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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).

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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


                      Fatigue screening scale and Epworth sleepiness scale – Click to view


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