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Fatigue -- described as a decreased state of alertness -- may impair a worker's safety, health, and productivity, costing employers billions of dollars each year. But companies that implement programs to address fatigue can improve the health and well-being of their workers and cut down on needless expenses.

"There is a growing recognition of the role of fatigue management in enhancing safety in the workplace," said Dr. Steve Lerman. "Most of the attention to this issue has historically been focused on the transportation industries. However, the focus is now expanding to other industries."

Fatigue defined. While many people think of fatigue and sleepiness as the same, they are not. "Sleepiness is just the tendency to fall asleep due to insufficient sleep while fatigue is the body's response to prolonged mental or physical activity as well as to sleep loss," said Dr. Natalie P.Hartenbaum, immediate past president of the ACOEM.

"Fatigue levels can be affected by not only quantity of sleep but also quality which can be affected by other factors, including timing of sleep (at night or during the day) or environmental factors such as temperature or light, and workload."

The effects of fatigue can be wide ranging.

Some industries address duty hours through regulation or guidelines. But there was no consolidated document that offered education and guidance on workplace fatigue that could be used by multiple industries.

Mitigating fatigue. Just about everyone has experienced fatigue at some point. A study published in the Journal of Occupational and Environmental Medicine in 2007 estimated that 38 percent of U.S. workers surveyed had felt fatigued at some point during a two-week period.

In addition, fatigue can be induced by factors such as working multiple jobs, child care responsibilities, and workplace practices such as scheduling and distribution of work tasks. While it is not necessarily possible to eliminate fatigue entirely, employers can reduce it by understanding and addressing some of the causes.

"Employers need to recognize the importance of a complete fatigue risk management strategy which includes adequate staffing, appropriate shift schedules, sleep disorder management, addressing the workplace environment, and education," Hartenbaum said. An integrated FRMS can minimize excessive fatigue and mitigate safety risks associated with it.

"Employers provide the opportunity for employees to obtain adequate sleep, educate employees regarding the importance of obtaining enough high-quality sleep and how to do so," Lerman said. "For the FRMS to be successful, the employees must take advantage of the opportunities and knowledge provided to obtain sufficient high-quality sleep."

Part of the process involves recognizing and addressing the signs of excess fatigue and designing the workplace and jobs to minimize fatigue and maximize alertness. The authors define an FRMS as "a scientifically based, data-driven addition or alternative to prescriptive hours of work limitations which manages employee fatigue in a flexible manner appropriate to the level of risk exposure and the nature of the operation."

More than just a set of rules and static information about fatigue, an FRMS is a "living process with an organizational proponent and regular activities," the guidance statement says. "The organization must arrange schedules of work that provide sufficient opportunities for rest, training to support fatigue management, and procedures for monitoring and managing fatigue within the organization. The employee has the responsibilities to use available time to be rested and fit for duty, to attend training and implement recommendations and to report cases of fatigue so that they can be better avoided in the future."

"An FRMS is at its core a safety program," Lerman said. "In addition to increased safety, an effective FRMS should enhance productivity, employee health, and product quality. Thus, an effective FRMS is an investment with an attractive return."

The authors identify the following five key components of an FRMS:

• Balance between workload and staffing.
• Shift scheduling.
• Employee fatigue training and sleep disorder management.
• Workplace environment design.
• Fatigue monitoring and alertness for duty.

"Like all management systems, an effective FRMS begins with management support and employee buy-in," Lerman said. "Also, like all management systems, it is an iterative process in which the effectiveness is measured and adjustments are made to achieve continuous improvements."

Lerman says there is no one-size-fits-all FRMS. It requires the active participation of many stakeholders and should be unique to each organization.

"There are experts who can advise on the development of an FRMS," Lerman said. "The purpose of this ACOEM guidance statement is to enhance the knowledge and skills of occupational physicians to provide this advice."

Read more at the WorkersComp Forum homepage.

March 26, 2012

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