Yesterday, we took a trip down to
Cardiff. It was my Father’s 88th birthday and my brother and sister whom I hadn’t
seen for a while were there. It was good to catch up. As much as I would have
liked to have stayed, this wasn’t possible, so it was a very long day. In fact
it is the second Saturday in a row where I have gone to bed after midnight and
then been up to post this blog first thing on Sunday morning. Although this
morning, it was good to get an extra hour in bed! Fortunately, these days I
don’t seem to need as much sleep as I once did, but that’s not the case for some
folk. Amazingly, we spend approximately a third of our lives asleep, and many
people - young people in particular - need a lot more sleep than the proverbial
eight hours. And it’s not just me who says this. Dr Michael Farquhar,
consultant in children’s sleep at Evelina London Children’s Hospital, posted an
interesting blog last week where he discussed the importance of sleep and the
positive impact effective sleep can have on our working lives.
Serendipitously, one of my
Twitter friends also posted last week that she was on her second long day in a
row, and was looking forward to her day off. All she really wanted to do was sleep
and do nothing else. Twelve hour shifts are the most common shifts worked by
nurses, and there are hundreds of websites offering scheduling formats for 12-hour
shift combinations. What caught my attention in Dr Farquhar’s blog was his concept
of ‘power naps’. Power naps are just 15 – 20 minutes long, and can help combat
the worse outcomes of fatigue and tiredness. Although they
might not work for everyone, power naps are definitely something for those
working in the NHS to consider. Of course NHS employers would need to
provide facilities so that their staff can take a power nap! Working long hours, and often on shifts and,
increasingly these days, in situations where the workload is relentless, will
take its toll on most people’s health and wellbeing. Having enough sleep, and
good quality sleep, is essential to our health.
Dr Farquhar suggests that when we
don’t have enough sleep, or have troubled sleep and inadequate time to recover
between shifts, we are likely to suffer short and long term issues. These can
include: irritability, being less empathic and patient, an inability to
concentrate, and being less able to cope with the unexpected. All of which are unhelpful
when working in front-line patient care. Longer term, the risk of disease such
as obesity, depression, and cardiovascular disease increases. Sadly, tiredness
in health care workers can also have catastrophic consequences for their
patients.
This was something I spent some
time last week discussing with my pharmacy colleagues at Wrightington, Wigan
and Leigh (WWL) NHS Trust. I was there to look at the difficulties in
developing criteria for effectively measuring the percentage of critical
medicines prescribed within 24 hours of admission or before a patient is moved
to a new clinical area. It is not an easy task. There are 11 such medicines*
listed in the WWL guidance. Some of these might be considered critical in some
situations and yet the same drug might be used for less critical conditions.
For example, anti-epileptics are on the list. One such drug in this category is
Carbamazepine. It is mainly used as an anticonvulsant, and when used in this
way it is clearly a critical medicine. It can also be used in other conditions,
for example trigeminal neuralgia; a use which would not be considered as
critical. It is a drug that is on the World Health Organisation’s List of
Essential Medicines; a list that contains the most effective and safe medicines
needed in a healthcare system.
As things stand at present and even with our very sophisticated
information system, teasing out the contextual use,
omissions and delays in the prescribing and administration of these drugs is
pretty much impossible. It can be done, but would demand huge resources in
sifting through mountains of data by hand. Currently, we gain assurance through
the cross-referencing of other data. For example, there were 79 wrong dose
incidents over the last 12 months. Each of these incidents is investigated and
the appropriate action taken. My colleagues took me through the medicines’
management data, much of which was very positive, and showing a trend in terms
of safety that was going the right way. The Trust is 14th
nationally for reporting medicine incidents, although analysis of these reports
shows that 96% of them had not led to any patient harm. That is good news, but
nothing to be complacent about. However, they also observed that many
of the medicine incidents appeared to occur when nurses and doctors were working long
days and having to face high pressure clinical demands.
We have a Trust Board meeting
next week and I think I will introduce the concept of power naps when making my
Board Assurance report. I hope that, as the relentless demands on the NHS continue, those
responsible for supporting staff delivering care, put in place approaches that
better enable colleagues to deal with and avoid the negative consequences of fatigue and
tiredness. And, given the early start to my day today (despite the
clock going back an hour), I will try the power nap approach out myself later
on.
*the 11 critical medicines – Antibiotics,
Antivirals, Anticoagulants, Anti-epileptics, Anti-Parkinson’s, Corticosteroids,
Insulin, Intravenous Fluids, Oral Hypoglycaemics, Cardiac Medicines, Immunosuppressants
post-transplant, Desmopressin
