Presentation
Stay SAFE: Learning to Manage Interruptions Safely Through Simulation-Based Education
DescriptionBackground: Interruptions to nurses are pervasive and, due to the dynamic and collaborative nature of nurses' work, cannot be completely eliminated. Research demonstrates that interruptions occur in 95-99% of nurse medication rounds and can increase the risk of making a medication error by nearly five times. Nurses and nursing students primarily engage or multitask (task-switch) when interrupted during medication administration, although nurse experts recommend the use of interruption management strategies. The human factors literature suggests that interruption management strategies, which refer to intentional behaviors used to handle an interruption, have the potential to improve patient safety.
Purpose/Aim: The aim of this presentation is to describe the investigation of the Stay SAFE interruption management strategy among prelicensure nursing students during simulated medication administration scenarios. The Stay SAFE strategy is based on the memory for goals cognitive science model which posits that forming associative cues (retrieval cues) when interrupted can decrease risks for errors. Stay SAFE is an acronym for: Stay where you are, S: Stay focused on your current task, A: Associate cues, F: Find a natural break/finish a subtask, and E: Evaluate the urgency of the interruption.
Design: A multi-site, multi-methods, repeated measures, pre-posttest research design was used.
Methods: Convenience sampling was used to recruit prelicensure nursing students from four nursing schools in the Midwest and Eastern regions of the United States. Invited participants were enrolled in different program types that included an accelerated (16-month) Bachelor of Science in Nursing (BSN) program, 4-year BSN program, and Associate Degree in Nursing (ADN) program. Upon graduation, all participants would be eligible to take the registered nurse (RN) licensure exam. The study was not part of any required coursework and took place outside of students’ regularly scheduled class times. An inclusion criterion was a previously earned passing grade on psychomotor medication administration skills. This criterion ensured that participants had the knowledge and skills to perform medication administration (the chosen skill to be interrupted) during the pre-posttest simulated scenarios.
Four different simulated scenarios, each with a duration of approximately 10 minutes, were completed individually by participants across three study visits. Scenarios were comparable in complexity and all participants experienced the same simulated scenarios in the same order. During each scenario, participants were interrupted in the medication room while reading a medication label. The interruption was caused by a trained actor playing a team member role who initiated a face-to-face conversation with the participant.
Data were collected from January-April 2024. During the first study visit, participants: 1) completed the baseline/pretest simulation, 2) received education on Stay SAFE via PowerPoint slides and videos, 3) engaged in expert guided practice of Stay SAFE in a simulated setting, and 4) completed the first posttest simulation. Participants returned 4-6 weeks after the first study visit to complete the second posttest simulation. Four-six weeks later, participants returned to complete the third posttest simulation.
All simulated scenarios were audio-video recorded to facilitate accurate data collection. Trained data collectors directly observed the recordings and documented the behaviors used by participants to manage the interruption on a researcher-made tool. The data collection tool included boxes to mark the behavior used when the interruption was initiated. The tool included options of: a) engage (immediate attention given to the interruption), b) multitask (task-switch), c) block (ignored the interruption attempt) d) Stay SAFE with additional boxes to indicate the specific Stay SAFE action(s) used (e.g., associated a cue by placing a finger on the working area), and e) other. Participants completed a paper checklist immediately after each simulated scenario to mark how they managed the interruption. Participants’ marked responses were compared with the observational data to validate or correct the findings.
Participants’ perceptions of the Stay SAFE strategy were explored via audio-recorded semi-structured interviews. Credibility of the qualitative findings was addressed through peer-debriefing and member checks. Two researchers independently coded the data by iteratively reading the transcribed interviews, then worked collaboratively to triangulate the codes for fittingness to themes.
Results: A total of 60 students, with a range of 11-20 from each site, participated in the study. During the baseline/pretest, all participants engaged or multitasked when interrupted. During the first posttest, a majority (98%) of participants used the Stay SAFE strategy. Most (93%) used Stay SAFE during the second posttest, and all (100%) used Stay SAFE during the third posttest. Participants described the Stay SAFE strategy as easy to use and remember, felt that using Stay SAFE when interrupted would lessen risks for errors, and discussed using Stay SAFE in hospital settings (such as when in their clinical rotations and their workplace) and when studying. Findings were similar across the study sites and nursing programs.
Conclusions/Take Away Points: Interruptions are inevitable in healthcare settings; therefore, healthcare workers and students require education on how to best manage interruptions. The Stay SAFE interruption management strategy can be easily taught to learners using simulation-based education methods. The Stay SAFE strategy aims to decrease risks for errors, thus it’s use may lead to safer patient care.
Purpose/Aim: The aim of this presentation is to describe the investigation of the Stay SAFE interruption management strategy among prelicensure nursing students during simulated medication administration scenarios. The Stay SAFE strategy is based on the memory for goals cognitive science model which posits that forming associative cues (retrieval cues) when interrupted can decrease risks for errors. Stay SAFE is an acronym for: Stay where you are, S: Stay focused on your current task, A: Associate cues, F: Find a natural break/finish a subtask, and E: Evaluate the urgency of the interruption.
Design: A multi-site, multi-methods, repeated measures, pre-posttest research design was used.
Methods: Convenience sampling was used to recruit prelicensure nursing students from four nursing schools in the Midwest and Eastern regions of the United States. Invited participants were enrolled in different program types that included an accelerated (16-month) Bachelor of Science in Nursing (BSN) program, 4-year BSN program, and Associate Degree in Nursing (ADN) program. Upon graduation, all participants would be eligible to take the registered nurse (RN) licensure exam. The study was not part of any required coursework and took place outside of students’ regularly scheduled class times. An inclusion criterion was a previously earned passing grade on psychomotor medication administration skills. This criterion ensured that participants had the knowledge and skills to perform medication administration (the chosen skill to be interrupted) during the pre-posttest simulated scenarios.
Four different simulated scenarios, each with a duration of approximately 10 minutes, were completed individually by participants across three study visits. Scenarios were comparable in complexity and all participants experienced the same simulated scenarios in the same order. During each scenario, participants were interrupted in the medication room while reading a medication label. The interruption was caused by a trained actor playing a team member role who initiated a face-to-face conversation with the participant.
Data were collected from January-April 2024. During the first study visit, participants: 1) completed the baseline/pretest simulation, 2) received education on Stay SAFE via PowerPoint slides and videos, 3) engaged in expert guided practice of Stay SAFE in a simulated setting, and 4) completed the first posttest simulation. Participants returned 4-6 weeks after the first study visit to complete the second posttest simulation. Four-six weeks later, participants returned to complete the third posttest simulation.
All simulated scenarios were audio-video recorded to facilitate accurate data collection. Trained data collectors directly observed the recordings and documented the behaviors used by participants to manage the interruption on a researcher-made tool. The data collection tool included boxes to mark the behavior used when the interruption was initiated. The tool included options of: a) engage (immediate attention given to the interruption), b) multitask (task-switch), c) block (ignored the interruption attempt) d) Stay SAFE with additional boxes to indicate the specific Stay SAFE action(s) used (e.g., associated a cue by placing a finger on the working area), and e) other. Participants completed a paper checklist immediately after each simulated scenario to mark how they managed the interruption. Participants’ marked responses were compared with the observational data to validate or correct the findings.
Participants’ perceptions of the Stay SAFE strategy were explored via audio-recorded semi-structured interviews. Credibility of the qualitative findings was addressed through peer-debriefing and member checks. Two researchers independently coded the data by iteratively reading the transcribed interviews, then worked collaboratively to triangulate the codes for fittingness to themes.
Results: A total of 60 students, with a range of 11-20 from each site, participated in the study. During the baseline/pretest, all participants engaged or multitasked when interrupted. During the first posttest, a majority (98%) of participants used the Stay SAFE strategy. Most (93%) used Stay SAFE during the second posttest, and all (100%) used Stay SAFE during the third posttest. Participants described the Stay SAFE strategy as easy to use and remember, felt that using Stay SAFE when interrupted would lessen risks for errors, and discussed using Stay SAFE in hospital settings (such as when in their clinical rotations and their workplace) and when studying. Findings were similar across the study sites and nursing programs.
Conclusions/Take Away Points: Interruptions are inevitable in healthcare settings; therefore, healthcare workers and students require education on how to best manage interruptions. The Stay SAFE interruption management strategy can be easily taught to learners using simulation-based education methods. The Stay SAFE strategy aims to decrease risks for errors, thus it’s use may lead to safer patient care.
Event Type
Oral Presentations
TimeMonday, March 3110:52am - 11:15am EDT
LocationPier 9
Simulation and Education (SE)