Distractions in the OR

Distractions and interruptions occur frequently in the operating room and procedural suites. They can negatively impact patient safety, care coordination, and efficiency by causing errors and patient harm. Distraction and interruptions in the OR and procedural suites are defined as events that divert attention from a primary task. Interruptions occur when distractions are responded to, abruptly disturbing and diverting attention away from the primary task. Many distractions and interruptions may be inevitable; however, techniques should be considered to mitigate their impact.

Some of the primary types of distractions and interruptions include phone calls and pages from other departments in the hospital, alarms, personnel entering and exiting the suite (traffic), music, case-irrelevant communication, turning on and adjusting equipment settings, and coordination issues.

Frequency of interruption and distraction is associated with the heightened incidence of human error, especially during critical phases of surgery. These errors can be in the form of active failures and latent conditions. Active failures are caused by the perioperative team’s direct action on a patient, while latent conditions are systemic inadequacies that are indirect causes of error. Active failures are often considered the immediate cause of errors; however, researchers underscore that most errors are attributable to latent conditions.

For example, a perioperative nurse who miscalculates a dose of medication due to an interruption and then administers the incorrect dose commits an active failure. On the other hand, the allowance of repeated interruptions during medication administration is the latent condition that increases the likelihood of active failures.  A 2011 study of perioperative nurses’ perceptions of near-miss patient safety events, revealed that distractions and interruptions were one of the most common causal factors, second only to team communication

In the same year, the Association of periOperative Registered Nurses (AORN) surveyed its members to determine what was considered the highest-priority patient safety issues and received similar results that highlighted distractions. The distractions were also correlated as a cause for key patient safety events and led to AORN establishing and updating guidelines that outlined key strategies for mitigating safety risks such as, wrong-site surgery, retained surgical items, missed counts, surgical time out, specimen mismanagement errors, and missed communication.

Missed communication is a failure where critical information is not shared, a team member did not speak up about a concern, timing for communicating was poor, or where known issues were not resolved.

Feil et el. reported on an analysis of event reports submitted through the Pennsylvania Patient Safety Reporting System (PA-PSRS) from January 2010 through May 2013. Three hundred and four events were reported to have occurred in the OR in which distractions and/or interruptions were a contributing factor.

The majority related to procedures, treatments, or tests (n = 224). Within this event type, surgery or invasive procedure issues were reported most frequently (n = 169), followed by laboratory test problems (n = 43). Of the surgery or invasive procedure issues, (the subtypes reported with greatest frequency were incorrect counts of equipment (n = 39) and needles (n = 27). Furthermore, within the subtype labeled “other,” three events involved specimen mishandling intraoperatively and three events involved the use of expired products or implanted materials that were discovered after use in the procedures. Of laboratory test problems, the event subtypes most frequently reported were mislabeled specimens (n = 10), incomplete or missing specimen labels (n = 10), specimen quality problems (n = 7), and specimen delivery problems (n = 7).

Distractions can be identified in the OR by performing a simple gap analysis and by reviewing incidents related to the distraction. Once the distractions are identified, an evidence-based team approach to decrease those distractions should be implemented.