Fatigue Risk Management in the Workplace

PURPOSE AND INTRODUCTION Key Points: Fatigue is an unsafe condition in the workplace. Like other risk factors, fatigue can be managed. Safety and productivity in the workplace are intimately related to worker health. A workplace may have chemical, physical, biological, and/or psychosocial hazards that have the potential to impact physical and psychological well-being. How these hazards are managed in the workplace is key. A workplace in which these hazards are well-controlled, with an active culture of health and a supportive work environment, can enhance worker health and well-being, both on and off the job. Healthier employees result in fewer health claims, better safety records, and greater productivity. Well-rested, alert employees are critical to safe and productive operations. Virtually everyone experiences some level of fatigue from time to time. However, excessive fatigue while working is an important condition in which the interrelationship of health, safety, and productivity can create a vicious or a virtuous cycle. Specific medical and lifestyle interventions have been shown to promote a well-rested and alert workforce. In addition, specific factors in the organization of work have been shown to promote either alertness or fatigue. Because of the potential impact of fatigue on health, safety, and productivity, any organization in which individuals work extended hours or hours during which people typically sleep can benefit from addressing fatigue in the workplace. This is particularly important for safety-sensitive operations such as the transportation, health care, and energy industries. Occupational and environmental medicine (OEM) physicians, whether directly employed by or serving as a consultant to an organization, have an important role to play in fatigue risk management. Where no program is currently in place, OEM physicians can and should advise management of the opportunities to enhance health, safety, and productivity through the development of a fatigue risk management system (FRMS). Where an FRMS is in place or under development, OEM physicians can and should play an active role in its development, implementation, and sustainability. The purpose of this article is to provide information to assist OEM physicians in these roles. It is designed to provide background, key concepts, and references needed to promote and support an FRMS. It is not intended to be a complete “how to” guide in this area. Design and implementation of a comprehensive FRMS requires a wide range of skills, backgrounds, and resources. Many of these resources may be available within an organization; however, it is likely that some will not be available in-house and will need to be contracted out. However, ownership must reside with senior management to ensure a sustained effort. Ergo, the role of the OEM physician to inspire and participate in the development and implementation of an FRMS can be key to a successful program. THE RISK OF EMPLOYEE FATIGUE IN THE 24/7 WORKPLACE Key Points: Fatigue is related to duration of sleep and timing (circadian rhythm) of sleep. Inadequate sleep is correlated with a variety of adverse medical outcomes. Various shift work schedules can affect both the duration and the timing of sleep. Inadequate duration of sleep is correlated with injury rate. Difference Between Fatigue and Sleepiness When the term fatigue is used, many think of it as the same as sleepiness, but these are actually two different (although related) states. Sleepiness is the tendency to fall asleep; fatigue is the body's response to sleep loss or to prolonged physical or mental exertion. Fatigue may be reduced by sedentary activity or rest without sleeping, whereas subjective sleepiness and the propensity for sleep are often exacerbated by sedentary activity or rest.1 Sleep propensity can be accompanied by decreased alertness which then leads to decreased attention to detail, impaired judgment, and slowed response time. This can affect productivity, safety, and overall health. Table 1 lists several factors that can lead to fatigue and sleep propensity and that affect the of Fatigue and decreased alertness from or sleep can have several slowed reduced reduced judgment, during and loss of in critical Sleep been as an health Many individuals to sleep loss or that requires a extended sleep but have shown that this is not the of and Fatigue key to fatigue are sleep and in sleep cycle. individuals will through several sleep in during sleep of the sleep by or some can lead to fatigue and its Sleep are and through the of are sleep with 1 to and sleep by individuals and hours of sleep to be some and may as many as hours When health, safety, and productivity, to be as important as duration and of sleep is the time an sleep on a rhythm) that is from within the and is but can from to Sleep to and a in the is a in sleepiness in the to 1 the sleepiness to be its and not in sleep and but and of some in the of environmental time however, can be by environmental such as or and by these in the individuals are to during the are to to some are not and may a shift work sleep The in of of and of work may several of work This may working hours of be hours such as and work a or extended of work may be or with in schedules or may be or some are by hours of by the of and may be by hours by the of currently are no by the Occupational Safety and to a of and work a shift other a with working on or or other many work of be work hours it may be the of the or the to work these of schedules for better The Sleep Sleep in that of that work not to sleep and that not sleep to Occupational of is that fatigue with extended and can have a impact on safety and This in to the duration of sleep these individuals but it is related to of sleep is shift and for on hours of sleep been shown to to a of sleep loss can affect the to on some hours sleep a can lead to to hours of fatigue and alertness have that are related to time of to time on with an risk of in the with the of to other such as and the of individuals are of alertness with subjective not with everyone extended hours or is impaired by sleep In in of alertness and have been the of fatigue on safety been is The Safety that are to these and in The Safety in fatigue been to be a or Fatigue been on the it in In to the been a of the of extended and in health It been that work have a greater risk of decreased on the of an or of a medical or are to be in physicians in work extended The risk of an of on the or of a medical the hours on with working are as many and medical risk of been in medical working extended and the that in to have been for of and an injury risk with of hours of sleep and work of have an risk of in working extended The of hours in the to the shift the to be related to the safety In an risk in hours the with hours for a sleep duration and a variety of medical adverse and and its medical A from the for on shift work and to an risk of but in to from sleep to A a loss of in productivity to sleep When fatigue with other of productivity, the productivity loss is A loss of productivity been work with the of the of the and the duration of time off work as factors that may affect the of THE AND OF Key Points: an to fatigue. factors hours or affect Fatigue these other fatigue to excessive working hours is not It in an the for and an available However, the of for working by or not provide the of needed for or The of the of to or better work hours not by of to work hours during the is its employees be to work hours and be hours a In to of the the hours the is to sleep from to hours have been by the of In the as the such as in of the of the However, the of the role of a the of that can people any time of the or and the that a to the of in different time a work and many employees in a work a result of these people in a 24/7 not as a of but as a of and other operations such as and hours to or is no to 24/7 operations for these the health and safety of and have been to the time and/or to for time This been of the but been to some safety critical within the The for for medical The Safety hours and for of and The Safety of hours and as as of rest and work However, is an that may not the of alertness for individuals safety-sensitive alertness not on many hours but on a variety of other factors is work to the whether the work alertness or whether are in place to whether sleep during time off or that time for other whether a sleep that and whether physical, or medical that with sleep. several of these factors are under the of an are it is critical to the as active in risk with fatigue. and are from comprehensive designed to promote of and either the fatigue or its potential OF THE FRMS THE FATIGUE RISK IN AND 24/7 Key Points: FRMS is to a a safety management system FRMS is and to in it is a system to risk with fatigue. 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However, an is a people and resources It a development to the the of fatigue with the development of an FRMS. fatigue as an fatigue risk management and may be as and comprehensive for and the fatigue risk to which a is However, it is or by an an FRMS may be as A or to hours of work which fatigue in a to the level of risk and the of the The Key of an FRMS A of have the key of an but the as by are to the of FRMS by on and of designed by of the safety and health management risk and by an by senior can be the of an FRMS. is some the of an are to be Safety management management and and FRMS may fatigue management fatigue risk information on fatigue as a its and to that fatigue system for fatigue fatigue management and for management sleep and a for the and of the FRMS that through a but the are of in an Sleep management is to an FRMS. FRMS requires a senior to be for fatigue However, key need to be a culture employees and management and information fatigue is is important to the successful implementation of an FRMS. with the management of however, is not a and the FRMS must be in response to the of the the environment, and the organization in which it FRMS in and The and in and the to the FRMS to fatigue. many of the are the the and in and have to from hours of work FRMS. the fatigue by the and in are an of This is a in the management of fatigue. with are to on in other the management of fatigue. 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The for FRMS in the and The Safety and the in that the work with the to a The should provide fatigue for the and a hours and of work and shift the from in with the of the the Fatigue for in the and in The a comprehensive and and that a of FRMS and are for under Safety may to of to and FRMS other and operations. of FRMS Safety and FRMS is an or of an which is on fatigue an the management of fatigue is and with the level of risk and the of the In addition, an FRMS of fatigue and be an FRMS requires of a and the of fatigue risk management a FRMS Key Points: The organization and for fatigue. 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This by senior management will ensure the rest of the on the FRMS. management should then a to a FRMS that and management to and guide the FRMS The of this should rest with however, individuals with a variety of and experiences should resources are should be to in fatigue management as or to this is a that the fatigue management will a to fatigue in response to of fatigue or adverse The is to fatigue by available to potential fatigue in of and to schedules or to of a FRMS is the of such a in a FRMS The for sleep is and it is the to sleep opportunities to and a for sleep. the can sleep is to alertness and a the is to hours of sleep in sleep need from to In with the employees to as sleep as needed and to sleep or for sleep requires with in will an then the should to to the as to be for the the in the the is for an or that or not work with or hours of the of sleep to be alert and and to whether the result of the or it is the to of fatigue to the The should not the of or to THE OF to Fatigue and of Key Points: The system to on and an within such a system from not but several FRMS of to and system of in the environment, In two to the of the and the system The on the of the or the the system on the that are and are to be are and to on the under which individuals work to the to this is the of a of and this an not on a but and the provide a of of within the are some on people and on and be complete and However, in are and opportunities for In other is a with its many The of the that the on the are and in will not lead to an on the in will to a through the system and a loss to The in the for two active and are the unsafe of for be or from impact on the of the system is on the from by and senior management. may lead to that in may lead to in the however, these may for many active that are often to can be and Key of an FRMS Key Points: The of from fatigue and shift fatigue and sleep workplace and fatigue and alertness for is extended the of fatigue the or is the in a of of which have to the or and that are of to any or In other such an or is the of a of Fatigue risk hours of safety management with from and an to the of in the FRMS. extended this while the of and an FRMS as a system that a of in the risk of fatigue. In are such that need to be managed by the which are as fatigue and sleep management. Fatigue and alertness for The of these impact sleep and the two affect alertness a but different will be in in the The key of a fatigue risk management with from to the FRMS an FRMS to be must in be the overall of the program. In and the level 1 requires the to be an for sleep. level the to ensure that the actually sleep. level it is to ensure that employees sleep are not for sleep level need to ensure that the not lead to level in the of a the FRMS to provide an to and the This with with the workplace the system with that the not lead to hours of in shift work operations by of shift from and by of in Fatigue Key Points: and can with shift and can with shift in of can with shift of the important of fatigue is an and and attention been to the and of shift such as without the impact of in the that are not shift play the role in the of time off time off of of work hours of the shift and the shift This is in 24/7 the of to on shift is the level is then the employees in that have to work hours or to the hours may be employees for hours the of shift shift and rest hours the in employees for hours the of shift shift and rest hours the employees work on off for the of and/or the of employees work or shift and rest hours the and to to a sleep and shift a the of by employees is and the hours and the shift a work of of from a of shift work of are however, In some of the is by of with the result that the in these individuals is the of The of a 24/7 can the of the with the of a 24/7 a level with an of to on the is to the hours and the work to working hours a on This a in of hours on the This may but it that during any employees may not be available to other work and in with Many 24/7 operations not or the impact of these factors and a shift with fewer the level and the time on and off Many not work and resources are to and and are to and in The of this is not the been a to of to productivity as or a the productivity of whereas the been may to be to by the the to without the of fatigue that are The are not It is that by and on to the in and is to be of However, the by the of time and a or time on may be any to some the of productive work as as hours of may not provide productive of as excessive of are with fatigue and greater risk of and a and can is to be of greater or may to of by as as by some operations and the to 24/7 operations. that been a for a to or In such is the will may be to to the with a employees may be working or a with and from fatigue and In some the is for or are and is an to the on as as may be but often the employees are to work during the extended and fatigue the Safety in its of the that and that the on the time working This to the by the and of the which requires to a comprehensive FRMS that addressing of have the of 24/7 operations the is the same of the and the same of the many shift work operations are not often for a variety of of of and such operations are the same level on management may to an level This can result in a and and of this is a that with the same of for shift of the this the that the of on and many for on In 24/7 operations may to the level by by or by but some of the time. the is are often by a a the of the and the the of the is the to be to are the are for often hours or the of the The is that schedules are and which sleep are by to and to for work on and by to in or of The of employees on the the risk of the fewer the the are and the the rest that by fatigue risk the level can be When the of employees is reduced to the it the fatigue risk of the level of on fatigue risk time different of to in from by of of both and fatigue by the of sleep and extended time on as as and of the to a is by employees as a to the employees will for which not the is often of employees are for of the available that for to be managed. the employees risk on the may to as or can on employees can in a need the of in other be or The risk of fatigue in these employees can be sleep may a is the vicious and that is by a 24/7 that is with on a of 24/7 of the on the level of from and by of and often to to the In such employees and by an to be which the of and the on the other employees to a of employees may with the and fatigue and the rate. This in the of and while employees are and the vicious and The is of the that must be in and an FRMS for two important The of fatigue risk with as shift schedules and be designed the and as as fatigue management should be specific to the schedules that are The in a FRMS is often to be in the and of employees and are of However, and or are this is actually a as This requires senior management on and fatigue the may hours of or which the on and hours of However, the of these may excessive fatigue it is to to of particularly with to time of the for the FRMS its hours of it is the and for addressing and to the of or the of that are needed to be employees to to the available and the in to and a system that better in these have been a is needed to ensure that of and other of been are then shift can then be and Key Points: the the to be during the and the work requires A of can the risk of fatigue during shift can be to the of on the level of worker fatigue. potential of fatigue is the work The work the time in the sleep the the sleep time sleep to or The sleep is some of time the time must the time to to and from work and time to in such as and the requires hours of sleep sleep opportunities must be hours to sleep and fatigue with sleep opportunities to sleep are opportunities to sleep during the is to sleep during the hours of the are Sleep are with shift work sleep and sleepiness are the of shift A is shift to sleep and hours and that of with shift work This is actually not work is not it is a a term to is with the of an schedules to the that for activity and This a condition in which the to the time it is by to the of but the is not with the time. The result of is a sleep that an adverse the is to be This can sleep to fall and of that can lead to sleep and sleep The shift worker is by the that or is work and of time from the and a the same as the on the shift worker that must work is to sleep loss that to the risk of working a is to be the shift worker on shift can from the of the in alertness and potential sleep The risk with this can with the of shift the same of sleep during the sleep in the can an sleep that risk with is no to this The to fatigue risk is to that opportunities to sleep to from sleep on the of to of sleep opportunities through sleep and environmental and to alertness on the and that that are and to a can or is no that sleep or risk on of the that is typically hours sleep the shift a that on time. However, are many on both and and the of for alertness are to without a of the When on individuals to to sleep a of need to an shift on the shift to may fatigue for on the the an the shift to and sleep while are the that it is to fall The shift time is a of the of the shift and should be with have been alertness for shift work and Sleep The the the greater the of time the sleep and the greater the of on and that as is an risk of same however, that within the to fatigue can the risk with in that shift shift of and The shift is often not the work to work or in the work opportunities to sleep for that the or extended Sleep loss is and to a sleep. Because of the from the can with the of shift work on is from the not from the of fatigue the of in alertness and sleep of sleep that or and sleep are the and the Fatigue the Fatigue and the in these factors are and the may be in of subjective of or of the of are in of in as of This to of response on a time have shown that time is correlated with on other However, fatigue is of physical fatigue. of fatigue are of to are not designed to the of physical or fatigue. the of the can be as for the fatigue with It is that the in the to a variety of that or on the of mental and However, specific in on these skills, and in or alertness may not in the to it is to that