Why Manage Fatigue? Annual FPNL & Nursing Education Conference 26th June 2014 FH Fox MB, ChB, DOH, FFOM

What is Fatigue? “Extreme tiredness resulting from mental or physical exertion or illness” Lack of energy or motivation Tiredness Sleepiness We tend to use fatigue as meaning “likely to fall asleep” We must remember that sleepiness is only a symptom of fatigue. Sleepiness is only one adverse consequence of fatigue

Why Manage Fatigue? Tired people at work are a fact of life Worker health is intimately related to safety and productivity There are numerous factors in the workplace that add to fatigue or cause it, to this; Add night shifts with circadian rhythm disruption Workload and working environment factors Long shifts and overtime Personal factors Healthy, well rested, alert employees are critical to safe and productive operations

Link between Fatigue and Accidents In a study that looked at 89,729 person-years of data Shifts >12h/day had an injury incidence rate 38% higher than 8 hour shifts Each 2 hours worked after 8 hours resulted in an increase of 1.2 injuries per 100 worker-hours Another studied 1.2 million accidents An exponentially increasing accident risk was observed Beyond the 9th hour at work the relative accident risk increased dramatically beyond the 8th hour at work Risk increases steadily with each successive night shift 18 hours without sleep = blood alcohol of 0.05 mg%

Accident Risk by Hours at Work Relative Risk over 4 Successive Night Shifts

Ask yourself If yes, then Do you have tired workers? Where can they cause an accident? Could the accident result in serious injury or death? Could the accident have a major impact on production? If yes, then Establish a forum to assess and manage the risk Management champion Worker consultation and involvement Line Ownership

What is Risk Management? A process of; Identifying the hazards, Assessing exposure Assessing the risk Prioritising the need Identifying controls Implementing controls Continuous monitoring of control effectiveness Continuous improvement of controls

Fatigue Risk Management Is a Management function Is not a medical problem Needs a multidisciplinary team and approach

5 Steps Risk assessment Controls Education and training Monitoring and Review Continuous improvement Identify the factors that lead to risk Design and implement controls for these factors Think about: what you have direct control of, what you can influence, and what the employee/ worker has control of. Monitor the implementation and effectiveness of your controls. Training records, frequency of training, use of rest rooms, referrals, incidents etc Use the information to improve your programme

Fatigue equation4  

Fatigue Risk Management4   Sleep management Education and training Lifestyle interventions Health screening and counselling Nutrition Optimal design of shift system and rostering Ergonomics interventions taking account of abilities and limitations of workers 4. Adapted from Schutte

5 levels of control Adequate staffing levels Sufficient opportunity for sleep Sufficient sleep obtained Workplace environment factors identified and controlled Sufficient alertness, behaviour (fitness for work) The 5 key defenses of a fatigue risk management system Moore-Ede Quoted in ACOEM Guidance Statement

Risk Assessment Policies Shift rosters Workplace environment Staffing Overtime Shift rosters Commute time? Start times Shift length Continuous Rotation Workplace environment Ergonomics Workload )physical and mental Rest breaks, meals, drinking water Personal factors Home environment Health and wellness

Controls Workload – staff balance Optimise the shift system Educate and train workers and families Fatigue, sleep hygiene, environment Optimise the working environment Physical factors Task factors (monotony, workload etc) Breaks, meals, refreshments (water) Optimise the employee Medical factors (sleep disorders), alcohol and drugs, chronic disease Detect and manage the tired worker Self declaration, observation, procedures, technology, naps, [caffeine] Investigate all incidents with a specific focus on fatigue Manage working hours strictly Think about what you have direct control over, what the worker has direct control over and then what you can influence.

How? Fatigue Risk Management Programme Scientifically based Data driven Cooperative Shared responsibility – TRUST is essential Senior management champion Documented programme document with clear definition of roles and responsibilities, objectives and KPIs

Technology Is only part of an integrated programme Is equivalent to PPE and is a rescue strategy Should form part of the data collection process, as with incident investigation Should ideally be independent of the operator Should be linked to an intervention to manage fatigue e.g. change of task, fatigue breaks etc

Key Factors for Success Management champion Collaborative approach Clearly defined programme with objectives and KPIs Decide what success looks like for you Measurement and monitoring of KPIs

Medical input “Medicals” M – metabolic (hypothyroid), medication, mental illness, iron deficiency E - energy distribution (meal frequency – hypoglycaemia - reactive) D – drugs, dehydration, diabetes, diet, depression I – infection (TB, HIV) C – cancer, conditioning, chronic disease, chronic fatigue syndrome, coeliac disease A – anaemia, alcohol, anxiety L – lifestyle S – sleep disorders (apnoea, insomnia, restless legs)

It’s obvious The Result Improved safety Improved productivity Lower costs It’s obvious

References Dembe AE, Erickson JB, Delbos RG, Banks SM. The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States. Occup Environ Med 2005;62:588–597 Hänecke K, Tiedemann S, Nachreiner F, Grzech-Šukalo H. Accident risk as a function of hour at work and time of day as determined from accident data and exposure models for the German working population. Scand J Work Environ Health 1998;24 suppl 3:43-48 Folkard S, Tucker P. Shift work, safety and productivity. Occupational Medicine 2003;53:95– 101 Schutte PC. Fatigue Risk Management: Charting a path to a safer workplace. The Southern African Institute of Mining and Metallurgy Hard Rock Safe Safety Conference 2009. Moore-Ede M. Evolution of Fatigue Risk Management Systems: The “Tipping Point” of Employee Fatigue Mitigation. CIRCADIAN R White Papers. Available at: www.circadian.com/pages/157 white papers.cfm. 2009. Dawson D, McCulloch K. Managing fatigue: it’s about sleep. Sleep Med Rev. 2005;9:365–380. ACOEM Guidance Statement: Fatigue Risk Management in the Workplace. ACOEM Presidential Task Force on Fatigue Risk Management: Lerman SE, Eskin E, Flower DJ, George EC, Gerson B, Hartenbaum N, Hursh SR, Moore-Ede M. JOEM 2012;54(2):231-257 HSE Fatigue Risk Calculator – rr446ca.xls