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What’s New in the Patient Safety World

September 2020

AORN on Distractions and Interruptions



AORN has issued a position statement on “Managing Distractions and Noise During Perioperative Patient Care” (AORN 2020). It begins with 4 beliefs:


A major focus is on the use of personal electronic devices (eg, mobile phones, tablets, laptop computers). Ring tones and alarms from personal electronic devices contribute to distraction. And “undisciplined use of cellular devices in the OR by any member of the perioperative team may be distracting and may affect patient care”, and that includes activities such as texting on smartphones.


Excessive noise may also interfere with the ability to communicate effectively, make it difficult to understand content, and contribute to miscommunication and lead to errors.


They note that the Environmental Protection Agency (EPA) recommends that the level of continuous background noise in hospitals not exceed 45 decibels (dB) during the day, and WHO (World Health Organization) recommends that environmental noise levels not exceed 30 dB. Moreover, OSHA (Occupational Safety and Health Administration) permissible exposure limit (PEL) for noise is 90 dBA for all workers for an 8‐hour day. Noise levels in hospitals often exceed such recommendations. Specialties in which powered surgical tools and impact‐producing equipment are used demonstrated higher noise levels than other specialties.


A noisy environment may both be associated with physical and psychological symptoms in healthcare workers and serve as a distraction that interrupts patient care and potentially increases the risk for error. They cite other studies showing causes of distractions and interruptions such as team members entering and leaving the room, equipment alarms, parallel conversations, and telephones or pagers. They also note other studies that showed increases in noise (eg, talking during the closing phase of a surgical procedure) may be associated with increases in surgical site infections.


The AORN position statement then goes on to describe a litany of activities that commonly cause distractions and interruptions in healthcare settings, including patient care activities, behavioral activities, electronic activities, technology, and mechanical/environmental factors,


It then goes on to discuss importance of the sterile cockpit concept, in which nonessential conversation and activities do not occur during critical phases of a surgical procedures, such as time‐out periods, critical dissections, surgical counts, medication preparation and administration, confirming and opening of implants, induction and emergence from anesthesia, and care and handling of specimens. Surgical team members should give their full attention to performing their responsibilities during critical phases. It does acknowledge that critical phases may occur at different times for different team members.


The position statement comes with over 60 references and also has links to useful resources from other organizations.



Prior Patient Safety Tips of the Week dealing with interruptions and distractions:

·       January 28, 2020         “Dang Those Cell Phones!”







AORN. (Association of periOperative Registered Nurses). AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care. AORN Journal 2020; 111(6): 675-680





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