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+. The Fatigued Anesthetist. Leah Baumgardner RN, SRNA Sarah Rohrbaugh RN, SRNA. +. Objectives. Describe contributing factors associated with workplace fatigue of the anesthesia provider Identify the impact workplace fatigue has on anesthesia providers
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+ The Fatigued Anesthetist • Leah Baumgardner RN, SRNA • Sarah 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
SAFE EFFECTIVE CONTINUOUS OBSERVATION ASSESSMENT OF PATIENTS RESPONSE VIGILANCE
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.
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.
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...”
Professor William Stewart Halsted + • Created the first surgical residency program in 1889
+ Libby Zion • Libby’s death sparked creation of resident duty hour requirements
Internal Factors + • Intensity of Work • Caseload • Patient Acuity • Work and On-call Schedules
+ The Recommendations
Seems Simple + So Why Are We Still Fatigued? • Financial Expenditures • Lack of Adequate Staffing • “That’s The Ways It Has Always Been Done”
Alertness Management Program • Schedule Policies • Healthy Sleep • Alertness Strategies • Education • Scientific and Policy Support
+ Sleep Aids vs. Good Sleep Habits
+ Alertness Strategies
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.