2021 Edition 2
clinical initiatives, research and current updates in treatment
Burnout and Patient Safety Smita Dey-Chatterjee, Epic Pharmacy Murdoch Our healthcare system is continuously being bombarded with growing pressures – from an increasing and aging population, the burden of chronic diseases, funding cuts, and global crises such as COVID-19. In face of these major challenges, burnout in the healthcare industry has garnered national and international attention.
So, what is burnout syndrome? Work-related burnout refers to emotional, mental, and physical exhaustion, and results from prolonged workplace stress. It results in a sense of
cynicism and detachment from the job, decreased satisfaction, and a reduced sense of accomplishment.¹ One way researchers check for burnout is by using the Maslach Burnout Inventory (MBI) which looks for symptoms seen in Table 1.
What causes burnout and why does it matter? The cause is both multifactorial and complex. [See Figure 1]. The continuous giving of self to others and repeated exposure of others’ suffering in a high-stress and under-resourced
environment are among the most common reasons healthcare staff are prone to burnout.³ It has been linked to increased absenteeism, job turnover and various illnesses such as cardiovascular disease and depression.⁴ Medication errors, failure to recognise lifethreatening signs and symptoms, and hospital-acquired infections have also been linked to poor staff wellbeing and burnout.3,5,6 Studies have found rates of burnout in doctors to vary between 41% and 76% and in nurses to vary between 20 - 40%.7,8
Table 1. Characteristics of burnout²
Exhaustion
Depersonalisation
Inefficacy
Wearing out
Cynicism
Reduced personal accomplishment
Loss of energy
Negative or inappropriate attitudes toward job, patients, coworkers
Reduced productivity/capability
Depletion
Indifference
Low morale
Debilitation
Irritability
Inability to cope
Fatigue
Loss of idealism
Tendency to negatively evaluate one’s work
Can be emotional or physical
Withdrawal
Feeling insufficient to perform one’s job
Inability to express empathy or grief Detachment
Medication safety Medications are one of the most common healthcare interventions and are associated with a high incidence of errors and adverse events. A literature review conducted in Australia found medication incidents to be the second most frequently reported incident in acute care.⁹ The Australian Commission on Safety and Quality in Health Care states that “up to 50% of medication errors are potentially avoidable”.¹⁰
Healthcare professionals prescribing, supplying and administration of medicine whilst fatigued can lead to adverse events that are preventable. A recent study found up to 48% of physicians experiencing emotional burnout self-reported medical errors which included ordering the wrong medication.¹¹ Nurses reported that up to 75% of their medication administration errors have been due to fatigue, exhaustion and burnout.¹² Medication
administration errors included incorrect preparation, inadequate monitoring of effects, overlooking allergies, giving the wrong medication or dose, and administering medications via the wrong route or at the wrong time.¹³ Indeed, burnout in staff significantly increases the risk of medication errors with a clear way forward in reducing these incidents being the implementation of strategies aimed at reducing burnout.2,3,14 Continued on page 2