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Original Investigation
December 20, 2019

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

Author Affiliations
  • 1Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 3Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 4Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 5Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 6Center for Healthcare Quality and Analytics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 7Division of Pediatric Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 8Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 9Department of Nursing, Christiana Care Health System, Newark, Delaware
  • 10Department of Mathematics, Temple University, Philadelphia, Pennsylvania
  • 11Deputy Editor, JAMA Pediatrics
JAMA Pediatr. 2020;174(2):162-169. doi:10.1001/jamapediatrics.2019.5001
Key Points

Question  Are mobile telephone interruptions temporally associated with pediatric intensive care unit nurses’ errors during medication administration?

Findings  In this cohort study of 257 nurses and 3308 patients in a pediatric intensive care unit, incoming calls on nurses’ institutional mobile telephones occurring in the 10 minutes before medication administration were significantly associated with increased risk of error. The risk was higher during night shifts and among nurses with fewer than 6 months’ experience, and it also varied by nurse to patient ratio and level of patient care required.

Meaning  This study’s findings suggest that, although communication-related interruptions cannot be eliminated, interventions to reduce the frequency and adverse consequences of interruptions should include consideration of time of day, nurse experience, nurse to patient ratio, and level of patient care required.

Abstract

Importance  Incoming text messages and calls on nurses’ mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.

Objective  To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration.

Design, Setting, and Participants  A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children’s hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications.

Exposures  Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse’s PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required.

Main Outcomes and Measures  Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned.

Results  Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22).

Conclusions and Relevance  This study’s findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.

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