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Manage staff fatigue to improve patient safety
Part 2 of 2
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
Worker fatigue can adversely impact every aspect of health care performance. High levels of fatigue cause reduced productivity and an increased risk of adverse events. Fatigued caregivers may not think clearly, which is vital to making patient care decisions. Tired people often are unaware that they are not functioning as safely as they would be if they were not fatigued. Shift work and extended hours are common work practices in health care facilities, and yet these practices are known to contribute to higher levels of staff fatigue. Reducing the patient safety risks caused by staff fatigue requires action on the part of management and workers. It is the responsibility of managers to protect staff from the adverse effects of fatigue. It is the responsibility of staff members to ensure that they are fit for duty during their work time.
A 2007 National Patient Safety Goal (NPSG) proposed by the Joint Commission relates to preventing patient harm associated with health care worker fatigue. If it is selected as one of the 2007 NPSGs, health care organizations will be expected to identify conditions and practices that may contribute to worker fatigue, implement processes to identify fatigue that poses a threat to patient safety, and take action to minimize that risk. Implementing this goal will involve three steps:
The first step when managing staff fatigue is to identify factors within the workplace that may contribute to fatigue. One particular factor that should be considered carefully is staffing. It is important to determine if staffing decisions are providing people with sufficient opportunity for rest and recovery between shifts. Consider the following:
One way to identify workplace factors that contribute to fatigue is to consult with staff members. Ask them if they regularly feel fatigued. Also ask about any near misses they have encountered. Review patient incident reports, paying particular attention to incidents that occur during periods of high staff fatigue (e.g. during the latter half of shifts or during the night particularly 2 am to 6 am).
Once potential hazards are identified, the associated risks should be analyzed. It is impossible to eliminate all factors that contribute to staff member fatigue. Therefore it is important to prioritize the risks associated with the hazards. Risk is the likelihood that patient safety will be compromised because of the factors that contribute to fatigue. To assess risk, consider both likelihood and consequences. For instance, what is the likelihood that an incident will occur when people are asked to work an extra four hours beyond an eight-hour shift? And if an incident does occur, what would be the consequence (e.g. catastrophic, major, moderate, and minor)? Because health care professionals work in diverse environments job-specific factors must be taken into consideration when prioritizing risks, such as:
Implement control measures
The third step when managing worker fatigue involves selecting and implementing control measures to reduce risks. The ideal solution when managing fatigue is to completely eliminate contributing factors. However, often this is not possible. The second-best option is to reduce the effect of contributing factors, such as:
The final step in managing worker fatigue is to monitor and review the effectiveness of control measures. Have the chosen control measures been implemented as planned? Are the measures working? Are there any new problems? This evaluation can be undertaken by consulting with staff members, supervisors, the risk manager or patient safety officer, and other individuals or groups involved in patient safety improvement. Also, monitor patient incident reports to assess the incidence of fatigue-related events. There should be a process for ongoing monitoring and evaluation of workplace fatigue and its impact on patient safety.
Health care organizations are just beginning to understand fatigue-related patient safety risks and implement strategies for reducing these risks. The obvious answer might be to reduce work hours for staff. However, limits on work hours may not be possible. Plus, work hours are not the only factor affecting staff performance. Tools and strategies also must be aimed at reducing workplace factors that increase the risk of fatigue-related errors. This can include specific staff training programs, redesign of job responsibilities to "fatigue-proof" risky tasks, and managing workload differently.