Preventing fatigue among healthcare workers

Given the well-documented link between healthcare worker fatigue and adverse events, The Joint Commission has issued a “Sentinel Event Alert: Health Care Worker Fatigue and Patient Safety.” The document urges greater attention to preventing fatigue among health care workers and suggests specific actions for health care organizations to mitigate the risks.

“Health care is a round-the-clock job, and safety has to be the priority,” says Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., president, The Joint Commission. Nurses working longer than 12-hour shifts are involved in three times more fatigue-related preventable adverse events than their peers with more regular hours, according to a study in The Joint Journal on Quality and Patient Safety. They are also at greater risk of injuring themselves on the job.

“The recommendations in this Alert give health care organizations the strategies to help mitigate the risks of fatigue that result from extended work hours – and, thereby, reduce the likelihood that fatigue will contribute to preventable patient harm," says Chassin.

The Joint Commission document addresses the effects and risks of an extended work day and of cumulative days of extended work hours. It recommends that healthcare organizations: 

• Assess fatigue-related risks such as off-shift hours, consecutive shift work and staffing levels.
• Examine processes when patients are handed off or transitioned from one caregiver to another, a time of risk that is compounded by fatigue.
• Seek staff input on designing work schedules that minimize the potential for fatigue and provide opportunities for staff to express concerns about fatigue.
• Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue such as engaging in conversation, physical activity, strategic caffeine consumption, and short naps.
• Educate staff about good sleep habits and the effects of fatigue on patient safety.

The Joint Commission suggests that health care organizations encourage teamwork as a strategy to support staff who work extended work shifts or hours. For example, it might be helpful to use a system of independent second checks for critical tasks or complex patients.

Also, The Joint Commission proposes, organizations should consider fatigue as a potentially contributing factor when reviewing all adverse events, and educate employees on the importance of good sleep habits, including ensuring their rest environment is conducive to sleeping.

The Alert is available at jointcommission.org