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Safety Representatives

Meeting

July 22, 2009

ENVIRONMENTAL & OCCUPATIONAL SAFETY

Northwestern Memorial Hospital

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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.

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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

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Incident TrendIncident Type Prevalence

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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.

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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!!!

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Open Discussion Questions??