Cognitive Load, Interruptions, Disruptions for RNs during Medication Administration

Purpose: The purpose of this study is to: 1.) describe the cognitive load Registered Nurses (RNs) experience during the course of medication delivery to patients in acute care hospitals, 2.) explore the extent that interruptions and disruptions occur and add to a nurse’s cognitive load, and 3.) investigate the impact of these factors on lapses in procedure and medication errors at a large, community hospital which was one site among 9 in a national research collaborative.

Background:  Nurses believe there are multiple factors contributing to medication errors (Kreckler, Catchpole, Bottomley, Handa & McCulloch, 2008). These include distraction, interruption, heavy workload, inexperience and neglect (Tang et. al, 2007). Interruptions and distractions place a greater demand on memory and increase cognitive load (Agyemang & While, 2010). Increased cognitive loads lead to loss of attention, increasing the vulnerability and potential for errors. Nurses are at risk of an interruption and distraction with every medication pass (Elganzouri, et al, 2009). A better understanding of these factors as reported and observed by nurses is needed to improve system reliability, reduce risk and prevent medication administration errors among hospitalized patients.

Methods: The design is a descriptive, correlational study among a virtual network of hospitals sponsored and coordinated by the Improvement Science Research Network (ISRN).   The unit of analysis is an episode of medication administration given to one patient in a medical surgical unit. Data was collected by 2 trained observers during the process of medication administration using a structured observation sheet at each site. Distractions were measured using RN self-report. RNs observed completed the NASA Task Load Index questionnaire to measure cognitive load. To analyze the hierarchical design with episodes nested in nurses and nurses nested in hospitals, multilevel regression models will be used. 

Results: Data analysis will be completed by November 2014. The type and frequency of interruptions, distractions, and cognitive load RNs reported and associations with procedural and administration errors will be presented from the site in relation to the aggregate.

Implications: Findings from this study have implications for identifying the unique and challenging demands RNs encounter delivery medications in acute care hospitals. Medication errors can take an emotional toll on nurses (Treiber & ones, 2010). Knowledge about interruptions, distractions and cognitive load can inform safeguards to prevent errors and reduce risks for both patients and nurses.

ISRN funding by NINR 1RC2NR011946-01, 01S1, 01S2; RWJF INQRI grant ID: 63510