Joint Commission Alert on Healthcare-Worker Fatigue

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OAKBROOK TERRACE, Ill.―The link between healthcare worker fatigue and adverse events is well documented, according to the Joint Commission in a new issue of Sentinel Event Alert: Healthcare worker fatigue and patient safety. The Alert urges greater attention to preventing fatigue among healthcare workers and suggests specific actions for healthcare organizations to mitigate the risks.

An article in the November 2007 issue of The Joint Commission Journal on Quality and Patient Safety reported that nurses who work more than 12-hour shifts and residents working recurrent 24-hour shifts were involved in three times more fatigue-related preventable adverse events. In addition, healthcare professionals who work long hours are at greater risk of injuring themselves on the job.

“Healthcare is a round-the-clock job, and safety has to be the priority," said Mark R. Chassin, MD, FACP, MPP, MPH, president, the Joint Commission. “The recommendations in this Alert give healthcare organizations the strategies to help mitigate the risks of fatigue that result from extended work hours―and, thereby, reduce the likelihood that fatigue will contribute to preventable patient harm."

The Alert addresses the effects and risks of an extended work day and of cumulative days of extended work hours. The Joint Commission Alert recommends that healthcare organizations:

The Joint Commission also suggests that healthcare organizations encourage teamwork as a strategy to support staff who work extended work shifts or hours. For example, use a system of independent second checks for critical tasks or complex patients. Also, organizations should consider fatigue as a potentially contributing factor when reviewing all adverse events, and educate employees on the importance of good sleep habits, including ensuring their rest environment is conducive to sleeping.

The warning about healthcare worker fatigue is part of a series of Alerts issued by the Joint Commission. Previous Alerts have addressed diagnostic imaging risks, violence in healthcare facilities, maternal deaths, healthcare technology, anticoagulants, wrong-site surgery, medication mix-ups, healthcare-associated infections, and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on the Joint Commission website.

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