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

2. 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

3. 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

4. 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%

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

6. 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

7. 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

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

9. 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

10. Fatigue equation4

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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)

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

20. 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: white papers.cfm
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):
HSE Fatigue Risk Calculator – rr446ca.xls