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Patient Safety Tip of the Week
May 9, 2023
Can Light Reduce
Fatigue-Related Errors?
Fatigue is a major
contributor to errors and accidents in all industries, not just healthcare. Our
many prior columns on fatigue in healthcare have focused on the long work hours
that are a major cause of fatigue. So, the focus has largely been on preventing
fatigue by managing those work hours. But what about acute interventions to
minimize fatigue and the errors that often occur because of fatigue. Well-timed
breaks and even power naps may have a beneficial effect (see our November
2012 What's New in the Patient Safety World column The Mid-Day Nap and our September 6, 2016 Patient Safety
Tip of the Week Napping
Debate Rekindled).
But how about light?
Light, of course, is the major driver of circadian rhythms. After a couple
preliminary trials (Olson
2019, Cyr
2022) to see if light could reduce
fatigue and prevent errors, Cyr and colleagues (Cyr
2023) conducted a randomized controlled trial of an evening light
intervention on night shifts. The study recruited 57 nurses at the McGill University Health Centre who worked schedules that
rotated between day and night shifts within the same week.
Participating nurses completed the study over 3 non-consecutive
10-day periods during which they worked similar shift schedules. The first
period served as the baseline; participants then learned about their randomly
assigned intervention and followed it during the second and third periods.
During the initial
10-day observation period, nurses in the experimental group made a total of 21
errors, ranging from giving the wrong medication dose to accidental needle
pricks. However, when given 40 minutes of bright light exposure from a portable
light box before their night shifts, the number of errors by nurses reduced to
an average of only 7 errors a reduction of 67%. In contrast, nurses in the
control group reported 19 errors during the baseline and an
average of 18 during each intervention period, for a 5% reduction.
More experimental
participants mentioned improvements in fatigue or alertness at work on the
post-study questionnaire (73%) than those in the control group (41%).
This trial confirmed
the results of the previous feasibility study (Olson
2019) where the researchers saw a
similar 62% reduction in the number of errors at work.
The authors also
speculate whether sunlight might replace the light
box in similar interventions, at least in the
summer. Getting sunlight before sunset and then avoiding light the following
morning could potentially improve circadian alignment without the need for
additional equipment. They
suggest future research could test this hypothesis.
These study results
are quite provocative. Very few patient safety interventions produce a 67%
reduction in errors. Wed like to see replication of these results in other
settings and, more importantly, studies showing sustainability of the results.
Some of our other columns on the role of fatigue in
Patient Safety:
November 9, 2010 12-Hour Nursing Shifts and Patient Safety
April 26, 2011 Sleeping Air Traffic Controllers: What About
Healthcare?
February 2011 Update
on 12-hour Nursing Shifts
September 2011 Shiftwork and Patient Safety
November 2011 Restricted Housestaff
Work Hours and Patient Handoffs
January 2012 Joint Commission Sentinel Event Alert:
Healthcare Worker Fatigue and Patient Safety
January 3, 2012 Unintended Consequences of Restricted Housestaff Hours
June 2012 June 2012 Surgeon Fatigue
November 2012 The Mid-Day Nap
November 13, 2012 The 12-Hour Nursing Shift: More Downsides
July 29, 2014 The 12-Hour Nursing Shift: Debate Continues
October 2014 Another Rap on the 12-Hour Nursing Shift
December 2, 2014 ANA Position Statement on Nurse Fatigue
August 2015 Surgical Resident Duty Reform and
Postoperative Outcomes
September 2015 Surgery Previous Night Does Not Impact
Attending Surgeon Next Day
September 29, 2015 More on the 12-Hour Nursing Shift
September 6, 2016 Napping
Debate Rekindled
April 18, 2017 Alarm
Response and Nurse Shift Duration
July 11, 2017 The
12-Hour Shift Takes More Hits
February 13, 2018 Interruptions
in the ED
April 2018 Radiologists
Get Fatigued, Too
August 2018 Burnout
and Medical Errors
September 4, 2018 The
12-Hour Nursing Shift: Another Nail in the Coffin
August 2020 New
Twist on Resident Work Hours and Patient Safety
August 25, 2020 The Off-Hours Effect in
Radiology
September 2020 Daylight
Savings Time Impacts Patient Safety?
January 19, 2021 Technology to Identify
Fatigue?
October 12, 2021 FDA Approval of Concussion
Tool Why Not a Fatigue Detection Tool?
February 2022 Does
Time of Day Matter?
May 2, 2023 ACGME Work Hour Guidelines
Not Good Enough
References:
Cyr M, Artenie DZ, Bikaii AA, et al. An evening light intervention reduces
fatigue and errors during night shifts: A randomized controlled trial. Sleep
Health 2023; Published online April 18, 2023
https://www.sciencedirect.com/science/article/abs/pii/S2352721823000359
Olson JA, Artenie DZ, Cyr M, Raz
A, Lee V. Developing a light-based intervention to reduce fatigue and improve
sleep in rapidly rotating shift workers. Chronobiol
Int 2019; 37(4): 573-591
https://www.tandfonline.com/doi/full/10.1080/07420528.2019.1698591
Cyr M, Artenie DZ, Bikaii AA, Borsook D, Olson JA.
The effect of evening light on circadian-related outcomes: a systematic review.
Sleep Med Rev 2022; 64: 101660
https://www.sciencedirect.com/science/article/abs/pii/S1087079222000739
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