Fight Fatigue, Reduce Error

The Joint Commission says fatigue risks patient care

The Joint Commission has issued a position warning  healthcare agencies to fight medical errors by fighting fatigue. Citing the link between health care worker fatigue and adverse patient care events, the Joint Commission revisited the issue of extended shifts and fatigue in a recent Sentinel Event Alert. 

According to the Joint Commission: 

Fatigue resulting from an inadequate amount of sleep or insufficient quality of sleep over an extended period can lead to a number of problems, including:

• lapses in attention and inability to stay focused
• reduced motivation
• compromised problem solving
• confusion
• irritability
• memory lapses
• impaired communication
• slowed or faulty information processing and judgment
• diminished reaction time 
• indifference and loss of empathy

 In 2007, the JC noted that strong evidence exists linking medical error, fatigue, and extended duration shifts. The findings indicate that exteded shift and night shift workers make 36% more serious preventable adverse errors than others and have a 61% more needlestick or sharps injuries. 

The take home message is that healthcare organizations need to assess the shift work/hours worked environment in their institutions for patient and provider safety. Key to reducing errors is to provide a culture of proactive safety. Staff should be able to express concerns about fatigue in the same way they would express concern if a colleague were impaired by intoxication.

Can these findings be applied to prehospital care? Certainly. While not be the norm in prehospital care, many services do work 24 hour shifts. It's far more common to find EMS professionals who may work far more than 24 hour shifts between multiple jobs. That is, work 12 or 16 hours at one EMS agency then go work another 8 or 12 at a part-time gig. Part-time work and other "off duty" work is not addressed by the JC in terms of healthcare providers. The fact remains that many EMS professionals do work more than one job. There is, of course, the dreaded "late call" that threatens to turn you 16 hour shift into much, much more.

Read The Joint Commission News Item/Action Alert: Click here
Direct Download Sentinel Event Alert: Click here