Healthcare worker fatigue and patient safety

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The link between health care worker fatigue and adverse events is well documented, with a substantial number of studies indicating that the practice of extended work hours contributes to high levels of worker fatigue and reduced productivity. These studies and others show that fatigue increases the risk of adverse events, compromises patient safety and increases risk to personal safety and well-being.

Many factors contribute to fatigue, including but not limited to insufficient staffing and excessive workloads.
The impact of fatigue resulting from an inadequate amount of sleep or insufficient quality of sleep over an extended period can lead to a number of problems, including:

1. Lapses in attention and inability to stay focused
2. Reduced motivation
3. Compromised problem solving
4. Confusion
5. Irritability
6. Memory lapses
7. Impaired communication
8. Slowed or faulty information processing and judgment
9. Diminished reaction time
10. Indifference and loss of empathy

Findings from a groundbreaking 2004 study of 393 nurses over more than 5,300 shifts – the first in a series of studies of nurse fatigue and patient safety – showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care.

Additional studies show that longer shift length increased the risk of errors and close calls and were associated with decreased vigilance, and that nurses suffer higher rates of occupational injury when working shifts in excess of 12 hours.

Still, while the dangers of extended work hours (more than 12 hours) are well known, the health care industry has been slow to adopt changes, particularly with regard to nursing.

Sometimes a needle or screw will break leaving a fragment behind. Is this a reviewable sentinel event?

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As per JCI, in some cases, a broken needle or screw fragment is recognized at the time of surgery and a clinical judgment is made to leave the fragment in the patient. That decision is based on an assessment of the relative risks of leaving it in versus removing it.
It would therefore not be considered an unintentionally retained foreign object. Intentional retained foreign object is not a negligence.