PS43 2019: Fatigue

 

List:

·        Premise

·        Facts

·        Causes of fatigue

·        Effects of fatigue

·        Individual responsibilities

·        Department responsibilities

 

Premise:

·        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)

 

Facts:

·        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

 

Causes of fatigue:

·        Sleep deprivation

·        Long work hours

·        Irregular shift work

·        Poor sleep recovery

·        Ageing (poorer recovery from sleep deprivation)

·        Pregnancy

 

Effects of fatigue: (from 16+ hours)

·        ↓Vigilance

·        ↓Judgement

·        ↓Psychomotor speed

·        ↓Cognitive function

·        ↓Motor function

·        ↓Communication

·        ↓Empathy

 

Individual responsibilities:

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

 

Department responsibilities:

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

 

 

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