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Best Practices in Employee Safety (See Best Practices in Patient Safety above)

  • • Conduct an intensive field study by department of all hazardous situations through observation, walk-through, screening surveys, incident and record analysis, and medical review of injuries. Assess the scope of the hazards as a baseline for improving existing programs and establishing new programs, and develop techniques of hazard prevention and control utilizing recognized Best Practices.
  • • Integrate employee safety and patient safety into one program with one director to avoid duplication of effort and confusion in implementing policies.
  • • Establish a safety and health policy and program with goals and objectives involving top management leadership as well as employees, and teach managers and supervisors how to work within the program successfully, and periodically conduct evaluations and redirection as necessary to improve employee and patient safety.
  • • Supervisors and managers as well as employees should analyze routine hazards for each job or process and the necessary steps along the way to complete the work assignment. They should then meet together to resolve the problems and reduce or eliminate the hazards.
  • • Submit yearly to senior management and the Board of Trustees a report including: all system or process failures; numbers and types of incidents and how handled; whether patients and families were informed of the incidents; and what actions are now being taken to prevent these types of problems in the future.
  • • Establish the position of Environmental Health, Safety, and Infection Control Specialist at all larger institutions and give this individual high-level administrative authority as well as working staff to assist other departments in carrying out their assigned duties in a manner that will reduce environmental, health, safety, and infection control problems. For smaller institutions, set up a process where the Environmental Health, Safety, and Infection Control Specialists can be housed at one of the institutions and shared by two others.
  • • All levels of staff should be involved in accident/incident or near accident/incident investigations to get complete input on what occurred and how to resolve the issues. The investigations should be carried out utilizing standardized forms in order to be able to statistically analyze what is occurring by department and types of procedures.
  • • When conducting an incident investigation, always attempt to determine who was involved, what happened, when did it happen, where did it happen, why did it happen, how did it happen, and what systems and/or procedures were in place that should have prevented it from happening.
  • • Periodically, highly qualified individuals should conduct a proactive comprehensive industrial hygiene, safety, health, and potential healthcare-associated infections survey throughout the major problem areas of the institution and report results to high-level management, middle management, and the employees working within each of the departments. Excellence should be rewarded and problems should be corrected.
  • • Maintain a written current inventory of all hazardous materials and hazardous wastes, their storage and disposal.
  • • When a new chemical or new piece of equipment is introduced into the facility, determine in advance all potential hazards and preventive measures needed to avoid the hazards.
  • • Provide safety, health, and infection-control training at the orientation programs for all new employees. Also provide brief continuing education programs in all areas on a periodic basis, when new problems arise, when new procedures are being put into effect, and when new research occurs which furthers the knowledge of the various members of staff.
  • • Develop a nurse staffing plan that has adequate resources for 24/7 staffing coverage and provide active highly skilled managers that will ensure patient safety.
  • • Enforce all current hand-washing requirements that have been established by CDC or the World Health Organization. Employee failure to comply with these requirements, whether the individual is a physician or housekeeping personnel, should result in the first steps of disciplinary action leading, if necessary, to suspension.
  • • Provide excellent care and treatment for all staff who become sick or injured while at work and provide for physical examinations before returning to normal duties.
  • • All employees must receive proper immunizations before starting work assignments.
  • • Design work processes taking into account potential ergonomic problems and seek to simplify and standardize the work assignment as well as provide sufficient numbers of personnel to carry out the assignment.
  • • Ergonomic injuries can be reduced by rotating workers through repetitive tasks.
  • • Machine guards should be provided to protect the operator and other employees from all machines that can injure people while operating.
  • • Back injuries can be reduced by assessing the situation and determining how best to transfer patients from beds to chairs, chairs to toilets, chairs to chairs, or car to chairs, and how many people are necessary to assist the individual depending on weight and physical condition.
  • • Slips, trips, and falls can be reduced by: using non-slip surfaces; using non-slip shoes; providing water absorbent mats; immediately cleaning up all spills of liquids and bodily fluids, placing cones on floors that are being washed, and washing only one part of the corridor or room at a time so that there is always a dry surface to walk on; keeping all floors clean and dry; and reporting all hazards immediately and dispensing cleaning crews swiftly.
  • • Provide prompt ice and snow removal and constant inspection of walkways, staircases, and parking lots.
  • • Provide umbrella sleeves and bags at all entrances.
  • • Establish policies and procedures to prevent and if necessary immediately treat those individuals who have been exposed to blood-borne pathogens including HIV virus through sharps injuries.
  • • Provide a confidential medical examination as part of a total postexposure evaluation for all employees who have been exposed to blood-borne disease as well as any other type of injury or illness.
  • • Present in-service training including safe injection practices on a routine basis to all employees who may be exposed to sharps injuries and blood-borne disease transmission.
  • • Substitute safe alternatives for invasive procedures where possible.
  • • Provide special vaccinations if necessary for individuals who are exposed to hepatitis B virus or other blood-borne pathogens.
  • • Never use needles or syringes for more than one patient or to draw up additional medication.
  • • Use safe needle disposal methods in waterproof boxes.
  • • Conduct environmental sampling techniques consisting of using moistened wipes on work surfaces and extraction and analysis for specific antineoplastic drugs, six to eight of which can be identified at this point.
  • • Use bleach to decontaminate and deactivate certain classes of antineoplastic agent. Reference should be made to those listed by the US Environmental Protection Agency (EPA) as hazardous waste and dispose of them accordingly.
  • • Use personal protective equipment when handling antineoplastic agents and other hazardous pharmaceuticals. Always use gloves and gowns. For those with latex allergies there are new materials on the market. Depending on the drug being used, it may be necessary to double glove. Use a mask or respiratory equipment depending on the level of hazard of the drug being utilized. Check with Occupational Safety and Health Administration (OSHA) requirements or CDC requirements.
  • • Employees involved in the preparation, administration, or disposal of hazardous drugs that they may be exposed to, should report any symptoms of occupational exposure including nervous system effects, rashes, sore throats, dizziness, headaches, nausea, diarrhea, vomiting, or any effects on pregnancy.
  • • Use a mask, eye protection goggles, or face shields during any procedures where there are likely to be splashes or sprays of blood, body fluids, or secretions. This is especially true during sectioning or endotracheal intubation.
  • • Use a mouthpiece, resuscitation bag, or other ventilation devices to prevent contact with secretions from the mouth or nose of the patient.
  • • Soiled patient care equipment is hazardous and must be disposed of in special containers marked biological hazards.
  • • Bag soiled laundry and remove to laundry washing facilities immediately. Do not shakeout linens or try to wash any of the material in any place other than the laundry facility. In the event of soiled laundry from people with infections, double bag it and then mark it as infectious and hazardous.
  • • Use ventilated biological safety cabinets and closed system drug transfer devices when preparing antineoplastic drugs. A closed system drug transfer device is a mechanical piece of equipment that does not allow the transfer of environmental contaminants into the system or the escape of the hazardous drug or vapor outside the system. (See endnote 44.)
  • • Immediately clean up and remove all spills of hazardous drugs and dispose of them in an appropriate manner.
  • • Use non-toxic drugs or safe procedures when possible instead of toxic drugs on the patient.
  • • Provide a written workplace violence prevention policy, educate all levels of employees on how to avoid or contain violence, and enforce it rigorously. Any acts of violence by a staff member against another staff member should be severely punished and if necessary the individual’s employment should be terminated.
  • • An in-depth analysis should be made of the entire institution to determine areas where violence might occur and policies and practices should be put into effect to reduce the potential or eliminate it.
  • • All acts of violence should be recorded as incidents and reviewed by the safety committee to determine how to prevent this from occurring in the future and also whether there a larger problem than just this single incident.
  • • Install and maintain alarm systems in high-risk areas and check the response time of appropriate levels of protection from security and the local or state police if necessary.
  • • Provide adequate lighting in all parking lots and an escort service especially for women at night from the hospital to their cars and make sure that the person is secure within the vehicle and leaving the premises in an appropriate manner.
  • • Control access to various parts of the institution based on the need for the individual to be in any given place.
  • • When people come into the facility obviously arguing or fighting, have security separate them into different areas and make sure that they do not come together later.
  • • Develop appropriate work schedules to keep personnel working within the same timeframe over long periods of time. Decrease the mandatory hours of work and only allow several additional hours of overtime in the event of an absolute emergency.
  • • Evaluate carefully the hand-off time between shifts because this is prime time for fatigued workers to become injured or make poor patient decisions, and patient coverage is reduced.
  • • Establish continuing education programs which explain to the healthcare workers the relationship between fatigue and occupational health and safety problems as well as work errors resulting in danger to the patients.
  • • Provide adequate rest and lunch breaks to allow healthcare workers to rest and regroup as well as get nourishment in order to have better performance.
  • • Provide a realistic staffing pattern and do not overburden the staff with too high a workload while maintaining appropriate quality of care.
  • • Conduct routinely fire drills, disaster drills, radiological disaster drills, biological triage and decontamination drills, and all hazards emergencies.
  • • Prepare an evacuation plan for the institution in the event of a fire, flood, or other disaster which may affect the institution. Determine how critical care patients will be removed and where patients will be taken to get them out of the danger zone.
  • • Prepare, institute, and test frequently a disaster plan which will go into effect if there is a disaster within the community and the institution will be utilized for treatment of the victims and of emergency medical service personnel.
  • • Install metal detectors at all entrances to reduce the chance of firearms and knives being brought into the institution by employees, patients, visitors, construction people, and suppliers.
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