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Sterile cockpit

From the March 24, 2005 issue

Distractions are a major cause of error. So it makes sense to take a cue from the airline industry about the need to specifically prohibit potentially distracting activities during the implementation of critical duties. In fact, strictly enforced prohibitions can be found in the written policies related to flight crewmember duties (Sec. 121.542) as follows:

(a) No certificate holder shall require, nor may any flight crewmember perform, any duties during a critical phase of flight except those duties required for the safe operation of the aircraft. Duties such as company required calls made for such nonsafety related purposes as ordering galley supplies and confirming passenger connections, announcements made to passengers promoting the air carrier or pointing out sights of interest, and filling out company payroll and related records are not required for the safe operation of the aircraft.

(b) No flight crewmember may engage in, nor may any pilot in command permit, any activity during a critical phase of flight which could distract any flight crewmember from the performance of his or her duties or which could interfere in any way with the proper conduct of those duties. Activities such as eating meals, engaging in nonessential conversations within the cockpit and nonessential communications between the cabin and cockpit crews, and reading publications not related to the proper conduct of the flight are not required for the safe operation of the aircraft.

(c) For the purposes of this section, critical phases of flight includes all ground operations involving taxi, takeoff and landing, and all other flight operations conducted below 10,000 feet, except cruise flight.

Unfortunately, no such prohibitions are in place for healthcare practitioners during the implementation of critical duties. It’s common for physicians to be interrupted with pages or questions while attempting to review and prescribe medications; for nurses to be interrupted while transcribing an order or administering medications; for pharmacists to be distracted by phone calls or questions while entering orders into the computer, or preparing or checking chemotherapy or TPN; for technicians to be interrupted while returning medications to stock; and so on.

Patients, like airline passengers, entrust professionals with their safety. Thus, during critical phases of our work, doesn’t it make sense to create a “sterile cockpit,” designing procedures and systems to eliminate unnecessary distractions and interruptions, while controlling and minimizing others?
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