Beth Lofgren, PharmD, BCPS
Beth Lofgren, PharmD, BCPS
Beth Lofgren, PharmD, BCPS, received her PharmD degree from the University of Tennessee at Memphis in 1999, after completing a BS at the University of Tennessee at Martin. She started her pharmacy career in retail and has practiced in home health, long-term care, and hospital pharmacy. She has also been blogging as the Blonde Pharmacist since 2004, focusing on education for peers and provider status for pharmacists.

Pharmacy Distractions Lead to Medication Errors

JANUARY 04, 2015

Yesterday, I decided to record the number of distractions I face throughout a regular work day. This proved to be a distraction itself, considering the pharmacy where I worked that day has an open plan where technicians, phones, cubicles, and the door to the hospital hallway are all within 10 feet of where I sat. There are 4 or 5 telephone lines that ring regularly. There are also usually 1 or 2 other pharmacists sitting within 5 feet of me, and 2 or 3 technicians in the same vicinity.
 
In one workday, I recorded more than 150 interruptions. I even faulted myself for starting personal conversations that distracted others. With only an hour left in my shift, an employee came in and turned on music at a level enjoyed in the car when no one else is around. At that point, I was done for the day on mentally productive tasks, so instead, I sat and thought about what in the world we are doing as professionals to ensure patient safety comes first.
 
What are some things we can do to make the pharmacy workplace less distracting? Interruptions contribute to medication errors, so having a dedicated space where interruptions are not allowed should be implemented.

Chemotherapy entry, preparation, and checking definitely falls into this category. The Institute for Safe Medication Practices found that each interruption is associated with a 12.7% increase in errors (nursing). I have personally attempted to enter new chemotherapy on a patient in the past in the noisiest place where phones are ringing consistently, technicians are interrupting the workflow with issues on the phone that they cannot handle, and other staff are walking by just to chat, all while the TV is reporting the news and a radio in the back is piping out 80s music. It is enough to cause me to go into panic mode.

Ask for a dedicated space with less distractions or a no interruption zone. You may not get it, but at least it is on the record that you asked. In the meantime, I have tried using headphones to completely block out all noise when concentration is key. Though I would love to work in silence, blocking out everything but 1 sound is better than 10 sounds interrupting and distracting what you are trying to do safely. 
 
Another source of interruptions is when a medication is out of stock. This can completely lead a pharmacist into a rabbit hole of issues. First, I ask if we have the medication, which leads to comments on inventory failure and which process is to blame. Second, we have to call other hospitals and ask to borrow a medication, which interrupts them, as well. We also have to call a courier service to deliver the medication, which leads to delay in delivery of treatment to the patient.

If we could reduce missing medications, we could reduce distractions and phone calls. This type of interruption falls under system distractions, along with medication timing and other issues that distract how we handle system failures or deficits.
 
Alert fatigue is another source of distraction. It is common for me to receive 5 or more alerts per order when entering a medication, the majority of which are unnecessary. For example, when entering a sodium chloride intravenous (IV) fluid, I am routinely alerted that the chloride in the IV fluid will be a duplication with the potassium chloride. I will also receive an alert that sodium chloride is on national backorder.

Most of the time, medication alerts include what is formulary, nonformulary, depleted, and a duplicate of a class that isn't clinically significant. Alerts also frequently notify staff of insignificant labs that can include a time period longer than current hospitalization, and even suggest how to enter medications differently for a new process that can change quite often. All of the important stuff can be diluted quickly by things that are nowhere near as important as the task at hand.

Educating staff is very important for handling distractions and improving patient safety. Knowing when to interrupt the pharmacist with something important that cannot wait a second and when to write a note for the pharmacist to handle a few minutes later is vital. Placing phones with multiple lines in a separate area to lower distractions while the pharmacist is entering or checking orders is an idea to consider. Educating a technician on how to answer the phone and troubleshoot is invaluable!
 
The Institute for Safe Medication Practices offers even more ideas to help pharmacists and technicians focus on what matters most: patient safety.

References
1. Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170(8):683-690. 
2. 
Anthony K, Wiencek C, Bauer C, Daly B, Anthony MK. No interruptions please: impact of a no interruption zone on medication safety in intensive care units. Crit Care Nurse. 2010;30:21-29.



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