Wednesday, May 16, 2012

Decreased Productivity due to Presenteeism

Ergoweb 16 May 2012

A study involving Sweedish employees has found that presenteeism (attending work when ill) was associated with the psychosocial risk factors of work demands, work control, social climate, employee commitment to the organization, and role compatibility.  When these issues were addressed, the odds of future presenteeism were reduced for all risk factors except work demands.

Whilst the impacts of absenteeism are quite well understood, this is not the case for presenteeism.  In this study particpants were asked “How many times the past 12 months have you been at work even though you according to your health state should have stayed at home?” At the time of the first evaluation, 45.4% reported as performing presenteeism two or more days over the prior year while at the second evaluation, this changed to 44.8% - not statistically significant.

In presenting background information, the authors note that studies have found:
  1. An average of $2.30 productivity loss occurs for every $1.00 spent on medical and pharmacy costs
  2. Presenteeism costs an estimated $255 per employee per year among US companies
  3. For some specific disorders, financial losses due to presenteeism far exceed those due to absenteeism
  4. Higher levels of presenteeism are related to high stress, lack of emotional fulfillment, physical inactivity, unhealthy body mass index, and poor diet
  5. Higher levels of absenteeism are associated with physical inactivity, high stress, and diabetes/high blood glucose
  6. Employees who perceived their jobs to be more stressful than satisfying had greater levels of presenteeism, poor health, greater levels of depression, and riskier lifestyle behavior.

Monday, May 14, 2012

Risk Focus: Slips, trips and falls

UK P&I Club Loss Prevention Booklet

Slips, trips and falls represent nearly one in three of the large personal injury claims submitted to the Club and which aggregate to a staggering $155 m over the past ten years. They are constant too, with very little variation in numbers of claims from year to year.

It is easy to dismiss these unpleasant accidents as ‘human error’, or even ‘crew negligence’, but to examine
the detail of so many of them is to reveal other contributors to the chain of causation. Training could have been deficient or even completely missing, as there is often an assumption that people ‘can look after themselves’ and must take responsibility for their own actions. The environment, which is mostly a function of design, may well have been a contributor, if there was inadequate lighting, or the dangers were not obvious, or the particular design of the ship required people to put themselves ‘in hazard’ just to get a job done. And the procedures aboard ship may have been devised without proper consideration of the risks of carrying them out.

‘We have always done it this way!’ may be no guarantee that it will be the safest way, and may involve people in taking hazardous short cuts. But because of the huge costs of these claims, and because of the human suffering represented by each of them, the Club strongly believes that a concerted attack must be made on the incidence of slips, trip and falls. These are accidents which occur for a reason, and if we understand the reasons behind the existence of these hazards rather better, then we can put in place controls that will hopefully prevent accidents occurring, but will also mitigate their consequences.

A proactive and precautionary approach can be very useful in reducing the incidents of slips, trips and falls, in first of all identifying hazards which have the potential to hurt people. Very often accidents occur because nobody has considered that what they are doing might be hazardous. Just walking around the ship with a sharp eye and an open mind can help to identify features which might, in an unguarded moment, hurt people.

A Bow Tie has been developed highlighting that 'controls' that reduce the risk of slips trips and falls include:

* Adequate lighting
* Hazards/Obstructions identified/clearly marked
* Non-slip surfaces in place/maintained
* Appropriate footwear used
* Good housekeeping of working areas - oil/rubbish/equipment
* Access control - guardrails/wires etc
* Safety equipment in use - harness/nets etc

And mitigation to reduce the risk of a significant claim include:
* Accident reporting system
* Personal protective equipment
* Adequate first aid
* Evidence collection/retention
* Use of third party assistance

Wednesday, May 09, 2012

DNA Contamination blamed on human error

Channel 4 News 9 May 2012

The error occurred at what is described as the most advanced automated DNA testing system in the UK at LGC forensics labs in Teddington. A used plastic sample holder containing up to eight vials of DNA was mistakenly reloaded into the machine by a laboratory worker, instead of being put into a bin. The system had been installed in March 2011, and the contamination occurred in October.
Every DNA sample in that seven month period has been checked, and LGC said no other instance of contamination had been uncovered. The regulator is now working with the company in monitoring new procedures that have been put in place, to ensure the mistake is not repeated.

The DNA mix up was discovered by Greater Manchester Police detectives, after they had charged a 20 year old suspect in October last year with raping a woman in a park.
At that time LGC had informed the GMP that there was a strong match with DNA extracted from clothing. But detectives found that the suspect could not have been at the scene, because he was in prison 300 miles away, awaiting trial on other unrelated offences.

Greater Manchester Police were informed of the mix-up in March, and the Crown Prosecution Service dropped the case against Adam Scott from Exeter, in Devon.

There was some concern that the blunder could have implications for the convictions in the Stephen Lawrence case, which depended heavily on DNA evidence, and for which some of the tests were carried out at the same laboratory, but further tests to double check results were carried elsewhere.

Friday, May 04, 2012

Your doctor is only human, but patient safety is priority

This is Nottingham 4 May 2012

Numerous studies from around the world have shown that sometimes doctors make mistakes when prescribing, and occasionally patients are harmed as a result.
Along with colleagues from the University of Nottingham, and several other universities, we have recently completed the largest study ever of prescribing errors in general practices.

This week the General Medical Council (GMC) launched our report at a press conference in London and life has been a bit of a whirlwind since with headline news on Wednesday, and me being asked to do numerous radio interviews (including a 5:30am call from Radio 4!).

The likely reason for this level of media interest has been the uncomfortable finding that around one in 20 prescriptions issued by GPs contains an error.

It is important, however, to emphasise that we found the vast majority were safe. Also, many of the errors we found were relatively minor. The study showed the need for improvement in terms of typing clear dosage instructions on prescriptions, getting the dose and timing right, and making sure blood tests are done if these are needed.

We are now looking at ways of helping GPs.

We have published an important study in The Lancet showing how pharmacists can help GPs reduce errors.
And we are developing a "patient safety toolkit" to help general practices with patient safety.

Wednesday, May 02, 2012

Millions of GP prescriptions contain dangerous errors: research

The Telegraph 2 May 2012 by Rebecca Smith

Almost two million GP prescriptions contain potentially life threatening errors with mistakes in those given to one in five patients, research by the General Medical Council has found. 

Errors including wrong dosages, lack of instructions and insufficient monitoring of patients on dangerous drugs were 'common'.

Elderly and young children are twice as likely to be given a prescription with an error because the over 75s are often on several drugs and the correct dose can be difficult to calculate in youngsters because it is usually based on body weight, the study found.
Time pressures during GP consultations are thought to be to blame along with complex computer software that makes it easy to select the wrong drug or incorrect dose from drop-down menus and frequent distractions and interruptions.

Several GPs said practice nurses who are responsible for managing some long-term conditions often asked them to sign prescriptions without seeing the patient and this made them 'uneasy' and also interrupted them during clinic meaning they may make mistakes themselves.

Also repeat prescriptions were often issued without questioning if the patient still needed the medicine, or if superior ones were available and results from separate clinics were often not relayed to the GP meaning drug doses were not adjusted, it was found.

Human error and not a lack of understanding or knowledge was behind most mistakes, the study said.
Extending the average GP consultation from 13 minutes to 15 and better training in safety would help, lead author, Prof Tony Avery, of Nottingham University, said.

Pharmacists and GP receptionists can also help by carrying out medicine reviews and checking monitoring arrangements.

Errors classed as severe included, a 62-year-old woman with a documented allergy to penicillin who was prescribed flucloxacillin, a similar drug, and elderly patients prescribed blood thinner warfarin, who should have been closely monitored but who were not tested for two years.

Moderate errors included a four-year-old girl with a stomach upset who was prescribed a drug that should be used 'with caution' in children.

Minor errors found in the study included a one-year-old girl who was given two prescriptions for antibiotics in the same consultation but with different doses stipulated.

Failing to request that the patient be monitored was the most common serious error followed by prescribing a drug the patient was allergic to.

Almost all of the serious errors related to one drug, warfarin, which has been used as rat poison. It is prescribed to thin the blood in people at risk of blood clots. It must be carefully monitored because it interacts with other drugs and some foods and patients with levels too high can suffer potentially life threatening stomach bleeds.

Repetitive strain? Try repetitive rest

Morgan Hill Times 2 May 2012 by Nancy Lowe

Many computer users stay in a “ready-to-go” position at all times without giving arm, hand, shoulder and neck muscles enough opportunities to rest. There's a simple method to correct this. I call it repetitive rest, but one of my clients called it the “zen” of ergonomics, and once you try it you may agree.

During computer interactions there can be many, many moments when your hands are not actively engaged in keying or mousing. You are reading an email, composing creative thoughts in your mind or waiting for a page or application to open. These instances may last a few seconds or over a minute. Instead of hovering over the keyboard or grasping the mouse to be ready for the next click, this is a wonderful opportunity to give your body a breather by resting your hands and arms in relaxed, neutral positions.