Fatigue Management Program September 21, 2018 Fatigue Management Program Review of Proposal Presenter: Jacques R Conaway, MD, FCCP, FAASM Medical Director, Sleep Center Member, Emerging Physician Leadership Council
Fatigue Management Program Background Program Goals & Objectives Program Review Assessment Phase Interventions Track Progress September 21, 2018
What is Fatigue? A decreased capacity to perform mental or physical work, or the subjective state in which one can no longer perform a task. Fatigue manifests in physiological performance decrements and cognitive impairment. Fatigue primarily arises as a result of inadequate restorative sleep, but is also influenced by time of day and prior wakefulness September 21, 2018
Healthcare Delivery and Fatigue Fatigue is a by-product of our 24-hour healthcare delivery system Healthcare worker fatigue linked to increased risk of: Adverse events Compromised patient safety Compromised worker safety and well-being The Joint Commission published a “Sentinel Event Alert” regarding Healthcare worker fatigue and patient safety on 12/14/2011. September 21, 2018
Objective: To compare the relative effectiveness on performance of sleep deprivation and alcohol. Methods: Performance effects were studied in the same subjects over a period of 28 hours of sleep deprivation and after measured doses of alcohol up to 0.1% BAC. Results: After 17-19 hours without sleep performance on some tests was equivalent or worse than a blood alcohol concentration of 0.05%. After longer periods without sleep, performance reached levels equivalent to the max alcohol dose given to subjects (BAC of 0.1%). Conclusions: The fatigue of sleep deprivation is an important factor likely to impair performance and safety on the road and in other industrial settings. September 21, 2018
Fatigue Management Program Goals and Objectives Improve health and safety of hospital staff through fatigue / sleepiness education. Reduce hospital risk associated with fatigue-related performance deficits Reduce fatigue-associated barriers to learning (residency). September 21, 2018
Fatigue Management Program Key Elements Fatigue-Related Risk Assessment Interventions Educational Program Review Hospital Fatigue-related Policy Create a “No-Fatigue” Hospital Culture Program effectiveness September 21, 2018
Fatigue Management Program Assessment of Fatigue-Related Risk MyHealth Online Questionnaire incorporate questions that assess fatigue risk and sleep quality Screen for primary sleep disorder(s) which increase fatigue-related risk (e.g. Obstructive Sleep Apnea) Review current staffing and other policies to address extended work shifts and hours Review patient hand-off processes (fatigued staff are prone to errors during these transitions) September 21, 2018
Fatigue Management Educational Program General Outline Consequences of Fatigue and Sleepiness Sleepiness and Driving Healthy Sleep Tips Shift Work Tips Fatigue Management in Residency September 21, 2018
Fatigue Management Educational Program Consequences of Fatigue and Sleepiness Fatigue is an impairment Effects of Fatigue / Sleepiness Performance Cognitive function Metabolic effects (appetite) Medical / Nursing Care September 21, 2018
Fatigue Management Educational Program Sleepiness and Driving Magnitude of the Problem Characteristics of Drowsy Driving Are you at risk? Risk reduction September 21, 2018
Fatigue Management Educational Program Healthy Sleep Tips Why we need sleep Basic sleep physiology Better sleep tips September 21, 2018
Fatigue Management Educational Program Shift Work Tips Health & Safety Effects of Shift Work Tips and Coping Strategies When / Where to go for medical help September 21, 2018
Fatigue Management Educational Program Fatigue Management in Residency The scope of the problem Causes of sleepiness Consequences of sleep deprivation Recognizing the warning signs of sleepiness Alertness strategies Sleep Myths and Facts September 21, 2018
Fatigue Management Program Hospital Fatigue Policies Review policies to address extended work shifts, hours, and staffing. Policy for fatigue / sleep-impaired associate Reporting policy (self reporting) Appropriate action(s) based on fatigue risk degree Immediate action – encourage a rest break, caffeine Other countermeasures – task rotation Possible referral for medical evaluation Assess ability to develop / implement a “Sleep Break” policy. September 21, 2018
Fatigue Management Program Promote a “No-Fatigue” Hospital Culture Provide opportunities for staff to express fatigue-related concerns. Teamwork / additional support to associates who work extended hours and shifts Independent second checks for critical tasks Always consider fatigue when reviewing hospital errors and adverse events. September 21, 2018
Fatigue Management Program Track Effectiveness MyHealth Web Portal Sleep Quality Questionnaires / scores Fatigue Assessments Medical / Nursing Errors Timing of errors / relationship to different shifts Absenteeism September 21, 2018
Anne Rogers, PhD, RN, FAAN Emory University, School of Nursing “An overwhelming number of studies keep saying the same thing – once you pass a certain point, the risk of mistakes increases significantly. We have been slow to accept that we have physical limits and biologically we are not built to do the things we are trying to do.” September 21, 2018
FATIGUE MANAGEMENT PROGRAM September 21, 2018