1. 10/10/2016
1
Safety and Scheduling
Sharon M. Weinstein, MS, RN, CRNI,
FACW, FAAN, CSP
Patient care yesterday and today… Trends in care
• Increasing elderly population
• Higher patient acuity
• Shorter length of stay
• Shift to alternative settings
• Increased responsibility of patients and
caregivers
• Hospitalists
• Automation
Gallup Poll…trust Institute of Medicine
• Fatigue in human error
Medical errors
• Major cause of
morbidity and
mortality
• Resident fatigue is a
contributing factor
• Specific timeframes
in which is
compromised
Collaboration
• Physician
• Nurse
• Inter-professional
• Interdepartmental
Timing is Everything
• Value of real-time
• What does the
evidence show?
• Productivity
• Performance
• Employee satisfaction
• Profitability
Outcomes
Automated
• Measurement of
outcomes
• Enhancements in patient
care
• Tracking mechanisms
• Pay for performance
Manual
• Lack of data to payers
• Time involved
• Narrative satisfaction
• Question of fairness
• Lack of transparency
• Analytics
• Logistics
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2. 10/10/2016
2
The Environment
 Workload
 Work hours
 Work
environment…
Fatigue: healthcare professionals
• Risk for errors
• Critical fatigue impairment
• Rotations
Who Owns Safety?
Employee Employer System
Adverse Events Performance impairment
Work-related Non work-related
Work schedule Quantity of sleep
Actual hours worked, including
overtime and additional shifts
Quality of sleep
Type of work involved Absence or presence of sleep disorders
Work environment Existing health issues
When performance drops
• Sleepiness
• Lack of concentration
• Impaired recall
• Irritability
• Poor judgment
• Slower response times
• Reduced communication
• Reduced fine motor skills
• Reduced coordination
• Reduced visual perception

3. 10/10/2016
3
Fatigue Avoidance Scheduling Tool
• Day shift
• Trauma shift
• Night shift
• Pre-work
• On-call
Fatigue countermeasures
• Take a break
• Fatigue Reduction Management
• Occupational and Environmental Medicine
• Appropriate scheduling
• Emergency situations
• Napping
Commitment
Attacha sense of urgency Partner with staff to ensure
consistency of policy and
procedures
Create a collaborative work
environment
Educate and empower staff
Identify the areas and practices that
may result in staff fatigue
Prioritize fatigue countermeasures and
monitor effectiveness
Evaluate staffing and scheduling
practices and automate systems
Offer opportunity for feedback and
ideas for improvement
Engage staff in recruitment and
retention activities and promote
innovative strategies
Follow the system
Early recognition Staffing Challenges “Our lives begin to end the
day we become silent about
things that matter.”
Martin Luther King Jr.
sharon@smwgroupllc.com
sharon@sharonmweinstein.com
Smwgroupllc.com