The Joint Commission is calling attention to long work hours in a new Sentinel Event Alert released today. With documented links between healthcare worker fatigue and adverse events, as well as lower productivity, the accrediting body is warning hospitals about the potential dangers of extended hours and excessive workloads.
Work schedules and shift length can affect providers' sleep and therefore their job performance. Sleep deprivation or lack of quality sleep over an extended amount of time can lead to confusion, irritability, memory lapses, loss of empathy, and compromised problem-solving, among other things, according to the Alert.
"An overwhelming number of studies keep saying the same thing--once you pass a certain point, the risk of mistakes increases significantly," Ann Rogers, a sleep expert at Emory University's School of Nursing, said in the report. "We have been slow to accept that we have physical limits and biologically we are not built to do the things we are trying to do."
That tipping point, according to studies, is more than 12 hours of work. For example, a 2004 study found that nurses who worked 12.5-hour or longer shifts were three times more likely to make an error in patient care.
The Joint Commission's attention to work hours isn't the first from an accreditation agency. The Accreditation Council for Graduate Medical Education (ACGME) in July 2003 implemented duty-hour restrictions for residents to a maximum of 30-hour shifts and no more than 80-hour work weeks. Last year, the ACGME published its final version of the duty-hour standards.
With increased focus on work hours, the Joint Commission's Alert offers guidance, like other Sentinel Alerts. The Joint Commission suggests organizations assess their fatigue-related risks, including off-shift hours and consecutive shift work; examine the hand-off process; invite staff to offer input in their own work schedules; implement a fatigue management plan; and educate staff about the effects of fatigue on patient safety.
For more information:
- read the Sentinel Event Alert (.pdf)
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