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Abstract
Introduzione. Le interruzioni lavorative che si verificano durante la pratica infermieristica sono pericolose per la sicurezza del paziente, comportando un pesante carico cognitivo per l'operatore e aumentando il rischio di commettere errori. Materiali e metodi. È stato condotto uno studio osservazionale nelle UU.OO operative di Neurochirurgia e Chirurgia Vascolare di un ospedale ligure. L'osservazione è durata 1 mese, dal 1 luglio 2012 al 1 agosto 2012. Per la raccolta dati sono state utilizzate 3 schede, una per ogni turno lavorativo, nelle quali ogni operatore doveva riportare in quale attivití veniva interrotto e da cosa. Risultati. Sono state rilevate un totale di 7744 interruzioni lavorative nel mese di rilevazione (5676 in Neurochirurgia e 2068 in Chirurgia vascolare). La fonte di maggior interruzione è il campanello (38%), seguito dal telefono (28%) e dalle richieste dei parenti (24%). In generale le attivití principalmente interrotte sono state il rifacimento dei letti/cure igieniche, somministrazione e preparazione della terapia, passaggio di consegne e compilazione della documentazione infermieristica. Conclusioni. Le interruzioni lavorative rimarranno una parte inevitabile nella pratica infermieristica, a causa della sua stessa natura. Occorre di conseguenza intervenire sulle interruzioni ritenute evitabili e sulle variabili organizzative che le generano, al fine di aumentare la sicurezza del paziente ed ottimizzare le attivití assistenziali.
Key words: assistenza infermieristica, interruzioni lavorative, management, rischio clinico.
ABSTRACT
Introduction. Interrumption that occur during nursing practice are hazardous for patient safety, resulting in a heavy cognitive load for the health care professionals and increases the risk of making mistakes. Methods. An observational study was carried out in UU.OO operation of Neurosurgery and Vascular Surgery at a hospital in Liguria. The observation lasted one months, from July 1st, 2012 to August 1st, 2012. For data collection were used three form, one for each work shift, in which each health care professional had to report what activity was interrupted and why. Results. A total of 7744 interruptium (in 5676 in Neurosurgery and 2068 Vascular Surgery). The major source of interruption was the bell, followed by the phone and relatives' questions. In general, activities interrupted were mainly made beds / hygiene care, administration and preparation of medication, handover and completion of the nursing documentation Conclusion. Interrumption will be an inevitable part of nursing practice, because of its very nature. It is therefore necessary to intervene on interruptions deemed avoidable and organizational variables that generate them, in order to increase patient safety and improve care activities.
Key words: Nursing care, interrumption, management, clinical risk
Dettagli dell'articolo
Riferimenti
- Alvarez, G., & Coiera, E.W. (2005) Interruptive communication patterns in the intensive care unit ward round. International Journal of Medical Informatics, 74(10), 791-796.
- Biron, A.D., Lavoie-Tremblay, M., & Loiselle, C.G. (2009a) Characteristics of work interruptions during medication administration. Journal of Nursing Scholarship, 41(4), 330-336. DOI: 10.1111/j.1547-5069.2009.01300.x
- Biron, A.D., Loiselle, C.G., & Lavoie-Tremblay, M. (2009b) Work interruptions and their contribution to medication administration errors: an evidence review. Worldviews on Evidence Based Nursing, 6(2), 70-86. DOI: 10.1111/j.1741-6787.2009.00151.x.
- Cades, D.M., Boehm-Davis, D.A., Trafton, J.G., & Monk, CA. (2011) Mitigating disruptive effects of interruptions through training: what needs to be practiced? Journal of Experimental Psychology. Applied, 17(2),97-109. doi: 10.1037/a0023497.
- Ebright, P.R., Patterson, E.S., Chalko, B.A., & Render, M.L. (2003) Understanding the complexity of registered nurse work in acute care settings. The Journal of Nursing Administration, 33(12), 630-638.
- Grundgeiger, T., Sanderson, P., MacDougall, H.G., & Venkatesh, B. (2010) Interruption management in the intensive care unit: Predicting resumption times and assessing distributed support. Journal of Experimental Psychology Applied, 16(4), 317-334. DOI: 10.1037/a0021912.
- Hall, L.M., Ferguson-Paré, M., Peter, E., White, D., Besner, J., Chisholm, A., Ferris, E., Fryers, M., Macleod, M., Mildon, B., Pedersen, C., & Hemingway A. (2010) Going blank: factors contributing to interruptions to nurses' work and related outcomes. Journal of Nursing Management, 18(8), 1040-1047. DOI: 10.1111/j.1365-2834.2010.01166.x.
- Healey, A.N., Sevdalis, N., & Vincent, C.A. (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics, 49(5-6), 589-604.
- Hedberg, B., & Larsson, U.S. (2004) Environmental elements affecting the decision-making process in nursing practice. Journal of Clinical Nursing, 13(3), 316-324.
- Hopp, P.J., Smith, C.A., Clegg, B.A., & Heggestad, E.D. (2005) The use of attention-directing tactile cues. Human Factors, 47(1), 1-11.
- Kalisch B.J., & Aebersold M. (2010) Interruptions and Multitasking in nursing care. Joint Commission Journal on Quality and Patient Safety, 36(3), 126-132.
- Li, S.Y., Magrabi, F., & Coiera, E. (2012) A systematic review of the psychological literature on interruption and its patient safety implications. Journal of the American Medical Informatics Association, 19(1), 6-12. DOI: 10.1136/amiajnl-2010-000024.
- Magrabi, F., Li, S.Y., Dunn, A.G., & Coiera, E. (2011) Challenges in measuring the impact of interruption on patient safety and workflow outcomes. Methods of Information in Medicine, 50(5), 447-453. DOI: 10.3414/ME11-02-0003
- Palese, A., Sartor, A., Costaperaria, G., & Bresadola V. (2009) Interruptions during nurses' drug rounds in surgical wards: observational study. Journal of Nursing Management,17(2),185-192. DOI: 10.1111/j.1365-2834.2007.00835.x.
- Polit, D.F. & Tatano Bech, C. (2004) Nursing research. Principles and Methods. VII ed., Philadelphia PA, US: Lippicott Williams & Wilkins.
- Tremblay, S., Vachon, F., Lafond, D., & Kramer, C. (2011) Dealing with task interruptions in complex dynamic environments: are two heads better than one? Human Factors, 54(1), 70-83.
- Westbrook, J.L., Woods, A., Rob, M.I., Dunsmuir, W.T., & Day, R.O. (2010) Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. DOI: 10.1001/archinternmed. 2010.65.
Riferimenti
Alvarez, G., & Coiera, E.W. (2005) Interruptive communication patterns in the intensive care unit ward round. International Journal of Medical Informatics, 74(10), 791-796.
Biron, A.D., Lavoie-Tremblay, M., & Loiselle, C.G. (2009a) Characteristics of work interruptions during medication administration. Journal of Nursing Scholarship, 41(4), 330-336. DOI: 10.1111/j.1547-5069.2009.01300.x
Biron, A.D., Loiselle, C.G., & Lavoie-Tremblay, M. (2009b) Work interruptions and their contribution to medication administration errors: an evidence review. Worldviews on Evidence Based Nursing, 6(2), 70-86. DOI: 10.1111/j.1741-6787.2009.00151.x.
Cades, D.M., Boehm-Davis, D.A., Trafton, J.G., & Monk, CA. (2011) Mitigating disruptive effects of interruptions through training: what needs to be practiced? Journal of Experimental Psychology. Applied, 17(2),97-109. doi: 10.1037/a0023497.
Ebright, P.R., Patterson, E.S., Chalko, B.A., & Render, M.L. (2003) Understanding the complexity of registered nurse work in acute care settings. The Journal of Nursing Administration, 33(12), 630-638.
Grundgeiger, T., Sanderson, P., MacDougall, H.G., & Venkatesh, B. (2010) Interruption management in the intensive care unit: Predicting resumption times and assessing distributed support. Journal of Experimental Psychology Applied, 16(4), 317-334. DOI: 10.1037/a0021912.
Hall, L.M., Ferguson-Paré, M., Peter, E., White, D., Besner, J., Chisholm, A., Ferris, E., Fryers, M., Macleod, M., Mildon, B., Pedersen, C., & Hemingway A. (2010) Going blank: factors contributing to interruptions to nurses' work and related outcomes. Journal of Nursing Management, 18(8), 1040-1047. DOI: 10.1111/j.1365-2834.2010.01166.x.
Healey, A.N., Sevdalis, N., & Vincent, C.A. (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics, 49(5-6), 589-604.
Hedberg, B., & Larsson, U.S. (2004) Environmental elements affecting the decision-making process in nursing practice. Journal of Clinical Nursing, 13(3), 316-324.
Hopp, P.J., Smith, C.A., Clegg, B.A., & Heggestad, E.D. (2005) The use of attention-directing tactile cues. Human Factors, 47(1), 1-11.
Kalisch B.J., & Aebersold M. (2010) Interruptions and Multitasking in nursing care. Joint Commission Journal on Quality and Patient Safety, 36(3), 126-132.
Li, S.Y., Magrabi, F., & Coiera, E. (2012) A systematic review of the psychological literature on interruption and its patient safety implications. Journal of the American Medical Informatics Association, 19(1), 6-12. DOI: 10.1136/amiajnl-2010-000024.
Magrabi, F., Li, S.Y., Dunn, A.G., & Coiera, E. (2011) Challenges in measuring the impact of interruption on patient safety and workflow outcomes. Methods of Information in Medicine, 50(5), 447-453. DOI: 10.3414/ME11-02-0003
Palese, A., Sartor, A., Costaperaria, G., & Bresadola V. (2009) Interruptions during nurses' drug rounds in surgical wards: observational study. Journal of Nursing Management,17(2),185-192. DOI: 10.1111/j.1365-2834.2007.00835.x.
Polit, D.F. & Tatano Bech, C. (2004) Nursing research. Principles and Methods. VII ed., Philadelphia PA, US: Lippicott Williams & Wilkins.
Tremblay, S., Vachon, F., Lafond, D., & Kramer, C. (2011) Dealing with task interruptions in complex dynamic environments: are two heads better than one? Human Factors, 54(1), 70-83.
Westbrook, J.L., Woods, A., Rob, M.I., Dunsmuir, W.T., & Day, R.O. (2010) Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. DOI: 10.1001/archinternmed. 2010.65.