Speaker number 4 in the @AAGBI Facing Fatigue #covid19webinar.

Occupational physician Dr Peter Noone. (He has no less than 8 post-nominals on his opening slide, including a law degree!)

Shiftwork and fatigue in healthcare workers.

Notes a number of NHS workers who have fallen asleep driving home, causing death of themselves and others. Industrial accidents have had fatigue as a causal factor - oil/gas and aviation - these have led to change. Legislation in health and safety around fatigue.

'Unless and until the employer has done everything - and everything means a good deal - the workman can do next to nothing to protect himself, although he is naturally willing enough to do his share'.

Sir Thomas Legge - first medical inspector of factories/workshops in the UK.

Fatigue has well known effects on task performance:

Reduced alertness
Interpersonal skills (less communicative)
Lose situational awareness (big picture)
Attention to detail
Complex decisions - attention tunnelling, difficulty handling uncertainty

Accidents increase during night shift, over successive shifts, over hours of duties, duration since last break.

After 24 hours awake - equals BAC of 0.1 = too drunk to drive.

Health and safety regulation mandates that risk is assessed.

? consistent with good practice
? fatigue tool
? how tiring do the staff find it

Tools should predict fatigue risk, be proactive (alertness consideration tool) and then reactive when adverse events occur (was fatigue a factor).

Error trajectory level: work related fatigue, insufficient recovery, reports of fatigue, fatigue related errors, incident, accident.

Need control measures at each level of the error trajectory to decrease risk of fatigue related accident.

Work and individual factors need to be considered.

Joint responsibility of fatigue - employee and organisational.

Fatigue can be measured in a number of subjective and objective ways.

HSE fatigue risk index is one model.

Higher score correlates with risk of micro sleep.

Here's the link - free for all.

https://www.hse.gov.uk/research/rrhtm/rr446.htm

Self-assessment tool - individual fatigue likelihood scorecard; must be linked to an HR procedure.

Gives points for: sleep in prior 24 hrs, sleep in prior 48 hrs, hours awake since last sleep

Actions include - keep an eye on yourself, look out for each other, go back to bed.

Role of fitbits:

Pros - not intrusive, easy, can pick up unintentional sleeps
Cons - measures activity not sleep, can't tell sleep vs wake, predictive and not real time, doesn't account for individual differences

Counter measures include work schedule design (tucker 2015)

favour rapid forward rotation
avoid quick returns
minimise consecutive early starts
avoid long shifts
flexible hours can mitigate some effects of night work

Dr Noone says many international organisations have good resources for best practice rostering. Here's one:

https://ama.com.au/sites/default/files/documents/210803_Best_Practice_Rostering_Resource_Kit_pdf.pdf

General principles of fatigue risk management systems:

Science based
Data driven
Cooperative (include all stakeholders)
Implemented
Integrated
Continuously improved
Budgeted
Owned by leadership

Key points:

Fatigue a major factor in poor performance
Individuals poor at assessing own fatigue risk
Attitudes to breaks and hours in health not allowed in other safety critical industries
No evidence that HCWs are 'immune' to fatigue
Must assess and reduce our fatigue risk