Less Stress, More Success

Helping nurses manage distractions to provide high-quality healthcare

“Medication errors remain a significant problem in healthcare today,” asserted Patricia Donohue-Porter, M.S. ’78, Ph.D. ’87, R.N., associate professor in the College of Nursing and Public Health, whose research offers insight into the cause of the problem and hope for substantially reducing medication errors.

“It’s estimated that medication errors hurt at least one and a half million people yearly,” said Dr. Donohue-Porter. “In the past, errors in nursing were looked at—within the context of a very punitive healthcare system— as the fault of the individual nurse. However, because of increasing national attention focused on patient safety and quality issues, there has been a gradual shift toward a more just culture where error is seen as part of a systemwide failure.”

Now, multiple dimensions—involving both individual nurses and the healthcare system—are carefully examined in an effort to find out why medication errors occur. “This work is a direct consequence of improvement science,” Dr. Donohue-Porter said, referring to the methodology for using disciplined inquiry as a means to solve a specific problem of practice. Her research draws from the Improvement Science Research Network (ISRN), a National Institutes of Health network of clinical and academic scholars who are focused on transforming healthcare.

Dr. Donohue-Porter’s work on medication administration errors evolved from an academic-clinical partnership with Lily Thomas, Ph.D. ’99, vice president of System Nursing Research at Northwell Health, the largest integrated health system in New York state. Like Dr. Donohue-Porter, Dr. Thomas is an alumna of Adelphi’s Ph.D. program, as well as a current Buckley Visiting Scholar.

“Several years ago, Dr. Thomas and I collaborated on another patient safety initiative—improvement in handoff communication during change of shift in hospitals,” explained Dr. Donohue-Porter. “When she became a member of the national steering committee of the ISRN, she asked me to serve as her academic partner on the current study.”

The two wondered if the multiple interruptions and distractions nurses experience during their clinical day had an impact on error. They designed a study, “Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors,” that employed a model of the origin of medication administration errors to examine medication administration at nine hospitals.

“We were very interested in measuring the cognitive workload of nurses,” Dr. Donohue-Porter said. “To achieve that objective, we turned to the findings of aerospace engineering, using a measure developed by NASA, the NASA Task Load.” That instrument measures the cognitive- capacity demands placed on individuals by considering such factors as time, mental and physical demands, effort and frustration. The focus of this study was unique, as it investigated how known individual and environmental factors interacted and culminated in errors.

“We were interested in how many task loads nurses can hold in mind before the multiple mental tasks become too much to process,” said Dr. Donohue-Porter. “We also wanted to see if interruptions and distractions would increase nurses’ cognitive load.”

The first phase of their study showed multiple interruptions and distractions during medication administration and, in turn, a significantly increased cognitive load. “We have also found that as the number of medications being administered increases, so does the risk of a medication administration error,” said Dr. Donohue-Porter.

In the second phase of their study, Dr. Donohue-Porter and Dr. Thomas will continue to refine their understanding of the impact of technology on medication errors. “Our results have also pointed us toward change in the teaching of medication administration to nursing students at both the undergraduate and graduate levels,” said Dr. Donohue-Porter. “The undergraduate student must be prepared not only to calculate medication dosages correctly, but must know how to effectively deal with an environment that may provoke errors. Nurse practitioner students need these skills as well, which can be taught through simulation.”

Ph.D. students who may be leading nursing practice in hospitals or preparing to assume faculty roles can also benefit from the strategies outlined by Dr. Donohue-Porter, who directs the College’s Ph.D. in Nursing program. “This study will have direct implications for a change in nursing education,” she concluded.