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      • Record: found
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      Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol

      protocol

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          Abstract

          Introduction

          Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review.

          Methods and analysis

          The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling.

          Ethics and dissemination

          Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED.

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          Most cited references27

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          Task switching.

          Stephen Monsell (2003)
          Everyday life requires frequent shifts between cognitive tasks. Research reviewed in this article probes the control processes that reconfigure mental resources for a change of task by requiring subjects to switch frequently among a small set of simple tasks. Subjects' responses are substantially slower and, usually, more error-prone immediately after a task switch. This 'switch cost' is reduced, but not eliminated, by an opportunity for preparation. It seems to result from both transient and long-term carry-over of 'task-set' activation and inhibition as well as time consumed by task-set reconfiguration processes. Neuroimaging studies of task switching have revealed extra activation in numerous brain regions when subjects prepare to change tasks and when they perform a changed task, but we cannot yet separate 'controlling' from 'controlled' regions.
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            Executive control of cognitive processes in task switching.

            J S Rubinstein, D E Meyer, J Evans (2001)
            In 4 experiments, participants alternated between different tasks or performed the same task repeatedly. The tasks for 2 of the experiments required responding to geometric objects in terms of alternative classification rules, and the tasks for the other 2 experiments required solving arithmetic problems in terms of alternative numerical operations. Performance was measured as a function of whether the tasks were familiar or unfamiliar, the rules were simple or complex, and visual cues were present or absent about which tasks should be performed. Task alternation yielded switching-time costs that increased with rule complexity but decreased with task cuing. These factor effects were additive, supporting a model of executive control that has goal-shifting and rule-activation stages for task switching. It appears that rule activation takes more time for switching from familiar to unfamiliar tasks than for switching in the opposite direction.
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              Task switching: interplay of reconfiguration and interference control.

              André Vandierendonck, Baptist Liefooghe, Frederick Verbruggen (2010)
              The task-switching paradigm is being increasingly used as a tool for studying cognitive control and task coordination. Different procedural variations have been developed. They have in common that a comparison is made between transitions in which the previous task is repeated and transitions that involve a change toward another task. In general, a performance switch cost is observed such that switching to a new task results in a slower and more error-prone execution of the task. The present article reviews the theoretical explanations of the switch cost and the findings collected in support of those explanations. Resolution and protection from interference by previous events explain part of the switching cost, but processes related to task setting and task preparation also play a prominent role, as testified by faster execution and lower switch costs when the preparation time is longer. The authors discuss the evidence in favor of each of these sets of accounts and raise a number of questions that situate task switching in a broader context of cognitive control processes. The role of several aspects of the task set, including task variations, task-set overlap, and task-set structure, is addressed, as is the role of knowledge about probability of task changes and about the structure of task sequences.
              Article 0 comments Cited 185 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2015
                Publication date (Electronic): 13 October 2015
                Volume: 5
                Issue: 10
                Electronic Location Identifier: e009076
                Affiliations
                [1 ]Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, New South Wales, Australia
                [2 ]Pharmacy Department, Prince of Wales Hospital , Sydney, New South Wales, Australia
                [3 ]Emergency Department, Prince of Wales Hospital , Sydney, New South Wales, Australia
                Author notes
                [Correspondence to ] Dr Magdalena Z Raban; magda.raban@ 123456mq.edu.au
                Article
                Publisher ID: bmjopen-2015-009076
                DOI: 10.1136/bmjopen-2015-009076
                PMC ID: 4606441
                PubMed ID: 26463224
                SO-VID: 4bb2a3c6-8df8-429e-b5d6-adabea9486cf
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 13 June 2015
                Date revision received : 18 August 2015
                Date accepted : 21 September 2015
                Categories
                Subject: Health Services Research
                Subject: Protocol
                Subject: 1506
                Subject: 1704
                Subject: 1691
                Subject: 1694

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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