I believe that distraction is one of the most powerful factors in errors and harm to patients in a hospital. To improve patient safety we need to be alert and watch out for distraction so we do not miss a trick in patient care.
All staff must work hard on reducing distraction to enable us all to concentrate hard on the work of treating patients with major illnesses.
You probably need some examples to get you thinking about distraction.
If you are a nurse you have probably seen plenty of cases where a noisy confused patient gets all the attention all night on the ward, whilst the quiet old man who does not want to cause any trouble slips into septic shock.
Cardiac arrests are a distraction for doctors. Especially during daytime, I have seen crowds of doctors around the arrest, and seen how difficult it is for the leader to get doctors to leave. The arrest team needs to small and well defined to run the arrest effectively.
The other doctors should be back at work treating their patients and perhaps preventing the next arrest call. I saw this on EAU recently when a patient arrested in the corridor. All the doctors and many of the nursing staff involved themselves in the arrest, leaving the other 28 patients with major medical illnesses unattended.
Interruptions are a major distraction. A nurse recently told me that she was interrupted three times by other professional staff while preparing a morphine injection. The processes for administering controlled drugs are complex and must be followed to the letter. Yet nurses and doctors are constantly interrupted by people asking questions, phone calls, bleeps, noise - the list goes on.
These distractions make it much more likely that errors will occur and result in harm to our patients.
One of the most important roles of the doctor is to make a diagnosis. The process requires active thinking, while interviewing and examining a patient. It may then need several minutes of quiet reflection and discussing time to devise a plan for investigation and treatment.
However, the doctor given the task of making the diagnosis is surrounded by distractions – people butting in, another patient deteriorating, a host of minor tasks that someone else should have done. It is even a distraction not to have had a break.
Medicine is not magic; it is the compassionate appliance of science to patients with major illnesses. We need to watch out for the distractions that might steal our patients’ safety from under our noses.
Dr Gordon Caldwell is a consultant physician at Worthing Hospital