Occupational Health Programs

Occupational Health Definition WHO/ILO defines occupational health as: the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations the prevention amongst workers of departures from health caused by their working conditions

Occupational Health Program Components 1) Safety and Accident Prevention 2) Hazard Identification 3) Exposure Monitoring and Health Surveillance 4) Injury and Illness Management (Case Management) 5) Emergency Response and Disaster Planning 6) International Travel 7) Ergonomics Program 8) Integrated Job Safety Analysis – identify job activities and associated occupational risk factors and modes of remediation and accommodation

Occupational Health Service Goals To protect workers from health and safety hazards To facilitate safe placement of workers according to their physical, mental and emotional capacities To assure adequate medical care and rehab of occupationally ill and injured To assist in measures related to personal health Source: McCunney, R. A Practical Approach to Occupational and Environmental Medicine, 1994.

Occupational Health Directives OSHA General Duty Clause Lab Standard Respiratory Protection Standard Etc. Texas Department of State Health Services Laboratory Animal Care Accreditation (AAALAC) Joint Commission accreditation for health care organizations Occupational management system standards (OHSAS 18001) Many others

Employee Risk Assessment Recommend placement of employee Screen for health/safety issues Baseline data: physical, mental, historical Meet regulatory mandates (OSHA) Identify exposure and risk factors that are hazardous to employee’s health Educate employee on safety & health issues

Exposure Reporting Systems Develop institutional exposure control plan Identify responsibilities of occupational health personnel Establish injury/illness reporting mechanisms report forms, telephone hotlines Worker’s compensation Ensure compliance with HIPAA regulations

Exposure Follow Up Review of completed report form Follow-up with ill/injured person Ensure documentation of type of exposure along with exposure route-trend analysis Subsequent visits to employee health as determined by individual circumstances

Safety Devices and Preventative Measures Perform job safety analysis to determine employee hazard risk categorization Implement use of retractable syringes, sharps containers, etc. Engineering controls Personal protective equipment Proper immunizations

Workers’ Compensation Benefits System Board Insurance Carrier Injured Worker OHN/CM Manager Payroll Information Health Care Provider

Case Management Objectives: avoid inappropriate medical care avoid lost time when able to perform modified duty avoid anger, frustration of employee maintain open communications between all parties avoid permanent disability encourage rehabilitation, when possible The effectiveness of case management needs to be evaluated; set measurable goals-ie reduced lost days, another example may me premium paid per employee, needs to be tracked over the long term 3-5 years More intangible goals, worker satisfaction, safety track record, appropriate and effective care Consider cost benefit analysis-report to your manager-avoided fees, negotiated fees, outcome of the care, review your interventions; savings realized Medical payments, cost of procedures avoided, costs associated w/potential lost work days

Program Evaluation Build evaluation into the design of the program Evaluate based on the objectives (be sure they were established to start with) Choose an evaluation tool- Chart review or document review, Customer Survey, Observed practices, Trends in employee injury data Report program information in terms of impact or benefits as well as cost Consider cost benefit analysis as a part of the evaluation (small cost up front vs. large payout later?) Plan to collect evaluation data in a manner that avoid the DRIP (data rich, information poor) issue. Certainly it is good to know the percentage of the targeted population participating in a program but what does that really tell you about the quality of the program? Referring back to the needs assessment, how well did the program meet the need of the employees? For blood borne pathogens, the employee need is protection from needlestick injuries. How many needlestick injuries occurred from a preventable cause? How does that compare to pre-program numbers? How did each needlestick occur by category (pt. Jumped, disposal issues, needle in bed, dropped needle, over full sharps container). How have those trends changed? How many of the needlestick injuries were managed according to protocol (seen within 2 hours, got meds in a certain way, got certain meds, etc.). Where were the problems and why? Systems barriers or employee compliance? This type of information will assist you in improving the program and provide feedback to management on the actual effectiveness of the intervention rather than the effectiveness of the nurse in tracking the employees.

Characteristics of Successful Health Promotion Programs Support from the top Priority within mission Input from mgmt & workers Qualified staff Include all shifts Source: Chenoweth, D.H. (1991) Health Promotion at the Worksite Defined budget Use on/off site facilities Conduct assessments & screenings with follow up Participate in community programs