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Joint Commission highlights healthcare worker fatigue

Wednesday December 14, 2011
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The Joint Commission has issued an alert on healthcare worker fatigue and patient safety, citing the well-documented link between such fatigue and adverse events in the healthcare setting.

The commission's latest Sentinel Event Alert urges greater attention to preventing fatigue among healthcare workers and suggests specific actions for healthcare organizations to mitigate the risks.

An article in the November 2007 issue of The Joint Commission Journal on Quality and Patient Safety reported that nurses working more than 12-hour shifts and residents working recurrent 24-hour shifts were involved in three times more fatigue-related, preventable adverse events. In addition, healthcare professionals who work long hours are at greater risk of injuring themselves on the job.

"Healthcare is a round-the-clock job, and safety has to be the priority," Mark R. Chassin, MD, FACP, MPP, MPH, president of The Joint Commission, said in a news release. "The recommendations in this alert give healthcare organizations the strategies to help mitigate the risks of fatigue that result from extended work hours — and thereby reduce the likelihood that fatigue will contribute to preventable patient harm."

The alert addresses the effects and risks of an extended workday and of cumulative days of extended work hours. The Joint Commission alert recommends that healthcare organizations:

Assess fatigue-related risks such as off-shift hours, consecutive shift work and staffing levels.

Examine processes when patients are handed off or transitioned from one caregiver to another, a time of risk that is compounded by fatigue.

Seek staff input on how to design work schedules that minimize the potential for fatigue and provide opportunities for staff to express concerns about fatigue.

Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue such as engaging in conversation, physical activity, strategic caffeine consumption and short naps.

Educate staff about good sleep habits and the effects of fatigue on patient safety, and ensure staff workers' rest environment is conducive to sleeping.

The Joint Commission also suggests that healthcare organizations encourage teamwork as a strategy to support staff who work extended work shifts or hours. For example, organizations could use a system of independent second checks for critical tasks or complex patients. Also, organizations should consider fatigue as a potentially contributing factor when reviewing all adverse events.

The warning about healthcare worker fatigue is part of a series of Sentinel Event Alerts issued by the Joint Commission. Previous alerts have addressed diagnostic imaging risks, violence in healthcare facilities, maternal deaths, healthcare technology, anticoagulants, wrong-site surgery, medication mix-ups, healthcare-associated infections and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on the Joint Commission website (www.jointcommission.org). To download a PDF of the latest alert, visit www.jointcommission.org/sea_issue_48/.

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