Fatigue Recognition and Mitigation

Healthcare professionals must be aware of the negative effects of sleep deprivation and fatigue on their ability to provide safe and effective patient care.

Professionalism is demonstrated through a personal role in the following:

Assurance of one’s fitness for duty.
Time management before, during, and after clinical assignments.
Assurance of the safety and welfare of patients.
Acting on impairment in oneself and others.

The L.I.F.E. Curriculum (Learning to Address Impairment and Fatigue To Enhance Patient Safety) notes “People on average require approximately 8 hours of sleep every 24 hours to satisfy their physiological needs. When people get less than 5 hours of sleep over a 24-hour period, their peak mental performance usually deteriorates. (LIFE Teachers Guide).

Stethoscope on a background X-ray images

Two types of fatigue errors

Errors of commission – doing something incorrectly.
Errors of omission – not doing something that should be done.

Common Causes of Fatigue

Inadequate sleep
Fragmented sleep, less than six hours per night
Desynchronized circadian rhythms
Illness
Depression/anxiety/stress
Sleep Disorders
Emotional drain

You might be fatigued if you experience any of the following:

Mental Symptoms

Narrow attention span & forgetfulness
Reduced performance standards
Feelings of depression
Impaired judgment/decision making

Physical Symptoms

Frequent unexplained headaches
Muscular aches and pains
Blurred/double vision
Loss of appetite
Micro-sleeps that cause a lapse in judgment

You might see the following in someone who is fatigued:

Mental Symptoms

Irritability/intolerance
Difficulty focusing and problem-solving
Reduced short-term memory
Lack of interest and drive
Confusion and fearfulness
Decreased startle response
Anxiety
Social withdrawal

Physical Symptoms

Nodding off
Degraded motor skills
Tenseness and tremors
Slower reaction time
Falling asleep at inappropriate times

Fatigue Mitigation Tips

Know your own alertness/sleep pattern
Eat nutritionally and avoid heavy meals
Get regular exercise
Ensure a healthy sleep environment (cooler temperature, dark, quiet)
Try to keep the same schedule on workdays and off days to maximize alertness
Get 7-9 hours of sleep nightly
Avoid starting call with a sleep deficit.
Avoid heavy meals within 3 hours of sleep
Avoid stimulants to keep you up
Avoid alcohol to help you sleep
Avoid heavy exercise three hours before sleep
When engaged in clinical responsibilities
Immediately contact/notify someone if you are too fatigued to work
- Upper-level resident
- Attending
- Program director
Strategically nap. 20-30 minutes improves alertness and performance
- Do not nap longer as you risk extreme grogginess
If up all night, be aware that your least alert time is 6 – 11 a.m.
Utilize your program’s call room/nap room or available transportation
Take action to relieve a fatigued colleague from patient care duties after ensuring a smooth transition of care