FLC OF AN LTT JET FAILED TO RESET THE ALTIMETER DURING CLB OUT; PASSING FL180; RESULTING IN ATC QUESTIONING THEIR CRUISE ALT WHICH WAS OVERSHOT BY 300 FT.

Narrative

I DEPARTED PTK FOR PUB. I WAS THE PF; AND WE CLBED TO AN ALT OF FL390. DURING CLB OUT; ALL NORMAL CHKLISTS WERE CALLED FOR AND COMPLETED. THE EXCEPTION WAS WITH THE FL180 CHKLIST. I CALLED FOR THE 180 CHK. THE FO READ 29.92 AND I PROCEEDED TO SET IT INTO MY ALTIMETER. AS I STARTED TO TWIST THE KNOB; I WAS INTERRUPTED BY A NOISE BEHIND ME. IT WAS A NURSE ASKING ME A QUESTION ABOUT FLT TIME. I MUST OF NOT RESET THE ALTIMETER ALL THE WAY TO 29.92. WHEN I LEVELED OFF AT FL390; THE CTLR ASKED ME MY ALT. I RESPONDED FL390. I DIDN'T CATCH MY ERROR OF NOT HAVING 29.92 SET IN MY ALTIMETER. THE CTLR ASKED ME 2 MORE TIMES; AND THEN TOLD ME TO STOP SQUAWK. I TURNED OFF MODE 'C.' I THEN THOUGHT IT WAS A XPONDER ERROR. I TOLD THE CTLR THAT I WOULD TRY MY OTHER XPONDER. WHILE I WAS SWITCHING XPONDERS; I REALIZED MY ERROR. I SET 29.92 IN MY ALTIMETER; AND SHOWED 300 FT HIGH. I DSNDED TO FL390 AND SWITCHED MY SECOND XPONDER ON. THE CTLR RPTED ME LEVEL AT FL390. I THINK THAT THE DISTR IN THE COCKPIT BY THE NURSE DURING CLB OUT CAUSED THE FO AND MYSELF TO MISS THE COMPLETION OF THE FL180 CHK. AFTER LEVELOFF; WE BOTH THOUGHT IT WAS AN INACCURATE MODE C BECAUSE WE BOTH REMEMBERED CALLING AND AT LEAST STARTING THE 180 CHK; WHICH INCLUDED RESETTING THE ALTIMETER SETTINGS. COCKPIT DISTRACTIONS CAN BE MORE NUMEROUS IN AN AIR AMBULANCE SIT. THE NURSES OFTEN TRY TO ASK CRITICAL QUESTIONS TO THE PLTS DURING CRITICAL PHASES OF FLT. EVEN IF THE PLTS DON'T ANSWER; IT IS STILL DISTRACTING. ALSO; SOMETIMES PATIENTS AND EMER MEDICAL ACTIVITY BEHIND THE PLTS CAN BE DISTRACTING; NO MATTER HOW MUCH YOU TRY TO IGNORE IT.