1. Creating a Healthy Work Environment: Strategies that Reduce Healthcare Worker Fatigue “Take a Break” Program Nursing Best People and Professional Excellence Committee Goals: Sarah Buenaventura, Chairperson, RN, BSN, CMSRN Sleep deprivation ­ Could be damaging to muscles, ligaments, and tendons which can lead to ergonomic injuries ­ Has been associated with a threefold increase in risk of sharps injury Change the language of the Personal Conduct policy to reflect the support of an authorized break with rest or sleep in a designated non- patient care, non-public hospital space. Develop a wellness education plan for employees  Safety training to include the impact of fatigue on errors  Stress management classes  Fatigue management classes  Sleep clinic resource and referrals Establish a culture of acceptance in identifying and admitting fatigue in workers Establish expectations of worker accountability in decreasing fatigue Modify organizational scheduling standards and guidelines electronically to reflect the Institute of Medicine’s recommendations  not to work over 20 hours of overtime in a week  limit number the number of consecutive 12 hour shifts  no scheduling of double shifts Maintain the RN “Take a Break” program Continue and plan for an organizational FY 2010 Human Resource wellness goal reflecting a decrease in healthcare worker fatigue Employee injuries, both sharps and ergonomic Patient safety-related errors Unscheduled PTO hours and unavailability Feelings of fatigue and stress Healthcare costs Staff satisfaction and ability to rely on coworkers Anticipated Project Outcomes Interventions What is a meal break? “Uninterrupted for at least 30 minutes, involving no pagers or phones and the option to leave the clinical area.” Why is this important? ­ Time away improves safety and quality 10% decrease in error risk with a full meal break (NDNQI data) ­ Improves staff morale and retention Nurses report higher ratings of work context, practice environment, and likelihood of staying in current position (NDNQI data) ­ Happier staff = happier patients Implementation Establish standards and put systems into place to ensure breaks (i.e. buddy systems or a “Take a Break” lunch reliever, provide resources/exemplars) Use a formal, documented system for assigning meal breaks, i.e. buddy systems, team identified with patient centered care model, or a “Take a Break” lunch reliever Ensure proper hand-offs (SBAR) including phone or pager Record and monitor those units not consistently taking breaks Committee identified members as coaches for clinical coordinators on units with low rates or inconsistency of staff receiving meal breaks Anticipated Outcomes Consistency with taking meal breaks Quality of job performance and job satisfaction Fatigue, errors Planned resurvey via electronic nursing poll questions (open house-wide) in September 2009 Nurse’s Week Survey: May 2009 The Impact of Fatigue on Performance Background Data Percent of Staff Taking a Break: September 2008 As consecutive shifts increase, so does injury risk As time between breaks increase, so does injury risk The last 30 minutes of a 2-hour work period has TWICE the injury risk as the 30 minutes immediately after a break According to the Institute of Medicine (1999), as described in the report brief of To Err is Human: Building a Safer Health System: “Errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. Thus, mistakes can best be prevented by designing the health system at all levels to make it safer-to make it harder for people to do something wrong and easier for them to do it right” (p.2).