re tending to patients’ medication needs increases the chances of error. As the number of distractions increases, so do the number of errors and the risk to patient safety.

“We found that the more interruptions a nurse received while administering a drug to a specific patient, the greater the risk of a serious error occurring,” said the study’s lead author, Johanna I. Westbrook, director of the Health Informatics Research and Evaluation Unit at the University of Sydney in Australia.

For instance, four interruptions in the course of a single drug administration doubled the likelihood that the patient would experience a major mishap, according to the study, reported in the April 26 issue of the Archives of Internal Medicine.

Experts say the study is the first to show a clear association between interruptions and medication errors.

It “lends important evidence to identifying the contributing factors and circumstances that can lead to a medication error,” said Carol Keohane, program director for the Center of Excellence for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston.

“Patients and family members don’t understand that it’s dangerous to patient safety to interrupt nurses while they’re working,” added Linda Flynn, associate professor at the University of Maryland School of Nursing in Baltimore. “I have seen my own family members go out and interrupt the nurse when she’s standing at a medication cart to ask for an extra towel or something [else] inappropriate.”

Julie Kliger, who serves as program director of the Integrated Nurse Leadership Program at the University of California, San Francisco, said that administering medication has become so routine that everyone involved — nurses, health-care workers, patients and families — has become complacent.

“We need to reframe this in a new light, which is, it’s an important, critical function,” Kliger said. “We need to give it the respect that it is due because it is high volume, high risk and, if we don’t do it right, there’s patient harm and it costs money.”

About one-third of harmful medication errors occur during medication administration, studies show. Prior to this study, though, there was little if any data on what role interruptions might play.

For the study, the researchers observed 98 nurses preparing and administering 4,271 medications to 720 patients at two Sydney teaching hospitals from September 2006 through March 2008. Using handheld computers, the observers recorded nursing procedures during medication administration, details of the medication administered and the number of interruptions experienced.

The computer software allowed data to be collected on multiple drugs and on multiple patients even as nurses moved between drug preparation and administration and among patients during a medication round.

Errors were classified as either “procedural failures,” such as failing to read the medication label, or “clinical errors,” such as giving the wrong drug or wrong dose.

Only one in five drug administrations (19.8%) was completely error-free, the study found.

Interruptions occurred during more than half (53.1%) of all administrations, and each interruption was associated with a 12.1% increase, on average, in procedural failures and a 12.7% increase in clinical errors.

Most errors (79.3%) were minor, having little or no impact on patients, according to the study. However, 115 errors (2.7%) were considered major errors, and all of them were clinical errors.

Failing to check a patient’s identification against his or her medication chart and administering medication at the wrong time were the most common procedural and clinical glitches, respectively, the study reported.

In an accompanying editorial, Kliger described one potential remedy: A “protected hour” during which nurses would focus on medication administration without having to do such things as take phone calls or answer pages.

The idea, Kliger said, is based on the U.S. Federal Aviation Administration’s “sterile cockpit” rule. That rule, according to the Aviation Safety Reporting System, prohibits non-essential activities and conversations with the flight crew during taxi, takeoff, landing and all flight operations below 10,000 feet, except when the safe operation of the aircraft is at stake.

Likewise, in nursing, not all interruptions are bad, Westbrook added.

“If you are being given a drug and you do not know what it is for, or you are uncertain about it, you should interrupt and question the nurse,” she said.

Source on net: http://www.medicinenet.com/script/main/art.asp?articlekey=115738
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Health

Habits that can age you 12 years

Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests.

The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Monday’s Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

“You don’t need to be extreme” to be in the healthy category, Kvaavik said. “These behaviors add up, so together it’s quite good. It should be possible for most people to manage to do it.”

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

The U.S. government generally recommends at least 4 cups of fruits or vegetables daily for adults, depending on age and activity level; and about 2 1/2 hours of exercise weekly.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations including the United States.

June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity.

The findings don’t mean that everyone who maintains a healthy lifestyle will live longer than those who don’t, but it will increase the odds, Stevens said.

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