Introduction The impacts of staff fatigue on patient safety, staff safety and wellbeing has been well documented. Fatigue amongst staff has been recongised by many organisations as a significant risk and features on the risk register. A systematic review in 2016 demonstrated a positive relationship between night shift working and increased errors and decreased performance.

Another study in 2019 found that circadian misalignment increases cognitive vulnerability on sustained attention, information processing and visual-motor performance, particularly after more than 10 hours of scheduled wakefulness. 20 hours of wakefulness can cause impaired performance equivalent to being over the UK legal driving limit for alcohol. It has also been found that workers who drive home after a 12-hour shift are twice as likely to have a crash as those working eight-hour shifts. It is therefore crucial that fatigue that trusts put fatigue and rest as a priority to ensure both staff and patient safety.

Aims and objectives of the research project or activity This project aimed to initiated a fatigue working group whose sole purpose was to look further into the issues of fatigue in staff at Royal Bolton Hospital. This group is comprised of members of staff from both medical and nursing teams, occupational health, workforce, organisational development, communications. Using a driver diagram this group has identified three main areas of focus:

Education – ensuring staff have the knowledge around the impact of fatigue on decision making abilities and practical ways to help themselves. Including the benefit of a 20minuite nap.

Culture - That staff feel they have permission to rest during their breaks on shift should they wish and that this is role modelled within the organisation.

Facilities – that staff have access to appropriate spaces to rest before and after shifts.

Method or approach The group met on a monthly basis and reported into the trust people committee. We started out collecting some data through a staff survey. It was identified that 59% felt they had been so tired after a shift they felt unsafe to get home. 63% of staff said they would have a nap on shift if they had adequate facilities to do so with 25% unsure. 58% of staff said they would rest post a night shift if they had availability to do so with a further 21% unsure. When asked about what they would like to see implemented staff wanted access to recliner chairs and spaces to rest, rota designs to support night working and better education around fatigue. Ensuring senior sponsorship was crucial. Engagement of staff at all levels has been key ensuring that information is disseminated through multiple routes.

Findings Significant progress has been made in all three areas.

Regarding Education, we have successful incorporation of fatigue discussions into trust human factors training. A fatigue week in October 2023 introduced staff to some of the facts around sleep through a Quiz and the launch of ‘Even hero’s need sleep’ campaign. Providing information and resources both physically and on the trust intranet.

To support this work around Culture we have created of an induction video around the importance of sleep and permission for staff to take breaks. The video features a range of staff including the Chief nurse and the Medical Director championing and permitting the naps and rest on shift. We have also introduced questions around safety to drive home into morning handover. A ‘fatigued themed swartz’ round was also held.

Finally, we have successfully received funding (through the Bolton Charity) for recliner chairs to enable staff to have the ability to rest with chairs located across wards and inpatient areas. A second set of chairs have been placed in on call rooms to provide staff with access to quick use chairs that they use to rest before driving home should they wish. Evaluation is currently in progress.

Key messages With rates of staff dissatisfaction and burnout high amongst NHS staff, fatigue is a real risk to patient and staff safety. The problem of staff fatigue is multifactorial and requires and an MDT and wholistic approach. By using a Quality Improvement approach to understand the problem we have been able to identify key factors and focus on them. Giving the staff the knowledge to understand the impact of fatigue, providing them with spaces to rest both during and after shift and crucially giving them permission to do so. We hope that talking about fatigue becomes the norm and through leading on this work staff feel valued and safe at work enabling them to provide the best care for patients. Initially feedback has been overwhelmingly positive. Further work to embedded the changes into handover is ongoing and to look a rota design to support staff into transitions into night shifts.