Nurse Distractions in the Intensive Care Unit

Abstract

Critical care nurses are often distracted or interrupted in their daily work caring for seriously ill patients in the fast-paced, high-tech Intensive Care Unit (ICU) setting. Distractions can lead to poor patient outcomes if they result in mistakes in practice. Nurses respond to distractions in a number of ways, such as acknowledging the distraction, multitasking, or interrupting the task at hand. Much of the literature focuses on medication errors, but little is known about events and responses leading to the error or other distracted patient care tasks. The purpose of this study was to describe distraction and nurses’ response to distractions during bedside care in the ICU. Specifically, we aimed to describe (1) tasks distracted/interrupted, (2) sources of distraction, (3) how distractions were managed, and (4) nurses’ perceptions of distractions during bedside care. Four nurses, with 1-27 years’ (mean=10.25 years) experience, were observed during bedside care in the ICU. Each nurse was observed for four 15-minute patient interactions. The nurses were then debriefed about what they found to be distracting and what they were thinking/feeling during the observation. The 16 observations (~4 hours total) and debriefing interviews were coded and analyzed using basic qualitative description and constant comparison in Atlas.ti. Forty-four distractions were observed, half (22;50%) were interruptions. Tasks most commonly interrupted were patient assessment (n=24) and medication preparation/ administration (n=12). Alarms and monitors were the most frequent sources of distraction (n=14), followed by coworkers (n=12). Nurses reported that distractions by coworkers were often beneficial to their practice and patient care, but identified missing or out-of-reach equipment and alarms and monitors as “true” distractions, which accounted for 4 and 14 distractions, respectively. These findings are consistent with the literature that medication preparation/administration is commonly disrupted. However, this study goes a step further to address disruptions of other important nursing tasks and nurses’ perceptions of those distractions.