测量急诊科中断、多任务处理与处方错误之间的关系：一项研究方案。
Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol.
作者信息
Raban Magdalena Z, Walter Scott R, Douglas Heather E, Strumpman Dana, Mackenzie John, Westbrook Johanna I
机构信息
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
出版信息
BMJ Open. 2015 Oct 13;5(10):e009076. doi: 10.1136/bmjopen-2015-009076.
INTRODUCTION
Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review.
METHODS AND ANALYSIS
The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling.
ETHICS AND DISSEMINATION
Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED.
引言
在临床环境中，干扰和多任务处理很常见，认知心理学文献表明它们会影响工作表现，增加出错风险。然而，关于它们对临床工作中错误的影响，我们了解得相对较少。本研究将通过直接观察和病历审查，评估急诊科（ED）中处方错误、干扰和多任务处理之间的关系。
方法与分析
本研究将在澳大利亚悉尼一家拥有440张床位的教学医院的急诊科进行。医生在白班工作期间（08:00至18:00），观察员将在其附近跟随观察2小时。使用经过验证的活动计时工作观察方法（WOMBAT）工具，将任务、干扰和多任务处理的时间戳数据记录在手持计算机上。还将记录导致干扰和多任务处理的提示信息。当医生开处方时，将记录图表类型和所书写的图表部分，以及患者的病历号（MRN）。临床药剂师将查阅患者记录并评估处方医嘱中的处方错误。每个处方任务的处方错误率将按错误数量除以该处方任务期间开具的医嘱数量来计算。将使用统计模型评估处方错误率与提示、干扰和多任务处理率之间的关联。
伦理与传播
已获得医院研究伦理委员会的伦理批准。符合条件的医生将收到书面信息表，如果他们同意参与，将获得书面同意书。医生的详细信息和MRN将与处方错误数据分开保存，并且不会出现在最终分析数据集中。研究结果将在出版物中传播，并反馈给急诊科。
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