News: OSHA Shines a Light on Healthcare Workplace Hazards
Federal agency examines the state of worker safety in hospitals and offers resources for improvement.
The Occupational Safety and Health Administration (OSHA) has created an online resource of information about work-related injuries and illnesses among people who work in hospitals and other healthcare settings. These workers face hazards that range from needlesticks to muscle strains, falls, and communicable diseases as well as violent injury and death caused by angry or deranged patients, family members, or other members of the public. And they are injured on the job more often than workers in any other profession.
In Caring for Our Caregivers: Facts About Hospital Worker Safety, OSHA states that between 2000 and 2011, hospitals reported a higher rate of injury and illness among full-time employees than manufacturing, construction, or the average rate across all private industry in the United States. In 2011, hospitals had the largest number of cases that resulted in lost days at work, again coming in “ahead” of construction, manufacturing, and private industry.
The authors of the report—one of many resources available for download on the OSHA website—disclose the sources and limitations of the data, which reflect the breadth and complexity of the healthcare industry. The data come primarily from the U. S. Bureau of Labor Statistics, insurance companies, and published literature. The detailed findings can be used to understand the effects of a variety of forces and to focus attention and resources where they are needed most.
More than half (54%) of the injuries that kept workers at home for at least one day in 2011 were attributed to musculoskeletal disorders (MSDs), or “sprains and strains.” It is not surprising that the hazard event that occurred most often (in 48% of cases) in the same time period was “overexertion and bodily reaction,” which includes the effects of actions such as lifting, bending, and slipping (without falling). Statistics from 2011 seem to complete the picture, indicating that patients are the most common cause of injury (33% of cases), followed by “floors, walkways, ground surfaces.” Data for every year between 1992 and 2011 show that the highest rate of days-at-work lost to injury and illness occurred in nursing and residential care facilities, followed by hospitals, private industry (overall), and ambulatory care.
A Culture of Safety for All
Officials from the National Institute for Occupational Safety and Health (NIOSH) and The Joint Commission joined Dr. Lucian Leape, chairman of the Lucian Leape Institute (LLI) at the National Patient Safety Foundation (NPSF), and Dr. David Michaels, U.S. assistant secretary of labor for occupational safety and health, at a press briefing on January 15, 2014, to introduce OSHA’s new educational resource.
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Worker Safety in Hospitals Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation |
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Since the mid 1980s, Dr. Leape has been working to prevent harm due to medical errors by applying systems thinking to the problem and improving the culture of behavior and accountability among co-workers and organizations. At the press briefing, he said, “We’ve come to realize that one of the most important things we can do to make our hospitals safe for patients is to make them safe for our workers—our nurses, nursing assistants, aids, orderlies and all of the support staff.”
Dr. Erin DuPree, chief medical officer and vice president of The Joint Commission, joined Dr. Leape in emphasizing the importance of establishing a culture of safety for workers as well as patients, saying that “a successful safety program cannot be separated into silos with programs for workers unrelated to those for patients.”
NPSF/LLI and the Joint Commission Center have published monographs about workplace safety. In March 2013, the Lucian Leape Institute published Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care. In November 2012, The Joint Commission published Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Both publications are available online without charge (see sidebar).
Dr. Michaels urged hospitals to use the new resources together with ongoing improvement efforts to enhance the reliability of all programs. He also pointed out that workplace injuries and illnesses contribute to rising healthcare expenditures, costing U.S. hospitals $2 billion each year.
The OSHA website includes national statistics and a self-assessment questionnaire to help hospitals understand the extent of the problem, lessons learned from hospitals that have implemented workplace safety improvement programs, a guidebook to safety and health management systems, and an extended section of resources about safe patient handling.
HHS Releases SAFER Guides for Health IT
New tools will help providers and health IT developers make safer use of electronic health records.
A new set of guides and interactive tools to help healthcare providers use electronic health information technology products, such as electronic health records (EHRs), more effectively are now available at www.HealthIT.gov.
The Office of the National Coordinator for Health Information Technology (ONC) at HHS has released the Safety Assurance Factors for EHR Resilience (SAFER) Guides. These guides are a suite of tools that include checklists and recommended practices designed to help healthcare providers and the organizations that support them assess and optimize the safety and safe use of EHRs.
The release of the SAFER Guides marks an important milestone in the implementation of the HHS Health IT Patient Safety Action and Surveillance Plan, which was issued in July 2013. “A basic premise of the Health IT Safety Plan is that all stakeholders have a shared responsibility to make sure that health IT is safely implemented and that it is used to improve patient safety and care,” said Jacob Reider, MD, chief medical officer at ONC. “The SAFER Guides combine the latest applied knowledge of health IT safety with practical tools that will help providers—working closely with EHR developers, diagnostic service providers, and others—effectively assess and optimize the safety and safe use of EHR technology within their organizations.”
The SAFER Guides complement existing health IT safety tools and research developed by the Agency for Healthcare Research and Quality (AHRQ) and ONC. AHRQ’s Patient Safety Organizations (PSO) have explicitly identified health IT as a high priority area because of the enormous impact EHRs have on patient safety. PSOs are charged to help their members improve patient safety, and the SAFER Guides give them an evidence-based tool to do so.
Rigorously developed by leading health IT safety and informatics researchers and based on the latest available evidence, expert opinion, stakeholder engagement, and field work, each SAFER Guide addresses a critical area associated with the safe use of EHRs through a series of self-assessment checklists, practice worksheets, and recommended practices. Areas addressed include:
- High Priority Practices
- Organizational Responsibilities
- Patient Identification
- Computerized Physician Order Entry (CPOE) with Decision Support
- Test Results Review and Follow-up
- Clinician Communication
- Contingency Planning
- System Interfaces
- System Configuration
Each SAFER Guide has extensive references and is available as a downloadable PDF and as an interactive web-based tool.
“With the release of these guides, stakeholders now have ready access to additional evidence-based knowledge and practical tools to optimize EHR safety,” said Jon White, M.D., director of AHRQ’s Health IT portfolio. “Consistent with the Health IT Safety Plan, health care providers and those who support them will use these guides to develop a culture of safety, shared responsibility, and continuous improvement around health IT.”
The SAFER Guides are available at http://www.HealthIT.gov/saferguide.