Anesthesia Management: 9 Ways to Prevent Fatigue-Related Errors in Healthcare
Author : Doc Clemens
9 Ways to Prevent Fatigue-Related Errors in Healthcare
“We understand that fatigue has been a contributing factor in many adverse events that we analyze – the Joint Commission reviews some 900 sentinel events every year; fatigue has played a role in many of these," says Ana McKee, the commission's executive vice president and chief medical officer who helped prepare the alert.
According to the alert, "the healthcare industry has been slow to adopt changes, particularly with regard to nursing" to prevent fatigue-related preventable healthcare-associated mishaps.
The alert quotes Ann Rogers, a sleep medicine expert with Emory University in Atlanta, as saying, "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."
McKee says that routine root cause analyses performed after adverse events usually take into consideration worker alertness. For example, investigators try to assess "what was the capacity of the individuals involved? Had they worked extra shifts, were they short on staff so people extended their time?
"You might hear that there was a staffing shortage, or someone called in sick and was unable to be relieved so someone else did a double shift. It's not uncommon to hear that these are contributors when an adverse event happens," McKee says.
As healthcare executives look to the labor force to impose cuts, healthcare worker fatigue is something that can become an even bigger problem, potentially being a factor in more errors in patient care, she says. "Whenever an organization is restrained financially, staffing is always affected, and [increased numbers of adverse events are] a potential consequence."
McKee emphasizes that the sentinel alert notice was not provoked by any one incident, but by a number of studies linking adverse events to worker fatigue.
"We just felt it's time," McKee says. "The Accreditation Council for Graduate Medical Education (ACGME) has addressed this by reducing residents' hours" to a maximum of 30 hours per work shift and a maximum of 80 hours per week. "And we wanted to recognize that this is not a risk just to residents, but to all healthcare workers."
10 signs and symptoms of fatigue
· Lapses in attention and inability to stay focused
· Reduced motivation
· Compromised problem solving
· Confusion
· Irritability
· Memory lapses
· Impaired communication
· Slowed or faulty information processing and judgment
· Diminished reaction time
· Indifference and loss of empathy
Among the studies listed to underscore the need to prevent fatigue, the commission's alert noted one in 2004 which revealed that nurses who work shifts of 12.5 hours or longer "are three times more likely to make an error in patient care," and that workers in shifts in excess of 12 hours suffer higher rates of occupational injury.
9 Ways to Prevent Adverse Events
The Joint Commission advises all organizations perform nine tasks to avoid fatigue-related adverse events:
1. Assess your organization for fatigue-related risks, including off-shift hours and consecutive shift work, and review staffing and other policies to address extended work shifts and hours.
2. Assess patient hand-off processes and procedures since these transitions are a time of high-risk for errors related to fatigued staff.
3. Invite staff input into designing work schedules to minimize fatigue.
4. Create a fatigue management plan with scientific strategies for fighting fatigue, such as engaging in conversations with others (not just listening and nodding), doing something that involves physical action such stretching, consuming caffeine but not at times when one is already alert, and taking short naps of about 45 minutes.
5. Educate staff about sleep hygiene, which includes getting enough sleep and taking naps, engaging in pre-sleep routines such as yoga or reading, and avoiding food, alcohol or stimulants such as caffeine that can impact sleep.
6. Provide opportunities for staff to express concerns about fatigue.
7. Encourage teamwork to support members of the staff who work extended work shifts or hours, such as using a system of independent second checks for critical tasks or complex patients.
8. Consider fatigue as a potentially contributing factor when reviewing all adverse events.
9. Assess the organization's ability to provide sleep breaks to ensure it fully protects sleep to ensure good quality sleep, including providing uninterrupted coverage, response to pagers and phones and coverage of admissions and continuing care, and provide a cool, dark, quiet, comfortable room with eye masks and ear plugs if necessary.