IMPACT OF FATIGUE RISK MANAGEMENT SYSTEM ON FATIGUE AND SITUATION AWARENESS OF SURGICAL INTENSIVE CARE UNIT NURSES

Abstract

In healthcare sector, the consequences of shift work induced fatigue in healthcare professionals can adversely impact patient safety. However healthcare sector continues to manage shift work related fatigue risk through prescriptive hours of service guidelines. This study explores fatigue and situation awareness of Surgical Intensive Care Unit (SICU) nurses before and after the implementation of a performance based FRMS. Method: The study was conducted at SICU of a tertiary care hospital in Singapore. Participants were nurses doing rotating shift work. The study was designed to be conducted in a naturalistic setting and was carried out over 4 main phases: Preliminary studies, Pre FRMS, FRMS and Post FRMS. In the preliminary studies and Pre FRMS phase, fatigue and SA of nurses working in rotating shifts were analysed through roster analysis, fatigue survey, selfreporting of fatigue and sleepiness, actigraphy, vigilance testing and SA estimation. A customised performance based FRMS was developed based on the findings of the roster analysis and fatigue survey. FRMS included modifications to the SICU work roster to optimise their individual work and rest schedules, education of nurses on fatigue self-management, working with the SICU management for provision of alertness measures and fatigue countermeasures for the shifts identified as high risk. Measures for fatigue and SA were repeated in the Post FRMS phase. Results of Pre and Post FRMS phases were compared. Shift patterns (morning, afternoon and night shift) and shift timing (start and end of shift) were the main independent variables for intra shift and inter shift variation respectively. The dependant variables for fatigue and sleepiness were fatigue scores (Samn Perelli Fatigue Checklist), response time (Vigilance task) and sleepiness scores (Karolinska Sleepiness Scale). The dependant variables for situation awareness were the situation awareness scores (Situation Awareness Rating Technique). Statistical analysis was done for measures of fatigue, sleepiness, and response time and SA scores for Pre FRMS and for Post FRMS phase. The results were compared at start and end of shift and between morning, afternoon and night shifts. Pre and Post FRMS scores for each of the variables were then compared to study the impact of FRMS. The dependant variables for the shift patterns and shift timings were compared using Analysis of Variance (ANOVA) to test if there was any difference between the groups. Based on the outcome of ANOVA, if there were differences between the groups, ttests were done. Results: The number of participants (n) that took part in the study varied based on the different phases of the study: Pre FRMS phase (n=36); FRMS phase (n=34); Post FRMS phase (n=28). 28 participants completed all the phases of the study and data from these subjects was used for the comparative analysis of the Pre and Post FRMS phase. Mean fatigue scores and mean sleepiness scores at the end of shift were higher compared to the start of shift for morning, afternoon and night shift. There was an overall decrease in mean fatigue scores and mean sleepiness scores in the Post FRMS phase as compared to Pre FRMS phase. SA scores at the end of shift were lower compared to the start of shift for morning and night shift and showed no difference for the afternoon shift. There was an overall increase in mean SA scores in the Post FRMS phase as compared to Pre FRMS phase. This difference was not statistically significant. Discussion: The results provide an insight into the relationship between fatigue arising from shift work and SA in health care workers in a naturalistic field setting. Results showed that implementation of FRMS in SICU was associated with reduction in fatigue and sleepiness scores and improvements in SA scores. This study identifies the fatigue assessment tools that have the potential to be used in the healthcare sector for assessment of fatigue related to shift work. It also demonstrates the relevance and effectiveness of FRMS in nurses in SICU.