+

The Fatigued Anesthetist Leah Baumgardner RN,

SRNASarah Rohrbaugh RN, SRNA

+Objectives

Describe contributing factors associated with workplace fatigue of the anesthesia provider

Identify the impact workplace fatigue has on anesthesia providers

Identify patient safety issues arising from fatigued anesthetists

Examine strategies to minimize anesthesia provider workplace fatigue 

+WAKE UP! QUIZ TIME!!!True or False: Sleep is a time when your body and brain shut down for rest and relaxation.

True or False: The primary cause of insomnia is worry.

True or False: The body has a natural ability to adjust to different sleep schedules such as working night shift or traveling to different time zones.

True or False: People need less sleep as they grow older.

http://www.nhlbi.nih.gov/about/ncsdr/patpub/patbub-a.htm

5

SAFE

EFFECTIVE

CONTINUOUS OBSERVATION

ASSESSMENT OF PATIENTS RESPONSE

VIGILANCE

CIRCADIAN RHYTHM

SLEEP HOMEOSTASI

S

Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP, 26(2), 117-129.

PERFORMANCE

9

Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235.

Psychomotor performance after 17 hours of wakefulness = Psychomotor performance of blood/alcohol level of

0.05 - 0.08%

10AANA CODE OF ETHICS:“CRNAs preserve human dignity, respect the moral and legal rights of health consumers, and support the safety and well being of the patients under their care...”

+

Professor William Stewart HalstedCreated the first surgical residency program in 1889

+

Libby Zion

Libby’s death sparked creation of resident duty

hour requirements

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Internal Factors

Intensity of WorkCaseload

Patient AcuityWork and On-call Schedules

+The Recommendations

+ Seems Simple

Financial Expenditures

Lack of Adequate Staffing

“That’s The Ways It Has Always Been Done”

So Why Are We Still Fatigued?

Alertness Management Program

Schedule Policies

Healthy Sleep

Alertness Strategies

Education

Scientific and Policy Support

16

+Sleep Aids vs. Good Sleep

Habits

+Alertness Strategies

19

In Summary Describe contributing factors

associated with workplace fatigue of the anesthesia provider Circadian Disruption and Sleep

Debt Identify the impact workplace fatigue

has on anesthesia providers Health and Performance

Identify patient safety issues arising from fatigued anesthetists Decreased Vigilance

Examine strategies to minimize anesthesia provider workplace fatigue  Alertness Management Program

+ References Accreditation Council for Graduate Medical Education. (2010, September). ACGME Duty Hours. Retrieved February 10, 2013, from

Accreditation Council for Graduate Medical Education: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/Common_Program_Requirements_07012011[1].pdf

American Association of Nurse Anesthetists, (2010). Scope and standards for nurse anesthesia practice. Retrieved from AANA website: http://www.aana.com/resources2/professionalpractice/Document/PPMScopeandStandards.pdf 

American Association of Nurse Anesthetists. (2012, June). American Association of Nurse Anesthetists. Retrieved February 2, 2013, from Position Statement 2.17 Patient Safety: Fatigue, Sleep and Work Schedule Effects: http://www.aana.com/resources2/professionalpractice/Documents/PPM%20PS%202.17%20Patient%20Safety.pdf

Association of perioperative Registered Nurses. (2005). Position Statement on Safe Work/On-Call Practices. Association of perioperative Registered Nurses.

Biddle, C., & Aker, J. (2011). The national study of sleep-related behaviors of nurse anesthetists: Personal and professional implication. AANA Journal, 79(4), 324-331. Retrieved from http://www.aana.com/newsandjournal /Documents/sleeprelated_0811_p324-331.pdf

Czeisler, C. A. (2009). Medical and genetic differences in the adverse impact of sleep loss on performance: Ethical considerations for the medical profession. Transactions of the American Clinical and Climatological Association, 120, 249-285. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744509/

Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235.

Howard, S., Rosekind, M. R., Katz, J. D., & Berry, A. J. (2002). Fatigue in anesthesia: Implications and strategies for patient and provider safety. Anesthesiology, 97 (5), 1281-1294. Retrieved from http://journals.lww.com/anesthesiology /Citation/2002/11000/Fatigue_in_Anesthesia__Implications_and_Strategies.35.aspx

Niederee, M. J., Knudtson, J. L., Byrnes, M. C., Helmer, S. D., & Smith, R. S. (2003). A survey of residents and faculty regarding work hour limitations in surgical training programs. Archives of Surgery, 138 (6), 663-671. doi: 10.1001/archsurg.138.6.663.

Rosekind, M. R. (2005). Managing fatigue 24/7 in health care: Opportunities to improve safety. Anesthesia Patient Safety Foundation Newsletter, 20(1). Retrieved from http://www.apsf.org/newsletters/html/2005/spring/06managing.htm

Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., et al. (2006). Improving alertness and performance in emergency department physicians and nurses: The use of planned naps. Annals of Emergency Medicine, 48(5), 596-604. doi: 10.1016/j.annemergmed.2006.02.005

Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP, 26(2), 117-129.