We write as the National Fatigue Management Awareness Campaign, to raise the issue of fatigue among healthcare workers (HCW) during the national effort against Covid-19.
The Movement Control Order (MCO) extension until 28th April 2020, rigorous contract tracing and increased diagnostic testing are measures adapted by the Malaysian Government and Ministry of Health (MOH) in flattening our epidemic curve in order to match with our healthcare system capacity. A crucial capacity is our HCW, therefore management of HCW fatigue is vital to ensure sustainability of healthcare nationwide.
The Covid-19 pandemic aggravates HCW’s underlying accumulated fatigue due to sleep deprivation attributed to longer working hours caused by inadequate staffing and higher workload demand.
MOH reported on 11th April 2020 that 224 HCW in Malaysia were infected with Covid-19 while medical laboratory technologists (MLT) nationwide have conducted between 9,000 to 12,000 Covid-19 tests per day between 3rd to 9th April 2020 until 10pm and on weekends.
Other factors include discomfort and dehydration associated with personal protective equipment (PPE) wear in hot climate, information overload from frequently changing guidelines, anxiety over misdiagnosing patients, concern about infecting self and others and the tragic deaths of HCW colleagues (locally and internationally) due to commuting accidents, crisis unpreparedness, suicide from work-related fatigue or Covid-19 infection itself.
Despite these contributing factors, HCW need to remain resilient in fulfilling the clinical work demands and hardly have time for own grief. Unmanaged fatigue can impair HCW’s physical, emotional, cognitive and psychological wellbeing. They are susceptible to error and negligence, consequently affecting patient safety and healthcare quality.
MyREST recommends immediate strategies to overcome HCW fatigue during this pandemic for the HCW, healthcare managers, policymakers and general public.
Firstly, we recommend fatigue management strategies for the HCW. We propose using the REST acronym, which stands for:
R – Recognising own fatigue symptoms and signs:
Physical symptoms (headache, giddiness, muscle aches, yawning repeatedly, frequent blinking or heavy eyelids)
Emotional symptoms and signs (moodiness, irritability, anger, frustration)
Cognitive symptoms and signs (forgetfulness, difficulty focusing, poor attention and coordination, impaired judgment and decision making).
E – Empowering HCW through words of encouragement by uplifting HCW colleagues, being concerned and offering positive affirmations to one another
S – Sleep hygiene
Rest during duty: HCW should be allowed for frequent micro breaks (10-20 minutes) to unwind as opposed to a long period of break within long hours of duty.
Nap post duty: to prevent commuting accidents, fatigued HCW should take a quick nap in designated sleeping areas first and only drive home once they feel refreshed and alert.
Sleep at home: HCW can follow proper sleep hygiene practices, such as switching off work mode, focusing on family matters and taking a warm shower. Prior to bedtime HCW should avoid caffeine, heavy meals, staring at the mobile phone screens and rumination.
T – Teamwork. HCW from other departments, health facilities, contract and volunteerism must prepare themselves with proper knowledge, skills and attitude in order to assist comrades.
Secondly, we recommend fatigue management strategies for the middle managers, hospital directors and healthcare clinic leaders. Healthcare managers can reduce HCW fatigue during their duty, post duty and throughout the crisis by the following suggestions:
During HCW duty
- provide a designated area for HCW to rest
- offer human touch through words of encouragement either in person, online or by placing motivational quotes on wall frames at HCW working areas
- arrange for 30 minutes to 1-hour informal session between HCW groups and counsellor/ psychologist using online platform, to enable HCW to vent their feelings, share work-related fatigue issues and receive motivations from the moderator
- arrange for volunteer e-hailing drivers to coordinate free hospital transportation to fatigued staffs
Throughout the crisis
- ensure adequate infection control system and protective measures are in place
- collaborate with NGOs, engineers and safety officers on innovative measures to minimise HCW risk to infection, such as isopod, intubation box and phone booth swab cubicles
- empower staffs through training
- encourage the utilization of Mental Health Psychosocial Support (MHPSS) introduced by MOH
Thirdly, we recommend fatigue management strategies for the policy makers. In addition to appreciation expressed by our Prime Minister, Director General for Health, Ministers and officials towards HCW, recruiting additional HCW and volunteers and collaborations with various stakeholders, the following strategies need to be emphasized by policymakers:
- mobilise non-medical volunteers to non-critical areas so that HCW’s expertise are being delivered to critical areas within their training only
- health insurance companies and private health facilities to revise the financial barrier to Covid-19 screening tests to allow more affordable access hence offload the Government laboratory settings
- provision of lunch packs, tents, fans and portable air-conditioners to HCW in Government health clinics located in resource scarce suburban areas
- clear communication and coordination between ministries with advice from MOH regarding business recommencement, to prevent new clusters forming leading to incapacitated healthcare system
Other than the obligation to stay at home, maintain social distance and practice hand hygiene, the general public is also advised to:
- visit the health facilities only if they are seriously ill and utilise telehealth services recommended by the MOH for Covid-19 consultation to reduce frontline HCW workload
- families of HCW should remain connected with HCW on duty or during quarantine/admission, to prevent psychological and emotional sequalae related to isolation
- monitor their own health at home especially for chronic disease patients, adopt healthy lifestyle, comply to prescribed medications and avoid taking unapproved therapies
- NGOs and health professionals are to engage with social medial influencers, celebrities and community leaders on creating public awareness of Covid-19 and staying healthy
MyREST supports the strategies implemented by MOH and Government of Malaysia in battling against Covid-19. Our recommendations aim to complement the existing approaches to ensure HCW fatigue are addressed and managed accordingly. We believe this can be achieved through collective efforts as HCW individual, healthcare managers, policymakers and the general public. Our healthcare system will collapse if we fail to protect our HCW now.
Malaysia’s National Fatigue Management Awareness Campaign was launched on 24th February 2020. MyREST aims to promote awareness about the importance of fatigue management and to empower workers and organizations on best practices of fatigue management.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.