Fatigue Mitigation:

How do we do it?

 

(To be read in conjunction with ACORN Standards)

(Please note, Standards refered to are the 2012 ACORN Standards)

A Sample Fatigue Safety Policy

 

(For the real one, see the BRAND! NEW!

ACORN Guideline

in the 2014-2015 Standards)

 

There are three tiers to successful implementation of safety guidelines:

 

1) Organisational Executive Management: setting up an organisational culture which

optimises and directs the way managers implement strategies, and thus improve the

way clinicians perform the safety culture

 

2) Nurse Unit Management and Educators: Setting up the team and work environment

and thus improve the way clinicians can engage in their performance of a safety culture

 

3) Peri-operative nurse clinician: Enacting the clinical performance of a safety culture

 

Surgical Services Executives and Administrators shall:

 

Identify and respect limits of fatigue: that 17 hours of continued

wakefulness equals a performance equivalent of Blood Alcohol level of 0.05 g/DL, and

that greater than 12.5 hours of work per day increases error risk by 2-3 times

 

• Install a culture of fatigue safety by way of instigating leadership in the

culture of fatigue safety, since safety change initiatives are only effective when they are

supported from the very top, and then filtered down

 

• Employ a hierarchy of risk management actions (S17: Risk

Management)

 

• Recognise fatigue as a patient and staff safety risk

 

• Eliminate as much as possible system causes of fatigue

 

• Reduce the probability of fatigue occurring as much as is

reasonably possible (avoidance)

 

• Control fatigue by facilitating the implementation of

restitution measures when fatigue occurs

 

• Set fatigue safety outcomes and seek reports on progress and obstacles

to implementation (S15: Quality Management)

 

• Optimise organisational resources and develop Fatigue Safety Systems

such as:

 

• Sustainable workloads both day and night

• Identify and mitigate black spots for fatigue safety

• Identify and respect concrete infrastructure, human and

time resource boundaries

 

• Develop a hierarchy of measures, for example:

 

• use of taxis to convey perioperative staff safely to and from

work when fatigue boundaries may reasonably be expected

to be exceeded

• provision of sleep/quiet rooms

• provision of sleep pods

• set rules which optimise clinical napping

 

• Provide managers responsible for implementation of these systems with the skills

necessary for the employment and enforcement of resource boundaries and fatigue

safety measures.

 

• Research the economic effects, positive or negative; and the operational effects,

positive or negative in order to further understand fiscal and clinical outcomes related to

Fatigue Safety

 

Nurse Unit Managers and Educators shall:

 

Identify and respect limits of fatigue: that 17 hours of continued

wakefulness equals a performance equivalent of Blood Alcohol level of 0.05 g/DL, and

that greater than 12.5 hours of work per day increases error risk by 2-3 times

 

• employ leadership skills to communicate and implement organisational

and departmental fatigue safety strategies

 

• develop clinical frameworks for fatigue safety by employing best practice

in clinical processes (S15: Quality Management)

 

• empower perioperative nurses to engage in fatigue safety measures

(S17: Risk Management)

 

• optimise as much as possible workload, workload distribution and work

intensity to enhance fatigue safety (S19: Staffing Requirements)

 

• utilise performance management processes to ensure clinicians work

within fatigue safety boundaries (S10: Performance Review)

 

• ensure adequate education, competency and orientation of new and

existing staff with respect to maximising the fatigue safety culture (NR7)

 

• develop fair and equitable fatigue-mitigating rosters including lower

fatigue-risk on call structures (S19)

 

• employ rest strategies which facilitate well-being and work effectiveness

 

• Be vigilant for opportunities to further improve team behaviours

which may flag or exacerbate fatigue (S1;PS3;PS5)

 

Perioperative nurses shall:

 

Identify and respect limits of fatigue: that 17 hours of continued

wakefulness equals a performance equivalent of Blood Alcohol level of 0.05 g/DL, and

that greater than 12.5 hours of work per day increases error risk by 2-3 times

 

• Set up personal parameters which accommodate effective performance

of clinical duties and personal safety within the context of fatigue safety (PS7)

 

• Educate self to rationale and effect of fatigue safety measures by

attending inservice, professional development or other educational opportunities

pertaining to physical, cognitive and emotional fatigue and the spectrum of effective

fatigue management strategies (NR7)

 

• Collaborate with peers and managers to achieve an effective fatigue safe

workplace by:

 

• Reporting fatigue in self or others (S15, S17)

• Reporting fatigue safety related sentinel events or near misses

(PS14, PS15)

 

• Optimise fatigue safe clinical performance (NR1, NR2, NR4,

NR7)

 

• Be accountable for their own fatigue safety behaviours (PS7)

 

• Be vigilant for opportunities to further improve team behaviours

which may otherwise flag or exacerbate fatigue (S1;PS3;PS5)

 

 

Disclaimer: Don't Panic.

If you are wondering why I would go to all the trouble to narrate a parallel poicy when I have already contributed grossly to the official ACORN Guideline, it is simply because of this:

Each item expressed above points to a previously existing clause in the ACORN Standards.

I simply want to remind you that the tools you need now have already been in existence prior to the release of the formal Guideline. Most of them have been there for a long time.

You don't need to panic or re-invent the wheel. You just need to reframe what you consider to be good performance parameters, and pay attention to the tools which already exist to help you.

Gracious thanks, 

Pete :)

 

 

Below Ten Thousand

An international collaboration

Empowering clinicians in safety culture