For many nurses, particularly those who work in hospitals, the work environment is fast-paced and unpredictable, requiring complex thought processes. They are usually caring for multiple patients with changing clinical needs. And as technology has simplified many tasks, the urge to do many things at once—to multitask—has become ever stronger. Yet research has definitively determined that multitasking is a myth.
The bottom line is this: While you may think you are doing two things at once, you are actually switching between them very quickly. Researchers illustrated this by placing test subjects in an MRI and measuring brain activity as they were asked to alternate between tasks. They found that the brain actually pauses between tasks, to push aside information needed to perform one task and replace it with the information needed for the second task. The researchers concluded that people do not actually have the ability to pay attention to two things simultaneously—which is why texting while driving is so dangerous. Multitasking increases the chances of making mistakes and missing important data or visual cues. It also makes you less likely to retain important information in your working memory, which can have an effect on your performance later. Because of this, multitasking has been identified as a human factor (as opposed to a systems factor) that is likely to lead to errors.
For nurses, multitasking during medication preparation or administration is especially dangerous. Yet concentrating on one thing at a time is easier said than done when it comes to a busy hospital unit, where interruptions are rampant.
Several observational studies have attempted to measure the frequency with which nurses are interrupted while performing a task—and they have found averages ranging from six interruptions per hour to 14. What’s more, the studies counted numerous times when nurses were interrupted again while responding to the first or even a second interruption!
To minimize the chance that a medication error will be caused by a distraction or interruption, some hospitals have adopted specific strategies. These include:
- Visual signals. The Institute of Medicine (IOM) has recommended that nurses wear a colored vest or apron while preparing and administering medications to patients. It provides a visual signal to others not to interrupt or disturb the nurse.
- No interruption zones. This approach involves using tape to mark off the zone around an automated dispensing cabinet or drug preparation area—or to place these areas in dedicated rooms. Again, the idea is to provide a visual cue that nurses within these zones should not be pulled away for other tasks or engaged in conversation.
- Checklists. Critical tasks with multiple steps (like distributing meds to several patients on the floor) can be added to a checklist that remains at the drug dispensing area. Nurses can refer to it after returning from an interruption, to help them remember where they left off.
- Preparation. When all supplies, orders, and documentation technologies are assembled together in the same place, there is less need to walk away to get something while preparing medications.
- No calls or pages. In hospitals that use mobile devices for patient calls and staff notifications, the alerts can temporarily be transferred to another staff member during medication preparation and administration.
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