Shift Work and Circadian Disruption
In recent years, considerable attention has been given to the role of shift work and sleep deprivation in medical error, road collisions, and other types of incidents. Disruption of circadian rhythm is a key issue for many types of
Fig 9.3: Sample Team Participation Policy
METHODIST HEALTHCARE SYSTEM METHODIST CHILDREN'S HOSPITAL OF SOUTH TEXAS
| TITLE: | Criteria for Transport Duty |
| EFFECTIVE DATE: | May 1997 |
| REVISED DATE(S): | March 19, 2006 May, 2011 |
| REVIEWED DATE(S): | |
| AUDIENCE: | Children's Transport Services |
| APPROVED BY: | Coordinator |
All standard policies and procedures represent our current knowledge and judgment regarding the issue covered by this policy.
If you can think of a better way to handle the issue covered in this policy/procedure, or if this policy/procedure needs to be revised to reflect changes that have occurred, please "draft" a revision and give it to the transport coordinator or the team medical director so that we can consider improving this policy/procedure accordingly.Policy:
1. On-duty team members will be physically and mentally able to manage a critical care transport. Criteria include, but are not limited to the following:
• The team member is able to lift up to 50 lb.
• The team member is able to withstand the potential stressors of the transport environment and transport activities. The team member is well rested—has had a minimum of á hours of sleep within the 24-hour period prior to on-duty status.
• The team member is able to tolerate variances in diet.
• The team member is not under the influence of medications that can cause excessive drowsiness or sedation.
• The team member has not ingested alcohol within 8 hours of on-duty status.
• The team member has not donated blood within the last 72 hours.
2. In the event of illness, injury, or personal difficulties that occur during a transport shift that would limit the team member's ability to adequately perform in the transport environment, the team member will notify:
• Transport coordinator, clinical administrator, or other supervisor
If the team member cannot be replaced with in-house or on-call coverage such that a full team could still be mobilized, the "Closure of Transport Services” policy/procedure will be initiated.
3. Team members who have symptoms that would limit their ability to perform their duties on transport must notify the transport coordinator or respiratory therapy director/supervisor. The team member will be alert to the following conditions that are relative contraindications to aeromedical transport and may render them ineligible for duty:
• Impacted sinusitis
• Invasive dental work within 24 hours of on-duty status
• Otitis media
• Scuba diving within 24 hours of on-duty status
• Any condition for which the employee health nurse has enacted work restrictions
• Any condition for which the team member's physician has placed him/her on work restrictions
4. Any team member who has been placed on work restrictions is required to furnish a physician's statement clearing him/her for transport activities before returning to active duty status.
5. Team members who are aware they are pregnant are requested to notify the Transport Coordinator (as well as their manager/director) of their condition. Pregnant team members will be allowed to remain on active status until their first prenatal appointment with their MD. At the time of the first prenatal exam, they must obtain a letter/note from their MD clearing them for continuing active transport status.
The pregnant transport provider assumes responsibility for informing her MD of the physical stressors of the transport environment and transport duties. She may provide her MD with a copy of this policy.MD indicates physician. Used with permission: Methodist Healthcare System, San Antonio, TX. workers. Certainly, health care has always been a 24-hour business. However, transport teams have special problems related to sleep deprivation and shift work. First, unlike their colleagues in the hospital, transport team members may not be exposed to the stimulation of lights and personal interactions that contribute to remaining alert. In fact, they may be required to travel for many hours in a darkened vehicle, performing relatively routine and monotonous tasks. Under such circumstances, vigilance and judgment may falter. Second, shifts can become lengthened with a prolonged transport, forcing the team member to work well beyond the scheduled end of the shift. For team members working several consecutive shifts, the result might be inadequate rest. In extreme cases, such as international or cross-country transports, team members may be subject to jet lag, further disrupting sleep. There are few easy solutions to this problem. All drivers and pilots should adhere strictly to regulations governing adequate rest before and after duty, even if this means that some transports must be delayed, divided into legs, or referred. Scheduling for team members should occur in a “circadian-friendly” manner, moving forward from day shifts to middle shifts to night shifts with adequate rest between the transition from nights to days. Dedicated transport teams (ie, the teams whose members have no other assigned or primary clinical duties when not transporting patients) may want to consider allowing team members to sleep during the night shift when not transporting patients. All teams should have rules dictating rest time before duty hours. Such rules should also address the minimum number of hours before duty that a team member can consume alcohol and certain medications.