Dr Frank Fox - Why manage fatigue

Why Manage Fatigue?
Annual FPNL & Nursing Education Conference
26th June 2014
What is Fatigue?
“Extreme tiredness resulting from mental or physical exertion or
● Lack of energy or motivation
● Tiredness
● Sleepiness
● We tend to use fatigue as meaning “likely to fall asleep”
● We must remember that sleepiness is only a symptom of
● Sleepiness is only one adverse consequence of fatigue
Why Manage Fatigue?
● Tired people at work are a fact of life
● Worker health is intimately related to safety and productivity
● There are numerous factors in the workplace that add to fatigue or
cause it, to this;
● Add night shifts with circadian rhythm disruption
● Workload and working environment factors
● Long shifts and overtime
● Personal factors
● Healthy, well rested, alert employees are critical to safe and
productive operations
Link between Fatigue and Accidents
In a study that looked at 89,729 person-years of data
 Shifts >12h/day had an injury incidence rate 38% higher than 8 hour
 Each 2 hours worked after 8 hours resulted in an increase of 1.2 injuries
per 100 worker-hours
Another studied 1.2 million accidents
An exponentially increasing accident risk was observed Beyond the
9th hour at work
the relative accident risk increased dramatically beyond the 8th hour
at work
Risk increases steadily with each successive night shift
18 hours without sleep = blood alcohol of 0.05 mg%
Accident Risk by Hours at Work
Relative Risk over 4 Successive Night
Ask yourself
● Do you have tired workers?
● Where can they cause an accident?
● Could the accident result in serious injury or death?
● Could the accident have a major impact on production?
● If yes, then
● Establish a forum to assess and manage the risk
● Management champion
● Worker consultation and involvement
● Line Ownership
What is Risk Management?
A process of;
Identifying the hazards,
Assessing exposure
Assessing the risk
Prioritising the need
Identifying controls
Implementing controls
Continuous monitoring of control effectiveness
Continuous improvement of controls
Fatigue Risk Management
● Is a Management function
● Is not a medical problem
● Needs a multidisciplinary team and approach
5 Steps
Risk assessment
Education and training
Monitoring and Review
Continuous improvement
Fatigue equation4
Fatigue Risk Management4
Sleep management
Education and training
Lifestyle interventions
Health screening and counselling
Optimal design of shift
system and rostering
Ergonomics interventions
taking account of abilities
and limitations of workers
4. Adapted from Schutte
5 levels of control
Adequate staffing levels
Sufficient opportunity for sleep
Sufficient sleep obtained
Workplace environment factors identified and controlled
Sufficient alertness, behaviour (fitness for work)
The 5 key defenses of a fatigue risk management system
Moore-Ede Quoted in ACOEM Guidance Statement
Risk Assessment
● Policies
● Staffing
● Overtime
● Shift rosters
● Commute time?
● Start times
● Shift length
● Continuous
● Rotation
● Workplace environment
● Ergonomics
● Workload )physical and mental
● Rest breaks, meals, drinking water
● Personal factors
● Home environment
● Health and wellness
● Workload – staff balance
Manage working hours strictly
● Optimise the shift system
● Educate and train workers and families
● Fatigue, sleep hygiene, environment
● Optimise the working environment
● Physical factors
● Task factors (monotony, workload etc)
● Breaks, meals, refreshments (water)
● Optimise the employee
● Medical factors (sleep disorders), alcohol and drugs, chronic
● Detect and manage the tired worker
● Self declaration, observation, procedures, technology, naps,
● Investigate all incidents with a specific focus on fatigue
● Fatigue Risk Management Programme
● Scientifically based
● Data driven
● Cooperative
● Shared responsibility – TRUST is essential
● Senior management champion
● Documented programme document with clear definition of roles
and responsibilities, objectives and KPIs
● Is only part of an integrated programme
● Is equivalent to PPE and is a rescue strategy
● Should form part of the data collection process, as with
incident investigation
● Should ideally be independent of the operator
● Should be linked to an intervention to manage fatigue
● e.g. change of task, fatigue breaks etc
Key Factors for Success
Management champion
Collaborative approach
Clearly defined programme with objectives and KPIs
Decide what success looks like for you
Measurement and monitoring of KPIs
Medical input
● “Medicals”
M – metabolic (hypothyroid), medication, mental illness, iron
E - energy distribution (meal frequency – hypoglycaemia reactive)
D – drugs, dehydration, diabetes, diet, depression
I – infection (TB, HIV)
C – cancer, conditioning, chronic disease, chronic fatigue
syndrome, coeliac disease
A – anaemia, alcohol, anxiety
L – lifestyle
S – sleep disorders (apnoea, insomnia, restless legs)
The Result
● Improved safety
● Improved productivity
● Lower costs
Dembe AE, Erickson JB, Delbos RG, Banks SM. The impact of overtime and long work hours
on occupational injuries and illnesses: new evidence from the United States. Occup Environ
Med 2005;62:588–597
Hänecke K, Tiedemann S, Nachreiner F, Grzech-Šukalo H. Accident risk as a function of hour
at work and time of day as determined from accident data and exposure models for the German
working population. Scand J Work Environ Health 1998;24 suppl 3:43-48
Folkard S, Tucker P. Shift work, safety and productivity. Occupational Medicine 2003;53:95–
Schutte PC. Fatigue Risk Management: Charting a path to a safer workplace. The Southern
African Institute of Mining and Metallurgy Hard Rock Safe Safety Conference 2009.
Moore-Ede M. Evolution of Fatigue Risk Management Systems: The “Tipping Point” of
Employee Fatigue Mitigation. CIRCADIAN R White Papers. Available at:
www.circadian.com/pages/157 white papers.cfm. 2009.
Dawson D, McCulloch K. Managing fatigue: it’s about sleep. Sleep Med Rev. 2005;9:365–380.
ACOEM Guidance Statement: Fatigue Risk Management in the Workplace. ACOEM
Presidential Task Force on Fatigue Risk Management: Lerman SE, Eskin E, Flower DJ, George
EC, Gerson B, Hartenbaum N, Hursh SR, Moore-Ede M. JOEM 2012;54(2):231-257
HSE Fatigue Risk Calculator – rr446ca.xls
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