Don’t let fatigue create insomnia


Do you ever feel like a walking zombie while at work because you are so tired? Insomnia may be one of many reasons for health care worker fatigue, which is a serious issue for health-system administrators.

Workplace fatigue makes it more difficult to perform mental and physical activities. The link between health care worker fatigue and adverse events is well documented. The Joint Commission issued a Sentinel Event Alert in December 2011 giving recommendations to hospitals and health systems about this issue.

Fatigue leads to poor judgment, poor performance on skilled tasks, and slower reaction times. It affects one’s perception of the seriousness of a situation, and it is harder to undertake complex tasks requiring critical thinking when fatigued.

A high-risk time for patient care could be when sharing information at shift change, since both parties involved could be fatigued, and important information could be either not conveyed or not completely understood. Safety can be compromised when employees are fatigued. In the pharmacy, medication errors, particularly those involving calculations or activities that require multiple steps or close attention to detail, are more likely to occur when tired.

Among the most common factors contributing to health care worker fatigue are longer work hours and rotating shifts. Most research about workforce fatigue has been based on 8-hour shifts. Organizations including the Joint Commission and Institute of Medicine have urged health care employers to limit shift length and overtime.

Some states actually prohibit mandatory overtime for nurses, but there are no limits on shift length or voluntary overtime. In addition, fatigue can lead to many chronic health concerns, and many health conditions can cause fatigue. Workers need to get enough sleep to come to work fresh and alert.

The following are some suggestions for how the pharmacy department can manage fatigue:

  • Discuss workplace fatigue at staff meetings.
  • Look at shift length and overtime. If a work shift is 8 hours long, then limit overtime to 4 hours. If a work shift is 12 hours long, then do not allow overtime.
  • Look at rotating shifts. If pharmacy employees are on a rotating three-shift roster system, then forward rotation (day/afternoon to night shifts) is tolerated much better by employees.
  • Look at the number of consecutive shifts. Ensure that there is a minimum of 12 hours between consecutive shifts. If an employee works 12-hour shifts, consider limiting consecutive shifts to three.
  • Have a policy on second jobs and make sure that employees understand the obligation to get sufficient sleep and be fit for their primary job.
  • Consider what role fatigue could play when reviewing any medication errors.
  • Educate staff about sleep hygiene, the use of caffeine, and the effects of fatigue on patient safety.

There are many resources available, such as the Joint Commission alert mentioned above, to help both pharmacy managers and employees learn more about health care worker fatigue. Sometimes an employee may not realize how fatigued they actually are, while other times, they may come to work even though they know they are too tired to do their job responsibly.

The consequences of potential medication errors on patient safety are too great to avoid thinking about the role of fatigue. If this topic should cause insomnia, then steps must be taken to get adequate rest.