A tired, run-down surgical team is a potentially unsafe one, and many studies have linked healthcare worker fatigue to adverse events. The Joint Commission has issued a Sentinel Event Alert on the impact of healthcare worker fatigue and is providing recommendations to mitigate the associated risks to patient safety.

The Joint Commission notes that fatigue resulting from an inadequate amount of sleep or insufficient quality of sleep over an extended period can lead to problems among staff members such as lapses in attention, inability to focus, reduced motivation, confusion, impaired communication and slowed or faulty information processing and judgment.

The Sentinel Event Alert suggests taking a number of actions to help decrease the risks of fatigue that result from extended work hours, and in turn protect patients from preventable adverse outcomes. Among the suggestions:

Conduct a fatigue-related risk assessment. This includes an assessment of off-shift hours and consecutive shift work, and a review of staffing and other relevant policies to ensure they address extended work shifts and hours.

Analyze handoff processes. Patient handoffs are a time of high risk, especially for tired staff. The Joint Commission recommends assessing your handoff processes and procedures to ensure that they adequately protect patients.

Invite scheduling input from staff. Encourage team members to participate in designing work schedules to minimize the potential for fatigue.

Educate staff about sleep hygiene and the effects of fatigue on patient safety. Sleep hygiene includes getting enough sleep and taking naps, practicing good sleep habits and avoiding food, alcohol or stimulants that can impact sleep.

Provide a forum for staff to express concerns about fatigue. Support staff when they raise appropriate concerns and take action to address those issues.

Encourage teamwork. Use a system of independent second checks for critical tasks or complex patients as a strategy to support staff that work extended shifts or hours and to protect patients from potential harm.

Mark McGraw