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Policies and Procedures 13. Fatigue
The residents well-being is the utmost priority. Patient errors
are linked to fatigue. Taken from the ACGME duty hours
requirement:
duty hours limited to 80 hours a week, averaged over a four-week
period, including all in-house calls.
averaged over a four-week period, residents must have one day in
seven free from all educational and clinical responsibilities.
Residents in the final years of education must be prepared to
enter the unsupervised practice of medicine and care for patients
over irregular or extended periods. Nephrology fellows are
considered to be in the final years of education. It is desirable
that residents in their final years of education have eight hours
free of duty between scheduled duty periods.
continuous on-site duty, including in-house calls, may be
scheduled to a maximum of 24 hours of continuous duty. Programs
must encourage fellows to use alertness management strategies in
the context of patient care responsibilities. Strategic napping,
especially after 16 hours of continuous duty and between the hours
of 10:00 pm and 8:00 am, is strongly suggested. Fellows may remain
on duty for up to four additional hours to ensure that effective
transitions in care occur.
Signs and symptoms of fatigue: irritability, carelessness,
forgetfulness, interpersonal issues/conflict, falling asleep in
lectures/conference, feeling of no energy, comments about feeling
fatigued, increase in physical ailments (headaches, backaches,
nausea, etc.) Prevention of Fatigue: Provide a checklist of healthy
behaviors to residents Educate residents and faculty about warning
signs of fatigue Biannual resident self-assessment of fatigue
Educate residents about common job-related stressors that may
affect residents Distribute Fight Fatigue: A Training Handbook for
Residents Provide a safe environment for the resident to discuss
concerns about fatigue Monitor and control duty hours Monitor
moonlighting activities Early Identification of Fatigue:
Encourage faculty and residents to alert program director about
any personal concerns or concerns about a colleague with respect to
fatigue
Encourage staff to report to program director any concerns about
resident fatigue
