Outline Background to the project Project aims processes and outputs Fatigue is inevitable when 247 cover is required Project aims include evidencebased fatigue risk management The aim is to work together to implement a new approach ID: 1043584
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1. Safer Nursing 24/7New solutions for managing fatigue in nursing
2. OutlineBackground to the projectProject aims, processes and outputs
3. Fatigue is inevitable when 24/7 cover is requiredProject aims include evidence-based fatigue risk management The aim is to work together to implement a new approach
4. Research Team – 5 membersAdvisory Group – 14 members
5. FatigueIs a physiological state and results fromMissing out on sleep
6. Being awake for too longFatigueIs a physiological state and results from
7. Going against the body clockFatigueIs a physiological state and results from
8. High or low workloadFatigueIs a physiological state and results from
9. Shift workAny work pattern that requires you to be awake when you would normally be asleep, if you were free to choose your own schedule
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11. Not enough sleepfeeling sleepier, irritability, degraded alertness, slower reaction times, poorer coordination, slower thinking, loss of situation awareness, less creative problem-solving… and so on
12. Not enough sleepEffects of sleep restriction are: cumulativedose-dependent
13. Not enough sleepRecovering from restricted sleepsleep usually gets back to normal after 2 nights of unrestricted sleepnot 48 hours offrecovery of waking function can take more than 2 full nights of sleep
14. Why do we sleep at night?Pacemaker in the brain that drives daily cycles (circadian rhythms) inHow you functionHow you feelKeeps in step with the day/night cycleCircadian body clock
15. Circadian rhythm basics8 am4 amnoonmidnight8 pm4 pmnoonSLEEPCircadian wake driveTime of dayCircadian lowMost sleepyLowest body temperatureLeast functionalFatigue-related error most likelyHard to fall asleepNap windowHard to stay asleep
16. Social time vs biological timeLight sensitive circadian body clock doesn’t adapt to shift workWork during biological nightLess productiveHigher error and accident rates at workDrowsy driving going homeSleep during biological dayShorter sleepDisruption by environmental factors Competing time demands
17. Nurses who work rotating shifts are twice as likely toReport clinical errorsHave a motor vehicle accidentGold et al., 1992; Scott et al., 2006, 2007; Rogers et al., 2004; Trinkoff et al., 2007, 2011; Olds et al., 2010Safety of Patients and Nurses
18. Safety of Patients and NursesNurses working extended shifts (>8 hours) are2-3 times more likely toMake clinical errorsHave poorer patient outcomes, including increased patient mortalityFeel drowsy while driving Have a greater likelihood of injuring themselves and othersMore likely to report poor quality care and poor patient safety Gold et al., 1992; Scott et al., 2006, 2007; Rogers et al., 2004; Trinkoff et al., 2007, 2011; Olds et al., 2010
19. Association between working rotating night shifts and: Increased all-cause and cardiovascular disease mortalityIncreased lung cancer mortalityIncreased risk of ischemic strokeMonotonic increase risk of type 2 diabetes with increasing exposureGu et al., 2015; Brown et al., 2009; Pan et al., 2011
20. Safer Nursing 24/7 projectImplementing an Evidence-Based Approach to Fatigue Risk Management in Nursing
21. Build fatigue awareness and knowledge across the sectorProject promotional activities Website (www.safernursing24-7.co.nz) Traditional media, stakeholder meetings …Comprehensive package of accessible fatigue management training materials
22. Online surveyWho could participate?DHB Registered and Enrolled NursesWorking at least 30 hours per week on averageWorking in one of 6 practice areasChild health including neonatology, emergency and trauma, in-patient mental health, intensive care/cardiac care, medical, surgical
23. Online surveyOutcomesAn overview of what is being workedFatigue risk assessment matrices for evaluating rosters in each practice areaFatigue risk management training materials
24. Respondents49.5%31.1%56.2%47.8%42.2%
25. Code of PracticeCode of Practice for shift work and fatigue management in hospital-based nursingCollaboration with key stakeholdersBroad sector consultationParliamentary launch
26. Agency moving forwardIdentifying, or advocating for an agency with representation from all stakeholders, to take ongoing responsibility for establishing a cycle of continuous improvement in fatigue risk management.
27. What you can do nowVisit the website www.safernursing24-7.co.nzJoin the forumKeep an eye out for project updatesCombining our expertise is the key