The correlation between temporary staff and medication errors

A study in the Journal for Healthcare Quality originally published in November 2010 and titled, :Are Temporary Staff Associated with More Severe Emergency Department Medication Errors?” was designed to evaluate whether medication errors in an Emergency Department linked to temporary staff  were associated with more severe harm than those linked to permanent staff.  The results of the study did indeed show a correlation between errors involving temporary staff and increased patient harm.   Errors involving temporary staff were more likely to reach the patient, require additional monitoring, cause temporary harm and classified as life threatening than those involving permanent staff.  The researchers concluded that emergency department medication errors associated with temporary staff were more harmful than those associated with permanent staff.

Hospital managers have long grappled with a shortage of qualified applicants for critical positions.  I myself recall the great pharmacist shortage of the late nineties and had to fight off a Walgreens District Manager and a Eckerd Regional Recruiter who had decided to camp out in the lobby outside my pharmacy department to entice my pharmacists to jump ship.  Inevitably the lure of a free BMW lease was too strong for even some lifelong hospital pharmacists and I was forced to integrate a larger component of PRN or temporary staffing in order to meet the workload of the pharmacy department.

While largely unhappy with any degree of reliance on agency or temporary staff to fill schedule gaps, many managers have come to largely accept the trade off between well oriented permanent staff with scheduling limitations and well qualified but perhaps not as well oriented temporary staff with the flexibility to fill empty shifts.  The presence of temporary staff even works as a recruiting tool to lure full time staff into a more stable and preferred work schedule.  The Johns Hopkins study then, provides managers with benchmark data that essentially demonstrates a link between the severity of errors and lack of familiarity with a hospital’s specific policies and procedures, communication infrastructure and standards of practice are part of the staffing mix.  The study’s authors state:

“The Hopkins team cautions that while it may be easy to blame the temps themselves for the errors, the problem is probably more diffuse and complex. ‘A place that uses a lot of temporary staff may have more quality of care issues in general ,’ says Julius Cuong Pham, M.D., Ph.D, an assistant professor of anesthesiology and critical care medicine and emergency medicine at the Johns Hopkins University School of Medicine and the study’s leader. ‘It may not be the temporary staff that causes those errors but a function of the whole system.’”

I’ve bolded that last statement because it is the crux of the matter.  Engineering processes and systems that are intuitive, provide checks and balances, and that support safe practices through education, orientation and reorientation are critical to ensuring patient safety when it comes to integrating new and unfamiliar staff members into the organization.    JH, RPh

Links and Resources:

1) Are Temporary Staff Associated with More Severe Emergency Department Medication Errors?

2) Temporary ER Staff Poses Increased Safety Risk to Patients

3) Temp workers linked to more medical error

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