Leveraging Cognitive Science on Interruptions to Mitigate Medication Errors by Nurses

In our daily lives, it is not unusual to be interrupted during a task and then have trouble getting back on track or “in the groove.” But what if you are interrupted while preparing to give a medication to a patient? Many drugs, beneficial to the patient when administered appropriately, can have potentially lethal effects if given incorrectly.

According to the Agency for Healthcare Research and Quality Patient Safety Network, adverse drug events (ADE) account for nearly 700,000 emergency department visits and 100,000 hospitalizations annually.  Approximately 5% of hospitalized patients experience an ADE, making them one of the most common types of inpatient errors.

Interruptions are considered a large contributing factor to these errors, yet there is little research surrounding the topic or action being taken to educate aspiring healthcare professionals about the catastrophic outcomes that can result from a seemingly insignificant break in attention.

Meet Ginger Schroers, PhD, RNC, CNE who dug into this topic in creative ways using cognitive science through her dissertation study Realistic Interruptions During Simulated Medication Administration: An Examination of Errors and Interruption Management Strategies She successfully defended her dissertation in November 2020.  

As a PhD student at the Fitzpatrick College of Nursing, she examined how interruptions affect medication administration. Dr. Schroers explains that her ultimate goal “is to identify effective strategies to manage interruptions - strategies that will mitigate errors and increase task efficiency - that can be taught to nursing students.”

Supported by her dissertation committee chair Professor Helene Moriarty, PhD, RN, FAAN, the Diane L. & Robert F. Moritz Endowed Chair in Nursing Research and committee member Jennifer Ross, PhD, RN, CNE, associate professor, Dr. Schroers forged ahead to explore interruption management strategies for future nurses, and to involve the very people—nursing students—whom the study aims to educate.

The study was conducted as a simulation using Villanova’s senior nursing students who, playing the role of a registered nurse, had to administer medication for two patients: one patient whose medication preparation was interrupted by an actor portraying a nurse colleague, and one whose was not interrupted. Dr. Schroers’ research focused not only on the errors that arose as a result of the interruption, but how the students managed, or handled, the interruption (by, for instance, multi-tasking, ignoring or engaging) as well as if the students used any associative cues to help them return to the task of medication administration once the interruption ceased. “The cognitive science literature supports the use of associative cues to mitigate errors and increase task efficiency; however, there is limited research on the use of associative cues in healthcare settings,” notes Dr. Schroers. She plans to conduct a secondary data analysis to investigate the time to complete medication administration in the interrupted and uninterrupted simulated scenarios, and the time to complete the task based on the strategy that was used to manage the interruption.  

Dr. Moriarty commented on the impact of the work, saying, “Her use of cognitive science as the foundation for her dissertation is novel and innovative, and I expect will advance nursing science.” 

Dr. Schroers is an instructor at the Marcella Niehoff School of Nursing at Loyola University of Chicago. Her promise as a scientist was affirmed by the dissertation support she received by The National League for Nursing and Jonas Philanthropies through the 2019-2020 NLN Jonas Scholar program, The International Nursing Association for Clinical Simulation and Learning through award of the 2020 Debra Spunt/Laerdal Medical Grant, and The National League for Nursing 2020 Mary Anne Rizzolo Doctoral Research Award.

Dr. Schroers is forging new ground in nursing with this research. There are many general studies regarding errors in healthcare or the frequency of interruptions that occur in healthcare settings, but few that relate the two in the way that she has.

She is well on the road to disseminating her science. Dr. Schroers already has a total of four articles, either accepted for publication or published, at this time.