1. 1 Safety Representatives Meeting July 22, 2009 ENVIRONMENTAL & OCCUPATIONAL SAFETY Northwestern Memorial Hospital

2. 2 Meeting Agenda Welcome and Announcements  FY09 Workforce Safety Goal Update  “Safety Matters” initiatives Update  Hot Sheet M. Fiore [5 min] Environmental Stewardship  Special Waste Recycling Initiative Update  Pharmaceutical Waste Mgmt Update C. Ferguson [5 min] Organizational Risk Assessment Overview  Risk Assessment Strategy  General Findings  Multi-Year Action Plan Development K. Carter [10 min] Safety Representatives- Skill Set Development  Office Ergonomics Evaluation Tool and Techniques L. Zinnecker/All [30 min] Open Discussion – Questions/Concerns Closing- Action Items M. Fiore/All

3. NMH Goal- Back and Shoulder Goal: - Reduce employee back and shoulder injuries by 10% from FY08 Performance to Date: - We are currently 15 incidents above the goal which is 5.43% higher than June of FY 08. 3

4. Establishing a Zero Injury Culture at NMH Creating a Zero Injury culture does take an investment in time, effort and money, but return on these investments significantly outweighs the cost. An average of 650 occupational incidents occur at NMH per year 1 in 10

5. Increased Incident Reporting 5

6. Incident Trend Incident Type Prevalence 6 MonthFY08FY09 SeptemberBBF, Sharps OctoberBBF, Sharps; FallBBF, Sharps NovemberBBF, Sharps DecemberBBF, SharpsAssault, pt/vs to staff JanuaryBBF, Sharps FebruaryBBF, Sharps MarchBBF, Sharps AprilBBF, Sharps MayBBF, SharpsCaught in/under/btwn; Fall JuneBBF, SharpsStruck against/by July (to date)BBF, SharpsBBF, Sharps; Struck against/by

7. Employees cannot focus on providing the best patient care if they feel they must be concerned with their own safety. Employees put in the predicament of deciding between their safety and providing the best patient care can negatively affect the quality of care provided. Compelling evidence exists that employee turnover can negatively affect the quality of patient care. Employee Safety = Patient Safety

8. Safety Matters Highlights Safety Topic of the Month – SAFE Forum – Educational Sheets – Tip of the Month Marketing/Awareness – Safety Matters Department Page – Department Safety poster – NM Connect Special Edition – Medical Leadership standing agenda item Slip/Trip/Fall Prevention Team – Fein EE Entrance (new flooring + mats) – Slip cones – Wet Umbrella Bags – Over the Spill pads – Hazardous Weather e-mail alert Enhanced Safety Representative Program – Monthly meetings – Increased interactivity/education during meetings – Actionable items/accountability

9. DMAIC/Special Focus Groups Safe Material Handling – EVS chute re-design – EVS bio-tub re-design – EVS microfiber mops/new cart system – Material Handling class [NM Academy]- next class end of July – MM & Distribution Svcs- new carts and powered tuggers Blood/Body Fluid & Sharps Safety – Incident reporting training/education – Nurse sharps safety training – Procurement over-glasses PPE option – Device conversion (fragmin) Safe Patient Handling – Needs assessment/Procurement 50 additional Hovermatts – Audit/re-energize super-user program – Work with Pat Care leadership to transition into nursing “model of care” – In person root cause assessment for all injuries

14. Take Aways Make staff safety a visible part of everyday priorities Recognize, support and utilize department safety representatives. Promote transparency of all identified safety opportunities within your department. Maintain safety matters poster/department-specific goals Promote and educate on safety topic of month Be a visible “Safety Matters” advocate Accept that zero injuries can be a reality.

15. Environmental Stewardship Efforts Pharmaceutical Waste Recyclable Materials

16. Pharmaceutical Waste NMH’s Pharmaceutical Waste Program consists of the identification, collection and management of all pharmaceutical wastes In addition to ensuring compliance with US and Illinois Environmental Protection Agency regulations, this is NMH’s newest initiative toward being more “green” Proper management of pharmaceuticals is part of NMH’s Environmental Stewardship / Green-health Initiative

17. Millions of pounds of unused pharmaceuticals are flushed down the drain each year. These pharmaceuticals include antibiotics, anti-convulsants, mood stabilizers and sex hormones and consequently end up in drinking water supplies across the nation. At least one pharmaceutical has been detected in finished drinking water supplies in 24 metropolitan areas in the US. Pharmaceutical Waste

18. Other NMH Green Health Initiatives Special Waste Management Fluorescent Light Bulbs Used lamps are hazardous due to their mercury content. Amount Recycled FY 08 = 11, 921 lbs FY 09 = 6,570 lbs Batteries Batteries contain heavy metals such as lead, cadmium, mercury and nickel (and some contain sulfuric acid), which can contaminate the environment if improperly disposed. Amount Recycled FY 08 = 4,469 lbs FY 09 = 8,459 lbs Metal with Lead NMH recycles lead aprons, electronic circuit boards and containers formerly holding radioactive isotopes. Amount Recycled FY 08 = 1,219 lbs FY 09 = 3,067 lbs

19. Organizational Risk Assessment Risk Assessment is the cornerstone upon which a program is built April – June 2009

20. Similar Exposure Groups Intensive Care Units Antepartum/Postpartum Surgical Services Psychiatry Hematology/Oncology and Palliative Care Surgical/Neuro-/Ortho- Nursing Medicine Nursing Professional/Emergency Services Imaging Pharmacy Engineering Administration Laboratory Support Services

21. SEG Participation Participation Goal – 50%

22. Risk Risk = (Probability x Severity) – Mitigating Factors

23. Frequency of Occurrence LevelDescriptionDefinition AFrequentContinuously experienced BProbableWill occur frequently COccasionalWill occur several times DRemoteUnlikely but can reasonably be expected to occur EImprobableUnlikely to occur, but possible Hazard Severity LevelDescriptionDefinition 1CatastrophicDeath or system loss 2CriticalSevere injury, severe occupational illness, or major system damage 3MarginalMinor injury, minor occupational illness, or minor system damage 4NegligibleLess than minor injury, occupational illness, or system damage. Mitigating Factors RankDefinition 4Significantly high degree of effectiveness; >90% implementation and compliance 3High degree of effectiveness; 75-90% compliance/implementation 2Some effectiveness; 50-75% compliance 1Low Effectiveness; <50% compliance 0None available/No compliance

24. HIGHSERIOUSMEDIUMLOW Hazard Ranking Matrix Frequency of Occurrence Severity (1) Catastrophic (2) Critical (3) Marginal (4) Negligible (A) Frequent 1A2A3A4A (B) Probable 1B2B3B4B (C) Occasional 1C2C3C4C (D) Remote 1D2D3D4D (E) Improbable 1E2E3E4E

25. Summary General Tasks – Patient Care

26. Highlights- Patient Care IV Poles Broken beds/wheelchairs Patient movement Eliminate “gray” areas – PPE – Patient Handling

27. Support Services and Non-Patient Care Trends were not as evident between these groups because of the unique nature of the work performed by each

28. Organizational Trends Material handling was identified as a high risk task. – Push/Pull and carpet – Lack of Equipment Preventive Maintenance Lack of usage of safety equipment (PPE, Patient Handling, etc…) Cord management Lack of understanding/compliance with policy. Overall, department representatives identified the risks, but underestimated the severity.

29. Organizational 3 Year Employee Safety Plan Incorporated data from Risk Assessment Incorporated incident data (FY08 – current) Incorporated hazard surveillance(EOC Rounds) trends Incorporated safety officer perception/evaluation Currently in draft be presented to Sr. Leadership later this month.

30. 30 Safety Representative Skill Set Development Office Ergonomics

31. Office Ergonomics Major Job Factors The Job/Task The Tools/Equipment The Environment The Worker

32. Office Ergonomics Workstation Tips 1.Maintain the “S-Shape” of your Spine: check to make sure your ear, shoulder and hip stay in alignment. 2.Monitor Height: Top of monitor should be at or just below eye level; unless user wears bifocals – then height should be slightly lower. 3.Monitor Distance: 18-24” from eyes. 4.Keyboard: Recommend it be adjusted to elbow height. Upper arms should rest at user’s sides, forearms, wrists and hands should be parallel to the floor when keying. 5.Chair: Feet should rest flat on a footrest or the floor, thighs parallel to the floor. The lumbar support should fit user’s lower back, seat should fully support users thighs with approximately 2” clearance between seat edge and back of calves. 6.Reaches: Frequently used items should be within a 6-14” reach to avoid over reaching. 7.Exercises/Stretches: To break up static activity, stretch or exercise once every 1-2 hours.

33. Reduce Reaches Frequent reaches between 6-14”

34. Wrist Positioning Extension Deviation Neutral

35. Final Conclusions... Listen to your body Stretch/Exercise regularly Set-Up your workstation for the primary job tasks you do. Eliminate the clutter Alternate activities. THANK YOU!!!

36. 36 Open Discussion Questions??