1. 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

2. Fatigue Management Program
Background
Program Goals & Objectives
Program Review
Assessment Phase
Interventions
Track Progress
September 21, 2018

3. 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

4. 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

5. 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 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Fatigue Management Educational Program Sleepiness and Driving
Magnitude of the Problem
Characteristics of Drowsy Driving
Are you at risk?
Risk reduction
September 21, 2018

12. Fatigue Management Educational Program Healthy Sleep Tips
Why we need sleep
Basic sleep physiology
Better sleep tips
September 21, 2018

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. FATIGUE MANAGEMENT PROGRAM
September 21, 2018