Distractions and interruptions in a surgical room: perception of nursing staff

The Distraction Perceptions of Health Care Professionals in the Operating Room: The Disruptions in Surgery Index (DiSI)

PURPOSE

The purpose of the study was to evaluate the psychometric properties of the Disruptions in Surgery Index (DiSI) in operating room health care professionals and to determine the frequency of distractions DESIGN: Methodological study.

METHODS

The sample consisted of 152 health care professionals. Data were collected online using the DiSI scale. The language validity was ensured, and the data were analyzed with the content validity index, Cronbach α coefficient, and item-total score correlation. Data on distractions of health care workers were given as percentages and averages.

FINDINGS

The mean age of health care professionals was 27.3 ± 6.0 years, and 77.0% of them were operating room nurses. The content validity index of the scale was found to be 0.95. The Cronbach α coefficient of the scale was 0.953 for frequency, 0.967 for contribution to error, and 0.971 for obstruction of goals. The correlation between the item and the total item was positive and significant (p < .001). Tiredness was determined as the most common distraction factor, causing errors and making it difficult to achieve goals.

CONCLUSIONS

The DiSI was found to be a valid and reliable tool. The most common distractions, contributing to errors and obstructing to goals, were related to individuals' skills, performance, and personality. Health care professionals perceived the distractions related to the surgical processes and the situations of the team members in the coordination and situational awareness subdimension as the least distracting factor.

Prevalence and Characteristics of Interruptions and Distractions During Surgical Counts

BACKGROUND

Surgical counting is a complex and safety-critical task that requires sustained attention by multiple members of the surgical team in order to prevent the occurrence of an unintentionally retained foreign object. Interruptions and distractions in the operating room are common and can negatively affect task performance. However, the prevalence and sources of interruptions and distractions during safety-critical tasks, such as surgical counting, have not previously been quantified. An understanding of the characteristics of these events could be used to inform targeted improvements to patient safety.

METHODS

Observations were conducted of surgical procedures in order to quantify and describe interruptions and distractions during surgical counting activities. Analysis was separated into phases: the initial count, additions to the surgical field, removals from the surgical field, and closure counts.

RESULTS

Thirty-six surgical procedures were observed. Interruptions occurred in 10.0% of initial counts, 15.4% of additions, 23.5% of removals, and 33.3% of closure counts observed. The source of 80.4% of interruptions was a surgeon, usually asking the scrub nurse for an item. Distractions were present in 46.7% of initial counts, 38.5% of additions, 41.2% of removals, and 40.9% of closure counts observed. Common sources of distraction included music, conversations, people entering and exiting the theater, and ringing phones.

CONCLUSION

Interruptions and distractions are common during surgical counts and can significantly affect patient safety by jeopardizing the accuracy of the count. A number of suggestions are provided that could reduce interruptions and distractions and their consequences.