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Report, regulations focus on health care worker fatigue

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More than five years after Pennsylvania's Prohibition of Excessive Overtime in Health Care Act became law, the regulations needed to implement it have been approved.

The news comes as the Pennsylvania Patient Safety Authority reports that health care worker fatigue was cited as a contributing factor in more than 1,600 events between June 2004 and August 2013 — 37 of them causing harm and four resulting in patient death. 

"In studies conducted with nurses, it was shown that working a 12-hour work shift or working overtime is associated with difficulties staying awake while on duty, reduced sleep times, and nearly triple the risk of making an error," Theresa V. Arnold, PPSA manager of clinical analysis, said in a news release. "The most significant error risk observed was when nurses worked 12.5 hours or longer."

One of the first efforts made to reduce events related to fatigue was limiting the hours worked, Arnold said, but "further study suggests a more comprehensive approach is needed, as simply reducing hours does not address fatigue that is caused by disruption in sleep and extended work hours."

"Many hospitals have adopted 12-hour shifts as the norm and it is a similar choice among nurses who want to limit the number of days they work in a week, but research on the 12-hour shift and patient safety needs further review," Arnold said.

The Pennsylvania Medical Society explains the Prohibition of Excessive Overtime in Health Care Act this way: "Physicians working in certain health care facilities must be mindful of requests or assignments that may cause protected employees to work in excess of a predetermined and regularly scheduled daily work shift, or in excess of 40 hours per week."

The society says the new regulations:

• Do not apply to offices used primarily for private or group practice by a health care practitioner.

• Protect health care facility employees who are involved in direct patient care activities or clinical care services and who receive an hourly wage or are classified as nonsupervisory employees for collective bargaining purposes.

• Require facilities to develop a complaint and investigation procedure.

"The regulations define 'health care facilities' as hospitals, hospices, ambulatory surgical facilities, long-term nursing care facilities, cancer treatment centers, and inpatient drug and alcohol treatment facilities, and also apply to health clinics operated by the Departments of Corrections, Health, Military and Veteran Affairs, or Welfare," the society says.

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