The role of clinical communication loads in contributing to medication administration errors and task scheduling errors
Healthcare delivery is associated with a large number of avoidable errors that lead to patient harm. These errors are associated with a significant burden of morbidity and mortality on the Australian population. Our scientific understanding of the fundamental causes of error remains poor. This project aims to make a fundamental contribution to improving our understanding of this problem, and suggest initiatives which can improve the safety of health care in Australian hospitals.
The exchange of information between health professionals and between health professionals and their patients is a core element in the provision of safe and effective health care. Communication events make up over 80% of hospital doctors and nurses’ time. On average doctors are interrupted 15 times per hour and senior clinicians have even higher rates of interruption. Information exchange may be disrupted within health care settings in many ways and may have serious and often negative consequences. Within hospital settings we still have a relatively poor understanding of the amount or nature of communication which occurs and this limits our ability to design better ways of organizing and supporting care delivery. This study involves direct observational studies of doctors in an Emergency Department and nurses on four general hospital wards.The research will employ the use of handheld (PDA) data collection tools designed by our researchers in collaboration with the Centre for Health Informatics at the University of NSW, to allow for collection of detailed information about clinicians’ communication loads (eg interruptions) as well as medication administration processes.
The aim of this research is to:
Examine the relationships between clinicians’ cognitive & communication loads (ie interruptions and multi/parallel tasking) and two types of errors: Task scheduling errors which arise from working memory disruption and may be a primary source of error; and Medication administration errors, a leading cause of harm to patients.
Hypotheses being tested are:
Being interrupted while preparing or administering a drug increases the likelihood of a medication error
Interruptions & multi-tasking in high stress clinical environments increase task scheduling errors (ie tasks are left incomplete, delayed or forgotten)
Clinical experience may compensate for the effects of a high communication load
Lead Researcher: Professor Johanna Westbrook J.Westbrook@usyd.edu.au
Research Funding: HCF Health & Medical Research Foundation 2006-2007
Collaborators:
- Concord Repatriation General Hospital, Sydney
- Centre for Health Informatics University of NSW www.chi.unsw.edu.au
- St. Vincent’s Hospital, Sydney