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Working Overnight: Preventing, Controlling, And Training For Hazards

There is a unique set of risks for businesses that are required to operate 24 hours a day. Hazards in an after-hours working environment include everything from increases in slips and falls to a greater potential for workplace violence. The necessity for risk managers is to keep a vigilant eye on the different needs of these after-hours operations and to ensure that the work environment, employee training, and operation policies reflect the added risks inherent in the evening and overnight shifts.

Overnight Slip-and-Fall Risks

The following case study illustrates a common risk and workers compensation exposure associated with working overnight in a health-care organization — slips and falls.

Case Study: Two months ago, I.M. Well Medical Center modified the floor-care protocols used by their housekeeping department to maintain the shine on the floors in patient care units. The new protocol specified that all stripping and re-waxing of floors would be done between 5 p.m. and midnight, Monday through Friday. At 9:45 p.m. on Thursday, on the medical surgical floor, the workers in charge of floor maintenance had just finished stripping the floor and were beginning the process of re-waxing it. The patient care unit was very busy. It had a full census (every bed was occupied). The patients were very ill and were both mentally and physically compromised. The vacation schedule had also left the unit short one nurse, so the nurse supervisor had asked Mary to work a double shift. Mary, a 58-year-old registered nurse with osteoporosis, had two years to go before her early retirement. Because she needed extra money, she agreed to work her normal first shift (from 7 a.m. to 3:00 p.m.) and a second shift from 3:00 p.m. to 11:00 p.m.

The first shift had been extremely hectic and the second showed no sign of being any easier. Mary was not accustomed to being up at this time of night and was physically exhausted. The spicy vending machine meal she had wolfed down on her dinner break (the cafeteria had been closed) had left her stomach quite queasy. Yet, because she was conscientious and had five more patients to distribute medicines to before 10:00 p.m., she was quickening her strides when she reached the corridor leading from the nursing station to her next patient’s room. Mary had never worked this shift before and no one had briefed her as to what to expect. The hall was dimly lit at this time of night so the patients could sleep. There was no sign indicating that the floor was being waxed. As soon as her feet hit the still-wet, newly waxed floor, they slipped out from under her. A sharp “crack” was followed closely by Mary’s scream. She had broken her hip. Unfortunately, as a consequence of the injury, she was unable to return to her normal duties or even her normal vocation. The cost of the injury to her employer was a $125,000 workers compensation claim.

Estimated Magnitude of Problem

A frequent cause of injuries within a health-care organization during evening and overnight shifts is a slip and fall. A high percentage of the resulting injuries are relatively minor and have low costs associated with them. However, when injuries are more severe and medical treatment is required, a very different picture emerges. The experience of one major health-care organization reveals that the average cost of serious slip-and-fall claims is $15,000 to $25,000, with outlier claims approximating $125,000 to $175,000. Even though a majority of slips and falls may not have serious consequences, the high frequency of these types of claims — and the possibility for high losses if medical treatment is required — has most risk managers agreeing that it is necessary to create a specific strategy to address slips and falls during the evening and overnight shifts.

For another case study, I used OSHA’s “Safety and Health Program Management Guidelines” as a framework for identifying workplace hazards and for creating and implementing strategies to mitigate those hazards. I will again use this framework (work-site analysis; hazard prevention and control, combined with training and education; and commitment from management) to demonstrate how an organization might mitigate its slip-and-fall hazards during evening or overnight shifts.

Work-Site Analysis

The purpose of the work-site analysis is for the organization to identify the workplace hazards that may have created the potential for the injury. A records review is the recommended first step in the process. After Mary’s injury, the I.M. Medical Center’s safety committee concluded that they needed to take a more comprehensive approach to their slip-and-fall prevention program, so they undertook a work-site analysis. When the committee conducted a thorough review of their OSHA and workers compensation records and trended their findings on a time line, they found a 50-percent increase in frequency and severity of slip-and-fall injuries since the new floor-care protocol had been implemented. They also noted that most of their injuries occurred near the end of the 3 p.m. to 11 p.m. shift and the injury rate was markedly higher for individuals working double shifts.

The next step in the work-site analysis is to survey employees — to ask them to identify any hazards in their work environment that could lead to slip-and-fall injuries. In this case, the Medical Center decided to survey those employees normally working the second shift and those who had worked the second shift as part of a double shift. When the results were in, the Medical Center found that the new floor protocol had been an issue that troubled all nursing employees. In fact, the nurses expressed concern for both patient and employee safety. Furthermore, the majority of employees on the second shift reported that the lack of adequate meals combined with the dim lighting hampered their ability to stay alert and safe.

The remaining step in the analysis is to conduct a security assessment of the work site. It is a good practice to use a checklist for this step.

Hazard Prevention, Control, and Training

Once your organization’s security assessment is completed, the next step is to identify and implement controls to minimize exposures. The controls developed fall into three categories: engineering controls, administrative and work-practice controls, and post-incident response. For slip-and-fall injuries, the engineering controls will commonly be the most effective in reducing the hazards leading to injuries. Upon completing their work-site analysis, the I.M. Well Medical Center implemented the following engineering controls:

• the flooring used on all nursing units was made skid-retardant;
• the floor treatment was modified to increase the coefficient of friction; and
• the signage used for hazard identification was changed to be visible from 360 degrees, thus fully identifying the entire hazardous area.

The Medical Center supplemented these engineering controls with the following work-practice controls:

• the training program for all floor-care attendants was reviewed and revised;
• a monitoring system was developed and implemented to ensure ongoing compliance with safe practices;
• a five-minute training program on slip prevention was developed and shown to all staff at the beginning of their shift (included in this training was a discussion of the floor care scheduled during the particular shift);
• the dress code was modified to require all employees to wear slip-resistant shoes, with compliance to be assessed by supervisors at the beginning of each shift; and
• a multidisciplinary performance improvement team was formed to review and revise the timing of major floor-care procedures to minimize the impact on patients and to enhance the safety of all employees.

Commitment From Management

These controls were supplemented with a written commitment from senior management to take all necessary steps to eliminate slip-and-fall injuries. This commitment was reinforced monthly at employee forums and department manager meetings.

A Methodology For All Organizations

Although this article has focused on one common workers compensation exposure associated with working in the evening or overnight in a health-care organization, it uses a methodology for identifying and then mitigating many hazards within any organization.

ABOUT THE AUTHOR

The Journal of Workers Compensation is a quarterly review of risk management and cost containment strategies published by Standard Publishing in Boston, Massachusetts. For more information, please visit our web site, www.standardpublishingcorp.com, or contact the editor at 800-682-5759, extension 222, or subscription services at extension 228.

riskVue | The webzine for risk management profesionals
March 2001