industry & reform
Decreasing medical errors by reducing nurses ’ cognitive overload .
By Alan Stocker
In Australia , medical errors result in as many as 18,000 unnecessary deaths , while more than 50,000 patients become disabled each year .
Estimates suggest that 86 per cent of these events occur in a hospital setting . 1 Medical errors can be caused by a number of preventable factors , such as incorrect diagnoses or choosing the wrong medication . 2 Improving communication in hospitals can help lower the incidence of medical errors by reducing nurses ’ cognitive overload .
Nurses in hospital settings constantly segment what ’ s important and urgent . When they receive too much information at once , they can become overloaded and have difficulty segmenting , which can lead to mistakes .
The amount of information nurses need to deal with can quickly escalate . A constant stream of information means that nurses must maintain total concentration , make sense of that information , and decide how to act based on that information .
There are three types of cognitive load that can contribute to nurses becoming overwhelmed .
INTRINSIC COGNITIVE LOAD This is the amount of effort required to complete a problem or task .
In ordinary circumstances , completing each task correctly and efficiently is likely to be well within a nurse ’ s cognitive capabilities . However , this intrinsic load can
be affected by stress factors that are known to compromise a person ’ s working memory .
This can include things like lack of sleep , challenging relationships with colleagues , or previous errors . Large , deep emotions such as shame , guilt or grief can contribute to an increased intrinsic cognitive load .
In a busy hospital environment , nurses are receiving messages and instructions from colleagues and physicians , and they can be hindered by barriers such as multiple standards , conflicting protocols , and disparate communication tools . They often have to adapt their working style to suit the physicians on duty .
Furthermore , nurses are often overnotified regarding even minor changes to their patients ’ conditions .
All of this combines to create a drain on working memory .
EXTRINSIC COGNITIVE LOAD This is the level of cognitive effort that the clinical environment demands .
Nurses have very little control over this type of cognitive load because it comes from external stressors such as being bombarded with information , being given conflicting or confusing messages , or being given lots of information at once .
Nurses often have to split their attention between multiple patients , information sources and tasks . Added to that , they are often working at the top of their licence or accreditation , which means the work they do tends to be challenging . 3
Multitasking and frequent interruptions are a feature of nurses ’ daily lives . One study revealed that nurses were most likely to be interrupted and to multitask during the administration of medication , which creates risk for patient safety . 4
“ Multitasking and frequent interruptions are a feature of nurses ’ daily lives .
At the same time , nurses spend a significant portion of their day on documentation . One study found that nurses spend at least 25 per cent of their time charting , updating and reviewing patients ’ electronic health records . 5
GERMANE COGNITIVE LOAD This is the effort that people have to expend to make sense of new information .
If all the information is provided to a nurse in one message , they can make sense of that information relatively easily and determine the next best correct action to take .
However , if they ’ re presented with information out of context and need to check other systems or past notes and files to understand that information , then their germane cognitive load gets heavier .
Too often , nurses are given pieces of information in isolation . For example , they may be provided with a lab value but , without contextual information , that lab value isn ’ t useful .
This creates additional work as the nurse seeks the right data on which to base their actions .
When all three of these types of loads are heavy at the same time , it becomes clear that nurses are labouring under significantly adverse conditions .
The demands being placed on them can quickly lead to minor and major errors , and can culminate in burnout , leading highly trained and otherwise-capable nurses to seek new careers .
Hospitals can overcome these issues by standardising on a single clinical communication and collaboration platform that minimises cognitive overload .
By removing the need for retrieve , retain , and record information , these solutions can reduce the cognitive burden and make it easier for nurses and other healthcare colleagues to communicate effectively , thus reducing the risk of errors . ■
For references go to www . nursingreview . com . au Alan Stocker is the acting general manager of Connected Health AU
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