Dodging Distractions: Five Tips to Improve Your Patient Focus

Prioritizing and quiet zones among solutions nurses can implement to improve patient care

By Melissa Hagstrom, Contributor

Smartphones, pagers, equipment alarms, documentation requirements, chatty colleagues and countless other distractions on the hospital floor make it difficult for nurses to avoid interruptions when caring for patients. In fact, dealing with such distractions has become the subject of many research studies and case studies on patient safety.

While there are several major initiatives and high-tech solutions available to address the problem, there are also a few simple things staff and travel nurses can do immediately that can make a difference.

Two experts on the topic identify five key things you can do now--starting with your next shift--to limit distractions, reduce the potential for errors and elevate the level of your patient care:

1. Prioritize and delegate

"Have a plan for the day and prioritize your work. Identify what needs to be done that day, and what can wait for another shift," said Juliana Brixey, RN, PhD, an assistant professor at the University of Texas Health Science Center, School of Biomedical Informatics, who has conducted several studies on the impact of interruptions in the health care setting. "It's important to remember that a hospital is a 24-hour operation, and sometimes you have to pass on tasks to the next shift."

Brixey indicated that delegating tasks to other people--whether it is the unit secretary, charge nurse or nursing assistant--can help nurses focus on the task at hand instead of moving to the requested task and hoping they'll remember to come back to their original task. "Just because someone asks you to do something, doesn't mean you need to stop right then and do it," Brixey added. "There are things in the literature that show us when a nurse stops something to do something else, errors do occur. If you're engaged doing something with the patient, that should be your main priority."

2. Keep conversations to a minimum

Open lines of communication between nurses and patients are key to successful outcomes, but minimizing outside conversations, gossip and other mindless chatter can help to eliminate distractions and other interruptions. "[Nurses] can avoid unnecessary chatter about things that do not relate to the work they are doing," said Tess Pape, PhD, RN, CNOR, CNE, associate professor and RN-to-BSN coordinator at Lamar University in Beaumont, Texas.

"Keep conversation to a minimum at the bedside or when doing medication administration, because when you are stationary or stopped for a bit you become a target for interruptions and distractions during that time because people think they can get your attention," Brixey said.

3. Use special vests, signs and quiet zones

Featured in the Agency for Healthcare Research and Quality's (AHRQ) Innovation Exchange, Pape's usage of checklists, quiet zones, and medication sashes or vests to reduce distractions during medication administration is a best practice that has been implemented at hospitals all over the United States.

"Hospitals should implement the no interruption or quiet zone in the medication area and consider other environmental influences on nurses," Pape said. "In addition, a visible symbol worn by the nurse prevents interference as the nurse travels to the patient’s room with medications. Teamwork is also critical in that other staff members must respect this critical time and help prevent interruptions."

Implementing quiet zones or vests will require the approval of the hospital or unit, but Pape encourages nurses to bring these solutions to their managers, as her research shows these interventions can reduce medication errors and near misses.

4. Move away from multitasking

We live in a society where getting the most done in the shortest amount of time is viewed as being productive and efficient, when in reality, multitasking can zap focus, lead to errors and cause tasks to languish unfinished--especially in the health care setting.

"So many times nurses think they can multitask at critical times, and that is when errors occur," Pape said. "Multitasking among some in the younger generation has almost become a badge of courage or medal of honor. I have seen some nurses and many of my students with this attitude and they had a near miss error as a result."

"Focusing on one task at a time can help improve efficiency in your workflow and may reduce overtime for the unit," Brixey said. "Keeping your focus on the patient should be your most important task."

5. Realize it's okay to say “No”

"Sometimes you have to say no," Brixey said. "Maybe you are giving medicine or doing a procedure at the bedside; something where you are engaged with the patient and you can't always leave, sometimes in these situations you just have to say ‘No.’"

Teaching nurses that they have a right to say “Not now,” or “Come back and talk to me later,” is essential for reducing distractions and interruptions, Pape explained.

"Today, health care organizations and nurses must realize that people are human and that the potential for error to occur is real," Pape concluded. "People are just human and we don't have the capacity to withstand being bombarded by conversation, interruptions and noise and still be accurate in what we are doing. We need everyone to work to understand the correlation between the environment you work in and the outcomes of your work."

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