Introduction Fatigue is a common by–product of the 24 hour delivery of patient care. Defined as a decreased capacity to perform mental or physical work or the subjective state in which one can no longer perform a task, fatigue manifests in physiological performance decreases and cognitive impairment.¹ Fatigue thus poses elevated risk to the staff and patients of TSCUH and hospitals in Ireland and across the globe.

Methods The authors set out to introduce a Fatigue Risk Management System ² (FRMS) in a paediatric Hospital which would integrates management practices, beliefs and procedures to manage the risks associated with fatigue at the hospital. A review of the literature was conducted and a number of tools were utilised in undertaking the project including stakeholder analysis, risk assessment and a communication plan. The project was managed with reference to The HSE Change model. A local working group was formed to proactively manage this risk of fatigue with defined governance structures. The FRMS provides tailored defences against fatigue-related risks through the use of objective thresholds specifically for local environments. A policy was developed to support fatigue risk management system. Once the FRMS had been introduced locally a plan was devised to disseminate best practice at a national level.

Results A local working group has been established to address fatigue mitigation. Fatigue is now on the quality and risk agenda. Control strategies have been identified including:

• the introduction of strategic napping

• purchase of flat bed chairs to facilitate same

• environmental – a dedicated nap station ‘Snoozzone’ proposed

• education programme on fatigue & fatigue mitigation strategies introduced

• Fatigue risk scan is being completed and data collection is taking place

The fatigue scan is expected to influence the organisation of work and work scheduling to minimise the impact of fatigue and to provide adequate rest periods.The final FRMS (Fatigue Risk Management Strategy) document has now been completion.

Discussion Recent research shows that one in four doctors report driving home following work shifts when fatigued. There have been a number of deaths of doctors involved in road traffic accidents following night shifts in the UK in recent years associated with fatigue. Following the very positive feedback from staff following the successful introduction of a FRMS in a children’s hospital, a programme to introduce FRMS is now being extended to public hospitals throughout Ireland. This will not only help to improve the health and safety of doctors and other healthcare workers but shall ultimately improve patient care. The FRMS shall be launched nationally later in 2017 in liaison with WHWU (Workplace Health and Wellbeing Unit), HSE to address fatigue in public funded hospitals in Ireland. A position paper is currently being written by the authors for Faculty of Occupational Medicine Ireland.