James L, Elkins-Brown N, Wilson M, et al. Int J Nurs Stud. 2021;123:104041.
Many hospitals have adopted a 12-hour work shift for nurses and some studies have shown a resulting increase in burnout and decrease in patient safety. In this study, researchers assessed simulated nursing performance, cognition, and sleepiness in day nurses and night nurses who worked three consecutive 12-hour shifts. Overall results indicated nurses on both shifts mostly maintain their abilities on the simulated nursing performance assessment despite reporting increased sleepiness and fatigue. However there was more individual variation in cognition and some domains of performance.
NIOSH . NIOSH training for nurses on shift work and long work hours. By Caruso CC, Geiger-Brown J, Takahashi M, Trinkoff A, Nakata A. Cincinnati, OH: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2015-115 (Revised 10/2021)
Nurse fatigue has been associated with diminished decision-making skills that can contribute to patient harm. This online training program for clinicians and administrators will explore hazards related to nurse fatigue and provide strategies to address behaviors and systems that increase these risks.
Awan M, Zagales I, McKenney M, et al. J Surg Educ. 2021;78:e35-e46.
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) updated the duty hour restrictions (DHR) for medical residents to increase resident well-being. This review focused on surgical patient outcomes, resident case volume, and resident quality of life following the implementation of the 2011 update. Results showed DHR did not improve patient safety or surgical resident quality of life. The authors suggest future revisions meant to improve resident well-being not focus solely on hours worked in a single shift or week.
Jones AM, Clark JS, Mohammad RA. Am J Health Syst Pharm. 2021;78:818-824.
Burnout has been a focus of numerous studies since the beginning of the COVID-19 pandemic; however, this is the first to focus on burnout and secondary traumatic stress (STS) among health system pharmacists. Nearly two thirds (65.3%) of respondents had a moderate to high likelihood of experiencing burnout and 51% had a high probability of STS. Due to the association between burnout and decreased patient safety, it is critical that health systems address pharmacist burnout appropriately.
Whelehan DF, Algeo N, Brown DA. BMJ Leader. 2021;5:108-112.
Healthcare workers are facing occupational fatigue stemming from the COVID-19 pandemic (e.g., burnout, stress) as well as fatigue related to ongoing symptoms of the virus (“long COVID”). This article discusses preventive and proactive leadership strategies to address both types of fatigue, including screening for fatigue, providing reasonable accommodations for healthcare workers struggling with fatigue, stress mediation, and establishing organizational culture supporting sleep and rest.
The relationship between resident and physician duty hours and patient safety has been the focus of a lot of research. The relationship between nurse work schedules and patient safety is less explored. This review investigated the effect of extended or excessive nurse schedules on patient outcomes. Findings conclude that working more than 12 hours daily or more than 40 hours weekly may contribute to adverse patient outcomes. The authors recommend creating policies restricting nurse shifts to no more than 12 hours per day and 40 hours per week.
Rahman SA, Sullivan JP, Barger LK, et al. Pediatrics. 2021;147:e2020009936.
Reducing resident shift duration can improve resident health and patient safety. This study found that resident shifts limited to 16 hours can reduce performance impairment and medical errors, compared to extended work shifts (24+hours).
Fatigue among health care workers can increase the risk of errors. This large cross-sectional study of attending and house staff physicians found that sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Organizational policies should focus on reducing sleep-related impairment in order to reduce harm to patients and physicians.
González-Gil MT, González-Blázquez C, Parro-Moreno AI, et al. Intensive Crit Care Nurs. 2021;62:102966.
The COVID-19 pandemic has resulted in concerns about psychological and emotional well-being of health care professionals. In this cross-sectional study, critical care and emergency nurses in Spain report fears of COVID-19 infection, elevated workloads, higher nurse-to-patient ratios, communication struggles with management, and socio-emotional challenges in caring for their patients and themselves during the pandemic.
Schroers G, Ross JG, Moriarty H. Jt Comm J Qual Patient Saf. 2021;47:38-53.
Medication errors are a common source of patient harm. This systematic review synthesizing qualitative evidence concluded that nurses’ perceived causes of medication administration errors are multifactorial, interconnected, and stem from systems issues. Perceived causes included lack of medication knowledge, fatigue, complacency, heavy workloads, and interruptions.
Di Simone E, Fabbian F, Giannetta N, et al. Eur Rev Med Pharmacol Sci. 2020;24:7058-7062.
Based on survey data of a sample of nurses, the authors identified a significant association between perceived risk of near miss medication errors and both poor sleep quality and short resting time after a night shift.
Kolla BP, Coombes BJ, Morgenthaler TI, et al. J Gen Intern Med. 2020;36:51-54.
This observational study observed nonsignificant increases in patient safety incidents in the week following the transition into and out of daylight savings time (DST) over an eight-year period. The authors suggest policymakers and health system leadership evaluate risk mitigation strategies such as delayed shift start times during the transition to and from DST.
Patel AG, Pizzitola VJ, Johnson CD, et al. Radiology. 2020;297:374-379.
The authors analyzed CT interpretation errors committed by radiology fellows working off-hours over a four-year period and found that interpretation errors occurred more frequently at night and in the latter half of night assignments.
Landrigan CP, Rahman SA, Sullivan JP, et al. N Engl J Med. 2020;382:2514-2523.
This multicenter cluster randomized trial explored the impact of eliminating extended-duration work schedules (shifts in excess of 24 hours) on serious medical errors made by residents in the pediatric intensive care unit (ICU). The authors found that residents in ICUs which eliminated extended shifts in favor of day and night shifts of 16 hours or less made significantly more serious errors than residents assigned to extended-duration work schedules. The authors observed that the resident-to-patient ratio was higher during schedules which eliminated extended shifts, but also that these results might have been confounded by concurrent increases in workload in ICUs eliminating extended shifts.
Landrigan CP, Rahman SA, Sullivan JP, et al. N Engl J Med. 2020;382:2514-2523.
This article presents longitudinal follow-up of the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, which examined the effects of flexible duty-hour policies on resident outcomes. After four years, there was no evidence of increased duty-hour violations, decreased satisfaction or decreased well-being among residents randomized to flexible duty-hour policies. The researchers also observed that the beneficial impacts of flexible duty-hours persisted over the four-year period, whereas most of the negative effects diminished over time.
Kisely S, Warren N, McMahon L, et al. BMJ. 2020;369:m1642.
This meta-analysis examined the psychological effects of viral outbreaks on clinicians and effective strategies to manage stress and psychological distress. The review included 59 studies involving severe acute respiratory syndrome (SARS), COVID-19, Middle East respiratory syndrome (MERS), Ebola and influence. Compared with clinicians at lower risk, those in contact with affected patients had greater levels of both acute and post-traumatic stress, as well as psychological distress. Clinicians were at increased risk for psychological distress if they were younger, more junior, had dependent children, or had an infected family member. Identified interventions to mitigate stress and psychological distress included clear communication, infectious disease training and education, enforcement of infection control procedures, adequate supply of personal protective equipment (PPE) and access to psychological support.
Gunnar W, Soncrant C, Lynn MM, et al. J Patient Saf. 2020;16:255-258.
Retained surgical items (RSI) are considered ‘never events’ but continue to occur. In this study, researchers compared the RSI rate in Veterans Health (VA) surgery programs with (n=46) and without (n=91) surgical count technology and analyzed the resulting root cause analyses (RCA) for these events. The RSI rate was significantly higher in for the programs with surgical count technology compared to the programs without (1/18,221 vs. 1/30,593). Analysis of RCAs found the majority of incidents (64%) involved human factors issues (e.g., staffing changes during shifts, staff fatigue), policy/procedure failures (e.g., failure to perform methodical wound sweep) or communication errors.
Stimpfel AW, Fatehi F, Kovner C. Sleep Health. 2020;6(3):314-320.
Research provides evidence that sleep deprivation among nurses is a threat to patient safety. Using observational data, this study assessed the association between sleep duration among nurses and patient safety. On average, nurses reported less than 7 hours of sleep before a shift. Less sleep was associated with lower ratings on patient safety culture measures.
Farnborough, UK; Healthcare Safety Investigation Branch; December 18, 2019.
Maternal care during and after childbirth is at risk for never events including retained foreign objects. This analysis of a sentinel event involving a retained surgical tampon after childbirth discusses communication, fatigue, and process factors that contributed to the incident. The report suggests improved handoffs as one improvement strategy.
Ferguson BA, Lauriski DR, Huecker M, et al. J Emerg Med. 2020;58:514-519.
Cognitive errors caused by fatigue can impact patient safety. This study used a brief, electronic cognitive assessment tool to determine the effect of shift work on emergency medicine resident’s alertness. The authors found that alertness is lowest at the end of the evening shift (typically ending between 12:00-2:00am) and there is a significant difference in alertness between the start versus end of the night shift. No significant difference was observed in the day or evening shifts.
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