夜班期间小睡 20 分钟有助于提高医院工作人员和患者的安全

A review at this year's Euroanaesthesia congress in Milan, Italy (4-6 June) on the potentially lethal effects of fatigue on doctors and nurses themselves, and its impact on the quality of their clinical work and judgment and therefore patient safety, will be given by Consultant Anaesthetist Dr Nancy Redfern of Newcastle Hospitals NHS Foundation Trust, Newcastle, UK. She will conclude that due to these risks, "healthcare should have formal risk management systems like those required by law in every other safety-critical industry".

She will also recommend that all doctors and nurses need 20-minute power naps during night shifts to keep patients safe (and make their own journeys home after work safer), and also recommend that no doctor or nurse does more than 3 consecutive night shifts.

Dr Redfern will discuss evidence from various sources including surveys from the joint Association of Anaesthetists, Royal College of Anaesthetists and Faculty of Intensive Care Medicine fatigue working group, published in the journal Anaesthesia, that showed around half of trainee doctors, consultants and nurses had experienced either an accident or a near miss driving home after a night shift. Indeed, research has shown driving after being awake for 20 hours or more and at the body's circadian low point (in the night or very early morning when it most needs sleep) is as dangerous as driving with blood alcohol levels above the legal limit. And workers who drive home after a 12-hour shifts are twice as likely to crash as those working 8-hour shifts.

A 'sleep debt' begins building after 2 or more nights of restricted sleep, and it takes at least 2 nights of good sleep to recover from this. Cognitive function is impaired after 16-18 hours awake leading to a deterioration in the medical worker's ability to interact effectively with patients and colleagues. "When fatigue sets in, we in the medical and nursing team are less empathic with patients and colleagues, vigilance becomes more variable, and logical reasoning is affected, making it hard to calculate, for example, the correct doses of drugs a patient needs," explains Dr Redfern. "We find it hard to think flexibility, or to retain new information which make it difficult to manage quickly changing emergency situations. Our mood gets worse, so our teamwork suffers. Hence, everything that makes us and our patients safe is affected."

She will discuss how fatigue induces spontaneous, unrecognized uncontrolled 'sleep lapses' or 'microsleeps', which means driving home tired is the most dangerous thing a healthcare practitioner does. Evidence around short 20-minute power naps in improving staff and patient safety will be presented and ways of building this into night shift work discussed.

There is work going on at many levels to address the impact of fatigue. The European Society of Anaesthesiology and Intensive Care (ESAIC) (that hosts Euroanaesthesia) is working on producing guidelines for night working, while the Association of Anaesthetists has an active #fightfatigue campaign. The European Board of Anaesthesiology and the European Patient Safety Foundation are also active in this area, and Dr Redfern notes that several European countries are leading the way with action, including the UK, Romania, The Netherlands and Portugal.

We hope in the end that regulators will recognize that healthcare workers have the same physiology as employees in every other safety-critical industry and require formal fatigue risk management as part of its overall approach to patient and staff safety."

Dr Nancy Redfern of Newcastle Hospitals NHS Foundation Trust, Newcastle

She concludes: "We need to change the way we manage night shifts to mitigate the effects of fatigue. Those working shifts must ensure everyone gets a power nap, and that we support each other to remain safe and vigilant when we work through the night. Staffing schedules should allow sufficient time between shifts for proper rest, and no-one should do more than 3 night shifts in a row."

全文翻译（仅供参考）

今年在意大利米兰举行的欧洲麻醉学大会（6 月 4 日至 6 日）将审查疲劳对医生和护士本身的潜在致命影响，以及其对临床工作和判断质量以及患者安全的影响。由英国纽卡斯尔纽卡斯尔医院 NHS 基金会信托基金顾问麻醉师 Nancy Redfern 博士撰写。她将得出结论，由于这些风险，“医疗保健应该有正式的风险管理系统，就像其他所有安全关键行业的法律要求的系统一样”。

她还将建议所有医生和护士在夜班期间需要小睡 20 分钟，以确保患者安全（并使下班后自己回家的旅程更安全），并建议医生或护士连续夜班不超过 3 个。

Redfern 博士将讨论来自各种来源的证据，包括来自麻醉师协会、皇家麻醉师学院和重症监护医学学院疲劳工作组的联合调查，该调查发表在Anesthesia杂志上，该调查显示大约一半的实习医生、顾问和护士经历过夜班后开车回家的事故或险些错过。事实上，研究表明，在清醒 20 小时或更长时间后以及在身体的昼夜节律低点（夜间或最需要睡眠的清晨）驾驶与血液中的酒精含量超过法定限值驾驶一样危险。轮班 12 小时后开车回家的工人撞车的可能性是轮班 8 小时的工人的两倍。

“睡眠债”在 2 晚或更长时间的受限睡眠后开始累积，并且至少需要 2 晚良好的睡眠才能从中恢复。认知功能在清醒 16-18 小时后受损，导致医务人员与患者和同事有效互动的能力下降。“当疲劳开始时，我们医疗和护理团队对患者和同事的同情心会降低，警惕性变得更加多变，逻辑推理也会受到影响，从而难以计算出患者需要的正确药物剂量， ”雷德芬博士解释道。“我们发现很难考虑灵活性或保留新信息，这使得难以管理快速变化的紧急情况。我们的情绪变得更糟，因此我们的团队合作受到影响。因此，

她将讨论疲劳如何导致自发的、无法识别的、不受控制的“睡眠不足”或“微睡眠”，这意味着疲劳驾驶回家是医疗保健从业人员所做的最危险的事情。将展示关于提高工作人员和患者安全的 20 分钟小睡的证据，并讨论将其纳入夜班工作的方法。

在许多层面上都在开展工作来解决疲劳的影响。欧洲麻醉学和重症监护协会 (ESAIC)（主办 Euroanaesthesia）正在制定夜间工作指南，而麻醉师协会则积极开展#fightfatigue 运动。欧洲麻醉学委员会和欧洲患者安全基金会也积极参与这一领域，Redfern 博士指出，几个欧洲国家正在采取行动，包括英国、罗马尼亚、荷兰和葡萄牙。

我们希望监管机构最终能够认识到，医护人员与所有其他安全关键行业的员工具有相同的生理机能，并要求将正式的疲劳风险管理作为其患者和员工安全整体方法的一部分。”

纽卡斯尔纽卡斯尔医院 NHS 基金会信托基金的 Nancy Redfern 博士

她总结道：“我们需要改变管理夜班的方式，以减轻疲劳的影响。这些轮班工作必须确保每个人都能小睡一会儿，并且我们要相互支持，以便在我们通宵工作时保持安全和警惕。人员配备时间表应在轮班之间留出足够的时间进行适当的休息，并且任何人都不应连续上超过 3 个夜班。”

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