Staff Injuries Research Articles

A Perioperative Intervention to Prevent and Treat Emergence Delirium at a Veterans Affairs Medical Center

Emergence delirium (ED) is a temporary condition associated with a patient awakening from an anesthetic and/or adjunct agent (e.g., sedatives and analgesics). During the condition, patients risk harming themselves or staff by engaging in dangerous behavior, which may include thrashing, kicking, punching, and attempting to exit the bed/table. A multidisciplinary team at Veterans Affairs Pittsburgh Healthcare System (VAPHS) developed and implemented a multicomponent intervention to reduce the severity and occurrence of ED. The intervention consists of a training component and 21 clinical components. The 21 clinical components are implemented on a patient-by-patient basis and include routine screening for risk factors, enhanced communication among staff, adjusting the environment, following a specific medication strategy, and application of manual restraint (hands-on). The authors provide 15 online Supplemental Materials (S1–S15) to promote replication of the intervention. To our knowledge, this is the first manuscript that describes this type of multicomponent intervention in sufficient detail to allow others to replicate it. Following implementation of the intervention at VAPHS, perioperative staff reported that they observed a substantial reduction in the occurrence and severity of ED, ED-related patient and staff injuries, and ED-related loss of intravenous access and airway patency. Despite staff’s reported success of the intervention, rigorous research is needed to evaluate the efficacy of the intervention.

Incidence Of Team USA Staff Illnesses And Injuries During The Tokyo 2020 Summer Paralympic Games

Incidence Of Team USA Staff Illnesses And Injuries During The Tokyo 2020 Summer Paralympic Games

Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes.

Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care. We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents. The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States. Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics. The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates. A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.

How a Fetal Elevation Device Assists the Birth of a Neonate With a Deeply Impacted Head in the Pelvis

When a deeply impacted fetal head occurs in the maternal pelvis during a cesarean birth, current practice is for staff to place their hand into the introitus and push up to allow the physician to reach for the neonate’s head with ease. Case reports have described an increased risk of complications with this practice, including increased operative time, increased blood loss, infection, fetal skull trauma, and staff injuries. Costs associated with complications can create a financial systems’ burden and litigation related to maternal or fetal injury.

Innovations in Fatality Management During the COVID-19 Pandemic.

Innovations in Fatality Management During the COVID-19 Pandemic.

Nurses sustain manual handling risk assessment behaviours six-months after a training program to move patients safely: a pre-post study

Purpose To determine if a patient manual handling training program focused on dynamic manual handling risk assessment for staff and patient safety, together with the patient’s need for physical rehabilitation, can be transferred and sustained in clinical practice. Materials and methods Using a pre-post design, nurses (n = 72) from acute and rehabilitation wards participated in a 4-hour training session teaching dynamic manual handling risk assessment to safely move patients. Clinical observations audits of patient transfers were conducted prior to, and at 1-month and 6-months post training. Surveys determined experiences of training. Nurse musculoskeletal injuries and patient falls were measured 6-months after training. Results Program patient handling skills were competently implemented 89% of the time 1-month following training and were sustained 6-months following training. There was no change in falls rates and staff injury rates were very low pre- and post-training. Training was well received and all nurses passed the competency assessment. Conclusion The patient handling training program taught nurses to better identify factors associated with risk to themselves and their patients and gave them improved skills to help patients move. Skills were incorporated safely into clinical practice and sustained at 6-months. It is uncertain whether training impacted musculoskeletal injuries. Implications for rehabilitation A dynamic manual handling risk assessment program for safely transferring and moving patients balances staff safety with the patient’s need for physical rehabilitation. Nurses can be taught risk assessment skills to better identify factors associated with risk to themselves and their patients that can be translated to clinical practice. Thorough risk assessment at the point of the nurse-patient interaction can enable a patient to move at their highest level of function thus providing patients with opportunities to progress their rehabilitation at every interaction.

The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention

BackgroundShock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes.MethodsThis is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation.Results20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors.ConclusionEvidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications.Trial registrationPROSPERO CRD42019118834.

Comparison of three automated compounding devices for parenteral nutrition according to four key technical tests

ObjectivesAutomation of parenteral nutrition (PN) preparation is nowadays a recommended practice in order to reduce human errors and thus improve the safety and accuracy of the finished product. Other benefits...

Feasibility trial of weighted blankets as an intervention for emergence delirium in postoperative pediatric patients

BackgroundEmergence delirium (ED) is a significant problem in the post anesthesia care unit (PACU), resulting in dislodgement of medical devices, patient and staff injury, prolonged recovery, and parent dissatisfaction. Parental requests for the use of weighted blankets in the hospital setting have increased. However, while weighted blankets have shown potential as treatment for anxiety in adults and children, no studies have demonstrated their safe use with children in the hospital setting. PurposeTo explore the safety of weighted blanket use with children in the PACU as an intervention for ED, a feasibility study was conducted. Design and Methodology: A convenience sample of 93 participants, aged three to 10 years were recruited. Watcha scores, vital signs, length of wear time, and reason for blanket removal were recorded for all patients. ResultsEighty-five patients completed the study. Four participants experienced vital signs outside the defined safety parameters, with only one experiencing an adverse event (1.2%). This was consistent with the historic adverse event rate of 1% for the study site. Staff did not report issues with the use or cleaning of the blankets. Of interest, there was significant correlation between ED and suspected pain. ConclusionThe study demonstrated weighted blanket use is safe and feasible with children in the hospital setting, Additional studies are needed to determine the effectiveness of weighted blankets as an intervention for ED and the impact pain may have on the severity and prevalence of ED.

Implementing a program to reduce restraint and seclusion utilization in a public-sector hospital: Clinical innovations, preliminary findings, and lessons learned.

The Alternative to Restraint and Seclusion State Incentive Grant was a national initiative to reduce restraint and seclusion use in psychiatric hospitals and community based mental health settings sponsored by the National Association of State Mental Health Program Directors. This initiative was implemented in a large public sector psychiatric hospital. It involved the use of a restraint and seclusion prevention project team and a Patient-Staff Steering Committee collaborating on violence prevention. It also entailed systematic data collection and case reviews, staff-training on trauma-sensitive care and other relevant topics, employee recognition, as well as the use of specific restraint prevention tools including sensory modulation, positive behavioral support plans, comfort rooms, Wellness Recovery Action Plans, modified restraint orders, and new debriefing protocols. Compared with a 4-year baseline period, a 4-year implementation phase showed a reduction in annual restraints hours by 89%, annual staff injuries by 18%, and annual Workmen's Compensation medical costs by 24%. The findings illustrate the value of implementing systemic evidence-based practices to reduce restraint use, enhance the quality of care in tertiary care settings, and promote a new, patient-centered and recovery-oriented institutional culture. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PREDICTING THE FUTURE? UNDERSTANDING AGGRESSION RATING SCALES IN ACUTE CARE SETTINGS AND HOW TO UTILIZE THIS KNOWLEDGE

This Workshop aims to inform participants about aggression rating scales with special emphasis on utilizing them in acute care settings. This will be done through mini-lectures about rating scales and treatment options for aggression, clinical vignettes to assess the reliability of scales, and small-group discussions. Emphasis will be placed on the management of the agitated patient through pharmacological and nonpharmacological interventions. This interactive Workshop will consist of mini-lectures, clinical vignettes (videos), and small-group interaction on how to utilize aggression scales. The mini-lectures focus on providing: 1) a general overview of aggression and aggression scales utilized in acute care settings; 2) a review of how 3 hospitals are utilizing aggression scales in clinical practice; and 3) a basic overview of pharmacological and nonpharmacological interventions available for potentially aggressive patients. Clinical vignettes will be shown, and participants will utilize several different rating scales to assess firsthand the interrater reliability for each scale. There will also be a small-group discussion on how to incorporate rating scales into their electronic medical record and how to be able to use the data to predict aggression in children in the future. Handouts will also be provided. We expect participants to achieve a basic understanding of the aggression rating scales that could be utilized at their institution. In addition, participants will be able to use the data that they obtain from these scales to help with treatment decisions both on an individual patient level and a hospital level. With more children boarding due to increased demand of acute mental health services, it has become more imperative to understand which patients might become physically aggressive. This is important because it can dictate treatment such as medications, staffing, or even placement of patients awaiting psychiatric inpatient beds. In addition, with proper utilization of these scales, it could have secondary effects like reducing staff injury even in nontraditional mental health settings. The aim is for participants in this Workshop to take the learned skills back to their institution and utilize them to predict aggressive trends while utilizing evidence-based aggression scales.

What Do We Do When Things Fall Apart? Rapid Creation of a Pilot Psychiatric Intensive Care Unit in Response to Increased Acuity on a Psychiatric Inpatient Unit for Children and Adolescents

ABSTRACT The past two decades have seen a sharp increase in suicide and psychiatric hospitalizations for children and adolescents. While many youth are served well in the inpatient psychiatry setting, a subset of this population does not stabilize during an average length of stay and with the typical therapeutic interventions provided by an inpatient unit. This study examines the creation of a psychiatric Intensive Care Unit (ICU) for patients who exhibited the most severe and acute mental illness, self-injury, and aggressive behaviors on a child and adolescent psychiatric inpatient unit. The ICU was created in response to increasing numbers of restraints, assaults, and patient and staff injuries in the months preceding creation of the program and potential contagion effect of safety issues amongst patients. Post-implementation, nominal reductions in safety metrics were found in both the ICU and general milieus for patient and staff injuries and assaults. Nominal decreases in restraints and self-injury were also found in the ICU. Significant decreases in property destruction were found in both milieus and restraints significantly decreased in the general milieu. In addition, patients who participated in the ICU milieu were less likely to be re-admitted to an inpatient psychiatric unit following hospitalization. Overall, the ICU was well-received by staff and patients’ caregivers.

Pharmacologic Management of Acute Agitation in Youth in the Emergency Department.

When youth in the emergency department become acutely agitated, it can be dangerous and distressing to patients, families, and clinicians. Timely, effective, and patient-centered management is key to reducing the potential for patient and staff injury while preserving patient dignity. We review the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. We also discuss the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.

Association Between Skin Injuries in Medical Staff and Protective Masks Combined with Goggles During the COVID-19 Pandemic.

To explore the relationship between wearing protective masks and goggles and skin injuries in medical staff during the COVID-19 pandemic. Researchers conducted a cross-sectional, multicenter online survey. Respondents voluntarily completed the questionnaire on their smartphones. Ordinal and multinomial logistic regressions were used to identify factors related to skin injuries. In total, 1,611 respondents wore protective masks combined with goggles in 145 hospitals in China; 1,281 skin injuries were reported (overall prevalence, 79.5%). Multiple concomitant skin injuries (68.5%) and injuries in four anatomic locations (24.0%) were the most common, followed by injuries in three (22.8%), two (21.7%), and one location (11.0%). Multinomial logistic regression indicated that sweating increased the risk of injuries in one to four anatomic locations (95% confidence interval for odds ratio 16.23-60.02 for one location and 38.22-239.04 for four locations), and wearing an N95 mask combined with goggles and a daily use longer than 4 hours increased the risk of injuries in four locations (95% confidence interval for odds ratio 1.18-5.31 and 1.14-3.93, respectively). The prevalence of skin injuries among medical staff wearing protective masks combined with goggles was very high. These were mainly device-related pressure injuries, moisture-associated skin damage, and skin tears. The combination of various factors resulted in skin injuries at multiple sites. Preventing and managing sweating should be a focus for medical staff who wear protective masks combined with goggles for more than 4 hours.

Decreasing the Use of Restraints on Children Admitted for Behavioral Health Conditions.

Pediatric behavioral health admissions to children's hospitals for disposition planning are steadily increasing. These children may exhibit violent behaviors, which can escalate to application of physical limb restraints for safety. Using quality improvement methodology, we sought to decrease physical restraint use on children admitted to our children's hospital for behavioral health conditions from a baseline mean of 2.6% of behavioral health patient days to <1%. We included all children ≥3 years of age admitted to our hospital medicine service with a primary behavioral health diagnosis from July 1, 2016, to February 1, 2020. A multidisciplinary team, formed in July 2018, tested interventions based on key drivers targeted toward our aim. The primary outcome measure was the percent of behavioral health patient days on which physical restraints were ordered. The balancing measure was the percent of patient days with a staff injury event. Statistical process control charts were used to view and analyze data. Our cohort included 3962 consecutive behavioral health patient encounters, encompassing a total of 9758 patient days. A 2-year baseline revealed physical restraint orders placed on 2.6% of behavioral health patient days, which was decreased to 0.9% after interventions and has been sustained over 19 months without any change in staff injuries. Team-based quality improvement methodology was associated with a sustained reduction in physical restraint use on children admitted for behavioral health conditions to our children's hospital. These results indicate that physical restraint use can be safely reduced in children's hospitals.

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery.

Cesarean delivery is the most common surgery performed in the United States, accounting for approximately 32% of all births. Emergency Cesarean deliveries are performed in the event of critical maternal or fetal distress and require effective collaboration and coordination of care by a multidisciplinary team with a high level of technical expertise. It is not well understood how the physical environment of the operating room (OR) impacts performance and how specialties work together in the space.ObjectiveThis study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean.MethodsThis study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams. Data collected from focus group interviews were used to perform a task and equipment analysis. Survey data were coded and mapped by specialty to identify reported areas of congestion and time spent, and to identify themes related to physical space of the OR and labor and delivery unit.ResultsTask analysis revealed complex interdependencies between specialties. Thirty task groupings requiring over 20 pieces of equipment were identified. Perceived areas of congestion and areas of time spent in the OR varied by clinical specialty. The following categories emerged as main challenges encountered during an emergency Cesarean: 1) size of physical space and equipment, 2) layout and orientation, and 3) patient transport.ConclusionUser insights on physical space and workflow processes during emergency Cesarean section at the institution studied revealed challenges related to getting the patients into the OR expediently and having space to perform tasks without crowding or staff injury. By utilizing human factors techniques, other institutions may build upon our findings to improve safety during emergency situations on labor and delivery.

Adverse events of after-loading high dose rate brachytherapy reported to the United States Food and Drug Administration (FDA)

To provide an assessment of safety regarding high-dose-rate after-loading brachytherapy (HDR-BT) based on adverse events reported to the OpenFDA, an open access database maintained by the United States Food and Drug Administration (FDA). OpenFDA was queried for HDR-BT events between 1993 and 2019. A brachytherapist categorized adverse events (AEs) based on disease site, applicator, manufacturer, event type, dosimetry impact, and outcomes. Important findings are summarized. 372 AEs were reported between 1993 and 2019, with a downwards trend after 2014. Nearly half of AEs (48.9%) were caused by a device malfunction, and 27.4% resulted in patient injury. Breast (49.2%) and Gyn (23.7%) were the most common disease sites of AEs. Applicator breaks cause the majority of AEs (64.2%) and breast balloon implants were the most common applicator to malfunction (38.7%). User error contributed to only 16.7% of events. 11.0% of events required repair of the afterloader. There were no reported staff injuries or patient deaths from an AE, however 24.7% of patients received resultant incorrect radiation dose, 16.4% required additional procedures to rectify the AE, and 3.0% resulted in unintended radiation to staff. The OpenFDA database has shown a decreasing trend in AEs since 2014 for HDR-BT. Most AEs are not caused by user error and do not cause patient injury or incorrect radiation dose. Investigation into methods to prevent failures and improve applicators such as the breast balloon could improve safety. These results support the continued use of HDR-BT as a safe treatment modality for cancer.

An Evaluation of Feedback-Based Interventions on Promoting Use of Personal Protective Equipment in a School

ABSTRACT Employees working in human services are more likely to receive injuries on the job than in many other industries. Human service organizations that serve individuals who engage in dangerous behavior often require employees to adhere to safety guidelines, including utilizing protective equipment to minimize the risk of injuries. Despite protective equipment being prescribed in students’ treatment plans at a private day school, employees were often observed working with students without the prescribed protective equipment. Results from a Performance Diagnostic Checklist-Safety assessment varied across three classrooms. Therefore, individualized treatment packages were implemented in each classroom. Results indicated increased use of prescribed protective equipment across all three classrooms and an overall decrease in staff injuries sustained by student contact.

Risks to Healthcare Organizations and Staff Who Manage Obese (Bariatric) Patients and Use of Obesity Data to Mitigate Risks: A Literature Review.

This literature review explores obesity risks to healthcare staff and organizations that manage and caring for obese (bariatric) patients. These risks are anticipated to increase due to Australian population obesity rate projections increasing from 31% in 2018 to 42% by the year 2035, which will result in increased hospital admissions of patients with obesity. Literature searches were conducted through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, and Web of Science. Thirty studies met the inclusion criteria and were tabulated and critiqued using appropriate appraisal techniques. High risk of injury to healthcare staff was identified relating to bariatric patient handling tasks. High liability and financial risks of organizations were also identified relating to workers’ compensation and common law claims by injured staff and medical negligence claims by patients with obesity. Availability of obesity data was identified within clinically captured information, which could be utilized to inform obesity risk management programs. Future research should focus on improving the use and quality of obesity data to better understand obesity risks to healthcare organizations and staff, including accurate identification of obese patient admissions, enhanced ability to measure bariatric patient handling hazards and related staff injuries and improved assessment of bariatric intervention effectiveness.

Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit.

EMP was implemented in our PICU in May 2017. The percentage of appropriate physical and occupational therapist consults were determined. We also evaluated the activity levels received by the patient and the levels for which they qualified based on their medical condition. Failure Modes and Effects Analysis (FMEA) was performed to identify potential complications related to the mobilization of critically ill children. We created 4 simulation scenarios based on FMEA prioritized results. After the implementation of EMP, appropriate physical and occupational therapist consults significantly increased (P < 0.0001). However, most patients still failed to receive the optimal level of activity recommended by protocol. This failure was partly due to concern for safety events during mobilization. FMEA identified vital sign changes [Risk Priority Number (RPN) 97.8], staff injury (RPN 64), and pain/anxiety (RPN 60.5) as potential safety events. We performed various in-situ simulation sessions based on these potential events. In post-simulation evaluations, 100% of participants agreed that the simulation experience would improve their performance in the actual clinical setting. Feedback from simulations led to the development of an EM patient safety checklist and clinical pathway. We describe a novel technique of using FMEA to develop scenarios that simulate potential adverse events to optimize safe EM in PICU. An EM checklist and pathway can guide in the implementation of safe EMP.