Prevent and manage fatigue in healthcare and social assistance

Overview

How this helps your business

Fatigue is more than feeling drowsy. It is a current or ongoing state of tiredness that prevents people from functioning within their normal abilities.

Fatigue has an impact not only on your individual employees' mental and physical health, but also on others in your workplace including your clients/patients and the broader community. Fatigue can result in increased sick leave, errors, vehicle accidents, slower reaction times and affect your employees' ability to make good decisions.

All of these impacts have negative effects on your employees, workplace, and the community.

WorkSafe Victoria, 2017, Fatigue prevention in the workplace

Step 1

Learn more on this topic

Fatigue management in the healthcare, aged care, disability services and community services sectors is a complex issue that does not have a simple fix to suit every person and every workplace. Understanding some of the issues related to fatigue will help your workplace to prevent and manage the risk more effectively.

Fatigue is more than feeling tired or drowsy. Fatigue leads to mental or physical exhaustion and prevents people from functioning as they normally would.

Factors that can cause fatigue include work which involves long hours, intense mental or physical effort, repetition and shift work when the body is naturally set for sleep.

Fatigue has both short-term and long-term effects on people.

Short-term effects of fatigue have been compared to being intoxicated with alcohol. Fatigue results in people having a reduced ability to:

• concentrate and avoid distraction
• make decisions
• maintain alertness
• control emotions
• understand complex situations
• recognise risks
• coordinate hand-eye movements
• communicate effectively

Fatigue can also:

• increase error rates
• slow reaction times
• increase the likelihood of accidents and injuries
• cause micro-sleeps

WorkSafe Victoria, 2017, Fatigue prevention in the workplace

Long-term effects of fatigue include a higher risk of developing health issues such as diabetes, obesity, depression and cardiovascular disease.

Read more about work related fatigue in the fact sheet below.

Step 2

Write or review your policy

Leaders who see fatigue as just as important as other health and safety risks are taking the first step in designing work that addresses fatigue in the workplace.

Work and lifestyle often impact each other. Fatigue is not only a risk at work, it can be a risk outside of work. If a worker leaves their job exhausted this may reduce their ability to perform in other life roles, and potentially increases their risk of vehicle accidents driving home. Likewise, if a worker arrives at work fatigued their performance may be reduced. With the prevalence of casual positions in your industry, some workers have more than one job, so it is important to understand if there are any other factors that may be contributing to fatigue.

Workers have a responsibility to get enough sleep so that they arrive at work ready for duty. However, a number of personal reasons such as being a new parent or having an unwell child, can make arriving at work tired unavoidable. In a mentally healthy workplace, with high levels of trust and respect, staff are encouraged to report fatigue, whether it is work related or not. Staff can then negotiate short-term role or task changes to allow for recovery.

Creating a fatigue management policy and procedure can help to communicate your workplace's position on fatigue. A fatigue management policy may be a stand-alone policy or integrated with other work health and safety policies and procedures.

Consider including the following information in your fatigue policy:

• roles and responsibilities in fatigue management
• planning and designing work schedules and rosters
• work-related travel and commuting risks
• control measures for specific high risk tasks
• self-assessment fatigue checklists
• procedures for reporting potential hazards and fatigue risks
• procedures for self-reporting fatigue
• employment outside organisation
• procedures for managing fatigued workers, including what will happen if they are too fatigued to continue work (e.g. temporary task re-allocation)

In developing your fatigue management policy, affected staff and/or their health and safety representatives must be consulted. Take a look at the template below for some ideas on what your policy might look like.

Step 3

Consult your staff

Consultation with your staff about fatigue is an opportunity to share information, personal experiences of fatigue and workshop practical ways to address it.

Make sure you consider and engage everyone working in your organisation that may be impacted by mental and physical fatigue risk. Think about the following staff:

• direct client / patient care
• security
• cleaners
• food services
• administrative
• volunteers

Fatigue can also affect people other than your employees, such as clients, patients and the general public.

Here are some ideas to start the discussion:

• Ask the question – 'what unusual, strange or potentially unsafe things have you done at work due to being fatigued?'
• Discuss how community attitudes have changed towards safety. Encourage your workplace to think about fatigue in the same way we think about working under the influence of alcohol and drugs.
• Help staff to become informed decision-makers about their fitness for work based on fatigue.
• Educate staff about personal risk assessments and develop a culture of feeling safe to report when fatigued.
• Educate staff about microsleeps and the possible negative outcomes.
• Allocate additional human resources when fatigue risks are high.
• Challenge the 'badge of honour' culture of working when fatigued.
• Consider high risk tasks that can be avoided on night shift or early morning when fatigue risks might be higher.

Make sure your staff and/or their health and safety representatives are consulted when:

• planning and designing work schedules and rosters
• making decisions on how to manage the risks of fatigue
• proposing changes to working hours, work schedules and procedures
• making decisions about providing information and training on fatigue
• recording an incident or ‘near miss’ where fatigue was a factor

Share the tips for avoiding fatigue from Appendix 3 in WorkSafe's Fatigue prevention in the workplace with your staff to provide further awareness in your workplace.

Step 4

Assess the risk

Work in your industry has both mental and physical fatigue risks. Mental fatigue can come from work that requires being alert, continuous concentration with minimal variety in work, work performed under pressure and tight deadlines, emergency call outs and interacting with the public. Physical fatigue comes from work that is especially tiring and repetitive such as repeated manual handling of clients/patients.

Many services provide care 24 hours a day and 365 days a year. Rostering and shift allocation is a major part of the sector's way of managing fatigue. Often there are conflicting objectives when enterprise agreement negotiations are occurring. Consider fatigue risk when discussing this in your workplace.

Some researchers are encouraging employers and employee associations (eg. unions) to consider a Prior Sleep Wake Model (PSWM) rather than a Hours of Service (HOS) focus. That is, ensuring workers have adequate time to rest and recover prior to their next shift.

Review your organisation's physical and psychosocial/mental health risk register. Check whether fatigue is included as a risk, or whether you need to consider adding it.

Review the WorkSafe Victoria fatigue hazards identification checklist and the fatigue risk assessment chart below. Use data including incident reports, near misses, and the injury register to assess your fatigue risk and identify any links.

Some organisations use a Fatigue Risk Calculator such as the HSE Fatigue and Risk Index which helps identify where the most serious fatigue risks are. These are best used in combination with other risk assessment methods, including consultation with your staff.

Many industries have specific information and regulations to manage fatigue. Find out if there is an independent regulator that has put in place requirements to manage fatigue in your workplace. We've provided some links to more industry specific information about fatigue management in the 'Other resources' tab above.

Step 5

Manage the risk

The best way to control fatigue risks is to remove the main causes of fatigue in the workplace. Fatigue can occur from a combination of factors, so the most effective way is likely to be a combination of solutions.

When deciding on risk controls for your workplace, identify the controls you already have in place and whether they are working. Find out what other organisations similar to yours are doing to manage fatigue. Ensure that you consult with your staff, HSRs and employee representatives.

When choosing controls, consider:

• Patient/client carer ratios
• Skill mix so that 'heavy' clients/patients are not allocated inequitably
• Payroll implications when shifts/rosters are modified
• Client/patient allocation to agency staff who may have multiple jobs
• Specific fatigue risk to volunteers.

The 'Fatigue prevention in the workplace' guide below uses the risk hierarchy of controls. Start by removing fatigue risk at the source before considering measures that rely on work procedures. Read the guide to see what controls your workplace could consider.

For assistance with roster planning and managing risks at night read the below document. There is also a case study on how a large metropolitan hospital improved their management of fatigue due to a fatigue-related medication error.

Step 6

Review and keep improving

To allow for continuous improvement in preventing work-related fatigue, procedures must be monitored, evaluated and reviewed.

Talk with your staff using the following questions:

• Have control measures been implemented as planned?
• Are they working?
• Are there any new problems?

Work out how often you need to review fatigue risks and controls as well as your policy.
Think about:

• the level of risk (high-risk hazards need more frequent assessments)
• reviewing incidents, near misses, injuries and other data such as absenteeism and staff turnover rates to establish if they could be related to fatigue
• monitoring how often staff are reporting fatigue
• monitoring how teams respond to high fatigue risk events
• further review of control measures when there is workplace change