| Primary Author: | Susan L. Moran, DNP, MS, RN, NNP-BC |
| Co-Principal Investigators/Collaborators: | Chara Elliott Kurtz, BA, BSN, RN |
| Organization | Children’s Hospital Colorado |
Abstract
Purpose
This study assessed perceptions of neonatal nurse practitioner (NNP) interruptions, the effectiveness of an electronic medical record (EMR) message system in the reduction of non-urgent interruptions, and overall staff perception.
Background
The interruption of a primary task has demonstrated procedural failures and clinical errors (Barclay, 2010; Westbrook, Woods, Rob, Dunsmuir & Day, 2010) in bedside nursing (Kalisch & Aebersold, 2010) and physician practices (Kitch et al., 2008). Yet, this author is unaware of any research examining the effect of interruptions in a neonatal intensive care unit (NICU) or the advance practiced nurse.
Materials & Methods
NNP perception of interruptions was assessed through an electronic survey (REDCap Survey). Following, NNPs were shadowed and data collected on ten randomly-assigned days for a total of 120 hours. The post-interventional phase began by gathering a group of key stakeholders, of whom defined an urgent and a non-urgent communication and selected EMR messaging as the independent variable for measure. Three months after staff training ensued, research assistants returned to repeat the data collection process. The study concluded with a staff survey (REDCap Survey) to evaluate the new communication process.
Results
Sixty-four percent of the NNPs self-reported errors following interruptions and 86% expressed an interest in reducing interruption frequency. Variability in interruption frequency was seen in as many as every 9.6 to 45 minutes. Independent-samples t-test and Cohen’s d were conducted to compare interruptions per hour (t(238) = 0.60, p = .55, d = 0.08) per day (t(18) = 0.30, p = .76, d = 0.14) and duration of interruption (t(719) = 1.59, p = .11, d = 0.12). Although there was no evidence that the number of interruptions reliably decreased from pretest to posttest, the staff recognized the importance of interruptions (M = 4.18, SD = .676) and prefer that the new system stay in place (M = 3.89, SD = .787). A one-way analysis of variance revealed significant differences between the groups, (F(2, 77) = 8.43, p < .05). Post-hoc comparisons using Fisher LSD test noted that unit leadership did not perceive interruptions as an important issue when compared to nursing (p < .05) and nurse practitioners (p < .05).
Conclusion
A better understanding of the NICU operational environment may support improvement efforts in staff training and procedure. Additionally, findings suggest that overcoming barriers to change is multifaceted. Awareness, motivation, practicality, acceptance, beliefs and skills are all necessary considerations to alter practice behaviors.
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The ISRN published this as received and with permission from the author(s).