PS43 2019: Fatigue

 

List:

·         Premise

·         Fun 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)

 

Fun 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 flog yourself

·      Have a holiday now and again

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 (morning -> evening -> night)

·      Do not schedule staff for AM + PM + 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