Human Performance in the Medical Industry
Are you interested in real issues of human performance in the medical industry and why people make mistakes and cause sentinel events?
Then read this e-mail that was forwarded to me…
And post your comments here.
Please Post the following Question and Commentary:
How Long is Too Long for a Member of the Sterile Team to Remain Continuously Scrubbed into Surgery?
Although the public might not understand that medical professionals including the Surgeon must leave the OR briefly during lengthy Surgery, most conscientious practitioners realize that this is a normal safety measure necessary to combat fatigue. I am trying to get a consensus of feedback from those who routinely face this dilemma in the OR as to what time frame is universally accepted as the maximum period that any member of the sterile team can be expected to safely function while scrubbed into Surgery without a break. Although I am now in the “NIFA” training program to become a First Surgical Assist, even as a Surgical Technologist, performing the “scrub” role, I had to concentrate on anticipating the Surgeons needs during a case. After how long would you consider that scrub role jeopardized by fatigue to the point where I might have lost concentration and focus on the operation?
While a Surgeon can, and should, demand that the person assisting him is relieved, Nurses and Technicians fall under the control of OR Management which leaves us vulnerable to the vagaries of inappropriate OR coverage as determined by the Hospital. As a consequence of Hospital “downsizing” to cut costs redundancy of personnel has been severely limited to the point where during the off-shifts especially at night and on weekends there’s no free staff to break people out of Surgery for even a brief run to the bathroom! Calling in call team people to provide relief breaks is considered an unnecessary expense, despite the fact that there is a clearly established link between fatigue and medical errors. The sterile team scrubbed into Surgery are trapped without food or water until they are relieved; this also represents an unacceptable deprivation strain on the body. However there are no safeguards within the existing US employment laws or OCHA standards to insure that critical Hospital workers, including those in the OR, are not left for hours of continuous, and dangerous, practice without a break. “Breaks are at the discretion of the employer.”
I was left stranded at the field without relief for 8, 10 and on the worst occasion 12 hours straight. These situations impacted my ability to concentrate as my blood sugar plummeted; each time I reported becoming sick, dizzy and faint to the point of nearly passing out. When I complained that my condition in response to this hardship presented a danger to my patients I was targeted for removal and then fired. Incidents where any member of the OR team is forced to remain on task for that long should be documented in an “Incident Report,” as an extreme of this magnitude presents an unacceptable danger to the patient. The Geneva Convention strictly prohibits such inhumane treatment of working POWs! How many normal human beings are expected to go for 12 hours without water, food or urination?
There is a lot of talk about medical errors right now, but far less mention of the toxic work environment that now encourages mistakes. This situation is getting steadily worse. While “At Will” employment laws silence those who dare to speak out, lack of a humane break policy condones driving Hospital staff until they drop: is there any wonder that errors are on the increase? Little wonder that a sponge or an instrument is inadvertently left inside the patient when the scrub is almost comatose after a 12hour ordeal in Surgery. All the cross checking and safeguards are irrelevant if the Hospital staff are trying to function while so severely fatigued, hypovolemic or hypoglycemic that they are at the point of either falling asleep or passing out. When will the various safety advocacy groups in the US finally address this very real problem and insist on proper protective legislation? There have been advances recently with limiting the Residents working hours and trying to stop mandated overtime for Nurses, but much more emphasis must be placed on eliminating unnecessary fatigue among all of our medical staff.
No one is more important than the patient unconscious on the OR table. For my very prestigious Maryland Hospital the “Nursing Shortage” was a convenient excuse to justify unconscionable Managerial abuse that seriously endangered my patient in the OR. Doctors and Nurses face severe discipline when mistakes occur, but why isn’t a negligent Hospital policy that condones drastic staffing cut backs ever recognized as the real culprit? In some cases administration even offers financial bonuses to encourage self-serving Managers to implement inadequate staff coverage. Then they fail to hold a repeatedly abusive Manager accountable when they drive dedicated staff until they drop. This Managerial excess is focused purely on saving money not saving lives; we need proper safeguards in place to cub this negligent profiteering strategy before patients are harmed. Plus when staff are courageous enough to come forward and expose a pattern of ongoing negligent practices they must be protected from retaliation and taken seriously by accreditation agencies who’s duty is to protect the public. No medical institution no matter how iconic, prestigious or powerful should be immune fro rigorous scrutiny, as this lack of oversight encourages bending the rules, ignoring regulations and cost cutting that is harmful to safe patient care.
Relentlessly abusive Managers are a very valuable tool in facilitating staff downsizing without layoffs; I call this the spineless approach to cost cutting, but it makes our Hospital working environment extremely dangerous for the patients. The current Nursing crisis has come about through this dangerous downsizing and the creation of the toxic work environment that is driving Nurses to leave their chosen profession because they refuse to take unnecessary risks. The US does not have a “Nursing Shortage” it has a “Nursing Exodus.” The US healthcare industry is still consistently expecting all of our medical professionals to take bigger risks by making do with unsafe staffing practices.
This issue desperately needs to be addressed so please post comments here.
Kim L. Sanders-Fisher
January 5th, 2006 at 9:07 am
My wife worked for 18 years in two different hospitals as a nurse’s assistant, sugical aid, and unit clerk. I would agree with your assessment that what is perceived as a nursing shortage is actually a nursing exodus from the hospital environment for exactly the reasons you describe. The one constant throughout my wife’s experiences has been lack of qualified backup’s at the direct patient care level (plenty of admin staff, however). Mistakes (and eventual large lawsuits) by continuing a policy of extended hours and shortage of personnel are inevitable.
Close friends who are nurses tell me of leaving the hospital environment in favor of doctor’s offices or local clinics due to the shortage of help and extended hours demanded by hospital management.
The problems you describe, however, are apparent thoughout many industries in the U.S. Management, driven by their Board of Directors, and concerned with maximizing profits and dividends over all other issues, are reacting similarly, by cutting staff to the bone and compromising safety in many cases rather than look inwardly to other budget cutting measures. The amount of bonuses received by many corporate managers in a single year alone could pay for numerous additional full-time personnel.
Unfortunately, I would guess that the Boards that perform what is classed as ‘oversight’ of the medical community are made up of many ‘worker bees’. Until laws are passed similar to that used the Nuclear Regulatory Commission that foster reporting of safety issues and severely fine companies that attempt to quell or sequester reporting issues the conditions you speak of will continue. At least until some major lawsuits start to shutdown the offenders.
July 25th, 2008 at 7:56 pm
A lot of useful material you read! Thank you for it!