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1
Safety Representatives
Meeting
July 22, 2009
ENVIRONMENTAL & OCCUPATIONAL SAFETY
Northwestern Memorial Hospital
2
Meeting Agenda
Welcome and AnnouncementsFY09 Workforce Safety Goal Update“Safety Matters” initiatives UpdateHot Sheet
M. Fiore[5 min]
Environmental StewardshipSpecial Waste Recycling Initiative UpdatePharmaceutical Waste Mgmt Update
C. Ferguson[5 min]
Organizational Risk Assessment OverviewRisk Assessment StrategyGeneral FindingsMulti-Year Action Plan Development
K. Carter [10 min]
Safety Representatives- Skill Set DevelopmentOffice Ergonomics Evaluation Tool and Techniques
L. Zinnecker/All[30 min]
Open Discussion – Questions/ConcernsClosing- Action Items
M. Fiore/All
NMH Goal- Back and Shoulder• Goal:
- Reduce employee back and shoulder injuries by 10% from FY08
• Performance to Date:
- We are currently 15 incidents above the goal which is 5.43% higher than June of FY 08.
3
FY 09 Employee Injury ReductionBack & Shoulder Injuries
FY 08 & 09 YTD Sept - June
0
20
40
60
80
100
120
Sept Oct Nov Dec Jan Feb March Apr May June July Aug
FY 08 YTD Back/Shoulder FY 09 YTD Actual FY 09 YTD 10% ReductionTarget
Establishing a Zero Injury Culture at NMH
Creating a Zero Injury culture does take an investment in time, effort and money, but return
on these investments significantly outweighs the cost.
An average of 650 occupational
incidents occur at NMH per year
1 in 10
a
Increased Incident Reporting
5
Incident TrendIncident Type Prevalence
6
Month FY08 FY09
September BBF, Sharps BBF, Sharps
October BBF, Sharps; Fall BBF, Sharps
November BBF, Sharps BBF, Sharps
December BBF, Sharps Assault, pt/vs to staff
January BBF, Sharps BBF, Sharps
February BBF, Sharps BBF, Sharps
March BBF, Sharps BBF, Sharps
April BBF, Sharps BBF, Sharps
May BBF, Sharps Caught in/under/btwn; Fall
June BBF, Sharps Struck against/by
July (to date) BBF, Sharps BBF, Sharps; Struck against/by
• Employees cannot focus on providing the best patient care if they feel they must be concerned with their own safety.
• Employees put in the predicament of deciding between their safety and providing the best patient care can negatively affect the quality of care provided.
• Compelling evidence exists that employee turnover can negatively affect the quality of patient care.
Employee Safety = Patient Safety
Safety Matters Highlights• Safety Topic of the Month
– SAFE Forum– Educational Sheets– Tip of the Month
• Marketing/Awareness– Safety Matters Department Page– Department Safety poster– NM Connect Special Edition– Medical Leadership standing agenda item
• Slip/Trip/Fall Prevention Team– Fein EE Entrance (new flooring + mats)– Slip cones– Wet Umbrella Bags– Over the Spill pads– Hazardous Weather e-mail alert
• Enhanced Safety Representative Program– Monthly meetings– Increased interactivity/education during meetings– Actionable items/accountability
DMAIC/Special Focus Groups
• Safe Material Handling – EVS chute re-design– EVS bio-tub re-design– EVS microfiber mops/new cart system– Material Handling class [NM Academy]- next class end of July– MM & Distribution Svcs- new carts and powered tuggers
• Blood/Body Fluid & Sharps Safety– Incident reporting training/education– Nurse sharps safety training– Procurement over-glasses PPE option– Device conversion (fragmin)
• Safe Patient Handling– Needs assessment/Procurement 50 additional Hovermatts– Audit/re-energize super-user program– Work with Pat Care leadership to transition into nursing “model of care”– In person root cause assessment for all injuries
Take Aways
• Make staff safety a visible part of everyday priorities
• Recognize, support and utilize department safety representatives.
• Promote transparency of all identified safety opportunities within your department.
• Maintain safety matters poster/department-specific goals
• Promote and educate on safety topic of month
• Be a visible “Safety Matters” advocate
• Accept that zero injuries can be a reality.
Environmental Stewardship Efforts
•Pharmaceutical Waste
•Recyclable Materials
Pharmaceutical Waste• NMH’s Pharmaceutical Waste Program consists of the identification,
collection and management of all pharmaceutical wastes
• In addition to ensuring compliance with US and Illinois Environmental Protection Agency regulations, this is NMH’s newest initiative toward being more “green”
• Proper management of pharmaceuticals is part of NMH’s Environmental Stewardship / Green-health Initiative
Millions of pounds of unused pharmaceuticals are flushed down the drain each year.
These pharmaceuticals include antibiotics, anti-convulsants, mood stabilizers and sex hormones and consequently end up in drinking
water supplies across the nation.At least one pharmaceutical has been detected in finished drinking
water supplies in 24 metropolitan areas in the US.
Pharmaceutical Waste
Other NMH Green Health InitiativesSpecial Waste Management
• Fluorescent Light Bulbs Used lamps are hazardous due to their mercury content.
Amount RecycledFY 08 = 11, 921 lbsFY 09 = 6,570 lbs
• BatteriesBatteries contain heavy metals such as lead, cadmium, mercury and nickel (and somecontain sulfuric acid), which can contaminate the environment if improperly disposed.
Amount RecycledFY 08 = 4,469 lbsFY 09 = 8,459 lbs
• Metal with LeadNMH recycles lead aprons, electronic circuit boards and containers formerly holding radioactive isotopes.
Amount RecycledFY 08 = 1,219 lbsFY 09 = 3,067 lbs
Organizational Risk Assessment
Risk Assessment is the cornerstone upon which a program is built
April – June 2009
Similar Exposure Groups
• Intensive Care Units• Antepartum/Postpartum• Surgical Services• Psychiatry• Hematology/Oncology and
Palliative Care• Surgical/Neuro-/Ortho-
Nursing• Medicine Nursing
• Professional/Emergency Services
• Imaging • Pharmacy• Engineering• Administration• Laboratory• Support Services
SEG Participation
Percent Participation
0%10%20%30%40%50%60%70%80%90%
100%
Participation Goal – 50%
Risk
Risk = (Probability x Severity) – Mitigating Factors
Frequency of Occurrence
Level Description Definition
A Frequent Continuously experienced
B Probable Will occur frequently
C Occasional Will occur several times
D Remote Unlikely but can reasonably be expected to occur
E Improbable Unlikely to occur, but possible
Hazard Severity
Level Description Definition
1 Catastrophic Death or system loss
2 Critical Severe injury, severe occupational illness, or major system damage
3 Marginal Minor injury, minor occupational illness, or minor system damage
4 Negligible Less than minor injury, occupational illness, or system damage.
Mitigating Factors
Rank Definition
4 Significantly high degree of effectiveness; >90% implementation and compliance
3 High degree of effectiveness; 75-90% compliance/implementation
2 Some effectiveness; 50-75% compliance
1 Low Effectiveness; <50% compliance
0 None available/No compliance
HIGH SERIOUS MEDIUM LOW
Hazard Ranking Matrix
Frequency ofOccurrence
Severity
(1)Catastrophic
(2)Critical
(3)Marginal
(4)Negligible
(A) Frequent 1A 2A 3A 4A
(B) Probable 1B 2B 3B 4B
(C) Occasional 1C 2C 3C 4C
(D) Remote 1D 2D 3D 4D
(E) Improbable 1E 2E 3E 4E
Summary General Tasks – Patient Care
Top Ranking General Tasks
0%10%20%30%40%50%60%70%80%90%
ICU
Psy
chia
try
Hem
/Onc
/Pal
liativ
e
Ant
e/P
ost P
artu
m
Sur
g/N
euro
/Ort
hoN
ursi
ng
Med
icin
e U
nits
Sur
gica
l Ser
vice
s
Pro
fess
iona
l/Em
erg
ency
Ser
vice
s
Imag
ing
SEG Name
Patient Care
Material Handling
Medication
Patient Handling
Travel outside campus
Administrative
Highlights- Patient Care
• IV Poles
• Broken beds/wheelchairs
• Patient movement
• Eliminate “gray” areas– PPE
– Patient Handling
Support Services and Non-Patient Care
Trends were not as evident between these groups because of the unique nature of the work performed by each
Organizational Trends
• Material handling was identified as a high risk task.– Push/Pull and carpet– Lack of Equipment Preventive Maintenance
• Lack of usage of safety equipment (PPE, Patient Handling, etc…)
• Cord management• Lack of understanding/compliance with policy.• Overall, department representatives identified the
risks, but underestimated the severity.
Organizational 3 Year Employee Safety Plan
• Incorporated data from Risk Assessment• Incorporated incident data (FY08 – current)• Incorporated hazard surveillance(EOC Rounds)
trends• Incorporated safety officer perception/evaluation
• Currently in draft be presented to Sr. Leadership later this month.
30
Safety RepresentativeSkill Set Development
Office Ergonomics
Office Ergonomics Major Job Factors
• The Job/Task
• The Tools/Equipment
• The Environment
• The Worker
Office Ergonomics
Workstation Tips
1. Maintain the “S-Shape” of your Spine: check to make sure your ear, shoulder and hip stay in
alignment.
2. Monitor Height: Top of monitor should be at or just below eye level; unless user wears bifocals – then
height should be slightly lower.
3. Monitor Distance: 18-24” from eyes.
4. Keyboard: Recommend it be adjusted to elbow height. Upper arms should rest at user’s sides, forearms, wrists and
hands should be parallel to the floor when keying.
5. Chair: Feet should rest flat on a footrest or the floor, thighs parallel to the floor. The lumbar support should fit user’s
lower back, seat should fully support users thighs with approximately 2” clearance between seat edge and back of
calves.
6. Reaches: Frequently used items should be within a 6-14” reach to avoid over reaching.
7. Exercises/Stretches: To break up static activity, stretch or exercise once every 1-2 hours.
Reduce Reaches
Frequent reaches between 6-14”
Wrist Positioning
Extension
Deviation
Neutral
Final Conclusions...
• Listen to your body
• Stretch/Exercise regularly
• Set-Up your workstation for the primary job tasks you do.
• Eliminate the clutter
• Alternate activities.
THANK YOU!!!
36
Open Discussion Questions??