Health care facilities should take five steps to ensure staff aren't becoming sleep fatigued, according to a Sentinel Event Alert from The Joint Commission.
Shift length and work schedules impact job performance, and in health care, that means patient safety, the alert stated. A study of 393 nurses over more than 5,300 shifts showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care.
Furthermore, residents who work traditional schedules with recurrent 24-hour shifts:
--make 36 percent more serious preventable adverse events than individuals who work fewer than 16 consecutive hours,
--make five times as many serious diagnostic errors,
--have twice as many on-the-job attentional failures at night,
--experience 61% more needlestick and other sharps injuries after their 20th consecutive hour of work,
--experience a 1.5 to 2 standard deviation deterioration in performance relative to baseline rested performance on both clinical and non-clinical tasks, and
--make 300% more fatigue-related preventable adverse events that led to a patient’s death.
The Joint Commission recommended five specific steps to take:
1. Assess fatigue-related risks, including those for off-shift hours and consecutive shift work.
2. Assess hand-off processes and procedures to ensure that they adequately protect patients against mistakes due to fatigue.
3. Invite staff input into designing work schedules to minimize the potential for fatigue.
4. Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue. These strategies can include: engaging in conversations with others (not just listening and nodding); doing something that involves physical action (even if it is just stretching); avoiding caffeine when already alert or when nearing bedtime); taking short naps (less than 45 minutes).
5. Educate staff about sleep hygiene and the effects of fatigue on patient safety.
"We have a culture of working long hours, and the impact of fatigue has not been a part of our consciousness," said one physician, a sleep expert and author of several research studies on sleep's effects on providers and patient safety, in the report. "Most are unaware of sleep and circadian biology and the degree that it affects performance. And, most do not realize how much research supports the need to make changes."