findings concerning fatigued health care workers are truly eye opening

We tend to think of job-related fatigue as being relatively harmless in that it may result in some minor mistakes, yet be effectively counteracted with a few cups of strong coffee or a walk around the block. While this may be the case in office-type settings, there are other sectors in which this fatigue is very difficult to combat due to workload demands and, more significantly, can have devastating consequences.

To illustrate, one such sector where job-related fatigue can spell disaster is the medical field. Here, drowsiness may cause a physician to forget to run a test, a nurse to fail to make the necessary chart notation or a pharmacist to strike the wrong computer key.

Unfortunately, a recently published report by the Pennsylvania Patient Safety Authority, an independent agency tasked with “taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety,” shows how health care worker fatigue continues to be a problem here in the Keystone State.

While a complete summary of the report is clearly beyond the scope of a single blog post, it essentially found that there were 1,601 fatigue-related incidents reported to the agency between June 2004 and August 2013. Of these incidents, 37 were classified as serious events (i.e., those that resulted in harm), including four patient fatalities.

Breaking the numbers down further, the Pennsylvania Patient Safety Authority found the following:

  • Of the events reported in connection with health care worker fatigue, 88.5 percent involved medication errors (wrong dose, extra dose, dose omission, etc.) or errors related to tests, treatment and procedures (radiology errors, lab errors, surgical errors, etc.).
  • The five locations where the events reported in connection with health care worker fatigue most commonly occurred included the emergency department, pharmacy, medical/surgical unit, lab and general medical ward.
  • The most significant risk of an event associated with health care worker fatigue was posed by nurses working shifts of twelve-and-a-half hours and over.

Curiously, the report authors suggested that the solution to combating fatigue among health care workers, which it defined as a feeling of complete exhaustion accompanied by impaired cognitive/physical ability, could not be found in simply reducing shift hours. Instead, they concluded that the medical sector must adopt a more comprehensive approach, much like the fatigue and risk management systems currently used in other nations and other industries here in the U.S.

Before one dismisses 37 serious events over the course of a decade as a relatively small number, stop to consider that these were 37 lives that were likely forever altered simply because a health care worker failed to get the necessary rest. It’s events like these that demonstrate why it’s so important for patients injured by medical negligence to have a dedicated advocate by their side.

Source: The Pennsylvania Patient Safety Authority, “Healthcare worker fatigue is cited as a contributing factor in over 1,600 events reported to the Pennsylvania Patient Safety Authority,” June 5, 2014 

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