· Premise
· Facts
· Causes of fatigue
· Effects of fatigue
· Individual responsibilities
· Department responsibilities
· Anaesthesia is a cognitively and technically demanding field
· Many elective operations will continue into the evening
· Many emergency operations are performed at night
· Lots of recent evidence shows fatigue causes mistakes
· Mistakes cause harm to the patient and cost money
· We have an ethical responsibility to prevent this
· (also needlesticks and car crashes)
· Cognitive impairment begins at 16 hours
· At 24 hours wakefulness ≈ BAC 0.1%
· Peak drowsiness 3-7am and 1-4pm
· Caffeine restores performance but only up until 24 hours
· Naps 10-20 minutes are best
· Sleep deprivation
· Long work hours
· Irregular shift work
· Poor sleep recovery
· Ageing (poorer recovery from sleep deprivation)
· Pregnancy
· ↓Vigilance
· ↓Judgement
· ↓Psychomotor speed
· ↓Cognitive function
· ↓Motor function
· ↓Communication
· ↓Empathy
|
Short term plan |
· Ensure 8h recovery · If you can’t, then arrange cover or cancel it |
|
Long term plan |
· Don’t overwork · Take leave |
|
Awareness |
· Symptoms of fatigue |
|
Risk mitigation |
· Food, drink, nap |
|
Recovery |
· 2h nap after night shift then stay awake |
|
List management |
· No operating 2200-0800 unless threat to life, limb or organ · Elective cases should be completed before 2200 |
|
Rostering |
· Aim no working > 12 hours. Definitely no working >16 hours. · 8 hours rest between shifts · Produce rosters well in advance to allow planning · Forward rotating shifts are the least disturbing (a.m. -> p.m. -> night) · Do not schedule staff for a.m. + p.m. + evening on call · Sufficient overlap between shifts for handover · Plan to manage absence due to fatigue · Document and monitor unrostered overtime |
|
Other |
· Travel reimbursement: if too tired to drive home · Rest facilities: for overnight staff · Monitor risk factors, fatigue and its consequences |
Feedback welcome at ketaminenightmares@gmail.com