A systems approach to understanding pharmacist occupational fatigue and the case for fatigue risk management

Background Occupational fatigue occurs when work demands exceed capacity and resources. Evidence shows that occupational fatigue among physicians and nurses negatively impacts patient, employee, and organizational outcomes. Importantly, fatigue has been overlooked in the vast majority of community pharmacists who are experiencing excessive demands within the workplace. Pharmacist occupational fatigue has the potential to have impact on the safe use of medication in the outpatient setting. This study aimed to identify work system factors that promoted occupational fatigue in Wisconsin community pharmacists. Methods This qualitative study used the Conceptual Framework of Occupational Fatigue, which was adapted from the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Wisconsin community pharmacists participated in a 30-minute semi-structured interview to elicit themes and factors that contributed to or mitigated fatigue. Interviews were analyzed using deductive content analysis with a priori codes from the SEIPS framework and work system components. Results Between July 2021 and March 2022, 39 pharmacists participated in the study. Work system factors contributing to fatigue spanned multiple SEIPS domains including tasks (large volume of tasks, multitasking and frequent interruptions), organization (long work hours and limited staffing), physical environment (prolonged standing), tools and technology (centralized call centers), and external environment (COVID-19 related task expansion). Pharmacists reported factors that contributed to fatigue included their life outside of work that was enjoyable but could impact sleep (such as children) and using breaks to work uninterrupted instead of to rest. Factors that prevented fatigue included doing enjoyable tasks (patient interactions) and receiving support from organizational leadership and coworkers. Conclusions Pharmacist occupational fatigue spans the entire work system. Strategies aiming to address only personal factors, such as mindfulness, are insufficient. Fatigue risk mitigation strategies, instead, must also address the contributors of occupational fatigue, such as increased work demands and reduced capacity.