SPRING 2018 VOL. 38, NO. 2
F E A T U R E S D E P A R T M E N T S
11 4 Staying Current on Coordinated Approaches to Strengthen State and Local Public Government Affairs Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke 7 Editor’s Column By Gia E. Rutledge, MPH; Kimberly Lane, PhD, RDN; Caitlin Merlo, MPH, RDN; and Joanna Elmi, MPH 8 Association Community Liaison Report 19 17 Annual Treasurer's Report Nursing Overtime: Should It Be Regulated? By Cathleen Wheatley, MS, RN, CENP 23 Perspectives in Healthcare Safety 26 Statins Affect Skeletal Muscle Performance: Evidence for Disturbances in Energy Metabolism By Neeltje A. E. Allard, Tom J. J. Schirris, Rebecca J. Verheggen, Frans G. M. Russel, Richard J. Rodenburg, Jan A. M. Smeitink, Paul D. Thompson, Maria T. E. Hopman, and Silvie Timmers
ISSN 2168-8044
Committed to the health, safety and well-being of healthcare workers. TROUBLE GETTING YOUR PROGRAM IN TUNE? AmberPerez
You are not alone. Achieving sustainability and influencing culture acceptance can be the most challenging aspect to your program success. There are many successful program types and best practices, but which ones are right for you and how do you take on such a big initiative? This year at AOHP 2018, Andrew Rich, my co-presenter and I will be tackling these larger issues with practical tips and quality information to prepare you to harmonize SPHM with your organization. We hope you are able to join the session.
“Making your Safe Patient Handling & Mobility Program Sing” presented by Amber Perez MHA, CSPHP - Director of Clinical Services Wy’East Medical Andy Rich MS, OTR/L, CSPHP - Clinical Manager PHD & Diligent Our objectives are simply to: • Identify common constraints to SPH&M success that take your program out of tune • Provide application-based solutions allowing harmony to prevail when driving success • Show how short term and long term metrics will bring your safe patient handling audience to their feet and scream ENCORE!
September 5th - 8th, 2018 at the AOHP 2018 National Conference in Glendale, Arizona.
800.255.3126 | wyeastmedical.com Spring 2018
MISSION of the Association of Occupational Health Professionals in Healthcare Provide essential tools that empower members to ensure the health, safety and wellbeing of healthcare workers. AOHP JOURNAL EXECUTIVE EDITOR This is accomplished through: Kimberly Stanchfield, RN, COHN-S • Advocating for employee health and Journal of AOHP – in Healthcare safety 2010 Health Campus Drive • Occupational health education and Harrisonburg, VA 22801 networking opportunities • Health and safety advancement through best practice and research. • Partnering with employers, regulatory EDITORIAL ADVISORY BOARD agencies and related associations
Darlene Buckstead, MSN, RN MaryAnn Gruden, MSN, CNRP, NP-C, The Journal of the Association of Employee Health Nurse COHN-S/CM Occupational Health Professionals (AOHP) Cass Regional Medical Center Consultant – in Healthcare (© 2018 ISSN 2168-8044) Harrisonville, MO McMurray, PA is published quarterly by the Association of Occupational Health Professionals in Healthcare and is free to members. For Sandra Domeracki, MSN, FNP, RN, COHN-S Lee Newman, MD, MA, FACOEM, FCCP information about republication of any AOHP California Northern Chapter AOHP Conference Committee article, visit www.copyright.com. The Manager, Employee Health Services Professor, Colorado School of Public Health AOHP Journal is indexed in the CINAHL® San Francisco VA and School of Medicine database. San Francisco, CA Director, Center for Worker Health and Environment University of Colorado STATEMENT OF Mary C. Floyd, MPH, RN, COHN-S/CM Chief Medical Information Officer EDITORIAL PURPOSE AOHP Florida Chapter Axion Health, Inc. The occupational health professional in Return to Work Coordinator Aurora, CO healthcare is vital to ensuring the health, Occupational Health Services safety and well-being of both employees UF Shands Hospital and patients. The focus of this Journal is Gainesville, FL Stacy L. Stromgren, MSM, BSN, RN, COHN-S to: provide current healthcare information AOHP Executive Secretary pertinent to the hospital employee health Employee Health Supervisor professional; afford a means of networking John Furman, PhD, MSN, COHN-S The University of Kansas Health System and sharing for AOHP’s members; and AOHP Research Committee Kansas City, KS improve the quality of hospital employee Executive Director health services. Washington Health Professional Services Washington State Department of Health Leslie S. Zun, MD, MBA The Association of Occupational Health Olympia, WA AOHP Conference Committee Professionals in Healthcare and its directors Professor and Chair and editor are not responsible for the Department of Emergency Medicine views expressed in its publication or any Linda Good, PhD, RN, COHN-S Rosalind Franklin University of Medicine inaccuracies that may be contained therein. AOHP Research Committee Chair and Science/Chicago Medical School Chair, Materials in the articles are the sole Director, Employee Health Services Department of Emergency Medicine responsibility of the authors. Scripps Health Mount Sinai Hospital LaJolla, CA Chicago, IL EDITORIAL GUIDELINES Terry Grimmond, FASM, BAgrSc, GrDpAdEd AOHP Research Committee AOHP Journal actively solicits material to Director, Grimmond and Associates be considered for publication. Complete Microbiology Consultants Editorial Guidelines can be found at http:// Hamilton, New Zealand aohp.org/aohp/MEMBERSERVICES/Journal/ JournalEditorialGuideline.aspx.
EDITORIAL STAFF PUBLISHED BY Send Copy to AOHP Kimberly Stanchfield, RN, COHN-S Executive Editor: Kimberly Stanchfield, RN, COHN-S AOHP Journal Executive Editor Executive Director: Annie Wiest 125 Warrendale Bayne Rd., Ste 375 [email protected] Account Coordinator: Rita Kalimon Warrendale, PA 15086 Copy Editor: Kathleen Fenton (800) 362-4347 Designer: Katina Colbert Graphic Design Fax: (724) 935-1560 Publication deadlines for the Journal of Production Coordinator: TMR Print Group www.aohp.org AOHP-in Healthcare: Issue Closing Date Spring February 28 Edited, designed & printed in the USA Summer May 31 Fall August 31 All material written directly for the Journal of the Association of Occupational Health Winter November 30 Professionals in Healthcare is peer reviewed.
3 Journal of the Association of Occupational Health Professionals in Healthcare
Staying Current on Government Affairs
By Stephen A. Burt, MFA, BS Government Affairs Committee Chair Protecting Employee Health Information – Another Occupational Health Responsibility
A common question from oc- gories, HIPAA does not apply their business associates. ly, in relation to a work-related cupational health profession- to it at all. Indeed, even if an Examples of businesses that injury or when an employee als and human resource man- employer is a covered entity, now may be directly respon- requests medical leave or a agers has been "What is the HIPAA still does not apply to sible for HIPAA compliance disability accommodation. impact of the Health Insur- health information contained include data analysis, storage Most employers understand ance Portability and Account- “in employment records held (clouds), and transmission that such information is con- ability Act, better known as by a covered entity in its role services (internet service pro- fidential, but may not fully un- HIPAA, on an employer’s abil- as an employer.” So even for viders or ISPs), legal and ac- derstand what that means or ity to collect employee health those healthcare employers, counting services, billing and what they should do to pro- information for purposes although HIPAA may apply benefit management servic- tect it. of workers' compensation, to health information they es, actuarial and claims pro- Family and Medical Leave acquire in their capacities as cessing services, and a whole Employers should not forget, Act (FMLA), and Americans a healthcare provider, it does host of other businesses that however, that HIPAA does with Disabilities Act (ADA) not apply to health informa- perform activities which re- apply to an employer’s re- purposes?" It is a common tion they acquire in their roles quire them to have access to quest for health information misconception that HIPAA as employers. PHI to provide services for or from a covered entity. A cov- applies to employee health on behalf of heath industry ered entity may not disclose information. In fact, HIPAA Some employers that are not entities. Among other things, protected health information generally does not apply to covered entities, however, HIPAA compliance means to an employer without the employee health information are directly subject to HIPAA these businesses will have to employee’s authorization or maintained by an employer. for other reasons. Legisla- engage in physical, technical, as otherwise allowed by law. tion passed in 2009 as part of and administrative activities This is true even where the As healthcare professionals, the American Reinvestment to ensure the protection of employee is also a patient or we all know that HIPAA pro- and Recovery Act expanded PHI from unauthorized ac- member of the covered en- tects the privacy and security HIPAA privacy and security cess, use, or disclosure, and tity. Information maintained of patient health information requirements to a wide range they will also have to com- in that capacity may not be (PHI). While it is generally of businesses. Now, HIPAA ply with certain notification shared with human resourc- true that HIPAA does not ap- applies directly to businesses requirements in the event es or an employee’s manag- ply to employers simply be- that receive, create, maintain, of a breach of patient health ers, except as expressly au- cause they collect employee and/or transmit protected pa- record security. Penalties for thorized by the employee or health information, HIPAA will tient health information so non-compliance can be sub- applicable law. definitely affect employers in they can perform certain ser- stantial. It will be up to the the process of obtaining this vices on behalf of covered Employee Health Manager Generally speaking, a cov- information because HIPAA entities. These businesses or the healthcare facility's ered entity has broad au- usually applies to the health- are defined as “business as- HIPAA Compliance Officer thority to disclose protected care entity – known as a sociates” of covered entities to validate and verify that the patient healthcare informa- "covered entity" - from which under HIPAA. Business as- levels of protection business tion for treatment purposes. the employer is seeking the sociates may be found non- associates are providing are From there on, the limitations information. Covered enti- compliant and subject to sig- adequate. on disclosure begin to stack ties are defined as: (1) health nificant sanctions if they are up. With the exception of dis- plans; (2) healthcare clearing- not conforming to applicable Occupational Health closures for treatment activi- houses; and (3) healthcare provisions of the HIPAA Pri- and Employee Health ties, most other disclosures providers that electronically vacy and Security Rules. Records are subject to the “minimum transmit certain health infor- Employers obtain employee necessary” limitation embod- mation. If an employer does Occupational health profes- health information in a num- ied in HIPAA. The protected not fall into one of those cate- sionals need to be aware of ber of ways—most common- health information disclosed 4 Spring 2018
should be the minimum nec- in their possession. For ex- legal requirements are met, vacy of employees' personal essary to accomplish the pur- ample, the ADA requires em- disclose such information in health-related information pose of the disclosure. Cov- ployers that obtain disability- response to subpoenas, court by designating an in-house ered entities may disclose related medical information orders, or other legally autho- privacy official, adopting poli- protected health information about an employee to main- rized requests, but should ex- cies and procedures to keep in cases where the law re- tain it in a confidential medi- amine such requests closely this information private, and quires such disclosures, but cal file that is kept separate (possibly in consult with notifying employees of their only to the extent that such from the employee’s person- corporate legal counsel) and privacy rights, among other disclosure is required by law nel file. Such information may limit disclosure of health in- things. and the disclosure complies be disclosed only in limited formation only to the extent with and is limited to the rel- situations and to individuals specifically requested and au- GINA also requires employ- evant requirements of such specifically outlined in the thorized by the employee or ers to keep employee medi- law. This may explain why, regulations: applicable law. cal records confidential. GINA as an employer of healthcare • Supervisors and managers prohibits employers from employees, you are typically who need to know about Keeping Medical Records requesting or requiring that not satisfied with the quantity necessary work restric- Separate employees provide genetic or the quality of an employ- tions or accommodations. Special guidelines apply to information. If, however, the ee's FMLA or ADA paper- • First aid and safety per- medical information pertain- employer receives such in- work from another provider. sonnel, if a disability might ing to employees. For ex- formation inadvertently or require emergency treat- ample, the ADA imposes pursuant to one of the strict In the case of workers' com- ment. very strict rules for handling exceptions to the law, the pensation, HIPAA Section • Government officials inves- information obtained through employer must keep it in sep- 164.512(l) provides that a tigating compliance with post-offer medical examina- arate, confidential files. covered entity may disclose the ADA. tions and inquiries. Employ- protected health information ers who are covered by the According to an opinion let- “as authorized by and to the Similarly, the Genetic Infor- ADA must keep these medi- ter by the Department of extent necessary to comply mation Nondiscrimination Act cal records confidential and Labor’s Equal Employment with laws relating to work- (GINA) requires employers separate from other person- Opportunity Commission ers’ compensation or other that acquire an employee’s nel records. As mentioned (EEOC), employers must en- similar programs, established genetic information (although above, this information may sure that strict confidentiality by law, that provide benefits they generally should not re- be revealed only: to safety and separation are provided for work-related injuries.” As quest it) to treat it as a con- and first aid workers, if nec- to personnel records contain- such, any disclosure would fidential medical record in a essary to treat the employee ing personal medical informa- also be subject to state law separate medical file. It can or provide for evacuation pro- tion, and that occupational regarding workers' compen- be maintained in the same cedures; to the employee's health information must not sation. There is no specific confidential medical file as supervisor, if the employee's be intermingled in an elec- exception in HIPAA regard- disability-related information. disability requires restricted tronic health record (EHR) of ing disclosures for FMLA and However, different rules re- duties or a reasonable accom- an individual patient. Given ADA purposes. Therefore, garding when and to whom modation; to government of- that HIPAA normally exempts covered entities usually re- genetic information may be ficials as required by law; and employment records from quire a valid patient authori- disclosed apply - which do to insurance companies that the scope of its privacy and zation, pursuant to section not include supervisors, man- require a medical exam. security requirements, why 164.508, prior to disclosing agers, or first aid or safety should occupational health employee protected health personnel, but do include HIPAA also imposes privacy professionals, healthcare information to an employer others not on the list for dis- obligations on many employ- facilities, and health plans for purposes of FMLA and closure of disability-related ers who provide group health be concerned by this EEOC ADA. information. plans. Employers who ad- opinion? minister their own plans and Protecting Employee Requests for Employee have fewer than 50 partici- There are two important Health Information Un- Health Information pants don't have to comply reasons. First, healthcare fa- der ADA and GINA Notwithstanding the above, with HIPAA's privacy rules, cilities and health plans are Even when HIPAA does not employers may disclose em- and employers that spon- themselves employers and apply, healthcare employee ployee health information sor plans that receive only should be concerned with health departments still have with an employee’s express enrollment information have maintaining strict confiden- other legal obligations to authorization (which abso- minimal obligations. Un- tiality of medical information protect the confidentiality of lutely should be in writing). der HIPAA, employers are maintained in their employ- employee health information Employers also may, if certain required to protect the pri- ees’ personnel files. Second, 5 Journal of the Association of Occupational Health Professionals in Healthcare
while HIPAA exempts em- The EEOC opinion letter and health plans, both in their health records should be pro- ployment records from ap- makes clear that employers capacity as HIPAA-covered tected with extra safeguards plication of the HIPAA Privacy must ensure that personal entities and in their capacity because the data is at a high- and Security Standards ap- health information about ap- as employers, need to en- er risk of being accessed. plied to PHI, the EEOC states plicants or employees cannot sure appropriate separation Unfortunately, this extra layer that personal health informa- be accessed, except under and access controls exist of protection is often an over- tion maintained for medical the circumstances and to the with respect to both PHI and sight, or it is put on the back purposes (e.g., PHI) and oc- extent permitted under ADA employment/occupational burner. cupational (or work-related) and GINA. health information main- medical information should tained in paper or electronic What can you do? not be maintained in a single The result of the EEOC opin- form. Failure to do so could • Audit employee records on EHR, and the latter informa- ion effectively requires that result in potential liability un- a regular basis. tion clearly is subject to strict employers should, if not al- der ADA and GINA, as well • Run reports and logs to find confidentiality requirements ready doing so, take steps to as the more typical risk of a out who is accessing spe- under both the ADA and ensure that: “breach” under HIPAA’s re- cific charts, and record the GINA. Therefore, occupation- 1) various types of medical quirement to notify patients reasons for access. al health professionals, health information about em- when their medical records • Ensure that users are not plans and healthcare employ- ployees sought or main- have been accessed or ac- sharing their unique logins. ers should adopt appropriate tained for purposes of quired in an unauthorized, or Most activity is tracked via restrictions and separation disability determinations, illegal, manner. the sign-on user name. If with respect to EHRs that work-related functions or the user name shows up on contain both types of health accommodations, FMLA In Summary the audit report, then that is information. and other types of medical The HIPAA Privacy and Secu- the person believed to have leave, are obtained lawful- rity Rules call for us to pro- accessed the medical chart. The opinion letter, written ly in compliance with ADA, tect patients’ electronic per- • Find out the security lay- by the EEOC Office of Legal GINA and state confidenti- sonal health information to ers within your software. Counsel, states, “[a]ccess- ality and nondiscrimination the best of our ability. Now, Often, security is set up ing an individual’s medical laws; and Meaningful Use Section 45 loosely during implementa- records directly is no differ- 2) medical information con- CFR 164.308(a)(1) - Protect tion and the advanced fea- ent from asking an individual tained in employment files Electronic Health Informa- tures and functionality are for information about cur- is segregated into confi- tion - prompts us to perform never used, allowing easier rent health status, which the dential areas ( w h e t h e r a security risk analysis. When access for unauthorized us- EEOC considers a request paper or electronic) with ac- you review your policies and ers. for (disability or) genetic in- cess rights restricted only procedures, remember to • Define and communicate formation where it is likely to such lawful purposes, as think about the patients who internal policies and pro- to result in the acquisition opposed to general are also your employees. cedures for employee pa- of such information, particu- access rights typically af- Your occupational employee tients. larly family medical history.” forded to a wider range of Therefore, employers must management and human respect the confidential- resources personnel. Want to Attend the AOHP ity of all medical information maintained for employment The EEOC opinion letter also National Conference for FREE? purposes, whether an EHR states that when personal or paper medical record, and health information is main- Apply for the Sandra Bobbitt Scholarship. This award be careful when seeking au- tained together with occupa- was established to provide annual continuing educa- thorization from employees tional health information in a to access their EHR or other single EHR or paper medical tion scholarships to subsidize the educational efforts of medical records for work- record, particularly one that members. Applicants for this scholarship will be consid- related purposes. If done in allows someone with access an inappropriate way related to the EHR or paper record to ered for a complimentary attendance to the to obtaining disability or ge- view any information therein main conference plus a one-night hotel stay. netic information regarding a without restriction, a real pos- job applicant or current em- sibility of a violation of ADA, For more information, visit our website at ployee, such access can run GINA, or HIPAA exists if the http://aohp.org/aohp/ABOUTAOHP/AwardsScholarships.aspx. afoul of the confidentiality purpose of such access is and nondiscrimination provi- prohibited under such laws. Submission deadline is June 1. sions under ADA and GINA. Thus, healthcare providers
6 Spring 2018
Editor's Column By Kim Stanchfield, RN, COHN-S Executive Journal Editor “Connecting the Dots”
In my Occupational Health what documentation of ed to healthcare workers, it tial exposure, follow up, and Department, we constantly two MMR vaccines means was clear that they were not counsel. Healthcare work- communicate with health- in terms of staff immunity. aware of what Occupational ers need to be reassured care workers regarding their We also explain what a Health had communicated that when we advised them immunization status and their Measles, Mumps, Rubella to staff during their annual during their annual evalua- immunity to specific commu- IGG titer means. review that was specific to tion that they were immune nicable diseases. Following each individual’s Mumps im- to Mumps, it means the pa- current CDC guidelines, our We repeat this same review munity. tient they cared for with diag- healthcare system consid- each year to all staff during nosed Mumps has the same ers anyone who has had two their annual screening. I un- Any type of communicable disease, and they are still im- doses of MMR vaccine or a derstand, and I try to help our disease exposure is stressful mune. We are always “con- positive IGG titer of disease team understand that, in Oc- for healthcare workers. It is necting the dots” for them. (Measles, Mumps, and Ru- cupational Health, we “live our job to assess any poten- bella) documentation of im- and breathe” this type of in- munity. formation daily. Staff in other areas outside of Occupational We perform an annual oc- Health have multiple types cupational health screening of information to constantly on almost all staff (with few deal with, and our informa- exceptions). During the em- tion is quickly replaced by the ployee’s month of birth, the million other facts and bits of employee is required to have data they need to perform an evaluation in Occupational their daily jobs. Health. The evaluation in- cludes a: I am famous for saying • TB Screen (IGRA test if “healthcare employees do the screen is positive, as not connect the dots”. I be- we are in a low risk patient lieve that most of the coun- population). seling and communication • N95 fit test, if the job re- we provide employees flies quires it. out the window if the word • Review of allergies, medi- “exposure” is used. A recent cations, and any significant example is a smaller scale health changes. outbreak of Mumps at a lo- • Review of all immuniza- cal educational facility in our tions and immunity status. area. Our department was We show each employee following a possible Mumps a copy of his/her immu- exposure to staff in a patient nization status, stressing care unit. As our team talk-
7 Journal of the Association of Occupational Health Professionals in Healthcare
Association Community Liaison Report By Bobbi Jo Hurst, BSN, RN, MBA, COHN-S, SGE Association Community Liaison
Every day I am reminded of • Mumps at a national com- you hover over or click on the the spread of infectious dis- the important role that em- petition — During the handout's title, a preview of eases, state and local health ployee/occupational health weekend of February 23 its image appears. Most of the departments, healthcare pro- professionals play in the to 25, over 230,000 people handouts for patients are avail- viders, and community orga- lives of individuals working attended a national cheer- able in Spanish as well as Eng- nizations are working to coor- in healthcare. We have the leading competition in Dal- lish, and a few are available in dinate treatment and services opportunity to gain knowl- las, Texas. About 25,000 six other languages as well. for substance use disorders edge and to learn how we of them were athletes with HCV and HIV preven- can adopt best practices and and coaches exposed to Make sure you have updat- tion and care. However, even grow in our profession. mumps. Attendees were ed your vaccine information among public health workers from 39 states and nine sheets (VIS). CDC released and advocates, there remains News of outbreaks of vac- countries. new a VIS for recombinant a lack of awareness and ac- cine preventable communi- • Measles at three airports — zoster vaccine, an updated tion around the rise in acute cable diseases reminds us In two separate incidents, VIS for live zoster vaccine, hepatitis B infection. how important it is to improve international travelers with and posted final VISs for vaccination rates. Improved measles potentially ex- MMR, MMRV, and varicella. Hepatitis B education and healthcare vaccination rates posed people at airports in outreach often focuses on its have been shown to reduce Detroit, Newark, and Mem- Reported Cases of Hepa- most common global mode or eliminate the spread of phis. Detroit exposures oc- titis B Infection in Adults of transmission—from an in- disease among healthcare curred on March 6. Newark Increasing Due to Opioid fected mother to her baby personnel and patients. The and Memphis exposures Use during childbirth—but among National Foundation for In- were the result of a con- On February 21, the U.S. De- the other modes of hepatitis fectious Diseases (NFID) necting flight by one infect- partment of Health and Hu- B transmission, injection drug held a summit in November ed child on March 12. man Services published an use is a growing concern. In 2017 which included repre- article online titled The Rise 2015, the acute hepatitis B sentatives from professional IAC Spotlight! in Acute Hepatitis B Infection infection rate in the United healthcare organizations ac- The Immunization Action Co- in the U.S. Authored by Rhea States increased by 20.7%, tive in infection control and alition's (IAC's) Adult Vaccina- Racho, Hepatitis B Founda- rising for the first time since occupational health. From tion Handouts web page on tion, and Kate Moraras, Hepa- 2006. The sharpest increases this meeting, a call to action immunize.org contains many titis B Foundation and Hep B in new hepatitis B cases are was developed. This call to free, CDC-reviewed print ma- United, the article links the occurring largely in states that action, which can be found terials you can use to make opioid epidemic in the Unit- have been impacted the most at nfid.org, notes the need sure your adult patients are ed States to the risk of con- by the opioid epidemic. to provide and document im- vaccinated. This web page tracting infectious diseases munity to hepatitis B, MMR, can be found by selecting the through injection drug use. Tuberculosis Guidelines varicella, influenza, and Tdap. "Handouts & Staff Materials" The first three paragraphs are for Healthcare Providers Vaccination of healthcare indi- tab (second from the left) in reprinted below. Discussed on Listserv viduals prior to an exposure is the light gray banner across Currently, a work group in- much easier than responding the top of every immunize. In light of the ongoing opioid cluding AOHP members is to an exposure or outbreak of org web page and then se- epidemic in the United States, developing guidelines to be one of these communicable lecting "Adult Vaccination" in it is becoming increasingly published in the MMWR in illnesses. To assist members the drop-down menu. important to raise awareness June or July of 2018. The with best practices, AOHP about the risk of contracting draft has been sent to several is working with Dr. Kim from The Adult Vaccination Hand- infectious diseases such as organizations and individuals, the Centers for Disease Con- outs web page contains a hepatitis B (HBV), hepatitis C including AOHP members, trol and Prevention (CDC) to wide range of ready-to-print (HCV), and/or HIV through in- for peer review. Companion develop guidelines to assist resources for both healthcare jection drug use. documents will be written to with consistent immunization professionals and patients. assist with implementation of practices. Recent exposures Each item is accompanied To help address the link be- the new recommendations. include: by a brief description. When tween the opioid crisis and As soon as documents be- 8 Spring 2018
come available, they will be United States remain impor- workday) injuries and 345 fa- August 13-19 is Safe + shared with AOHP members. tant to continued progress to- talities occur annually among Sound Week. The goal for These recommendations will ward TB elimination. Testing workers directly affected by the campaign is to promote not define the type of tuber- and treatment of populations the final standard. OSHA’s fi- the understanding and adop- culosis testing that is to be most at risk for TB disease nal rule on Walking-Working tion of safety and health completed. The type of test- and LTBI, including persons Surfaces and Personal Fall programs. This is the time ing that shall occur is men- born in countries with high Protection Systems better employers can show their tioned in the 2017 guidelines TB prevalence and persons in protects workers in general safety commitment through at https://academic.oup.com/ high-risk congregate settings, industry from these hazards activities related to common cid/article/64/111/2811357. are major components of this by updating and clarifying core elements of recognized effort. standards, and adding training safety and health programs, In addition, CDC published and inspection requirements. management leadership, Tuberculosis—United States, OSHA Event Calendar worker participation, and a 2017 in the March 23 issue Updates As we get closer to summer systematic approach to find of MMWR (pages 317–323). The Occupational Safety and it is important to remember and fix hazards. The first paragraph is reprint- Health Administration (OSHA) Health Illness Prevention. ed below. has developed a calendar of The campaign kicks off May NIOSH Updates events for institutions to as- 25 with “Don’t Fry Day”. If Study on Hearing In 2017, a total of 9,093 new sist in promoting a safe work- you have workers who will Loss Prevalence in the cases of tuberculosis (TB) place for all. be working outside or in hot Health Care and Social were provisionally reported in environments, start planning Assistance Sector the United States, represent- May is National Safety on how you can protect them A new study from the Nation- ing an incidence rate of 2.8 Stand-Down to Prevent during the hot days. al Institute for Occupational cases per 100,000 population. Falls month. It was created Safety and Health (NIOSH) The case count decreased to draw attention to falls in OSHA and the National Safe- breaks down the prevalence by 1.8% from 2016 to 2017, the construction industry, but, ty Council have developed a of hearing loss experienced and the rate declined by 2.5% as many of you know, falls calendar of other events for by workers in the Health Care over the same period. These among hospital staff are a ma- institutions to assist in pre- and Social Assistance (HSA) decreases are consistent with jor concern. Some of the most venting a safe workplace for sector. The overall preva- the slight decline in TB seen severe injuries that occur to all persons. lence of hearing loss among over the past several years. healthcare workers are falls. It noise-exposed workers was This report summarizes pro- is important to take dedicated June is National Safety found to be 19%, while some visional TB surveillance data time the week of May 7 to Month. During this month, it subsectors within the HSA reported to CDC’s National focus on fall prevention and is time to highlight any safety had up to 31% prevalence of Tuberculosis Surveillance Sys- training. Plan-Provide-Train. concern you may have at your hearing loss. The study was tem for 2017 and in the last organization. In addition, Na- published recently in the Jour- decade. The rate of TB among There are also other fall risks tional Forklift Safety Day is nal of Occupational and Envi- non-U.S.-born persons in 2017 at healthcare facilities. It is im- June 12 (make sure that you ronmental Medicine. was 15 times the rate among portant at this time to make are abiding by the Power In- U.S.-born persons. Among sure that your institution is dustrial Truck standard), and Hearing loss is the third most non-U.S.-born persons, the aware of all fall risks and the June 23 is the compliance common chronic physical con- highest TB rate among all ra- new standard on Walking- date for the long awaited re- dition in the United States. Al- cial/ethnic groups was among Working Surfaces. spirable crystalline silica rule though a smaller percentage of Asians (27.0 per 100,000 per- for general industry (which workers in the HSA sector are sons), followed by non-His- OSHA’s Final Rule to Update, healthcare facilities fall under). exposed to hazardous noise panic blacks (22.0). Among Align, and Provide Greater – unlike industries like min- U.S.-born persons, most TB Flexibility in its General Indus- July 1 – This is a big date to ing or construction –NIOSH cases were reported among try Walking-Working Surfaces remember, the day that we researchers found that some blacks (37.1%), followed by and Fall Protection Require- are required to electronically subsectors in the HSA had non-Hispanic whites (29.5%). ments documents that fall submit the OSHA summary higher than expected preva- Previous studies have shown from heights and on the same page 300A form from 2017 lence of hearing loss for an that the majority of TB cases level (a working surface) are using the Injury Tracking Ap- industry that has had assumed in the United States are attrib- among the leading causes of plications System. OSHA has “low-exposure” to noise. uted to reactivation of latent serious work-related injuries put on hold the requirement TB infection (LTBI). Ongoing and deaths. OSHA estimates to submit the 300 forms, so Most of the HSA subsector efforts to prevent TB trans- that, on average, approxi- we currently just need to sub- prevalence estimates ranged mission and disease in the mately 202,066 serious (lost- mit the Summary Form. from 14% to 18%, but the 9 Journal of the Association of Occupational Health Professionals in Healthcare
Medical and Diagnostic Labo- have been hard at work to Exploring the association be- frequently. These results ratories subsector had 31% promote workers' health, tween organizational safety suggest that having more or prevalence and the Offices and have published several and health climates and se- reciprocal sources of peer- of All Other Miscellaneous new articles to share their re- lect productivity measures- based support may trigger er- Health Practitioners had a search: Harvard Center researchers gonomically-related behaviors 24% prevalence. presented on this topic at such as frequent utilization of Associations among health- the 2017 HERO Conference. equipment. Further work is needed to care workplace safety, resi- Their selected breakout ses- identify the sources of noise dent satisfaction, and qual- sion presentation is captured Work-family conflict, sleep, exposure and protect worker ity of care in long term care in brief in these proceedings. and mental health of nurs- hearing in the HSA sector. Suc- facilities- Researchers at the ing assistants working in cessful noise reduction mea- Center for the Promotion of Measuring best practices for nursing homes- Research- sures have been documented Health in the New England workplace safety, health, and ers at CPH-NEW examined in hospital settings, exposure Workplace (CPH-NEW) per- well-being: The Workplace the role of sleep in the asso- to chemotherapy drugs can be formed an integrated cross- Integrated Safety and Health ciation between work–fam- better prevented, and laborato- sectional analysis of relation- Assessment- Researchers at ily conflict and mental health ries can be modified to reduce ships among long term care the Harvard T.H. Chan School by collecting questionnaires the level of noise. For general work environments, employ- of Public Health Center for from 650 nursing assistants occupational hearing loss pre- ee and resident satisfaction, Work, Health, and Well-Being in 15 nursing homes. Results vention, NIOSH recommends and quality of patient care. describe the Workplace In- demonstrated that increased removing or reducing noise at Facilities in the better-per- tegrated Safety and Health work–family conflict was as- the source, and when noise forming group were found to (WISH) Assessment as a tool sociated with lower mental cannot be reduced to safe lev- have: better patient care out- that may inform organization- health scores. Workplace in- els, implementing an effective comes and resident satisfac- al priority setting and guide terventions to improve nurs- hearing conservation program. tion; lower rates of workers' research around pathways in- ing assistants’ mental health compensation claims; better fluencing implementation and should increase their control Total Worker Health® SRHP performance; higher outcomes related to work- over work schedules and re- NIOSH’s Total Worker employee retention; and place safety, health, and well- sponsibilities, provide support Health® (TWH) is defined as greater worker job satisfac- being approaches. to meet their work and family policies, programs, and prac- tion and engagement. needs, and address healthy tices that integrate protection Predictors of nursing staff sleep practices. from work-related safety and Dissemination and implemen- voluntary termination in nurs- health hazards with promo- tation research for occupa- ing homes: A case-control Workplace Violence tion of injury and illness pre- tional safety and health- CPH- study- CPH-NEW researchers Workplace violence contin- vention efforts to advance NEW researchers present utilized a case-control study ues to be an increasing prob- worker well-being. The sec- dissemination and implemen- to examine the contribution lem in healthcare. OSHA has ond international TWH sym- tation (D&I) concepts, frame- of work characteristics to developed a publication titled posium to promote worker works, and examples that can individual nursing staff turn- Guideline to Preventing Work- health is scheduled for May increase the capacity of oc- over in the long term care place Violence, which can be 8-11 in Bethesda, MD. To cupational safety and health sector. Results demonstrate found at https://www.osha. learn more, please visit www. professionals to conduct D&I that evening shift work and gov/SLTC/workplaceviolence/ twhsymposium.org. In addi- research and accelerate the shift length greater than eight index.html. tion, the latest Fundamental translation of research find- hours were factors contribut- of TWH addressed ensuring ings into meaningful, every- ing to voluntary termination. Another resource is provided confidentiality and privacy of day practices to improve by the International Associa- workers. The article discuss- worker safety and health. Social Network Analysis of tion for Healthcare Security es the need for data collec- peer-specific safety support and Safety (IAHSS). Its Indus- tion while ensuring that em- The Effect of Workforce Mo- and ergonomic behaviors: try Guidelines and IAHSS De- ployee privacy is maintained. bility on Intervention Effective- An application to safe patient sign Guidelines are intended Workplace health programs ness Estimates- Researchers handling- OHWC researchers to assist healthcare adminis- that penalize workers for their at the Harvard Center ana- applied Social Network Anal- trators in providing a safe and current health are not in align- lyzed a previously-conducted ysis (SNA) to test whether secure environment while ment with NIOSH’s approach. study to evaluate the impact advice-seeking interactions meeting all the regulatory re- To read more about the Fun- of highly mobile workforce among peers about safe pa- quirements. These guidelines damentals of TWH, please go populations on intervention tient handling correlate with were published in 2015 and to www.cdc.gov/niosh/twh/ effectiveness. Results indi- a higher frequency of equip- are only available to members. fundamentals.html. cate that researchers should ment use. Results show a Contact your security force consider the effect of the positive correlation between at your hospital to see if they NIOSH Centers of workforce’s mobility on antici- identifying more peers for have these guidelines to as- Excellence pated intervention outcomes. safe patient handling advice sist you with your workplace NIOSH Centers of Excellence and using equipment more violence prevention programs. 10 Spring 2018
Coordinated Approaches to Strengthen State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke
By Gia E. Rutledge, MPH1,2; Kimberly Lane, PhD, RDN2; Caitlin Merlo, MPH, RDN3; Joanna Elmi, MPH4
Chronic diseases, including heart dis- promoting healthy and safe behaviors, index.htm). DDT supports programs ease, stroke, cancer, diabetes, and obe- communities, and environments7. and activities to prevent or delay the sity, are the leading causes of death in onset of type 2 diabetes and to improve the United States and account for most The mission of CDC’s National Center for health outcomes for people diagnosed of the nation’s health care costs1. Heart Chronic Disease Prevention and Health with diabetes (www.cdc.gov/diabetes/ disease is the leading cause of death Promotion (NCCDPHP) is to “help peo- home/index.html). DNPAO focuses on among men and women in the United ple and communities prevent chronic decreasing obesity in the United States States, accounting for 1 of every 4 diseases and promote health and well- by encouraging regular physical activity deaths1. Approximately 140,000 Ameri- ness for all”8. NCCDPHP supports dis- and good nutrition at every stage of life. cans die each year from stroke, and it ease control efforts through 5-year term DNPAO supports healthy eating, active is a leading cause of long-term disabil- funding mechanisms called cooperative living, and obesity prevention by creat- ity2,3. It is estimated that more than agreements that are awarded to state ing healthy child care centers, hospitals, 9% of the US population has diabetes, and local public health agencies to schools, and worksites; building the ca- which is the leading cause of kidney fail- strengthen partnerships to improve pacity of state health departments and ure, lower-limb amputations other than health at the community level9. In 2013, national organizations; and conducting those caused by injury, and new cases NCCDPHP developed the State Pub- research, surveillance, and evaluation of blindness among adults4. Addition- lic Health Actions to Prevent Obesity, studies (www.cdc.gov/nccdphp/dnpao/ ally, more than one-third of US adults Diabetes, and Heart Disease and Stroke index.html). SHB’s aims are to improve have obesity, which is associated with (State Public Health Actions [SPHA]- the well-being of youth through healthy several chronic conditions5,6. 1305), a cooperative agreement that eating, physical education, and physical combined the efforts of 4 CDC divi- activity; to reduce risk factors associated Chronic diseases are common and cost- sions: the Division for Heart Disease with childhood obesity; and to manage ly, but many are preventable. Although and Stroke Prevention (DHDSP); the Di- chronic health conditions in schools it is important to address the underlying vision of Diabetes Translation (DDT); the (www.cdc.gov/healthyschools/statepro- risk factors for chronic diseases at the Division of Nutrition, Physical Activity, grams.htm). individual level, it is also critical to imple- and Obesity (DNPAO); and the Division ment population-based interventions, of Population Health’s School Health The primary purpose of SPHA-1305 is to including health promoting policies and Branch (SHB). The agreement funded 50 support state-level and statewide imple- environments that affect where we state health departments and the Dis- mentation of cross-cutting, evidence- work, live, play, and receive health care. trict of Columbia to implement strate- based strategies to promote health and This requires a multifaceted approach gies in health systems and communities prevent and control chronic diseases and the collective efforts of federal, to prevent chronic disease and reduce and their risk factors11. SPHA-1305 uses state, local, private, and community- complications associated with them10. a collective approach to 1) improve en- based organizations along with national State Public Health Actions provides vironments in worksites, schools, early partners. examples of how mutually reinforcing childhood education services, state and strategies are implemented. Two tiers local government agencies, and com- The Centers for Disease Control and of strategies were recommended, basic munity settings to promote healthy be- Prevention’s (CDC’s) mission is to pre- and enhanced (Figure 1). haviors and expand access to healthy vent or control all diseases that affect choices for people of all ages related to Americans7. CDC puts science into ac- Each of the 4 divisions focuses on a diabetes, cardiovascular health, physical tion by tracking diseases and determin- specific area of chronic disease. DHD- activity, healthy foods and beverages, ing their causes and by identifying the SP provides public health leadership obesity, and breastfeeding; 2) improve most effective ways to prevent and to improve cardiovascular health for all the delivery and use of quality clinical control them7. This work entails tackling Americans and to reduce the burden and other health services aimed at pre- the major health problems that cause and end disparities related to heart dis- venting and managing high blood pres- death and disability for Americans and ease and stroke (www.cdc.gov/dhdsp/ sure and diabetes; and 3) increase links
11 Journal of the Association of Occupational Health Professionals in Healthcare
between community and clinical orga- • Increased physical activity across the health disparities and improving health nizations to support prevention, self- life span equity among adults. SLPHA-1422 sup- management, and control of diabetes, • Improved medication adherence for ports interventions to prevent obesity, high blood pressure, and obesity10. The adults with high blood pressure or dia- type 2 diabetes, heart disease, and ultimate goal of SPHA-1305 is to make betes stroke (through control of high blood healthy living easier for all Americans. • Increased self-monitoring of high pressure) and to reduce health dispari- The following are primary outcomes of blood pressure tied to clinical support ties in the prevalence of these among SPHA-1305: • Increased access to and participation adults in the population overall and in pri- • Increased consumption of a healthy in diabetes self-management pro- ority populations12. SLPHA-1422 award- diet grams and type 2 diabetes prevention ees used the dual approach and mutu- programs ally reinforcing strategies to maximize • Increased breast- the impact of strategies implemented Figure 1. Strategies of State Public Health Actions to Prevent and feeding in SPHA-1305 by working with partners Control Diabetes, Heart Disease, Obesity, and Associated Risk and funding subawardees at the local Factors and Promote School Health (SPHA-1305) In 2014, CDC devel- level. By applying the dual approach, oped a second coop- states and large cities implemented erative agreement, strategies to improve the health of the State and Local Pub- whole population and of priority popula- lic Health Actions tions12. The strategies are described as to Prevent Obesity, mutually reinforcing because they are Diabetes, and Heart implemented simultaneously and syner- Disease and Stroke gistically to address multiple risk factors (SLPHA-1422), a pro- and chronic diseases12. gram designed for states and large cities Three tiers of strategies make up SL- to implement strate- PHA-1422, environmental strategies, gies to control and health system strategies, and com- prevent chronic dis- munity–clinical linkage strategies. The ease through a dual purpose of SPHA-1422 environmental approach — targeting strategies is to “support environmen- both the overall pop- tal and system approaches to promote ulation and priority health, support and reinforce healthful populations (groups behaviors, and build support for lifestyle of people who are at improvements for the general popula- high risk of chronic tion and particularly for those with un- disease, are experi- controlled high blood pressure and encing a dispropor- those at high risk for developing type tionate incidence of 2 diabetes”12. The purpose of commu- chronic diseases and nity–clinical linkage strategies is to “sup- conditions, or are ex- port health system interventions and periencing racial/eth- community–clinical linkages that focus nic or socioeconomic on the general population and priority disparities). This populations” (Figure 2)12. Environmen- competitive coopera- tal strategies were implemented in the tive agreement com- same communities and jurisdictions as bined the efforts of 3 health system strategies and commu- NCCDPHP divisions nity–clinical linkage strategies, with local (DDT, DNPAO, and improvements supported by statewide DHDSP), and was efforts funded by this cooperative agree- awarded to 17 states ment as well as those supported by and 4 large cities to SPHA-1305. The following are primary implement additional outcomes of SLPHA-1422: evidence-based strat- • Increased consumption of nutritious egies to expand the food and beverages and increased reach and impact physical activity of SPHA-1305 with • Increased engagement in lifestyle the aim of reducing change to prevent type 2 diabetes
12 Spring 2018
• Improved medication adherence for Oser et al describe how the Montana ments produced a list of needs and as- adults with high blood pressure Department of Public Health and Hu- sets for scaling up and spreading phar- • Increased self-monitoring of high man Services used SPHA-1305 fund- macy-led patient care services in Los blood pressure tied to clinical support ing to conduct an evaluation of a 3-year Angeles County. • Increased referrals to and enrollment intervention among 25 community in CDC-recognized lifestyle change pharmacies in ru- programs to prevent type 2 diabetes ral areas to improve Figure 2. State and Local Public Health Actions to Prevent Obesity, adherence to blood Diabetes, and Heart Disease and Stroke (SLPHA-1422) Strategies This special collection of articles in pressure medica- Preventing Chronic Disease describes tion16. In addition to how SPHA-1305 and SLPHA-1422 use patient-level data, a coordinated approach to chronic dis- Montana also imple- ease prevention and control. The collec- mented a statewide tion describes an evaluation approach survey of pharma- that was designed for state and local cists and identified health departments with differing lev- barriers perceived els of evaluation capacity and highlights from the pharmacy early outcomes at the national, state, point of view. Re- and local levels. This special collection sults indicate that the contains 12 articles: 4 by state health intervention was suc- departments, 2 by one large city, and 6 cessful with promis- authored by CDC staff members. Arti- ing improvements in cles highlight a range of SPHA-1305 and patient medication SLPHA-1422 strategies. An article by adherence. Park et al describes in detail the founda- tions for SPHA-1305, the strategies rec- Barragan et al focus ommended by each NCCDPHP division, on pharmacy-led the administrative and management strategies that the structure, and the model for providing Los Angeles County cross-division program and evaluation Department of Public technical assistance13. Given this com- Health implemented plex approach to implementing a nation- with SLPHA-1422 al chronic disease prevention initiative, it funding17. Authors was imperative that the evaluation de- report results from sign use a robust, multi-tiered approach a community and to accountability and learning. This com- stakeholder needs prehensive evaluation approach is de- assessment for scribed by Vaughan et al14. pharmacist services for management of Smith et al summarize Maryland’s ap- hypertension medi- proach to improving implementation of cation therapy. The quality improvement processes in Fed- needs assessment erally Qualified Health Centers through included 3 compo- the use of health information technology nents: 1) a policy and standardized reporting of clinical context scan, 2) a quality measures15. Other states inter- survey of participants ested in learning how to harness the in a pharmacy lead- potential of electronic health records ership symposium, and how to use population health data and 3) an internet to drive improvements in quality of care public opinion sur- will appreciate this step-by-step explana- vey of a final sample tion of how to gain the buy-in of health of more than 1,000 centers and how to build the operational English- and Spanish- structure of a data warehouse. The ar- speaking Los Ange- ticle also discusses challenges encoun- les County residents. tered in the process and plans for scal- A synthesis of results ing up these efforts. from these 3 assess- 13 Journal of the Association of Occupational Health Professionals in Healthcare
Mosst et al describe a practice-ground- more focus is needed to further improve 2 years of statewide data, tracked prog- ed framework used by the Los Angeles results by the end of the 5-year coopera- ress in implementing these 5 Empower County Health Department to scale and tive agreement. standards, and identified areas in which sustain the National Diabetes Preven- facilities needed additional support to tion Program (National DPP) by using a An article by Fritz et al examines the fully implement the standards. The re- diverse partner network18. By develop- SPHA-1305 strategy of increasing physi- sults indicate that 1 in 5 facilities fully ing a 3-pronged framework (expand- cal activity through community design21. implemented all 5 standards, with the ing outreach and education, improving In this community case study, the au- staff training standard having the high- health care referral systems and proto- thors describe how the Indiana State est level of implementation across facili- cols, and increasing access to insurance Department of Health used a workshop ties (77%) and the breastfeeding stan- coverage for the National DPP), Los An- model to support communities with im- dard having the lowest implementation geles County took an approach that oth- plementation of active-living opportuni- (44%). These findings can inform train- er large jurisdictions can use to identify ties in their communities to improve or ing and technical assistance efforts to people with prediabetes and expand ac- increase access to physical activity. The further support the implementation of cess to and use of CDC-recognized type authors report that providing a workshop these standards in Arizona’s licensed 2 diabetes prevention programs. model with follow-up support to the child care facilities. community resulted in policy adoption, Mensa-Wilmot et al use a mixed-meth- the creation of new advisory commit- An article by Pitt Barnes et al examines od evaluation approach to describe pre- tees, and new local funding allocations performance measures and reported liminary findings of a collaborative effort for active-living projects. These findings evaluation data from all 51 awardees to between CDC and state health depart- may inform efforts of other state health assess progress in improving the school ments designed to scale and sustain agencies as they collaborate with com- nutrition environment and services over the National DPP19. Grantees reported munities to improve physical access. the first 4 years of the program24. Find- reimbursement availability, practice ings indicated that, compared with year and provider referral policies, and hav- Geary et al describe the extent to which 2, by year 4 awardees made significant ing standard curricula as facilitators to 38 states’ Quality Rating and Improve- progress, especially related to providing implementing the National DPP lifestyle ment Systems (QRIS) include obesity professional development on strategies change program. Understanding activi- prevention content22. States can use to improve the school nutrition envi- ties implemented by grantees and the QRIS to set standards that define high ronment, adopting and implementing barriers and facilitators they identify quality care and to award child care pro- policies to establish standards (including is critical for developing relevant and grams with a quality rating designation standards for sodium) for all competitive timely technical assistance and for un- based on how well they meet these foods available during the school day, derstanding the impact of the program. standards (eg, a star rating). The authors not selling unhealthy foods and bev- reviewed each state’s QRIS standards erages during the school day, placing Morgan et al describe activities state and compared them with the 47 “high fruits and vegetables near the cafeteria health departments implemented to impact” obesity prevention standards cashier where they are easy to access, increase referrals to, coverage for, and contained in Caring for Our Children: and providing information to students availability of diabetes self-management National Health and Safety Performance or families on the nutrition, calorie, and education and support (DSMES) pro- Standards; Guidelines for Early Care and sodium content of foods available. How- grams20. By year 3 of SPHA-1305, more Education Programs, 3rd Ed (Caring for ever, the data also show that only 33.5% than 3,000 DSME programs had been Our Children)23. The authors found that of local education agencies adopted established in 41 states. State health of 38 states with publically available and implemented policies that prohibit departments contributed to these in- standards, 20 included at least one stan- all forms of advertising and promotion creases by assisting organizations in dard with obesity prevention content; of unhealthy foods and beverages. Be- establishing new DSME programs, pro- however, most had fewer than 5, sug- cause the federal requirement for local viding technical assistance to providers, gesting room for states to embed addi- school wellness policies now includes convening stakeholders to address gaps tional obesity prevention standards into addressing the marketing of unhealthy in DSME insurance coverage, and using QRIS. foods, additional training, technical as- marketing strategies to educate patients sistance, and guidance is likely needed about the importance of DSME. Con- The article by Papa et al examines 5 of to help districts adopt marketing poli- ducting early assessments of the ac- the child care standards of the Arizona cies. This special collection describes tivities implemented by state health Department of Health Services related overarching approaches and examples departments and analyzing progress in to obesity prevention that are part of the of interventions implemented by state performance measures associated with Arizona Empower Program, a program and local health departments to prevent them provides early outcome results that promotes healthy environments and manage obesity, diabetes, heart dis- that can be used to develop technical as- for children in Arizona’s licensed child ease, and stroke. Readers should note sistance to help grantees identify where care facilities24. The authors examined that these articles represent early evalu-
14 Spring 2018
ation results of both SPHA-1305 and Centers for Disease Control and Prevention, Atlanta, 13. Vaughan M, Davis R, Pitt Barnes S, Jernigan J, Georgia. Shea P, Rutledge S. Evaluating cross-cutting approach- SLPHA-1422 and demonstrate promise es to chronic disease prevention and management: 4 Division for Heart Disease and Stroke Prevention, that the implemented strategies are developing a comprehensive evaluation. Prev Chronic National Center for Chronic Disease Prevention and Dis 2017;14:E131. reaching populations in need and are Health Promotion, Centers for Disease Control and beginning to have a population-wide Prevention, Atlanta, Georgia. 14. Smith EA, Lapinski J, Lichty-Hess J, Pier K. Using health information technology and data to improve impact. As of 2016, the 2 national pro- chronic disease outcomes in Federally Qualified Health grams are in the final year of funding. References Centers in Maryland. Prev Chronic Dis 2016;13:E178. With ongoing analysis of performance- Centers for Disease Control and Prevention, National 15. Oser CS, Fogle CC, Bennett JA. A project to pro- measure data, the impact of these pro- Center for Health Statistics. CDC WONDER online da- mote adherence to blood pressure medication among tabase. Underlying cause of death, multiple cause of people who use community pharmacies in rural Mon- grams will continue to be examined and death, 1999–2013. Atlanta (GA): Centers for Disease tana, 2014-2016. Prev Chronic Dis 2017;14:E52. reported. Control and Prevention. https://wonder.cdc.gov/mcd. 16. Barragan NC, DeFosset AR, Torres J, Kuo T. Phar- html. Accessed November 22, 2017. macistdriven strategies for hypertension management 1. Yang Q, Tong X, Schieb L, Vaughan A, Gillespie C, in los angeles: a community and stakeholder needs as- Collectively, the work of SPHA-1305 and Wiltz JL, et al. Vital signs: recent trends in stroke death sessment, 2014–2015. Prev Chronic Dis 2017;14:E54. SLPHA-1422 demonstrates the barriers rates — United States, 2000–2015. MMWR Morb Mor- 17. Mosst JT, DeFosset A, Gase L, Baetscher L, Kuo and facilitators that affect state and local tal Wkly Rep 2017; 66(35):933–9. T. A framework for implementing the National Diabe- program development, implementation, 2. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, tes Prevention Program in Los Angeles County. Prev Das SR, Deo R, et al.; American Heart Association Sta- Chronic Dis 2017; 14:E69 and evaluation of chronic disease pre- tistics Committee and Stroke Statistics Subcommittee. 18. Mensa-Wilmot Y, Bowen SA, Rutledge S, Mor- vention initiatives and describes a coor- Heart disease and stroke statistics — 2017 update: a gan JM, Bonner T, Farris K, et al. Early results of dinated approach to implementing pro- report from the American Heart Association. Circula- states’ efforts to support, scale, and sustain the Na- tion 2017;135(10):e146–603. Errata in Circulation 2017; tional Diabetes Prevention Program. Prev Chronic Dis grams. This information will inform other 135(10):e646 and Circulation 2017; 136(10):e196. 2017;14:E130. state and local programs and further the PubMed 19. Morgan JM, Mensa-Wilmot Y, Bowen SA, Murphy potential reach of these approaches. 3. Centers for Disease Control and Prevention. Nation- M, Bonner T, Rutledge S, et al. Implementing key driv- al Diabetes Statistic Report, 2017. https://www.cdc. ers for diabetes self-management education and sup- The findings presented in this special gov/diabetes/pdfs/data/statistics/national-diabetes-sta- port programs: early outcomes, activities, facilitators, collection contribute practice-based tistics-report.pdf. Accessed November 22, 2017. and barriers. Prev Chronic Dis 2018;15:E15. knowledge to the field of chronic dis- 4. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prev- 20. Fritz PJ, Irwin K, Bouza L. Using a community ease prevention and management, evi- alence of obesity among adults and youth: United workshop model to initiate policy, systems, and envi- States, 2011–2014. NCHS data brief, no 219. https:// ronmental change that support active living in Indiana, dence of combining different disease- www.cdc.gov/nchs/data/databriefs/db219.pdf. Ac- 2014–2015. Prev Chronic Dis 2017;14:E74. specific funding streams to achieve cessed November 22, 2017. 21. Geary NA, Dooyema CA, Reynolds MA. Supporting early outcomes with greater efficiency, 5. National Institutes of Health. Clinical guidelines on obesity prevention in statewide quality rating and im- the identification, evaluation, and treatment of over- provement systems: a review of state standards. Prev and lessons learned for future coordinat- weight and obesity in adults: the evidence report. NIH Chronic Dis 2017; 14:E129. https://doi.org/10.5888/ ed national chronic disease programs. Publication no. 98-4083; September 1998. https:// pcd14.160518 www.nhlbi.nih.gov/files/docs/guidelines/obesity_ 22. American Academy of Pediatrics, American Pub- guidelines_archive.pdf. Accessed November 22, 2017. Acknowledgments lic Health Association, National Resource Center for 6. Centers for Disease Control and Prevention. Mis- Health and Safety in Child Care and Early Education. This research received no grant from sion, Role, and Pledge Web site. https://www.cdc.gov/ Caring for our children: national health and safety any funding agency in the public, com- about/organization/mission.htm. Accessed November performance standards; guidelines for early care and mercial, or nonprofit sector. 22, 2017. education programs. 3rd edition. Elk Grove Village (IL): 7. Centers for Disease Control and Prevention. About American Academy of Pediatrics; Washington (DC): the Center website. https://www.cdc.gov/chronicdis- American Public Health Association; 2011. Author Information ease/about/index.htm. Accessed November 22, 2017. 23. Papa J, Agostinelli J, Rodriguez G, Robinson D. Corresponding Author: Gia Rutledge, 8. Federal Grant and Cooperative Agreement Act. Pub. Implementation of best practices in obesity prevention MPH, Lead Health Scientist, Division of L. No. 95–224. 92 Stat. 3 (February 3, 1978). in child care facilities: the Arizona Empower Program, 9. Centers for Disease Control and Prevention. State 2013-2015. Prev Chronic Dis 2017;14:E75. Diabetes Translation, Health Education public health actions to prevent and control diabetes, 24. Pitt Barnes S, Skelton-Wilson S, Cooper A, Merlo and Evaluation Branch, National Center for heart disease, obesity and associated risk factors and C, Lee S. Early outcomes of State Public Health Ac- Chronic Disease Prevention and Health promote school health (DP13-1305). https://www.cdc. tions’ school nutrition strategies. Prev Chronic Dis gov/chronicdisease/about/state-publichealth-actions. 2017;14:E128. Promotion, Centers for Disease Control htm. Accessed November 22, 2017. and Prevention, 4770 Bufford Hwy NE, 10. US Department of Health and Human Services, Citations: MS-75, Atlanta, GA 30341. Telephone: Centers for Disease Control and Prevention. Placehold- Rutledge GE, Lane K, Merlo C, Elmi J. Coordinated Ap- 770-488-5661. Email: [email protected]. er for 1305 FOA. https://www.grants.gov/web/grants/ proaches to Strengthen State and Local Public Health search-grants.html?keywords=CDC-RFA-DP13-1305. Actions to Prevent Obesity, Diabetes, and Heart Dis- Accessed November 22, 2017. ease and Stroke. Prev Chronic Dis 2018;15:170493. Author Affiliations: 11. US Department of Health and Human Services, DOI: http://dx.doi.org/10.5888/pcd15.170493. 1 Division of Diabetes Translation, National Center for Centers for Disease Control and Prevention. CDC- Chronic Disease Prevention and Health Promotion, RFA-DP14-1422PPHF14 PPHF 2014: Heart disease Centers for Disease Control and Prevention, Atlanta, & stroke prevention program and diabetes preven- Georgia. tion. https://www.grants.gov/view-opportunity. 2 Division of Nutrition, Physical Activity, and Obesity, html?oppId=255893. Accessed November 22, 2017. National Center for Chronic Disease Prevention and 12. Park BZ, Cantrell L, Hunt H, Farris RP, Schumacher Health Promotion, Centers for Disease Control and P, Bauer UE. State Public Health Actions to Prevent and Prevention, Atlanta, Georgia. Control Diabetes, Heart Disease, Obesity and Associ- 3 Division of Population Health, National Center for ated Risk Factors, and Promote School Health. Prev Chronic Disease Prevention and Health Promotion, Chronic Dis 2017;14:E127.
15 Journal of the Association of Occupational Health Professionals in Healthcare
You Can Be a ROC Star! AOHP Recruit Our Colleagues (ROC) – A Better and Greater Campaign. The Recruit Our Colleagues (ROC) campaign is back, and it’s bigger and better than ever! ROC is a great way for members to help AOHP grow while earning rewards that can be used toward education and membership. The new ROC campaign offers five levels of individual awards, as well as an award for the chapter recruiting the most new members.
AOHP members are the organization’s most valuable asset, and the best way to spread the word about the value and benefits of our organization. When looking for ways to recruit new members to AOHP, consider the following: • Connect with colleagues in your own organization who are not AOHP members. AOHP is not just for nurses. Reach out to physicians and advanced practice professionals who are involved in your occupational health program. • Connect with providers outside your organization who partner with you in your program. • Reach out to colleagues from other facilities in your local area. • Obtain a list of facilities in your chapter’s geographic area, and make “cold calls” to the occupational/employee health employees in those facilities. (Lists were recently provided to chapter presidents). Briefly introduce them to AOHP and refer them to the AOHP website, or offer to send them information. Be sure to let them know what you value about your membership in AOHP. • Connect with occupational/employee health providers in non-hospital facilities such as clinics and post-acute care.
The new ROC campaign offers a grand prize that includes free registration to the next AOHP National Conference, three nights hotel, airfare reimbursement up to $250, round trip transportation from the airport to the conference hotel (up to $50), and a free AOHP membership for the following year. The total value of this prize is approximately $1,500. It would be so exciting to award this prize for the first time to one of our members at our conference in Glendale, Arizona in September 2018!
The current ROC campaign period runs from July 1, 2017 through June 30, 2018. There is still plenty of time to work toward a ROC reward, so get busy!
LET’S ROC! The following ROC awards are available: • The Whole Shebang – one award to the member recruiting the most new members (must recruit at least 10 to qualify). • Kit and Caboodle – awarded to members recruiting 10 or more new members, but not the winner of The Whole Shebang. • Half Kit and Caboodle – awarded to members recruiting six to nine new members. • Caboodle – awarded to members recruiting three to five new members. • Feather in My Cap – awarded to members recruiting one to two new members. • Pie in the Sky Chapter Award – awarded to the chapter recruiting the most new members.
For full details of the awards and campaign rules, please visit http://www.aohp.org/aohp/MEMBERSERVICES/RecruitOurColleagues(ROC).aspx. You can download a ROC Flyer - http://www.aohp.org/aohp/Portals/0/Documents/MemberServices/ROC%20Flyer.pdf to share with your colleagues.
Every new member strengthens our organization. Participate in our ROC Revival by sharing the benefits of AOHP membership with your colleagues, and earn rewards that will benefit your practice. For more information, visit www.aohp.org, call Headquarters at 800-362-4347, or email [email protected].
***In order to count as your recruit, new members must list your name as their recruiter when completing their AOHP Membership Application!
Let’s ROC someone’s world!!! Recruit Our Colleagues! Reach out and share the benefits of AOHP membership with your area colleagues.
16 Spring 2018
AOHP Annual Treasurer’s Report Year Ending 2017
In looking back at 2017, AOHP contin- AOHP publishes the Journal of the As- The following graphs depict AOHP’s ues to maintain financial stability with a sociation of Occupational Health Pro- financial position for the year 2017. balanced budget as we move forward fessionals in Healthcare quarterly. The Questions concerning this report, or into 2018. The AOHP Board strives to association also utilizes the services of requests for additional information, can maintain a positive financial position as a management company, Kamo Man- be obtained by contacting me by e-mail an organization to meet the needs of agement Services, LLC, to handle daily at [email protected] or by our members by providing resources, activities. Kamo is paid a fixed monthly phone at 303-789-8491. The financials assistance, and educational opportuni- fee, with separate charges for cer- are available for members to review ties that are beneficial and of interest. tain other services, and is contracted upon request. We explore opportunities to expand through December 31, 2021. membership, produce positive market- AOHP strives to maintain financial sta- ing strategies, and investigate other Overview for 2017: bility, and we welcome your sugges- sources of revenue to grow as an orga- • Total income and expenses for 2017 tions as AOHP moves forward as a nization. remained stable. world class organization. • Publications and advertising revenue A financial review was completed for continued to increase. Respectfully submitted, the year ending December 31, 2017 • Membership income remained sta- Dana Jennings, RN, BSN, CCM in accordance with accepted auditing ble. AOHP Executive Treasurer standards. AOHP works with Stelmack, • Annual National Conference income Dobransky and Eannace, LLC, certified and expense ratio continues to be public accountants and business con- positive. sultants.
AOHP Income Summary AOHP Expense Summary January through December 2017 January through December 2017 AOHP EXPENSE SUMMARY Total IncomeAOHP INCOME = $407,331.25 SUMMARY Total Expenses = $393,256.07 JANUARY - DECEMBER 2017 JANUARY - DECEMBER 2017 TOTAL INCOME $407,331.25 TOTAL EXPENSE $393,256.07 Webinars .19% Chapter Rebate, Publication-GS Broadcast Email Serv CEU .01% Journal Ads & 1.54% 1.44% Marketing, 2.76% .49% Subscriptions 2.89% Strategic Init., .91% CEU, .37% Job Posting Awards, .47% 1.66% Publications, 8.47% Other .21% Meetings, 4.9%
Dues 32.27% Conference, 50.39%
Confernce Revenue Mgmt Fee, 17.09% 60.84%
Operations, 13.11%
17
Mark Your Calendar! AOHP 2018 National Conference September 5-8, 2018 Glendale, AZ Renaissance Glendale Hotel 9495 W. Coyotes Blvd., Glendale, AZ 85305
It is never too early to start planning. Join us at the 2018 National Conference – Occupational Health A-Z. It will feature the most up-to-date information from A to Z and everything in between. A conference for both novice and experienced professionals in many occupational health practices areas.
Need help to get approval? Go to our website http://www.aohp.org/aohp/EDUCATION/NationalConference.aspx to download the Articulating Attendance Value Guideline and use the template to help to justify your conference attendance with your supervisor.
Keep Your Benefits - Renew Your Membership! AOHP is your single best source for advanced practice information and support, and the only national professional organization with an exclusive focus on the needs and concerns of occupational health professionals in healthcare. Our association represents thousands of healthcare workers – including you. AOHP’s success is measured by the level of experience and dedication shown by our members.
The deadline to renew your membership for the coming year is February 28, 2018, but you can renew at any time online at https://www.aohp.org/aohp/MEMBERSERVICES/RenewMembership.aspx. Just log in with your user name, as showed on the renewal notice, and password.
Please budget accordingly for 2018 so you can retain all the benefits AOHP offers while continuing to be a part of this vibrant, thriving organization that is well known as an authority in occupational health in healthcare.
Do You Know the Many Benefits AOHP Offers to Members? Let’s Name A Few!
Listserv AOHP hosts an electronic Discussion Email List Service as a free benefit of membership. The purpose of the AOHP Listserv is to facilitate discussions among AOHP members. By joining, you can connect with colleagues across the nation via email to share best practices and dialogue about the challenges and successes of working in occupational health in healthcare. Subscribe now to explore electronic networking, change your subscription format and access archived posts.
E-Bytes AOHP E-Bytes provides a summary of current occupational health information. It is distributed electronically from Headquar- ters every month and provides updates on the latest educational, regulatory and association information to keep members informed about pertinent, current information related to your professional practice.
AOHP Insight! AOHP Insight, offered exclusively to AOHP members, provides a wide range of occupational health tools and resources that can enhance every level of practice from beginner to enhanced. From up-to-date professional information to legislative updates, AOHP Insight is committed to deliver the knowledge you need to the right place, at the right time.
For more information about the benefits of your AOHP membership, visit http://www.aohp.org/aohp/MEMBERSERVICES/MemberBenefits.aspx or email [email protected]. Spring 2018
Nursing Overtime: Should It Be Regulated?
By Cathleen Wheatley, MS, RN, CENP
Definitions of Overtime by Lobo and colleagues (2015). Discus- Executive Summary A fundamental challenge in assessing sions of the overtime concept have ad- Nursing overtime is common in the prevalence and consequences of dressed antecedents that are societal, health care to accommodate staff- nursing overtime is the lack of a con- organizational, and individual; attributes ing needs despite evidence that it sistent definition. Lobo, Fisher, Ploeg, of perception of control or reward, rela- increases the incidence of patient and Peachy, and Akhtar-Danesh (2013) found tive value to off duty; and the stress as- nurse adverse events. the term overtime was poorly defined sociated with inability to prepare; and Some states have been successful and indiscriminately used. Definitions consequences that both benefit and in implementing overtime regulation; included mandatory, voluntary, coerced, impose risk for key stakeholders, includ- however, attempts at the federal and extended work hours; working an ing nurses, patients, and organizations level remain unsuccessful. off day; having on-call hours; having un- (Lobo et al., 2013) highlighting the com- paid versus paid overtime; and varied plexity of nursing overtime as a phenom- The healthcare industry faces ongoing quantifications of hours per week and enon of interest to the profession, indus- challenges with cost containment, work- hours per extended shift. They noted try, and society. force shortages, and a growing chronical- lack of agreement on the definition has ly ill patient population. These challenges led to disparate research methodolo- Overtime Prevalence are driven by reimbursement constraints gies, limiting the validity of findings and Nursing overtime is prevalent in the and expanding unfunded care; a global the ability to compare results or develop United States and in Europe. Bae (2012) shortage of nurses and other providers; appropriate intervention strategies. Sim- found 60% of U.S. nurses surveyed and the aging Baby Boomer generation’s ilar inconsistencies were found in the worked at least one type of overtime, consumption of services and longer life author’s review (see Table 1), and in an with only 10% reporting unpaid over- expectancy (Garrett, 2008). To maintain integrative review of nursing overtime time. Of nurses who reported work- economic viability, hospitals must pro- vide services to as many patients as Table 1. Overview of Published Literature on Nurse Overtime: Study Definitions and Table 1. possible to leverage overhead, maximize MethodologiesOverview of Published Literature on Nurse Overtime: Study Definitions and Methodologies revenue, and meet federal and state mandates for provision of services. Key Source Overtime Definition Methodology Bae, 2012 Paid and unpaid mandatory, paid and unpaid voluntary, paid Cross-sectional survey strategies employed by the healthcare and unpaid on call, an excess of 40 hours per week in industry to provide appropriate nurse principal position staffing levels include the use of con- Bae, 2013 Paid and unpaid mandatory, paid and unpaid voluntary, paid Cross-sectional survey and unpaid on call, an excess of 40 hours per week in tracted labor, flexible unbenefited posi- principal position tions, and both mandatory and voluntary Bae & Brewer, 2010 Mandatory/unscheduled overtime, voluntary overtime, paid Secondary analysis of cross- overtime (Lobo, Fisher, Peachey, Ploeg, on call, hours per week of 41-60 and ≥61 sectional survey data Bae & Yoon, 2014 In excess of 40 hours hours worked per week and in excess Quasi-experimental & Akhtar-Danesh, 2015). of 60 hours in principal position Beckers et al., 2008 Hours per week in excess of regularly scheduled/contracted Questionnaire Concerns have arisen about the nega- hours tive impact of overtime on both nurses Berney et al., 2005 Hours per week in excess of 40 hours Secondary analysis of institutional and patients due to nurse fatigue from cost reports Geiger-Brown et al., 2011 Hours per day in excess of 9-11 and ≥12; hours per week of Longitudinal survey with random long work hours, inadequate sleep, and 41-49 and ≥50 selection inadequate recovery time between Griffiths et al., 2014 Shift length of 8.1-10, 10.1-11.9, 12-13, >13 hours Cross-sectional survey shifts (Bae, 2012; Garrett, 2008). Nurs- Olds & Clarke, 2010 Mandatory overtime, paid overtime, and unpaid overtime Secondary analysis of anonymous ing overtime, regulations governing questionnaire, random selection overtime, and the effects of those regu- Rogers et al., 2004 Hours worked that exceeded scheduled hours, scheduled Prospective survey lations are reviewed, and a call to action overtime hours is posed. Stimpfel et al., 2015 Shift length of 8, 10, 12, or “other” hours; mandatory and Secondary analysis of cross- voluntary overtime hours (not quantified) worked per week in sectional survey data principal position
19 In European countries, Griffiths and colleagues faction have been associated with involuntary over- (2014) found 27% of nurses reported working over- time (Beckers et al., 2008; Garrett, 2008), and an time, but there was wide variation between hospitals increased odds ratio (OR) of inadequate sleep (OR and countries. Approximately half of all nurses 1.36) was found in nurses working mandatory over- (working both 8 and 12-hour shifts) reported working time or being on call more than once per month and some overtime, but nurses who worked shifts longer for quick turnarounds (Geiger-Brown, Trinkoff, & than 13 hours reported the most end-of-shift overtime Rogers, 2011). A greater occurrence of inadequate (60%). sleep was found for nurses working 9-11 hours per day versus 8 or fewer, and for those reporting week- Overtime Effects end shift work compared to those working no week- Researchers exploring the effects of nursing over- ends (Geiger-Brown et al., 2011). In addition to safety time have identified relationships between overtime risks, the fatigue associated with overtime negatively and practice errors, nurse fatigue and injuries, and impacts nurse morale and increases turnover intent, adverse patient outcomes (Bae & Fabry, 2014; Beckers with associated increased organizational costs due to et al., 2008; Lobo et al., 2015; Olds & Clarke, 2010; vacancies and voluntary turnover (Garrett, 2008; Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Reed, 2013). Medication administration errors were the most fre- An association between overtime and nurse out- quently reported practice error. Olds and Clarke comes such as needlestick and musculoskeletal (2010) found nurses working overtime of any type injuries, fatigue, illness, absenteeism, burnout, job reported an increased occurrence of wrong-dose med- dissatisfaction, and turnover intent was reported in ication error, and Lobo and coauthors (2015) identi- studies reviewed by Bae and Fabry (2014). They fied similar findings after 4 hours of overtime, regard- found a statistically significant relationship between less of shift length. Nurse fatigue and low work satis- overtime and falls, pressure ulcers, and nosocomial
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ing overtime, 54% worked less than thors (2015) identified similar findings An association between overtime and 12 hours a week of overtime and 46% after 4 hours of overtime, regardless of nurse outcomes such as needlestick and worked 12 hours or more per week. shift length. Nurse fatigue and low work musculoskeletal injuries, fatigue, illness, For those working less than 12 hours, satisfaction have been associated with absenteeism, burnout, job dissatisfac- 62% reported voluntary overtime, 18% involuntary overtime (Beckers et al., tion, and turnover intent was reported in mandatory, and 37% on call. For those 2008; Garrett, 2008), and an increased studies reviewed by Bae and Fabry working 12 hours or more per week odds ratio (OR) of inadequate sleep (2014). They found a statistically signifi- of overtime, 35% reported mandatory (OR 1.36) was found in nurses work- cant relationship between overtime and and 72% on call. Of the total sample, ing mandatory overtime or being on call falls, pressure ulcers, and nosocomial approximately 17% reported working more than once per month and for quick infections. Significant relationships were more than 40 hours per week as the turnarounds (Geiger-Brown, Trinkoff, & also found between quick turnarounds norm. Most nurses reported working Rogers, 2011). A greater occurrence of and hypoglycemic events and pneumo- overtime to make money and/or to not inadequate sleep was found for nurses nia deaths. let their co-workers down. Nurses who working 9-11 hours per day versus 8 or worked unpaid overtime reported doing fewer, and for those reporting weekend An increased risk of needlestick injury so to finish their work. Approximately shift work compared to those work- was reported by Stimpfel, Brewer, and half of the sample reported chronic nurs- ing no weekends (Geiger-Brown et al., Kovner (2015) in newly licensed nurses ing shortages on their unit. 2011). In addition to safety risks, the who worked 12-hour shifts, over 40 fatigue associated with overtime nega- hours per week, and weekly overtime Berney, Needleman, and Kovner (2005) tively impacts nurse morale and in- greater than 8 hours per week, with sig- found similar high usage in a retrospec- creases turnover intent, with associated nificance (incidence rate ratio 1.25) at tive study of nursing overtime in New increased organizational costs due to va- more than 8 hours of weekly overtime. York hospitals between 1995 and 2000, cancies and voluntary turnover (Garrett, When comparing nurses working more with an average of 4.5% of total worked 2008; Reed, 2013). than 8 hours of overtime per week with hours as overtime in all hospitals. Hospi- those who did not work overtime, they tal characteristics associated with higher overtime usage were for-profit status, unionization, lower nurse-to-patient ra- Table 2. Overview of State Nursing OvertimeTab lRegulationse 2. (as of 2015)* tios, and higher wages for registered Overview of State Nursing Overtime Regulations (as of 2015)* nurses. Year State Mandatory Overtime Shift Length and Respite Requirements Passed Alaska Illegal 14 consecutive hours 2010 In European countries, Griffiths and col- California Illegal, right to refusal without retaliation 12 hours in any 24-hour period 2001 leagues (2014) found 27% of nurses re- Extension required beyond scheduled shift ported working overtime, but there was Connecticut Illegal length prohibited except for emergency or 2004 completion of procedures wide variation between hospitals and Shift extension capped at 4 hours even for countries. Approximately half of all nurs- Illinois Illegal emergencies, 8-hour required rest following any 2005 es (working both 8 and 12-hour shifts) 12-hour shift Maine Illegal, right to refusal without retaliation 10 consecutive rest hours after working any reported working some overtime, but 2001 overtime nurses who worked shifts longer than Maryland Illegal Require extension beyond scheduled shift in a 13 hours reported the most end-of-shift predetermined schedule prohibited unless 2002 overtime (60%). emergency or critical skill needed Massachusetts Illegal 12 consecutive hours in any 24-hour period 2012 Overtime Effects Minnesota Illegal, right to refusal without retaliation 12 consecutive hours 2002 Researchers exploring the effects of Missouri Illegal for licensed practical nurses only None 2006 New Hampshire Illegal, right to refusal without retaliation 12 consecutive hours 2008 nursing overtime have identified rela- New Jersey Illegal Hours per week cannot exceed 40 2002 tionships between overtime and prac- New York Illegal None 2008 tice errors, nurse fatigue and injuries, Oregon Illegal 12 consecutive hours, hours per week cannot and adverse patient outcomes (Bae & exceed 48, shift extension capped at 4 hours 2001 even for emergencies Fabry, 2014; Beckers et al., 2008; Lobo Extension beyond scheduled shift prohibited Pennsylvania Illegal 2008 et al., 2015; Olds & Clarke, 2010; Rogers, except for emergency Hwang, Scott, Aiken, & Dinges, 2004). Rhode Island Illegal 12 consecutive hours 2008 Medication administration errors were Texas Illegal, right to refusal without retaliation None 2007 the most frequently reported practice er- Washington Illegal, right to refusal without retaliation None 2002 ror. Olds and Clarke (2010) found nurses West Virginia Illegal, right to refusal without retaliation 16 consecutive hours, 8 consecutive hours rest 2004 working overtime of any type reported required after any 12-hour shift an increased occurrence of wrong-dose * Emergency situation exceptions apply. medication error, and Lobo and coau- SOURCE: Adapted from J. Haebler, American Nurses Association, personal communication, July 13, 2016. 20 ment by the hospital to the nurse for refusing such an time refusal. Findings indicated states that restricted assignment. Neither bill progressed through the leg- total hours worked showed more mandatory overtime islative process in the 114th Congress. usage than states that did not, indicating a possible permissive effect for mandatory overtime within Impact of Regulation capped limits. Voluntary overtime was not similarly Bae and Brewer (2010) analyzed total nursing affected. Conversely, in a later study, Bae and Yoon hours worked, regular and overtime, including both (2014) found states with regulations limiting manda- mandatory and voluntary, in states with and without tory overtime and consecutive work hours reduced overtime regulations. Regulations included restric- mandatory overtime hours by 3.9 percentage points tions on total hours worked per day or per week, ban- and the incidence of working more than 40 hours per ning of mandatory overtime, and nurse right to over- week by 11.5 percentage points, concluding that both
216 NURSING ECONOMIC$/July-August 2017/Vol. 35/No. 4 Spring 2018
found a 32% increased risk (incidence and several state regulations on nurs- Act and stipulates that Medicare-partic- rate ratio 1.32) for the overtime group. ing overtime or extended shift regula- ipating hospitals establish a nurse staff- An increased risk of musculoskeletal in- tion, overtime in the healthcare industry ing committee comprising a minimum juries such as neck and back strain has remains largely unregulated at both the of 55% direct-care nurses and develop been similarly associated with overtime federal and state levels (Berney et al., staffing plans specific to each unit to and extended shift length (Bae & Fabry, 2005; Brooke, 2011). provide safe levels of nursing care based 2014; Lobo et al., 2015; Olds & Clarke, on patient population and nurse profi- 2010; Stimpfel et al., 2015). Many state-based nursing associations ciency (Civic Impulse, 2017a). H.R. 2083 have been pursuing nursing manda- also includes whistle-blower protections Olds and Clarke (2010) found a statisti- tory overtime regulation since the early and requires public reporting of staffing cally significant increased risk for patient 2000s (Schildmeier, 2012). In general, information, including nursing overtime falls with injury (p<0.05) and for noso- regulations prohibit hospitals and other usage. The second, the Nurse Staffing comial infections (p<0.01) for nurses healthcare institutions such as nursing Standards for Patient Safety and Qual- working over 40 hours in the average homes from forcing nurses to work more ity of Care Act of 2015 (H.R. 1602), was week. Lobo and associates (2015) found than their regularly scheduled hours introduced in 2004 and reintroduced in significant relationships between over- (Bae & Brewer, 2010). As of 2017, 18 2005, 2007, 2009, 2011, 2013, and 2015 time and catheter-associated urinary states have passed legislation restricting (Civic Impulse, 2017b). This bipartisan bill tract infections (OR 4.72) and pressure nurses’ mandatory overtime (J. Haebler, would amend the Public Health Service ulcers (OR 1.91). Bae (2013) found simi- personal communication, January 30, Act and require hospitals to establish lar trends for falls (OR 3.36) and for pres- 2017). As shown in Table 2, some states minimum direct-care registered nurse- sure ulcers (OR 3.50). have regulation addressing mandatory to-patient staffing ratios. The bill would overtime only, while others include re- allow nurses to refuse any assignment Despite the negative effects of nursing strictions on shift length and required they believe breaches minimum ratios overtime, select stakeholders receive respite periods. All states exempt these or for which they do not feel prepared, advantages. Healthcare facilities can regulatory requirements during emer- by education or experience, to perform manage nursing shortages and high cen- gency or disaster situations, and some the assignment without compromising sus peaks without hiring additional per- states, such as Massachusetts, have de- patient safety or their own license. The manent personnel with the associated fined emergency situations that qualify bill would prohibit retaliation or discrimi- costs for benefits (Berney et al., 2005; for the mandatory overtime exemption natory treatment by the hospital to the Griffiths et al., 2014), and nurses are (“Nursing Practice Alert,” 2013). nurse for refusing such an assignment. able to “make money” (Bae, 2012, p. Neither bill progressed through the leg- 69) and eliminate the negative financial Attempts to regulate nursing mandatory islative process in the 114th Congress. impact of flexing down during low cen- overtime at the federal level occurred in sus periods (Nelson & Kennedy, 2008). 2005 with the introduction of the Safe Impact of Regulation Mandatory overtime restrictions also Nursing and Patient Care Act (H.R. 791). Bae and Brewer (2010) analyzed total benefit certain groups: travel nurses and This bill would have prohibited Medicare- nursing hours worked, regular and over- their employers have the potential to participating healthcare facilities from time, including both mandatory and vol- benefit from the opportunities created mandating nurses to work more than 12 untary, in states with and without over- when hospitals turn to this contracted hours in a 24-hour period or more than time regulations. Regulations included labor pool to manage staffing needs 80 hours in a 2-week period except dur- restrictions on total hours worked per without breaching overtime restrictions ing emergencies or disasters (Gonzalez, day or per week, banning of mandatory (Sederstrom, 2013). 2005). The bill did not progress further overtime, and nurse right to overtime through the legislative process and has refusal. Findings indicated states that Current Regulations not been reintroduced to subsequent restricted total hours worked showed The negative effect of fatigue on perfor- congressional sessions. more mandatory overtime usage than mance has been demonstrated in other states that did not, indicating a pos- high-risk industries such as aviation, Current attempts to address safe nurs- sible permissive effect for mandatory commercial vehicle transit, and public ing staffing have been approached in overtime within capped limits. Voluntary safety (Lindsay, 2007; Olds & Clarke, two related acts, neither of which spe- overtime was not similarly affected. Con- 2010). While these industries have cifically restricts nurses’ mandatory versely, in a later study, Bae and Yoon work hour regulations, the healthcare overtime or shifts. The first, the Regis- (2014) found states with regulations sector has been slow to adopt similar tered Nurse Safe Staffing Act of 2015 limiting mandatory overtime and con- regulations (Berney et al., 2005; Lind- (H.R. 2083/S.1132), was introduced in secutive work hours reduced mandatory say, 2007). Except for work hour restric- 2007 and reintroduced in 2010, 2011, overtime hours by 3.9 percentage points tions for medical residents instituted by 2013, and 2015 (Civic Impulse, 2017a). and the incidence of working more than the Accreditation Council for Graduate This bipartisan bill would amend Title 40 hours per week by 11.5 percentage Medical Education in the early 2000s XVIII (Medicare) of the Social Security points, concluding that both mandatory 21 Journal of the Association of Occupational Health Professionals in Healthcare
overtime and consecutive work hour Cathleen Wheatley, MS, RN, CENP, is Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A., Aiken, L.H. (2014). Nurses’ shift length regulations effectively reduced nurse Chief Nurse Executive and Vice Presi- and overtime working in 12 European countries: The hours worked. In the analysis of the as- dent of Clinical Operations, Wake Forest association with perceived quality of care and patient sociation between mandatory overtime Baptist Health, Winston Salem, NC. safety. Medical Care, 52, 975-981. doi:10.1097/MLR.0000000000000233 regulation and outcomes, no effect was Lindsay, D. (2007). Police fatigue. FBI Law Enforce- shown for nurse injuries, but the regula- REFERENCES ment Bulletin, 76(8), 1-8. tion of mandatory overtime was associ- Bae, S. (2012). Nursing overtime: Why, how much, and Lobo, V., Fisher, A., Peachey, G., Ploeg, J., & Akhtar- ated with statistically significant higher under what working conditions? Nursing Economic$, Danesh, N. (2015). Integrative review: An evaluation of 30(2), 60-72. odds of nurse-reported adverse patient the methods used to explore the relationship between Bae, S. (2013). Presence of nurse mandatory overtime overtime and patient outcomes. Journal of Advanced events, inferring the same permissive regulations and nurse and patient outcomes. Nursing Nursing, 71(5), 961-974. doi:10. 1111/jan.12560 effect in capped-hour states (Bae, 2013). Economic$, 31(2), 59-89. Lobo, V.M., Fisher, A., Ploeg, J., Peachey, G., & Akhtar- Bae, S., & Brewer, C. (2010). Mandatory over- Danesh, N. (2013). A concept analysis of nursing over- Conclusion time regulations and nurse overtime. Poli- time. Journal of Advanced Nursing, 69(11), 2401-2412. cy, Politics & Nursing Practice, 11(2), 99-107. doi:10.1111/jan.12117 Nursing overtime, both mandatory and doi:10.1177/1527154410382300 voluntary, is prevalent in the healthcare Nelson, R., & Kennedy, M. S. (2008). The other side Bae, S., & Fabry, D. (2014). Assessing the relationships of mandatory overtime. American Journal of Nursing, industry as a solution for managing staff between nurse work hours/overtime and nurse and pa- 108(4), 23-24. shortages and high census episodes. tient outcomes: Systematic literature review. Nursing Nurse Staffing Standards for Patient Safety and Quality Outlook, 62(2), 138-156. Care Act of 2015, H.R. 1602, 114th Cong. (2015) There is sufficient evidence of the nega- doi:10.1016/j.outlook.2013.10.009 tive impact of this practice on nurse per- Nursing practice alert: Update on new law banning Bae, S., & Yoon, J. (2014). Impact of states’ nurse work sonal wellness and risk for workplace mandatory overtime. (2013). Massachusetts Nurse hour regulations on overtime practices and work hours Advocate, 84(2), 4. injury, patient outcomes, and nursing among registered nurses. Health Services Research, 49(5), 1638-1658. doi:10.1111/1475-6773.12179 Olds, D.M., & Clarke, S.P. (2010). The effect of work turnover to warrant the continued atten- hours on adverse events and errors in health care. Jour- tion of policymakers. Current evidence Beckers, D.G.J., van der Linden, D., Smulders, P.G.W., nal of Safety Research, 41(2), 153-162. doi:10.1016/j. Kompier, M.A.J., Taris, T.W., & Geurts, S.A.E. (2008). jsr.2010.02.002 demonstrating the impact of regulation Voluntary or involuntary? Control over overtime and is limited by the lack of a consistent defi- rewards for overtime in relation to fatigue and work Reed, K. (2013). Nursing fatigue and staffing costs: satisfaction. Work & Stress, 22(1), 33-50. What’s the connection? Nursing Management, 44(4), nition for nursing overtime and by dispa- doi:10.1080/02678370801984927 47-50. doi:10.1097/01.NUMA.0000428198.52507.0a rate research methodologies. Nurse re- Berney, B., Needleman, J., & Kovner, C. (2005). Fac- Registered Nurse Safe Staffing Act of 2015, H.R. 2083, searchers need to continue to study this tors influencing the use of registered nurse overtime in 114th Cong. (2015). topic to advance the body of knowledge hospitals, 1995-2000. Journal of Nursing Scholarship, Rogers, A.E., Hwang, W., Scott, L.D., Aiken, L.H., & and support the development and pro- 37(2), 165-172. doi:10.1111/j.1547- 5069.2005.00032.x Dinges, D.F. (2004). The working hours of hospital staff nurses and patient safety: Both errors and near errors motion of effective regulation. Although Brooke, P. S. (2011). Legally speaking ... when can staff say no? Nursing Management, 41(1), 40-44. are more likely to occur when hospital staff nurses several states have been successful in doi:10.1097./01.NUMA. 0000391673.35403.4b work twelve or more hours at a stretch. Health Affairs, 23(4), 202-212. regulating nursing overtime and extend- Civic Impulse. (2017a). H.R. 2083. 114th Congress: ed shifts, attempts at the federal level Registered Nurse Safe Staffing Act of 2015. Retrieved Safe Nursing and Patient Care Act of 2005, H.R. 791, 109th Cong. (2005). have not been successful. Two bills pro- from https://www.govtrack.us/congress/bills/114/ hr2083 posed to the 114th Congress had the po- Schildmeier, D. (2012). Massachusetts nurses win Civic Impulse. (2017b). H.R. 1602. 114th Congress: mandatory overtime ban. National Nurse, 108(6), 8-8. tential to address the problem through Nurse Staffing Standards for Patient Safety and Qual- Sederstrom, J. (2013). Overtime mandate can benefit staffing requirements and transparency, ity of Care Act of 2015. Retrieved from https://www. travel nurses. Healthcare Traveler, 21(2), 10-15. govtrack.us/congress/bills/ 114/hr1602 but they lacked specific language relat- Stimpfel, A.W., Brewer, C.S., & Kovner, C.T. (2015). ed to overtime, extended shifts, or re- Garrett, C. (2008). The effect of nurse staffing patterns Scheduling and shift work characteristics associated on medical errors and nurse burnout. AORN Journal, with risk for occupational injury in newly licensed spite periods. Neither bill was enacted; 87(6), 1191-1204. doi:10.1016/j.aorn.2008.01.022 registered nurses: An observational study. Interna- either those bills or new bills will need Geiger-Brown, J., Trinkoff, A., & Rogers, V. E. (2011). tional Journal of Nursing Studies, 52(11), 1686-1693. to be introduced to the 115th Congress The impact of work schedules, home, and work de- doi:10.1016/j.ijnurstu.2015.06.011 for further progression. Continued ef- mands on self-reported sleep in registered nurses. Journal of Occupational & Environmental Medicine, Reprinted from Wheatley, C. (2017). Nursing Overtime: forts by individual nurses, professional 53(3), 303-307. doi:10.1097/JOM. 0b013e31820c3f87 Should It Be Regulated? Nursing Economic$, 35(4), nursing associations, and other vested Gonzalez, R. (2005). The politics of caring. American 213-217. Reprinted with permission of the publisher, stakeholders should focus on influenc- Journal of Nursing, 105(4), 37-37. Jannetti Publications, Inc., East Holly Avenue, Box 56, ing policymakers through direct personal Pitman, NJ 08071-0056. contact, lobbying, expert testimony, po- litical action committees, policy drafts, alignment with other stakeholder spe- cial interest groups, as well as exercis- ing the power of the ballot.
22 Spring 2018
Perspectives in Healthcare Safety By Cory Worden, PhD Candidate, MS, CSHM, CSP, CHSP, ARM, REM, CESCO The Pragmatic Development of Actionable Processes to Reach High-Reliability Goals
There have been several in- others, they counter the very cupation with failure? What pert is not the ranking person stances in both written and hierarchal structures they’ve does that look like? Obvious- on the scene? (Christianson, spoken language in which I known since entering the ly, organizations are much at- Sutcliff et al., 2011). In short, have called the safety profes- workforce - healthcare orga- tuned to operations and their how does high-reliability be- sion "professionally paranoid." nizations, military, public ser- outcomes, so how does an come operationalized? Later, as I’ve briefed high-re- vice, or other organizations. organization show sensitivity liability theory and operation- to operations? If an organiza- Operationalization alization, others have called For example, while organi- tion, especially military, fire In seeking to operationalize me and the safety profes- zations are striving to meet protection, and law enforce- high-reliability theory and to sion "paranoid." Some mean customer satisfaction stan- ment units, has had centuries create an organization consis- it as a compliment, a tell-tale dards, regulatory compliance of hardwired chains of com- tently aspiring to better their of someone doing diligence measurements, and key per- mand, how exactly do these operations, the timeline of through each operation. Oth- formance indicators, how ex- teams learn to defer to exper- an incident can be consulted ers mean it quite literally, be- actly does one display preoc- tise when that supposed ex- (Worden & Lombardo, 2016). lieving me and the concept of high-reliability to be an act of Figure 1 – The incident timeline with the high-reliability principles applied to each pragmatic, paranoia, being over the top actionable process in high-reliability safety. and a loose cannon. Some have gone so far as to accuse me of being against the very organization I advocate for, as though bypassing safety is a noble act of loyalty to one’s employer.
High-reliability organizations can be distilled down to those who strive to create the saf- est and most effective opera- tions. They then constantly re-assess these operations for any semblance of the pos- sibility of failure so that con- cerns can be resolved before an incident occurs, including near-miss events.
High-reliability principles in- clude: preoccupation with failure; reluctance to simpli- fy; sensitivity to operations; deference to expertise; and commitment to resilience. These principles often come across to the uninitiated as abstract concepts, while to
23 Journal of the Association of Occupational Health Professionals in Healthcare
Within this timeline, all proac- With this, the organization gage in reluctance to simpli- needles in the appropriate tive measures such as hazard has now created a pragmatic fy. Often, organizations will disposal boxes. Furthermore, analyses, information pro- means to be preoccupied assume that employees have another observation could grams, and leading indicators with failure. Additionally, by been trained on a process be to check whether the fall to the left of the incident, gathering information on and that this will enable safe needle disposal boxes are a phenomenon Riley and Van processes, equipment, and operations when, in fact, the appropriately designed (such Horne of the United States other factors in the work- most effective hazard control as puncture-resistant) and Marine Corps referred to as place, deference to expertise has not been implemented, placed (such as appropriate striving to keep all actions is also now exemplified in an so the safest possible op- height on the wall). to the left of bang (Riley & actionable process. erations are not possible. Van Horne, 2014). All actions The organization has tried to On the contrary, lagging indi- falling to the right of the inci- Hazard Controls and In- simplify the process where it cators are the measurements dent are reactive, the actions formation Programs should not have. of how many incidents oc- responding, recovering, and Once hazards are analyzed, curred and how bad the con- reconstituting from the inci- hazard controls must be put Leading and Lagging sequences were – physically, dent. By placing operational, in place for each to prevent Indicators financially, and otherwise actionable activities around or mitigate injuries or dam- After safe processes are im- – when the hazard controls each element of the incident age from the hazard. These plemented, the potential inci- and safe work practices timeline, high-reliability can hazards must be addressed dent on the incident timeline were not followed. For ex- transition from an abstract with the most effective haz- falls between leading and ample, should the previously concept to a pragmatic, ac- ard control, starting with lagging indicators. Leading discussed machine guard not tionable practice. elimination and moving on indicators are the processes be used and incidents occur, to substitution, engineering, developed to validate wheth- lagging indicators – those Hazard Analysis administration, and Personal er or not the pre-determined indicators developed and Hazard analyses are an ongo- Protective Equipment if not safe processes and hazard measured after the incident ing, constant practice of pro- possible. Additionally, as controls are being operation- has occurred – could be the active organizations. With- with any hazard control, train- ally used and whether or not number of incidents from out consistent and recurring ing must be provided to en- they are operationally effec- the same causal factors, the efforts to identify possible sure all affected employees tive and as safe as possible. causal factors themselves – failure modes and means to know how to use the control, For example, if the deter- such as lack of training, lack resolve them, the organiza- where it is located, how to mined hazard control for a of equipment, human error, tion will be vulnerable to un- maintain it, and other means table saw is to use the ma- or other – financial implica- known hazards and threats. to the effective safe opera- chine guard over the point of tions of the incidents, or Hazard analyses must first be tions now enabled by the operation/saw blade, a lead- other. The major difference completed through a process implemented hazard control. ing indicator could be an ob- between leading indicators of brainstorming and also servation to monitor whether and lagging indicators is that through a reactive process to With these hazard controls or not the guard is being used a leading indicator provides identify failure modes already now in place and employ- and also whether or not the critical data that can be used observed. These analyses ees trained, an information guard is providing the proper to prevent injuries, while lag- must cover possible hazards program – everything from safety as intended. ging indicators can be used and threats and who in the bulletin boards to safety hud- to prevent future injuries, but organization is vulnerable to dles to emails to meetings to In another example, if the de- only based on data derived the hazard/threat. These haz- training sessions and every- termined hazard control for from injuries having already ards and threats can also be thing in between – provides avoiding a needlestick in a occurred. assessed by their function of consistent and recurring rein- healthcare organization is to frequency of previous occur- forcement of the expectation never recap needles, to nev- In terms of high-reliability op- rences and possible severity of the use of the applicable er leave needles in an uncon- erations, leading and lagging of consequence should the hazard controls. Through trolled area, and to always indicators again allow for def- hazard/threat manifest itself. these hazard control devel- safely dispose of contami- erence to expertise in that This can help in identifying opments and their associat- nated needles in the properly those most knowledgeable which hazards/threats are ed information programs, the placed disposal container, of the tasks at hand should more likely to manifest so organization has now created a leading indicator could be be consulted to determine that resources can be allo- a pragmatic means to con- an observation to see if em- which indicators to deter- cated to them more quickly tinue deferring to experts on ployees are not recapping mine, measure, and analyze when budget, manpower, each process to create the needles, not leaving needles regardless of rank, title, or and other constraints are ap- most effective hazard control laying in uncontrolled ar- position. Additionally, indica- plicable. while also beginning to en- eas, and safely disposing of tor development allows for
24 Spring 2018
sensitivity to operations in control was sufficient, or if pragmatic, operationalized the concept cannot become that these indicators should another culprit was at hand part of their operations. realized. However, when re- be developed to capture data in causing the incident. In ei- These must exist in every alized, it can create a safety during normal operational ther case, a thorough investi- part of the operation, every culture above and beyond all tempos so as to not interrupt gation into the incident based day. There cannot be a once- else. workflows and while allow- on the applicable lagging indi- a-year safety stand-down. ing for a commitment to re- cators allows for a pragmatic These high-reliability facets References silience. means to operationalize the must be in effect every day Christianson, MK, Sutcliffe, KM, Miller, appropriate high-reliability during every operation with MA & Iwashyna, TJ. (2011). Becoming a high reliability organization. Critical Care. Lagging indicators, despite concepts and to use them to every employee. The line Retrieved from https://www.ncbi.nlm. an incident having occurred, benefit safety throughout the employee must have just as nih.gov/pmc/articles/PMC3388695/ allow for resilience from the organization. much influence on the safety Riley, J. & Van Horne, PV. (2014). Left of bang. New York, NY: Black Irish Enter- incident and a means to de- of a process as the general tainment. Risk assessments: The catch- termine what went wrong, In Conclusion manager, especially as a sub- all for hazard analysis. (2011). Briefings whether the safe process Ultimately, high-reliability or- ject matter expert. There is on Hospital Safety, 19(3), 1-5. and hazard controls were ganizations must understand a great deal of swallowing Worden, C. & Lombardo, K. (2016). Situ- ational awareness: The often-ignored followed/used, whether the and implement high-reliabili- pride that goes into high-re- hazard control. AOHP Journal, 36(3), safe process and hazard ty principles as a real-world, liability concepts. Without it, 8-13.
2016 15th Edition Getting STARTED There's still time to buy the latest version of AOHP's renowned Getting Started Manual This comprehensive resource provides an overview of essential information the novice occupational health professional needs to promote the health, safety and well-being of healthcare workers. Some areas of occupational health practice that require expertise supported by Getting Started include: • New regulatory mandates and compliance requirements. • Health hazards associated with new technologies. • Emphasis on a safe and healthy worksite. • Recordkeeping processes and requirements. • Health assessments and fitness for duty policies. • Injury prevention and case management to reduce workers' compensation costs. • Risk management and loss control. • Emergency preparedness. If you purchased the 2014 edition of Getting Started after March 1, 2016, contact Headquarters at [email protected] to receive 40% off when you order the 2016 edition Getting Started Manual CD.
25 Journal of the Association of Occupational Health Professionals in Healthcare
Statins Affect Skeletal Muscle Performance: Evidence for Disturbances in Energy Metabolism
By Neeltje A. E. Allard,1 Tom J. J. Schirris,2,3 Rebecca J. Verheggen,1 Frans G. M. Russel,2,3 Richard J. Rodenburg,3,4 Jan A. M. Smeitink,3,4 Paul D. Thompson,5 Maria T. E. Hopman,1 and Silvie Timmers1
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26 Spring 2018
AOHP Awards and Scholarships Julie Schmid Research Scholarship The Association of Occupational Health Professionals in Healthcare invites proposals for an original research project on current and/or anticipated issues in hospital or healthcare-related occupational health. The Research Scholarship Award is $2,000. Proposals from non-members are welcome. The proposal deadline is July 1. Visit the AOHP website for more information at www.aohp.org. Other Awards and Scholarship Offerings AOHP proudly offers several additional opportunities for members and non-members alike. Do you or someone you know deserve to be nominated? Do you want to earn a free conference registration to attend the 2018 National Confer- ence? Nominate someone or apply TODAY! • AOHP Business Recognition Award – Recognizes a business(es) that supports occupational health professionals, and their membership and participation in AOHP. Nominations close July 1. • Honorary Membership Award - Recognizes a person(s) who is supportive of AOHP and has made a significant contribution to the field of occupational health in healthcare. Nominations close August 15. • Joyce Safian Scholarship Award - A $500 scholarship to be used for educational purposes. This scholarship recog- nizes a past or present association officer who best portrays an occupational health professional in healthcare role model. Nominations close July 1. • National Award for Extraordinary Member - Recognizes an association member who has demonstrated extraordi- nary leadership in the field of occupational health in healthcare. Nominations close July 1. • Sandra Bobbitt Continuing Education Scholarship - Provides annual continuing education scholarships to subsidize the educational efforts of members. Nominations close June 1. • Ann Stinson President’s Award for Association Excellence - Recognizes a chapter which has demonstrated out- standing performance and enhanced the image of occupational health professionals. Nominations close July 1. Consider applying for the AOHP awards and scholarships available to you. Learn more at http://www.aohp.org/aohp/ABOUTAOHP/AwardsScholarships.aspx.
33 Journal of the Association of Occupational Health Professionals in Healthcare WHILE YOU LOOK AFTER OTHERS, WHO LOOKS AFTER YOU? We do. AOHP Headquarters Chapter Presidents New England: Alfred Carbuto Annie Wiest, Executive Director Alabama: – contact Cynthia Hall [email protected] 125 Warrendale Bayne Road, Suite 375, New York – Nassau/Suffolk: Warrendale, PA 15086 California Northern: Curtis Chow Lorraine Chambers Lewis (800) 362-4347; Fax: (724) 935-1560 [email protected] E-mail: [email protected] Web: www.aohp.org [email protected] Southern: Lori McKinster Cox North Carolina: Jo Ella Waugh AOHP Executive Board of Directors [email protected] be [email protected] Executive President: Mary Bliss Florida: Susan Davis Pacific Northwest: Rebecca Schirle [email protected] [email protected] [email protected] Vice President: Lydia Crutchfield Georgia: Roger Burnett Pennsylvania: [email protected] [email protected] Central: Kimberly Kilheeney Executive Secretary: Stacy Stromgren [email protected] Heart of America – Kansas City: [email protected] Michelle Andra Eastern: Alfred Carbuto Executive Treasurer: Dana Jennings Tucker [email protected] [email protected] [email protected] Houston Area: Kathleen O'Neill Southwest: Megan Kapolka [email protected] [email protected] Regional Directors Illinois: Lorraine Pacha Rocky Mountain: Region 1: Jill Peralta-Cuellar [email protected] Rose Rennell [email protected] [email protected] Maryland: Tabe Mase Region 2: Cory Worden [email protected] South Carolina: E. Denise Smith [email protected] Michigan: Christine Schemansky [email protected] Region 3: Peggy Anderson [email protected] Virginia: Sarah Parris [email protected] Midwest States: Lisa Kincaid [email protected] Region 4: Alfred Carbuto [email protected] Wisconsin: Sharon (Sherry) Lemerond [email protected] [email protected] Region 5: Cynthia Hall [email protected]
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