2011-2012 Grant Awards

Board Research Grant

Management of Distraction and Interruptions During Nursing Care in ICU

Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh School of Nursing

Mary Beth Happ, PhD, RN, FAAN

Distractions and interruptions in the clinical environment pose an increasing threat to safe, error-free patient care. These disruptions may be particularly prevalent in acute and critical care settings, where information technology is ubiquitous and the environment is complex and chaotic. Although research has shown that interruptions are frequent—and likely inevitable—in these settings, the connections between interruptions and errors in health care are not yet fully understood. Furthermore, while interruptions are generally viewed in a negative light, some interruptions may be necessary to ensure effective communication and coordination in a complex and dynamic care environment. While understanding the sources and purpose of distraction and interruption and ways that nurses manage these challenges may play an important role in improving the safety of care, there are few studies on distraction and interruption management among nurses in the ICU.

This research project will address the problem of distraction and interruption as a potential source of error in adult critical care settings. In the first of two studies, the researchers will analyze video recordings of nurses providing bedside care in order to characterize types of interruptions and describe nurses’ strategies for managing interruptions. In the second study, the researchers will augment these findings through qualitative analysis of real-time observations and focus-group interviews with nurses working in the same types of critical care settings as were observed in the first study.

Findings of this research project will help to improve critical care patient safety by providing a more complete understanding of distraction and interruption during bedside care; identifying strategies for preventing and managing nurse disruption and interruption in the ICU; and providing practice-based evidence for the development of a program to improve clinicians’ safe management of distraction and interruption.

This grant is supported in part by generous contributions from NPSF Board members.

NPSF Research Grant

Identification and Validation of Risks to Patient Safety during Care Transitions of Older Adults Receiving Skilled Home Healthcare Services after Hospital Discharge

Alicia I. Arbaje, MD, MPH, Johns Hopkins University School of Medicine

Alicia I. Arbaje, MD, MPH

Errors during care transitions of older adults are common, costly, and sometimes lethal. A care transition refers to the movement of a person from one health care setting to another and is commonly associated with adverse outcomes. Although there is a strong movement to improve care transitions, the mechanisms by which to achieve better outcomes are not entirely clear. The aging of the population is leading to greater reliance on care delivered in the home, a poorly understood health care delivery setting. For reasons that are not completely clear, older adults who require skilled home health care (SHHC) services (e.g., nursing, physical therapy) after hospital discharge are among those at highest risk of experiencing suboptimal outcomes, including early rehospitalization. While there has been research on improving care transitions from hospital to home, interventions are often disease-specific or focus primarily on hospital-based discharge planning, and there has been scant research on hospital-to-SHHC transitions.

This project will use an approach based on principles of human factors and systems engineering to investigate threats to patient safety during care transitions and to develop sustainable interventions. In order to identify factors that contribute to unsafe care transitions, the researchers will conduct direct observations of the SHHC admissions process from the hospital to the patient’s home as well as semi-structured interviews of older adults, caregivers, and SHHC providers. The researchers will then develop and pilot test an innovative index that will enable SHHC agencies to identify older adults at high risk for suboptimal care transitions and target them for intervention during the hospital-to-SHHC transition.

By focusing on transitions to the SHHC setting, this study will begin to fill important gaps in research and provide evidence to support the development of interventions that address care transition risks in this setting. The study will support efforts to reduce the risks associated with care transitions by providing researchers, health system executives, and patient safety leaders with a tool to actively monitor care coordination processes and evaluate the effectiveness of interventions to improve safety during care transitions. Study findings have the potential for applicability to a broader group of patients discharged from hospital to home and requiring complex care.