An exhausted workforce increases the risk of errors.

120 P&T® • March 2009 • Vol. 34 No. 3 a blood alcohol concentration of 0.1%, which is above the legal limit for driving in most states.4 When people experience exhaustion, their performance varies widely. One moment performance might be good; the next moment, it’s in adequate as perceptions begin to dis engage during episodes of microsleep (intermittent lapses in consciousness).5 When people are tired, the physiological drive to sleep can result in sleep that lasts a few seconds to a few minutes. Their eyes might even be open without their awareness.5 Microsleep impairs performance and often leads to errors resulting from missed information or even from a loss of situational awareness. In one study, a videotaped, sleep-deprived anesthesiologist exhibited behaviors indicative of microsleep episodes during more than 30% of a four-hour procedure.6 Other industries have taken action to combat the effects of fatigue; however, the health care industry in general has largely disregarded the problem, especially because of the ongoing shortage of licensed practitioners. Several years ago, the Accreditation Council for Graduate Medical Education limited work schedules for medical residents to 80 hours per week (the European Union allows just a 56-hour weekly limit), and the Institute of Medicine recommended that nurses work no more than 12 hours a day and 60 hours per week, in any combination of scheduled shifts, mandatory overtime, and voluntary overtime.7 However, more needs to be done.