Impact of interruptions on the duration of nursing interventions: A study in a chemotherapy unit

Bertolazzi, Luana Gaino; Perroca, Marcia Galan

doi:10.1590/S1980-220X2018047503551

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018047503551 copy

Impact of interruptions on the duration of nursing interventions: A study in a chemotherapy unit^* * Extracted from the dissertation: “Interrupções no fluxo de trabalho de enfermagem: estudo em unidade de quimioterapia”, Programa de Pós-Graduação em Enfermagem, Faculdade de Medicina de São José do Rio Preto, 2017.

Impacto de las interrupciones en la duración de las intervenciones enfermeras: Estudio en unidad de quimioterapia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate interruptions during nursing interventions in a chemotherapy unit (sources and causes); measure their frequency, duration and the total elapsed time to complete the interventions.

Method:

This is an observational analytical study performed using a digital stopwatch. It was conducted in a teaching hospital between 2015/2016. The interventions performed and their interruptions were mapped and classified according to the Nursing Interventions Classifications (NIC) taxonomy.

Results:

There were 492 interruptions recorded in the 107 hours observed, especially in indirect care interventions. They were mainly caused by nursing professionals (n = 289; 57.3%) to supply materials (n = 65; 12.8%) and exchange care information (n = 65; 12.8%). The duration of interruptions ranged from 0:08 to 9:09 (average 1:15; SD 1:03) minutes. On average, interventions took 2:16 (SD 0:27) minutes to complete without interruption; however, the average was 5:59 (SD 3:01) minutes when interrupted.

Conclusion:

The interruptions were constant during the nursing work in the chemotherapy unit, including during the preparation and administration of medications, and increased the time to complete the interventions by an average of 163.9%.

Descriptors:
Nursing Process; Nursing Service, Hospital; Nursing Staff, Hospital; Workflow; Oncology Nursing; Standardized Nursing Terminology

Sources	Causes	Nursing Activities/Interventions
		Direct care	Indirect care	Total
		n(%)	n(%)	n(%)
Patients	Demands: - Emergency	8(1.6)	12(2.4)	20(4.0)
	- Physiological	24(4.8)	22(4.4)	46(9.1)
	- Educational	16(3.2)	16(3.2)	32(6.3)
	- Emotional	4(0.8)	2(0.4)	6(1.2)
	Environment control	5(1.0)	11(2.2)	16(3.2)
	Assistance for ambulation	-	7(1.4)	7(1.4)
Subtotal		57(11.3)	70(13.9)	127(25.2)
Relatives	Telephone call	1(0.2)	3(0.6)	4(0.8)
	Demands: - Educational	11(2.2)	5(1.0)	16(3.2)
	- Emotional	4(0.8)	3(0.6)	7(1.4)
Subtotal		16(3.2)	11(2.2)	27(5.4)
Nursing professionals	Exchange information	23(4.6)	42(8.3)	65(12.8)
	Parallel Conversation	4(0.8)	17(3.4)	21(4.2)
	Personal cellphone use	2(0.4)	7(1.4)	9(1.8)
	Supply/Disposal of Materials	32(6.3)	33(6.5)	65(12.8)
	Medical Control / Processes	18(3.6)	37(7.3)	55(10.9)
	PVA Care	14(2.8)	24(4.8)	38(7.5)
	Check Prescription	3(0.6)	8(1.6)	11(2.2)
	Environmental control	3(0.6)	2(0.4)	5(1.0)
	Educational demand	8(1.6)	12(2.4)	20(4.0)
Subtotal		107(21.2)	182(36.1)	289(57.3)
Multiprof. team	Exchange information	13(2.5)	25(5.0)	38(7.5)
Multiprof. team	Telephone	2(0.5)	17(3.3)	19(3.8)
Subtotal		15(3.0)	42(8.3)	57(11.3)
Technology	Computer system / equipment failure	1(0.2)	3(0.6)	4(0.8)
Subtotal		1(0.2)	3(0.6)	4(0.8)
Total		196(38.9)	308(61.1)	504⁽¹⁰⁰⁾

Professional Category	Number of interruptions	Hours Observed		Hours interrupted		Interruptions per hour
Professional Category	n(%)	h:min:sec	%	h:min:sec	%	n
Nurses	386(78.5)	79:14:08	74.5	23:08:33	21.7	4.9
Nursing technicians	106(21.5)	27:44:07	25.5	4:53:27	4.7	3.8
Total	492⁽¹⁰⁰⁾	106:58:15	100	28:02:00	26.4	4.6

Interventions	*Interventions performed without* interruptions**			*Interventions performed with* interruptions**
Interventions	n(%)	Variation (min:sec)	M(SD) (min:sec)	n(%)	Variation (min:sec)	M(SD) (min:sec)
Basic Physiological Domain
Ambulation	25(1.1)	0:56 - 3:10	2:00(0:34)	-	-	-
Transfer	9(0.4)	1:17 - 3:04	2:11(0:41)	-	-	-
Urinary Elimination	91(4.1)	0:21 - 4:12	1:08(0:26)	12(0.5)	1:39 - 5:30	2:23(1:24)
Food	90(4.0)	0:31 - 4:50	2:25(0:54)	4(0.2)	3:47 - 5:52	4:40(0:55)
Environment Control	89(4.0)	0:09 - 2:04	0:37(0:24)	1(0.04)	2:01 - 2:01	2:01
Pain control	20(0.9)	0:51 - 4:28	1:54(0:44)	-	-	-
Vomiting Control	3(0.1)	0:51 - 1:05	1:00(0:08)	-	-	-
Subtotal	327(14.6)	0:09 - 4:50	1:49(1:05)	19(0.8)	1:39 - 5:52	3:46(1:44)
Complex Physiological Domain
Hypoglycemia Control	8(0.4)	1:30 - 2:17	1:47(0:17)	1(0.04)	4:48 - 4:48	4:48
Collect venous blood	4(0.2)	2:34 - 9:18	5:01(3:43)	1(0.04)	4:21 - 4:21	4:21
Chemotherapy Control	119(5.3)	1:25 - 8:55	2:45(1:46)	19(0.8)	2:56 - 23:35	8:42(7:17)
Administration of medications	1202(53.8)	0:09 - 6:24	1:09(0:59)	120(5.4)	0:45 - 9:12	3:24(1:48)
Oxygen therapy	5(0.2)	2:08 - 3:11	2:47(0:27)
Venous puncture	339(15.2)	0:07 - 4:38	1:24(1:09)	57(2.6)	0:52 - 6:26	3:46(1:21)
Central venous access control	167(7.6)	0:44 - 10:03	3:15(2:08)	30(1.3)	1:30 - 9:57	5:00(2:33)
Subtotal	1844(82.7)	0:07 - 10:03	1:48(1:26)	228(10.2)	0:45 - 23:35	3:27(2:07)
Behavioral Domain
Emotional support	21(0.9)	0:50 - 8:55	3:28(2:32)	9(0.4)	5:44 - 23:35	06:13(8:12)
Teaching: Prescription Drugs	18(0.8)	0:44 - 3:25	1:45(0:47)	4(0.2)	3:02 - 4:25	3:56(0:47)
Subtotal	39(1.7)	0:44 - 8:55	2:37(1:13)	13(0.6)	3:02 - 23:35	10:04(8:41)
Family Domain
Caregiver support	23(1.0)	0:49 - 8:55	2:00(1:45)	1(0.04)	9:08 - 9:08	9:08
Subtotal	23(1.0)	0:49 - 8:55	2:00(1:45)	1(0.04)	9:08 - 9:08	9:08
Total	2233⁽¹⁰⁰⁾	0:07 -10:03	2:09(1:04)	261(11.7)	0:45 - 23:35	6:36(3:28)

Interventions	*Interventions without* interruptions**			*Interventions with* interruptions**
Interventions	n(%)	Variation (min:sec)	M(SD) (min:sec)	n(%)	Variation (min:sec)	M(SD) (min:sec)
Safety Domain
Triage: Phone	12(0.7)	1:03 - 4:32	2:39(1:07)	-	-	-
Monitoring vital signs	83(4.6)	0:27 - 1:04	0:43(0:07)	8(0.4)	1:05 - 4:01	2:34(1:01)
Anaphylaxis Control	14(0.8)	2:36 - 9:18	5:13(2:31)	1(0.06)	9:20 - 9:20	9:20
Protection against infection	584(32.4)	0:07 - 2:33	0:33(0:24)	53(3.0)	0:37 - 4:58	1:51(1:08)
Environment Control	118(6.5)	0:16 - 4:48	0:54(0:53)	6(0.3)	0:47 - 4:28	1:52(1:09)
Patient Identification	77(4.3)	0:26 - 2:40	0:56(0:21)	4(0.2)	1:35 - 3:09	3:02(1:34)
Subtotal	888(49.3)	0:07 - 9:18	2:34(2:38)	72(4.0)	0:37 - 9:20	3:13(2:29)
Health System Domain
Care upon admission	331(18.4)	0:21 - 4:12	1:44(1:01)	69(3.8)	0:57 - 9:47	3:38(2:01)
Check emergency car	12(0.7)	1:13 - 6:13	3:39(1:51)	2(0.1)	5:44 - 7:45	6:45(1:26)
Preceptor: Students	28(1.5)	0:52 - 7:16	2:26(1:34)	4(0.2)	2:04 - 13:22	9:28(6:25)
Preceptor: Employee	8(0.4)	0:51 - 3:05	1:47(0:42)	-	-	-
Doctor support	45(2.6)	0:54 - 3:26	2:02(0:41)	-	-	-
Supply Control	46(2.6)	0:21 - 4:18	1:24(0:47)	1(0.06)	2:19 - 2:19	2:19
Employee Supervision	4(0.2)	10:56 - 5:43	13:19(3:23)	2(0.1)	11:02 - 9:27	25:15(20:05)
Shift change	27(1.5)	1:21 - 5:44	3:27(1:08)	3(0.2)	4:04 - 4:38	4:19(0:17)
Documentation	112(6.2)	1:06 - 17:32	4:51(2:51)	74(4.1)	2:01 - 19:51	8:41(4:23)
Exchange care information	299(16.6)	0:17 - 9:52	1:38(1:02)	4(0.2)	2:09 - 3:35	2:46(0:37)
Subtotal	912(50.7)	0:17 - 17:32	2:51(3:20)	159(8.8)	0:57 - 39:27	6:16(6:29)
Total	1800⁽¹⁰⁰⁾	0:07 - 9:53	3:03(3:25)	231(12.8)	0:37 - 39:27	7:59(3:04)

NIC Domains	Duration of the Interruptions			Change in Time
NIC Domains	N(%)	M(SD)	No M(SD)	With M(SD)	Min:Sec(%)	P
Basic Phys.	19(3.9)	1:01(0:31)	1:49(1:05)	3:46(1:44)	+ 1:57(107.3)	≤0.01
Complex Phys.	228(46.3)	1:10(0:52)	1:48(1:26)	3:27(2:07)	+ 1:39(91.7)	≤0.01
Behavioral	13(2.6)	2:24(2:26)	2:37(1:13)	10:04(8:41)	+ 7:27(284.7)	≤0.01
Safety	72(14.6)	1:00(0:45)	2:34(2:38)	3:13(2:29)	+ 0:39(25.3)	Ns
Family	1(0.2)	0:53	2:00(1:45)	9:08	+ 7:08(356.7)	≤0.01
Health System	159(32.4)	1:27(1:12)	2:51(3:20)	6:16(6:29)	+ 3:25(119.8)	≤0.01
Total	492⁽¹⁰⁰⁾	1:15(1:03)	2:16(0:27)	5:59(3:01)	+ 3:43(163.9)	≤0.01

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author:
Luana Gaino Bertolazzi Av. Brg. Faria Lima, 5544 - Vila São José CEP 15090-000 - São José do Rio Preto, SP, Brazil lu.gaino@hotmail.com