The Fatigued Anesthetist

1. + The Fatigued Anesthetist • Leah Baumgardner RN, SRNA • Sarah Rohrbaugh RN, SRNA

2. + 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

4. + 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

6. CIRCADIAN RHYTHM

7. SLEEP HOMEOSTASIS

8. P E RFORMANCE 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.

9. Psychomotor performance after 17 hours of wakefulness = Psychomotor performance of blood/alcohol level of 0.05 - 0.08% Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235.

10. AANA 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...”

11. Professor William Stewart Halsted + • Created the first surgical residency program in 1889

12. + Libby Zion • Libby’s death sparked creation of resident duty hour requirements

13. Internal Factors + • Intensity of Work • Caseload • Patient Acuity • Work and On-call Schedules

14. + The Recommendations

15. Seems Simple + So Why Are We Still Fatigued? • Financial Expenditures • Lack of Adequate Staffing • “That’s The Ways It Has Always Been Done”

16. Alertness Management Program • Schedule Policies • Healthy Sleep • Alertness Strategies • Education • Scientific and Policy Support

17. + Sleep Aids vs. Good Sleep Habits

18. + 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

20. + 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.