Is there a relationship between workplace and patient safety?

AORN Journal,  Oct, 2006  by Linda K. Groah,  Lorraine J. Butler

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Six years after the Institute of Medicine released its report on medical errors, (1) the health care industry has moved from denying the scope of the problem to accepting the importance of error reporting and the inevitability of error transparency. Senior leaders and staff members are beginning to understand the enormity of the issues surrounding medical errors and the consequences to patients. This has resulted in a proliferation of patient safety improvement projects with widespread participation by health care professionals and facility-based committees. AORN also has been proactive regarding patient safety efforts.

Workplace safety for OR personnel has been on AORN's strategic list of priorities for more than 10 years, and several occupational hazards have been identified as posing a risk to perioperative staff members. These include hazards that are

* biological (eg, smoke plume, protein allergens in latex gloves, exposure to infectious microorganisms);

* ergonomic (eg, back injuries, repetitive motion, lifting heavy instruments);

* chemical (eg, disinfecting/sterilizing agents, formalin, anesthetic gases);

* physical (eg, lasers, fire, radiation);

* psychological (eg, long call hours, fatigue); and

* cultural (eg, verbal abuse, nonconformity with a code of conduct).

In compliance with federal, state, and local regulations, safety committees have been established in health care facilities to review current and potential work-related injuries.

Workplace committees and patient safety committees, while serving a vital role in addressing issues within their own frame of reference, typically do not focus on the relationship between working conditions in the health care setting and patient safety. There is a vital link between these two areas, and if workplace safety and patient safety resources were consolidated, it could have a greater impact on the desired outcomes of having competent, healthy employees who can provide quality care for patients in a safe and effective manner.

Workplace and Patient Safety Issues

Many safety issues affect both health care providers and patients in different ways. Examples include physical injuries, hand hygiene, and fire safety.

Physical injuries. Any occupational injury resulting from an unsafe workplace negatively affects a health care organization by increasing costs and reducing the facility's ability to provide services. A back injury sustained by a health care employee may not appear to directly affect the wellness of his or her patients, but it may result in the employee not being available for work. The employee's manager may have to temporarily fill the position with supplemental staff (ie, registry, travelers) who may not be well-versed in departmental policy and procedures. This could lead to patient injuries.

Hand hygiene. The practice of good hand hygiene among health care workers is widely accepted to be the single most important means for preventing the spread of infection among patients. (2)

Despite this supporting evidence, however, rates of compliance with hand hygiene programs in hospitals are reported to be at 25% to 50%. (3) Facilities have implemented several approaches to improve hand washing compliance, including staff member education, feedback on infection rates, and increasing the availability of waterless products. These efforts have proven largely unsuccessful by themselves. (3) If, however, the discussion of hand hygiene were to be expanded to include the perspective of workplace safety, the scope of the discussion could include a review of new products as well as information regarding the risk of noncompliance to employees, such as increased staff member respiratory infection rates that are linked to poor hand hygiene in the workforce.

Fire safety. One of the most devastating experiences that affect both patients and perioperative team members is the incidence of fires that occur in the OR. The majority of fires in the OR ignite on or in the patient. (4)

As part of an active workplace safety program, all perioperative staff members should participate in a fire drill at least quarterly. The fire drill should involve all members of the team carrying out specifically identified assignments. These assignments should include pulling the fire alarm, using fire-fighting equipment (eg, fire extinguishers), turning off piped-in gases, and unplugging electrical power cords. Videotaping the fire drill and discussing it as a team permits team members to critique their effectiveness and to correct any deficiencies. Participating in these discussions also encourages employees to expand their understanding regarding how employee wellness and patient safety are directly connected.

A Strong Safety Culture

By consolidating workplace and patient safety efforts, employees will begin to establish a foundation on which to build a strong safety culture that focuses simultaneously on patient safety and employee well-being. Facility leaders cannot independently promote patient safety without promoting workplace safety. Improving the overall safety of the health care system demands collaboration and participation of all stakeholders. This can be achieved by breaking down the silos of workplace safety and patient safety and combining their strategies into a workplace and patient safety committee.