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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD

1. Distractions and interruptions causing nurses and doctors to make errors
2. Noisy sleeping rooms make sleeping while on-call difficult

by , MD

Pretty nurse who is smiling!
How can you tell this nurse isn't
the one I mentioned? Because
she is smiling! Unlike this model,
real nurses have 1001 reasons
NOT to smile, thanks to dimwitted
hospital administrators who are
utterly incompetent in terms of
implementing simple ways to
prevent foreseeable errors.

A nurse who is a friend of mine recently made a mistake that could have killed a patient: she gave Coumadin® (warfarin), a blood thinner, to a patient whose blood was already excessively "thinned" from too much Coumadin. The patient was supposed to receive vitamin K to correct the Coumadin overdose. More Coumadin was the last thing that patient needed.

I suppose you could fault the nurse for making the error, and her boss will likely berate her for it. However, a smart manager would get rid of the manure pile instead of swatting flies. In other words, he would go after the source of the problem, not the manifestation of it. In this case, the nurse attributed her error to multiple distractions and interruptions, primarily from the family of the patient in this case. In their efforts to be helpful, they incessantly pestered the nurse with numerous demands. "Did you do this? Did you do that? He wants a glass of water. He wants a warm blanket. We want you to bathe him." This went on and on for hours, because this hospital has unlimited visiting hours.

Today's nurses are overworked and toil in an often chaotic environment in which distractions and interruptions are routine. Hence, trying to minimize those problems is the first remedy. But will her boss or the hospital administration do that? No. It's always easier to blame the nurse.

The next remedy is to upgrade their electronic medical records system. A good system, or even a reasonably competent system, would prevent such an error from occurring. The system knew the lab test results indicating that the patient's blood was too thin, and it knew that more Coumadin was ordered from the pharmacy to give to that patient. It is easy to program a computer to warn the user or block such a mistake. Where did they buy that computerized medical record system? From the discount rack at Toys-R-Us? Sheesh!

In researching this topic, I found multiple studies discussing nurse interruptions and distractions. One study found that nurses are interrupted, on average, at least 19 times during a three-hour period by at least 13 different types of sources. As an ER doctor, I would often be interrupted that many times in ten minutes (here is an example).

The potential for those distractions and interruptions to produce errors is compounded when they affect nurses and doctors who suffer from sleep deprivation. You've probably had more good nights of sleep in the past week than I've had in the past decade. Chronic sleep deprivation is unbelievably debilitating, yet the healthcare system is too backward to address this common problem. I've yet to see even one hospital do anything about this even when the contributing factor was something the hospital had the power to solve, if only the hospital administration had an ounce of common sense!

For example, consider the issue of sleeping while on-call. A catnap here and there while on-call can help restore alertness and efficiency, thereby minimizing the potential for medical errors. However, every hospital that I've ever slept in—or tried to sleep in!—had noisy on-call rooms filled with sound from slamming doors, people chatting in adjacent hallways, and frequent public-address system announcements in addition to light filtering in from under the door. Every architect and hospital administrator should know that a dark, quiet room is conducive to good sleep, yet they don't have the brains to provide it. The cost would be trivial compared with some of the adornments that hospitals often have, such as artwork, breathtaking foyers, and even ritzy water fountains. Such expensive glitter does nothing to improve patient care. If hospital administrators truly cared about delivering topnotch medical care, they would instruct the architects they control to skip the worthless embellishments and instead use that money for addressing problems that contribute to medical mistakes. However, as I have documented in numerous places in this site and, hospital administrators often aren't smart or caring enough to solve even simple problems. Instead, those problems linger for decades, affecting countless patients. This sordid malfeasance won't end until hospital administrators are personally held accountable for their mistakes, such as when doctors are sued for malpractice.

PS: I had several distractions and interruptions while writing this topic. Did I make any errors?

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