Dorrian Jillian, Lamond Nicole, van den Heuvel Cameron, Pincombe Jan, Rogers Ann E, Dawson Drew
School of Psychology and the Centre for Sleep Research, University of South Australia, Adelaide, Australia.
Chronobiol Int. 2006;23(6):1149-63. doi: 10.1080/07420520601059615.
The frequency and severity of adverse events in Australian healthcare is under increasing scrutiny. A recent state government report identified 31 events involving "death or serious [patient] harm" and 452 "very high risk" incidents. Australia-wide, a previous study identified 2,324 adverse medical events (AME) in a single year, with more than half considered preventable. Despite the recognized link between fatigue and error in other industries, to date, few studies of medical errors have assessed the fatigue of the healthcare professionals involved. Nurses work extended and unpredictable hours with a lack of regular breaks and are therefore likely to experience elevated fatigue. Currently, there is very little available information on Australian nurses' sleep or fatigue levels, nor is there any information about whether this affects their performance. This study therefore aims to examine work hours, sleep, fatigue and error occurrence in Australian nurses. Using logbooks, 23 full-time nurses in a metropolitan hospital completed daily recordings for one month (644 days, 377 shifts) of their scheduled and actual work hours, sleep length and quality, sleepiness, and fatigue levels. Frequency and type of nursing errors, near errors, and observed errors (made by others) were recorded. Nurses reported struggling to remain awake during 36% of shifts. Moderate to high levels of stress, physical exhaustion, and mental exhaustion were reported on 23%, 40%, and 36% of shifts, respectively. Extreme drowsiness while driving or cycling home was reported on 45 occasions (11.5%), with three reports of near accidents. Overall, 20 errors, 13 near errors, and 22 observed errors were reported. The perceived potential consequences for the majority of errors were minor; however, 11 errors were associated with moderate and four with potentially severe consequences. Nurses reported that they had trouble falling asleep on 26.8% of days, had frequent arousals on 34.0% of days, and that work-related concerns were either partially or fully responsible for their sleep disruption on 12.5% of occasions. Fourteen out of the 23 nurses reported using a sleep aid. The most commonly reported sleep aids were prescription medications (62.7%), followed by alcohol (26.9%). Total sleep duration was significantly shorter on workdays than days off (p < 0.01). In comparison to other workdays, sleep was significantly shorter on days when an error (p < 0.05) or a near error (p < 0.01) was recorded. In contrast, sleep was higher on workdays when someone else's error was recorded (p = 0.08). Logistic regression analysis indicated that sleep duration was a significant predictor of error occurrence (chi2 = 6.739, p = 0.009, e beta = 0.727). The findings of this pilot study suggest that Australian nurses experience sleepiness and related physical symptoms at work and during their trip home. Further, a measurable number of errors occur of various types and severity. Less sleep may lead to the increased likelihood of making an error, and importantly, the decreased likelihood of catching someone else's error. These pilot results suggest that further investigation into the effects of sleep loss in nursing may be necessary for patient safety from an individual nurse perspective and from a healthcare team perspective.
澳大利亚医疗保健领域不良事件的发生频率和严重程度受到越来越多的审视。最近一份州政府报告指出了31起涉及“死亡或严重（患者）伤害”的事件以及452起“极高风险”事件。在全澳大利亚范围内，之前的一项研究在一年内识别出2324起不良医疗事件（AME），其中超过一半被认为是可预防的。尽管在其他行业中疲劳与失误之间的关联已得到公认，但迄今为止，很少有医疗失误研究评估过涉事医护人员的疲劳状况。护士工作时间长且不可预测，缺乏定期休息，因此很可能会出现疲劳加剧的情况。目前，关于澳大利亚护士的睡眠或疲劳水平的可用信息非常少，也没有任何关于这是否会影响其工作表现的信息。因此，本研究旨在调查澳大利亚护士的工作时间、睡眠、疲劳及失误发生情况。通过日志，一家大都市医院的23名全职护士记录了一个月（644天，377个班次）的排班和实际工作时间、睡眠时间及质量、困倦程度和疲劳水平。记录了护理失误、险些失误以及观察到的失误（由他人造成）的频率和类型。护士报告称，在36%的班次中难以保持清醒。分别有23%、40%和36%的班次报告有中度到高度的压力、身体疲惫和精神疲惫。有45次（11.5%）报告在开车或骑车回家途中极度困倦，其中有三次报告险些发生事故。总体而言，共报告了20起失误、13起险些失误和22起观察到的失误。大多数失误被认为潜在后果较小；然而，有11起失误与中度后果相关，4起与潜在的严重后果相关。护士报告称，在26.8%的日子里难以入睡，在34.0%的日子里频繁醒来，并且在12.5%的情况下，与工作相关的担忧是其睡眠中断的部分或全部原因。23名护士中有14名报告使用助眠药物。最常报告的助眠药物是处方药（62.7%），其次是酒精（26.9%）。工作日的总睡眠时间明显短于休息日（p < 0.01）。与其他工作日相比，记录到失误（p < 0.05）或险些失误（p < 0.01）的日子里睡眠时间明显更短。相比之下，记录到他人失误的工作日睡眠质量更高（p = 0.08）。逻辑回归分析表明，睡眠时间是失误发生的一个重要预测因素（卡方 = 6.739，p = 0.009；指数系数β = 0.727）。这项初步研究的结果表明，澳大利亚护士在工作期间以及下班回家途中会感到困倦并出现相关身体症状。此外，会出现数量可观的各种类型和严重程度的失误。睡眠不足可能会增加犯错的可能性，重要的是，降低发现他人失误的可能性。这些初步结果表明从个体护士角度和医疗团队角度来看，可能有必要进一步调查护理工作中睡眠不足的影响，以保障患者安全。
