Intervening in Interruptions: What Exactly Is the Risk We Are Trying to Manage?

Area of Science:

• Healthcare safety science
• Risk management in medicine
• Human factors engineering

Background:

• Interruptions during medication administration are linked to errors.
• Current interventions often focus on eliminating interruptions using a barrier model.
• This approach may lead to unintended negative consequences in healthcare settings.

Purpose of the Study:

• Critically examine the assumptions of the barrier model for risk reduction.
• Evaluate the incompatibility of the barrier model with healthcare work.
• Propose alternative frameworks for designing interruption interventions.

Main Methods:

• Review of the barrier model and its application to healthcare interruptions.
• Analysis of unintended consequences of barrier-based interventions.
• Exploration of alternative risk management strategies.

Main Results:

• The barrier model's assumptions are often misaligned with complex healthcare work.
• Barrier-based interventions can have unforeseen negative effects on medication safety.
• Alternative approaches like high reliability organizing and resilience engineering offer different risk management perspectives.

Conclusions:

• Rethinking the approach to designing interruption interventions is crucial.
• Moving beyond the barrier model can foster innovation in healthcare safety.
• Adopting resilience engineering and high reliability principles may lead to more effective interruption management.