Interruptions and Distractions Before and After the Implementation of a Central Call
Center on Pharmacists and Technicians in a Community Pharmacy Setting
Nicole Caffiero, PharmD1,2; Nancy Nickman PhD, RPH1; Frank Drews PhD4; Brandon T. Jennings, PharmD, BCACP1,2;
Jordan B. King, PharmD1,3, Krystal Moorman, PharmD, BCPS1,2;
1
University of Utah College of Pharmacy, Salt Lake City, Utah; 2University of Utah Hospitals and Clinics, Salt Lake City, Utah;
3University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; 4University of Utah Department of Psychology
•  Interruptions and distractions are a well-known problem in health care1
•  To minimize distractions it has been suggested to “place phones away from
those selected healthcare workers who are actively preparing, dispensing, or
administering medications”2
•  “No Interruption Zones” to prepare and check medications in hospitals are
relative to the “Sterile cockpit” technique implemented by the Federal Aviation
Authority in 19812
•  One study of a “No Interruption Zone” reduced interruptions from 31.8%
to18.8%3
•  Implementation of a centralized pharmacy call center may improve critical safety
task performance and improve efficiency in pharmacies
Objectives
•  Define, identify and quantify the number and type of interruptions for pharmacists
(RPh) and technicians (CPhT) in a community pharmacy setting before and 3
months after implementation of a central pharmacy call center
Pre-Call Center Pharmacy Demographics
observations
Pharmacy
FTE RPh
FTE CPhT
RPh :
CPhT
1
1.5
2.25
1.5
1700
700
11
29.9
2
4
10
2.5
6000
2900
10
29.3
3
2.5
7
2.8
3700
700
10
29.8
4
1.5
3
2
1800
815
7
31.5
5
1.6
4
2.7
2100
1100
10
28.9
6
8
19
2.4
13,500
6000
10
21.3
7
2.5
4
1.6
3,100
1500
10
28.0
8
9
22
2.4
14,300
3250
10
24.2
†Average
Rx
dispensed†
Phone
Calls†
n
Time (hrs)
per month
Pre-Call Center Results
Figure 1. Number of interruptions during a 3 hour observation period
1
Data Collection
•  1 community pharmacy resident and
6 CPhT using Pocket Observer4
software on electronic tablets
•  Real time, in person observation
Observations
•  Interruptions defined as “break in
task”
•  3-hour time blocks for 5 weekdays
•  2 days of RPh (12 hours, Monday &
Thursday) per pharmacy
•  3 days of CPhT (18 hours, Tuesday,
Wednesday & Friday) per pharmacy
•  Pre-implementation and repeated 3
months post implementation (total of
10 observation days per pharmacy)
Statistics
•  Descriptive statistics
Pharmacist
3
92.08%
4
5
6
Pre-Call Center Results
7
Table 1. Ratio of phone interruptions to non-phone interruptions
8
0
10
20
30
40
50
Interruptions during a 3 hour observation
Methods/Processes
Design
•  Prospective, multi-site, pre and post
descriptive study to assess
implementation of a central
pharmacy call center
Technician
2
Pharmacy
Introduction / Background
Conclusions
Correspondence
Please address inquiries to:
Nicole Caffiero, PharmD
Community Practice Resident
University of Utah College of Pharmacy/Redwood Health Center
[email protected]
All authors have no relevant conflicts of interest to declare
•  Technicians in all pharmacies were more likely to be interrupted by the phone
•  Only pharmacists in Pharmacy 1, 3, 4, 5, 7 were more likely to be interrupted by
the phone
•  More interruptions occurred in the morning than the afternoon
•  Results of post implementation pending
Limitations
•  Multiple observers used causing observer bias
•  Phone interruptions can vary by day of week and time of year
References
1. 
2. 
3. 
4. 
Chisholm C, Collison E, Nelson D, et al. Emergency department workplace interruptions: are emergency physicians “interrupt driven” and “multitasking”? Acad Emergency Med. Nov
2000;7(11):1239-43.
Raban MZ, Westbrook JI. Are interventions to reduce interruptions and errors during medication administration effective? A systematic review. BMJ Qual Sage 2014; 23:414‐21.
Ly T, Korb‐Wells C, Sumpton D et al. Nature and impact of interruptions on clinical workflow of medical residents in the inpatient setting. J Grad Med Educ. Jun 2013; 5(2):232‐237
Pocket Observer. Noldus.