Sleep Deprivation/Fatigue Mitigation Khadijah Matin Organizational Learning

Sleep

Pre-Test 1.Residents must not be scheduled for Night float for more than a. (6) consecutive nights b. (8) consecutive nights c. (7) consecutive nights 2.Decreasing sleep by one hour a night for 7 consecutive nights is = to staying up for a. (1) day b. (24) hours once a week c. (12) hours once a week

Pre-Test 3.Falling asleep within 20 minutes is a sign of being well rested. a. True False 4.NYS 405 Regulations allow for an additional ___ hours for transition time. a. (4) b. (3) c. (2)

Pre-Test 5.Residents may not work more than ___hours per week, averaged over a ___week period. a. 70hrs. over 3wk. b. 80hrs. over 4wk. 6.Which of the following is an indication of not getting enough sleep a. You need a nap to get through the day b. You are not able to stay awake during a class or a meeting c. You frequently become irritable or anxious d. All of the above

Pre-Test 7. Duty hours include reading, studying, and academic prep time such as time away from patient care or preparing for journal club. a. True False 8. To cope with sleep deprivation you should exercise, however not more than 4 hours before bedtime. b. False

Pre-Test 9.Reading in bed is a good way to cope with lack of sleep. a. True b. False 10.All resident groups are permitted to moonlight.

Sleep Deprivation/Fatigue Mitigation The Biology of Sleep Here’s the given: Sleep like food, oxygen and water is an essential biological need. It reenergizes the body and allows the brain to store and reorganize information. Studies show that performance of newly learned skills does not improve until a person has had at least 6 and preferably 8 hours of sleep. During sleep the body secretes hormones that affect growth, metabolic, and endocrine functions. Activity in the ‘sleeping’ brain helps regulate gastrointestinal, cardiovascular, and immune functions improve until a person has had at least six – preferably eight – hours of sleep.

Sleep Deprivation/Fatigue Mitigation

Sleep Deprivation/Fatigue Mitigation Sleep Stages 1. A relaxed semiconscious state/vaguely aware of surroundings 2. The actual beginning of sleep. 3 and 4: Deeper sleep…growth/development and tissue repair… 4. The deepest phase of sleep, when the body recovers and heals REM: the eyes move rapidly…REM plays a major role in memory storage and retention, new learning and mental performance. The stage where the most dreaming occurs.

Sleep Deprivation/Fatigue Mitigation What is sleep deprivation? Sleep deprivation occurs when a person does not get sufficient amounts of quality sleep. In other words, sleep contrary to natural wake/sleep cycle – caused by work, health conditions, family responsibilities, etc. Studies have proved that decreasing sleep time by one hour a night for (7) consecutive nights is equal to staying up for (24) hours straight once a week. DID YOU KNOW? :Studies show that being awake for 18 hours produces impairment = a blood alcohol (BAC) of 0.5 and reaches an equivalent of .10 after 24 hours of wakefulness. Thus a drowsy driver may be as dangerous as a drunk driver and may be so tired that he does not recognize the onset of sleep.

Sleep Deprivation/Fatigue Mitigation

Sleep Deprivation/Fatigue Mitigation

How are you coping? Anxious? Lack of Motivation Symptoms of Depression

Sleep Deprivation/Fatigue Mitigation Indications not getting enough sleep… You need an alarm clock to wake you up at the right time You struggle to get out of bed in the morning You feel irritable, tired, and stressed during the week You have trouble concentrating/remembering You fall asleep in warm rooms during meetings or classroom training You need a nap to get through the day You feel drowsy while driving You fall asleep within 5 minutes of going to bed.

Sleep Deprivation/Fatigue Mitigation Studies of 3rd year medical residents show that losing only one night’s sleep caused medical knowledge test scores to drop to 1st year level. Even a minimal loss of sleep impacts general health Sleep deprivation has also been linked to inadequate levels of the hormone leptin. Leptin signals the body to stop eating when it’s full….CRAVINGS!

Sleep Deprivation/Fatigue Mitigation People suffering from sleep deprivation may not recognize their sleep condition or the fact that they are making mistakes!

Sleep Deprivation/Fatigue Mitigation What do you do? Coping Strategies Avoid eating, reading and watching TV in bed Avoid nicotine prior to bedtime Do not eat large meals within 4-5 hours of sleeping Use relaxation techniques to relieve stress and invite sleep Exercise but not more than 4 hours before bedtime. Realistic and honest assessment of your work life, personal relationships and ‘how am I doing?

Which do you choose?

Sleep Deprivation/Fatigue Mitigation New York State Resident Work Hour Regulations A maximum workweek of 80 hours A maximum shift of 24 consecutive hours A maximum ER shift of 12 hours Required 24 hour period off per week, and Required eight hours off between work shifts.

Duty Hours & Work Environment Residents may not work more than 80 hours per week, averaged over a four-week period There are no exceptions to this rule! A PGY-1 Resident not to exceed 16 hours of consecutive duty; A PGY-2 resident not to exceed 24 hours of consecutive duty. All residents must have 8 hours free between scheduled duty periods. Intermediate-level residents (PGY-2 and above) must have at least 14 hours free of duty after 24 hours of in-house duty. Residents must have at least one 24-hour period of scheduled non-working time each week;

Duty Hour Standards On-duty assignments of residents in the Emergency Department should not exceed 12 consecutive hours followed by 12 hours off; Averaging of duty hours must occur by rotation (i.e. 4-week period, 1-month, or the period of the rotation if it is shorter than 4 weeks) Duty hours do not include reading, studying, and academic preparation time, such as time spent away from the patient care unit preparing for presentations or journal club. When research is a formal part of the residency and occurs during the accredited years of the program, research hours or any combination of research and patient care activities must comply with the weekly limit on hours.

Moonlighting Time spent by residents in Internal and External Moonlighting must be counted towards the 80-hour maximum weekly limit. PGY-1 residents and OB/GYN residents are not permitted to moonlight

Additional Specialty Specific Night Float Maximum Frequency Residents must not be scheduled for Night Float for more than 6 consecutive nights Family Medicine: Night float experiences may not exceed 50% of a resident’s inpatient experiences OB/GYN and Surgery: Night Float must not be longer than 2 months in duration, and residents cannot be assigned more than three months of night float per year. There must be at least two months between each night float rotation.

Transition Time NYS 405 Regulations allow for an additional 3 hours for transition time. NYS Regulations trump ACGME standards which allow up to 4 hours Intermediate and Senior Residents may remain on duty for up to 3 additional hours of transition time to be used for transfer of patient care, rounds, or grand rounds No new patient care may be assigned during the 3-hour transition time. Transition time is included within the 12-hours maximum shift for the ED

Post-Test

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