Distraction is Deadly: Driving, Patient care, and Education
Presented by Greg Friese, MS, NRP Director of Education and Communication CentreLearn Solutions, LLC
Divide paper into fourths Label each quadrant...hat tip to Steven Covey Important and urgent Important and not urgent Not important and urgent Not important and not urgent
Place these things into each quadrant Facebook notifications – friend request, you were tagged in a post Email about a sale at your favorite store (REI) Text message from your spouse Text message from your child Phone call from friends and family Phone call from a student Email from a student Email from a vendor Email from employer Out of office reply Driving ambulance to cardiac arrest Driving ambulance for dialysis patient return to home Mild asthma Severe asthma
Discuss urgent, important Discuss types of calls and messages that are Important and urgent Important and not urgent Not important and urgent Not important and not urgent (Estimate percentage of calls in each category)
Experiential activity … flip the classroom … have them teach each other
Day 1 Class 1. Students need to learn how to Disable auditory, visual, and kinetic notifications Disable auto refresh for social networks (Facebook, Twitter, Google+, Instagram, etc.) Put phone out of physical and visual reach
98% of people surveyed know it is dangerous to text and drive.
74% of people do it anyway.
Survey by Center for Internet and Technology Addiction and AT&T
I can’t think of much else where the gulf between knowing danger and participating in behavior is so great…. Smoke Tobacco (18% of Americans http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/) Heroin (1.6% of Americans have used http://www.drugabuse.gov/publications/drugfacts/heroin) Soda/Cola (48% drink on a daily basis. http://www.gallup.com/poll/156116/nearly-half-americans-drink-soda-daily.aspx)
Pilot was sending TEXT messages …. Dozens and dozens during pre-flight. Messages sent while flying, while the helicopter was being prepared for return to service, and during his telephone call to the communication specialist when making his decision to continue the mission,
There are 3 general types of distraction
Manual or mechanical distraction – hands off the wheel
Anything that takes hands off the wheel – eating, texting, tying boots, grooming, adjust radio – lights – sirens
[this guy is doing both]
Manual distraction solution…hands-free and voice to text devices are not safer.
Hands free is not better. From http://tti.tamu.edu/2013/04/23/voice-to-text-apps-offer-no-driving-safety-benefit-as-with-manual-texting-reaction-times-double/
Cognitive load is not changed
Visual distraction - eyes of the road
Something that causes you to look away from road, patient, vial, syringe, protocol … sending a text.
This is impossible, dangerous, and potentially fatal.
“In the moments before the derailment, Garzon received a call on his work phone from Spain's national train company Renfe, court documents show. The call was to inform Francisco Garzon, 52, of the route that he needed to take. The court said Garzon was talking to train company personnel and based on black-box data recorders, appeared to be consulting a paper document at the time of the derailment. ”
Couple that with what we know about the impact of fatigue. 18 hours without sleep can be enough to have this equivalent BAC
From Distracted Driving and Risk of Road Crashes among Novice and Experienced Drivers Sheila G. Klauer, Ph.D., Feng Guo, Ph.D., Bruce G. Simons-Morton, Ed.D., M.P.H., Marie Claude Ouimet, Ph.D., Suzanne E. Lee, Ph.D., and Thomas A. Dingus, Ph.D.
Grant County deputies and the Platteville Fire Department and EMS responded to this crash on U.S. 151 at Southwest Road Monday around 11:35 a.m. The 2014 Ford Mustang owned by Avis Rent a Car and driven by Matthew Bruhn, 37, Jeffersron, rear-ended a tractor driven by Matthew Miller, 33, Platteville, pulling a trailer full of liquid manure. The sheriff’s department said Bruhn had been talking and texting on his cellphone when he hit the trailer. Bruhn was treated at Southwest Health Center in Platteville for a broken finger. U.S. 151 was blocked during manure cleanup. The state Department of Natural Resources
“Distracted driving was at least one of the factors in that deadly crash Feb. 16, 2013. IEMS members Timothy McCormick and Cody Medley died, their ambulance was smashed into by a driver who ran a red light.”Read more: http://fox59.com/2013/02/18/fatal-accident-again-highlights-problem-of-distracted-driving/#ixzz31ieyjIT0
Connected topics Just culture CRM Patient Safety
We are going to continue to dig on distraction …
Activity idea … [From Strategy for National EMS Culture of Safety] What is the risk of distraction during patient response, assessment, treatment, and transport? Understanding, reducing, eliminating distraction will have an impact on all community groups.
to self, partner, community (bystanders), and patient
Self – needle stick, lifting injury
Partner – lifting, slips, and falls, scanning for cross traffic (driver licking massive ice cream cone as driving through major intersection with red lights and sirens
Patient – medication administration error
Community – vehicle collision
What is a medical error?
National Coordinating Council for Medication Error and Prevention (NCCMERP) has approved the following as its working definition of medication error:
“... any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including: prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use”
“Good person doing what they think is the right thing to do.” Paul Misasi Sedgewick County EMS
Listen to Part 1 http://www.emseducast.com/archives/1166 Listen to Part 2 http://www.emseducast.com/archives/1179
Medication errors aren’t the fault of an individual forgetting or not using the 5 Rights, 6 Rights, or 10 Golden Rules of Medication administration
And the prominent Institute of Medicine report To Err Is Human: Building a Safer Healthcare System notes: “The majority of medical errors do not result from individual recklessness or the actions of a particular group—this is not a ‘bad apple’ problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”26
Draw up and administer ….
What are distractions and disruptions that happen when you are asked to administer medications … list several.
Back of the ambulance can become many of these things …
Med room had plenty of opportunities for visual, manual, and cognitive distraction.
But also lots of chances for disruption and interruption.
Share my experience with the Emergency Department “Med Room” was also … Shared by urgent care staff and supplies Storage area for lots of other supplies Buffet and eating area for staff Gathering spot for informal conversation Communication and sign-ups
Lecture 1 System Analysis Slide – in a discussion of 10 key elements of the medication system from the Learning Aids: Medication Errors, 2nd Edition From the American Pharmacists Association http://www.pharmacist.com/learning-aids-medication-errors-2nd-edition
Keep in mind that is mostly aimed at pharmacists, nurses, etc.
There are a lot of things that contribute to distraction …
Fatigue Stress Hunger Environment Culture – how we act in workspace
Culture … how we act in the workspace
NAME of Partner… Please put down the phone and focus on driving.
Our patient is expecting us to arrive ready and able to care for their emergency.
My kids are counting on me getting home safely at the end of this shift.
To meet their expectations I need your help.
I also promise that I will do everything I can to make sure you get home safely from this shift.
Experiential activity … That is the script I use to call out distraction that puts me at risk.
We should all have scripts that … Label the distraction Remind of the consequences Ask for a behavior change Promise a willing partner
Plan and deliver an injury prevention program … Distracted Driving
Learning facts about distracted may change student’s attitudes (about risk) and behavior (texting).
Deliver to different audiences … teens, civic groups, professional drivers
Injury Prevention – poster – develop and distribute.
Utilize other campaigns and distribute with other student groups in college
Disruptions and interruptions… take lots of forms …
Disruptive student behaviors (see Rom’s presentation on dealing with difficult student behaviors) Activities outside of or adjacent to classroom Novel situation – dog in the classroom Something more desirable … pizza delivery next store. Another person in the ambulance
Observation of behavior
Count interruptions for different tasks
Times kids interrupt conversation between me an my wife :)
“While managing the care for high volumes of patients, staff on the bustling unit identified that nursing staff dealt with multiple interactions at the same time as they’re entering medication orders or getting medication ready for patients. Staff analyzed total medication errors over a three month period on the surgical inpatient unit. The study revealed that up to a third of the mistakes were linked to distractions from avoidable interruptions. Staff members have created a “No Interruption” policy, that uses signs and special uniforms to identify areas in which staff are not to be interrupted while doing certain work.”
Grand River Hospital has implemented http://www.grhosp.on.ca/epulseaugust2012
Signs Special uniforms
To notify other staff to not interrupt nurses preparing and administering medications.
Preventing disruptions and interruptions
We could adapt the sign for paramedics.
Hang on the window of the ambulance … use in the lab.
Limit the number of people that can be in the ambulance or inside the no interruption zone
The following Patient Safety event was entered into the EVENT system today, August 1, 2013, at 5:28pm CDT. The record may have been altered to remove identifiers or for other administrative purposes.
Description: Close-Call. While preparing two medications for patient administration, the medic preparing them started drawing one from a vial of Adenocard, 6 mg/2 mL when they intended to prepare Zofran, 4 mg/2 mL. The other medic caught the mistake while it was being withdrawn from vial. No patient harm. Cause: Crew reviewed and believes that the primary contributor was multiple distractions from too many 1st responders & their wanting to converse while medic was working on preparing multiple syringes. Both correct med. syringes were then properly labeled & medication check procedures completed before administration. Confused vials were also the same physical size.
No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Units http://ccn.aacnjournals.org/content/30/3/21.short
No Interruption Zone Where? How to identify? When?
What would you put in the no interruption zone? Paramedic doing drug calculations Cardiac arrest pit crew.
Other ideas Side tracks on the safety express. Interruptions lead to errors and unfinished… Wait, what was I doing? http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=37
Put the code team in the no interruption zone …
From Johnson County Med Act Cardiac Arrest Check List and Pit Crew Procedure
How do you stay on the road or after an interruption … how do you get back on track?
Ask the class for ideas …
In the classroom as an instructor
In the classroom as a student
In the ambulance as a paramedic or a paramedic preceptor
From Johnson County Med Act Cardiac Arrest Check List and Pit Crew Procedure
Job Aids and Processes help get you back on track, as well as signaling a no interruption zone – time and place.
Conversations that are scripted/organized need to be practiced and consistently used.
http://www.kagoon.com/journal-of-emergency-primary-health-care-jephc-vol-7-issue-3-2009-article-990374/main “The crosschecking‟ measure is also viewed by Jenson et al as the most effective single measure to reduce medication error.”
What are the opportunities in class to add in “read backs” Homework assignments Quiz/test instructions Scenarios Skill sessions
Sec. 4511.204. (A) No person shall drive a motor vehicle, trackless trolley, or streetcar on any street, highway, or property open to the public for vehicular traffic while using a handheld electronic wireless communications device to write, send, or read a text-based communication. (B) Division (A) of this section does not apply to any of the following: (1) A person using a handheld electronic wireless communications device in that manner for emergency purposes, including an emergency contact with a law enforcement agency, hospital or health care provider, fire department, or other similar emergency agency or entity; (2) A person driving a public safety vehicle who uses a handheld electronic wireless communications device in that manner in the course of the person's duties; (3) A person using a handheld electronic wireless communications device in that manner whose motor vehicle is in a stationary position and who is outside a lane of travel; (4) A person reading, selecting, or entering a name or telephone number in a handheld electronic wireless communications device for the purpose of making or receiving a telephone call; (5) A person receiving wireless messages on a device regarding the operation or navigation of a motor vehicle; safety-related information, including emergency, traffic, or weather alerts; or data used primarily by the motor vehicle; (6) A person receiving wireless messages via radio waves; (7) A person using a device for navigation purposes; (8) A person conducting wireless interpersonal communication with a device that does not require manually entering letters, numbers, or symbols or reading text messages, except to activate, deactivate, or initiate the device or a feature or function of the device; (9) A person operating a commercial truck while using a mobile data terminal that transmits and receives data; (10) A person using a handheld electronic wireless communications device in conjunction with a voice-operated or hands-free device feature or function of the vehicle.
“VFIS wants you to know the facts when it comes to distracted driving while operating an emergency service vehicle.”
View, download, or embed full infographic at http://www.vfis.com/free-infographic-firefighter-EMS-distracted-driving.htm
Last sentence of chapter 1 of People Care, 2nd edition by Thom Dick.