41 st Annual AAGBI Linkman Conference Birmingham. Dr Kathleen Ferguson Honorary Treasurer AAGBI

Transcription

1 41 st Annual AAGBI Linkman Conference Birmingham Dr Kathleen Ferguson Honorary Treasurer AAGBI

2 Objectives and CoI Chaired the 2014 review Member of SALG

3 Published 2004 & 2014 EWTD & New Deal Guidance document to support department administration Encourage safe working practices Promote consideration of health and well being of anaesthetists

4 The original glossy recommendations 13 in total including Review of breaks Handover procedures Accommodation including on-call facilities Availability of refreshments Job plan construction Arrangements to support staff who considered themselves unfit to work due to fatigue Review of responsibilities for those over 55yrs Personal obligation

5 Fatigue - the facts Subjective feeling of needing to sleep Reduced alertness, impaired neurobehavioural performance, increased sleepiness, greater risk of injury and accident Most common cause is lack of restorative sleep

6 Sleep and level of fatigue Time spent awake Time spent asleep The time of day Sleep inertia Microsleeps Sleep and age

7 Time spent awake / time on task 14 hrs continuously awake - alertness significantly reduced 21 hrs continuously awake - comparable to effects of blood alcohol > 0.1% Accident risk increases nearly exponentially with hours at work Between 8 and 12 hrs work relative accident risk doubles

8 Time spent asleep 11 hours off does not equate to 11 hours sleep Most people need between 7.5 and 8 hours of sleep per night Sleeping less leads to a slow build up of sleep-debt (reduces alertness and performance) Cognitive effects of accumulated sleep debt can be compared with total sleep deprivation (2 weeks of 6 hr = 1 night of no-sleep)

9 Time of day Ability to achieve sleep depends on time of day Man cannot conquer the night circadian rhythm and biological clock Circadian rhythm affects alertness, performance, temperature and immunity Alertness and performance are at their highest late afternoon and evening Circadian nadir is at 3am 6am

10 Circadian rhythms and the biological clock Circadian rhythms - regular changes in mental and physical characteristics 24 hr cycle Biological clock - 25 hr cycle Light stimulates the retina Melatonin secretion decreased by light stimulus External triggers - zeitgebers

11 Greatest risk Significant sleep loss in combination with circadian rhythm disturbance Long day shift followed by a night on call and being in and working

12 Sleep inertia Passing state of reduced alertness and performance that appears for a period immediately after wakening Can last up to 30 mins or more

13 Microsleeps Mark of sleep deprivation Usually not aware of sleeping If you regularly fall asleep within 5 minutes of going to bed, you probably have severe sleep deprivation Often level of impairment is not appreciated by the individual (self monitoring is an issue)

14 Sleep and age Children demand most sleep Physiology of sleep changes with age Less REM sleep (restorative sleep) Increased sleep fragmentation More likely to carry a sleep debt because overall need does not decrease

15 Anaesthesia and fatigue Extended hours of work and shifts Out of hours activity ICU admissions Operative deliveries Consecutive shifts Shift patterns Breaks and rest

16 Adverse effects Others patient safety issues Self accidents / incidents Diabetes Hypertension &? MI TIA / CVA Some types of cancer Peptic ulceration

17 How can we mitigate these risks? Recognition Assessment Managing / Management Individual Preparation for night shifts Napping, bright light, eating and pattern, caffeine Service level

18 What control strategies are available? Fatigue management systems Fatigue and Risk Index passenger and freight rail designed by HSE, RCP Fatigue Risk Management System - Queensland Govt using FAID tool Fatigue Management plan - international oil and gas Assess risk Set thresholds Manage good rota design is the key

19 We know.. 50% have napped / microslept whilst undertaking anaesthesia 67% know a colleague who has napped 72% made mistakes due to tiredness 93% relate tiredness to work patterns 91% said fatigue affected their personal lives 61% sleep < 8 hours per night

20 Summary Missing restorative sleep leads to reduced cognition and increased health risks in night and shift workers Perception of levels of fatigue should be assessed Effort should be made to limit activity out of hours Need strategies for fatigue management

21