Occupational health and safety review. Alberta. Alberta Occupational Health and Safety.

16 Pages·1993·3.6 MB·English

by  Alberta. Alberta Occupational Health and Safety

(LAW
GOV
DOC
CAS
AL COH
013
1993
This Occupational Health and Safety
Review looks at Alberta's health care
industry — at the hazards and risks of
working in health care. In an already
financially strained industry, work-related
injuries and ill h ealth are an added cost.
Today, the industry is w orking to reduce
risk and make health care safer.
Occupational Health and Safety
publishes its Occupational
Health and Safety Review
every year. The Review looks
at workplace health and safety
in Alberta. It f ocuses on current
issues and on ways to improve
health and safety. The Review
also gives provincial
occupational health and safety
statistics.
Published March 1993
In March 1993 Alberta Occupational Health &
Safety became a division of Alberta Labour.
"Fifteen years ago, everybody as In Alberta's "5 long-term tare fa-
sumcd hospitals were healthy cilities—that i s n ursing homes and
places," says Heather Smith, presi- auxiliary hospitals— there are close-
dent oft he United Nurses of
to 14,000 employees. In 1991,
there were 82 3 l ost-time in|urics.
Alberta lUNAl. "Hospitals an-
where we deliver health care, so For every $100 in payroll, long-
they must be healthy. Then infor- term care facilities paid $2.29 cents
mation started to come out.
Albertans more than $4 billion to the WCB. In 1992, acute-care
Hospitals use anaesthetic and other
hospitals paid the WCB $13.7 mil-
every year -$1 1 m illion a day. gases and are full of sick people. lion. Long-term care facilities paid
another $6.3 million.
They may not be such healthy envi-
Those costs include Workers'
Compensation Board (WCB) Larry Odegard, president of the
Arlobnemretan'tss . "1 25 hospitals employ Alberta Healthcare Association,
claims — the money hospitals pay close to 50,000 people. That in- says, "Until now, hospitals and
cludes registered nurses, licensed
when staff are injured on the long-term care facilities haven't
practical nurses (nursing aides and looked at the opportunity to save
orderlies), technical and mainte- money on WCB. If t hey saved one
job. WCB assessments aren't the
nance staff. Every year, hospital
per cent of payroll, however, it
only costs, however. The actual
staff suffer more than 2,000 lost- would be very substantial. At the
time injuries. For every $100 in University of Alberta Hospitals, one
cost of work-related injuries and
payroll, hospitals pay Si. 08 to the per cent of payroll would be $2.5
illness to the health care industry WCB.
million. And that's what it costs the
may be as high as $1 20 million University Hospitals to run an 18-
or 20-bed unit tor a f ull vear."
annually.
1988
ESTIMATED LOST-TIME CLAIM RATES 1989
1990
1987 1991
Hospitals 4.0 1893
Lost-Time Claims 4126,8791 3 48.545 2490,3946 3 24.004 8 4290,1466 0
Estimated Person -Years 51,556
4.1 4.1
Average Claim Rate
3.9
Auxiliary Hospitals an d Nursing H77o.7m05 e s 885
Lost-Time Claims 771 895 823
7.5 13,695
Estimated Person-Yeors 11,073 12,220 13.210
Average Claim Rote 11,771 6.3 6.8 6.0
98 97 123
Senior Citizens Homes 4.0
Lost-Time Claims 91 97
2403
Estimated Person-Years 2076 2104 2451 2535
Average Claim Rate 4.4 4.7 38
5.1
1 MAY 19i994
employee morale, damaged equip-
ment and p roperty, other insurance
"When a health care worker is h urt on the job, there are enor-
costs, the costs of replacing and
mous costs - not only to the hospital, but to the individual, his
retraining staff. With those esti-
or her family and the community. The hospital or nursing
mates, the a ctual annual cost to the
home pays Workers' Compensation Board costs. The hospital health care industry could be Si 20
loses its investment in that employee and faces training and million.
hiring a new worker.
"Hospitals are not recognizing the
indirect costs," adds Mr. Odegard,
"It doesn't stop there. After work, there is t he physical pain ac-
"and those indirect costs all have
companied bpy sychological pain. This is e specially true when a nurse or nursing
an impact on the organizations —
assistant is h urt by a patient - someone he or she is caring for. Within the family, there
the cost of hiring replacement
can be times when injuries make it d ifficult to carry on as a parent or spouse. There may
workers, the impact on the person's
be a loss of i ncome and a loss of p hysical abilities. Suddenly it's difficult to join in fam-
ily activities or even take on basic chores. family and personal lives."
In Medicine Hat, the Regional Hos-
"As employers, we have to say these social costs aren't acceptable. They are avoidable.
WCB pirtaatl eesm p lwoyesr e1 ,0 g0o0i n pge o upple . 2 5 " pOeurr
Prevention works. It starts in the workplace, with proper training and procedures. From
there, the benefits reverberate through the home and community. cent a y ear," says Gerry
Hildebrandt, vice president of the
"The Government of A lberta plays an important part. Ten years ago, there were literally hospital. "Our annual WCB costs
went from $150,000 to more than
twice as many workplace fatalities in Alberta. Injury rates are dropping - steadily. A big
reason is A lberta Occupational Health and Safety's commitment to prevention, aware- $200,000. Now they're almost
ness and, w here necessary, enforcement. In 1993, occupational health and safety officers $400,000 a year. We said, 'We
and managers will keep their commitment. We'll continue sending out the message that can't cope with this.' "
injuries are preventable. In hospitals, nursing homes and other workplaces, Albertans
Adds Mr. Hildebrandt, "Our per-
spective was - if w e could get
shouldn't be getting hurt. We can prevent that pain and loss."
another organization or agency to
Stockwell Day
absorb the cost of lost time or un-
Minister of Labour
productive time, t hen it w ouldn't
cost us. If w e could get an insurer
or the WCB to absorb the costs of
Mr. Odegard adds that hospitals have a new worker doing the job, There is t he direct cost of
payingut in g ptote hoep l oer g wahnoiz a wteiroenn,' t t h ceonn t wrei b-
you are not as motivated to get t he
aren't always aware of the real workplace injuries and illness - a nd would be all right. We rationalized
costs to the system. "When some- injured person back to work. But the indirect costs. Research shows
one iso ff work, the WCB pays the the WCB is c harging the cost back that the actual costs can be six the problem and said, 'It's not ours.
We don't have to be very aggressive
cost of their salary. Then the hospi- to you. It a ffects your premium times the WCB costs. The actual
tal replaces the worker with dollars annual cost include losses from
rate. I'm not sure hospitals have
from the staff budget. Because you missed days, overtime, reduced
really paid much attention to that."
about it.' "
UNIVERSITY UBRAR*
2
UNIVERSITY GMLB^*
In September 1990. the WCB in- tor of A lberta Occupational Health
vited hospitals to join the Work
and Safety (AOHS), says, "It is "Health care staff an committed to helping pa-
Iniury Reduction Program. With possible to introduce effective
tients— at any cost. ( n fortunatety, too often the cost
escalating WCB costs, the Medicine health and safety programs into a
health care institution. Medicine is t heir own health and safety. Hospitals and long-
Hat Regional Hospital didn't hesi-
term care facilities pay the WCB $20 million a year.
tate. To s tart the program, the Hat Regional Hospital has done
That $20 million does not include health units and
just t hat. It h as proven it can be
WCB audited the hospital's health
community health care. Those are extras.
and safety program. "The audit
results really hurt," says Mr.
At Medicine Hat Regional, Brad
Hildebrandt. "We scored 500 out done." "In the health care industry, most lost-time claims
of a p ossible 2,000. We said, This Morrow manages the laundry de- are due to hack injuries. And many hack injuries are
partment and c hairs the health and
doesn't make sense. We're better preventable. Unfortunately, many health care pro-
than that.' And we sat down and safety committee. "We thought we
fessionals don't realize that. They think. 'Accidents
could spend Si 0,000 a year on
created a p lan." happen.' There's a fatalism about injuries.
safety programs," he says. "Well,
The Medicine Hat Regional Hospi we know we can save $49,000 in
"We have to change that way of t hinking. Alberta
tal has since received a $ 49,000
the first year. For a $ 10,000 invest-
Occupational Health and Safety (AOHS) can't
refund from the WCB. It h as sig- ment, we got five times that back.
change the health care industry. Our regulations
The administration looks at that
nificantly reduced its lost-time
claims and lowered its WCB costs. can't change the industry. Change starts when the
and they say, 'Go for it.' T hey
industry recognizes there is a problem, and changes
Dr. Hugh Walker, managing direc- would be crazv not to."
are needed.
"AOHS can be a big part of t he change. We can get
people together— get people talking and working
together. We've played that role in other indus-
tries— forestry, oil and gas. construction— and we've
had a lot of s uccess. In the oil and gas industry, for
example, some large plants have just one lost-time
claim a year. That's a major change since the 1970s.
"The health care industry can also be a success
story. Health care needs effective health and safety
programs, training, and an industry-wide commit-
ment to h ealth and safety. With those kinds of
changes, health care workers could do their jobs
without risking injury. And health care managers
could avoid throwing dollars at preventable inju-
Dr. Hugh Walker
Managing Director, Alberta Occupational Health and Safety
(May 19r8ies. "9 to March 1993)
WHAT ARE
Between 1987 and 1991,42.5 per other muscles — wrists, ankles,
shoulders. Together,
cent of hospital lost-time claims
were due to back injuries. Another musculoskeletal injuries add up to
80 per cent of health care injuries.
1 1.9 per cent were injuries to shoul-
ders and o ther parts of the trunk.
More than eight per cent of injuries
were from falling.
NUMBERS TALK
The Glenrose Rehabilitation Hospi-
Lost-time claims, however, don't
tal in E dmonton has been collecting
tell the whole story. In the United
injuries/' says Larry Odegard. He States, the American Journal of data on workplace injuries. The
suggests the health care industry Nursing recently reported that only hospital is n ot an acute care hospi-
tal, nor i t i s a n auxiliary hospital.
one third of injured nurses file
target back injuries and put all its
claims. The other two thirds It's job is r ehabilitation. There are
close to 700 full-time staff and 130
resources into eliminating them. thought back pain was just part of
the job. A 1983 study, Back pain in beds. Most patients are day pa-
tients. In1 991, back injuries cost
"We need some plans/' he says, the nursing profession, found that
many nurses miss work because of the hospital $211,568. For the
"that really make a difference."
back pain. Over 16 per cent of total
same year, the hospital's total WCB
costs were $300,309. Seventy per
days lost due to sickness was from
back pain. cent of t he hospital's WCB costs are
from back injuries.
A 1986 survey by S tubbs [Backing
out: nurse wastage associated with The nursing department has the
back pain) showed that 1.3 per cent highest number of incidents — 125
in 1991 and 130 in 1992. House-
of nurses were leaving the profes-
sion because of back pain. One in
keeping had 3 4 incidents in '91 and
29 said back pain contributed to 30 in '92. Housekeeping has fewer
their leaving. incidents, but there are also fewer
housekeeping staff. The Glenrose
Rosemary Pahl, president of the statistics show that housekeeping
Glenrose Rehabilitation staff also face risks.
Hospital in Edmonton,
Lorna Stewart came to
says, "Most injuries to
our staff are the University of A lberta
musculoskeletal injuries.
Hospitals in 1991, hop-
Therefore, the priority for
fPk' ing to improve the
education and prevention 5aJ hospitals' occupational
should be focused on this health and safety record.
Before she could design a h ealth
area." Musculoskeletal injuries are
mostly back injuries, but include and safety strategy, she needed data
that analyzed the hazards. "When
4
DON'T DROP THAT PACKAGE Gail Graham, occupational health
nurse at Medicine Hat Regional
"We need high profile attitudes towards occupational Back pain can start suddenly. You
health and safety. In our industry, it is a new phe- are lifting something or someone Hospital, says nurses are "con
nomenon tol ook at worker safety. As late as 1984 and it starts. Or it can come out of stantly lifting." Karen Kraselnicki is
the occupational health and safet)
nowhere, with no obvious cause.
and '85, hospitals had fire and safety committees. coordinator with the Good Samari-
With both types of pain, there is no
They were concerned with the structural safety of t he
clear cause and effect. Sudden back tan Society m Edmonton. The
building and the safety of t he patients. Over the last
pain may actually be the last in a society operates long-term care
decade, there has been an evolution— at least in the facilities, nursing homes and an
series of events, the aftermath of
hospital industry— towards looking at occupational years of heavy work and back auxiliary hospital. "Our workforce
health and safety and bringing in the workers' con- stress. While unexplainable back is a ging," says Karen. "Some staff
have spent 25 years in the nursing
cerns.
pain may actually date back to an
earlier incident that weakened the department. That's a l ot of years to
Heather Smith
back and set the stage for further
put strain on your back. There's no
President, United Nurses of Alberta injury .
precipitating incident. It's the rep-
The University of Wisconsin-Madi-
son School of Nursing studied the In an article (" Epidemiology of
physical demands of the nursing Low-hack pain in Industry"! in
Occupational Medicine, Dr. Arun
the president first asked me to take backs while mopping floors, mak- assistant's job. Nursing assistants etition."
Garg and Dr. Steven Moore explain
ing beds. Many slip a nd fall while said transferring patients was the
on this role," says Ms Stewart, "I
said — with a f air bit of confi- most stressful part of their jobs.
mopping floors.
dence— ' I'm sure the data is t here. And the study found that nursing
The study also showed that critical assistants do a l ot of transfers.
It h asn't been analyzed, hut I'm
care nurses have the most injuries.
sure it's there.' It w asn't." Every shift, each nursing assistant
Those are nurses working in neo- in the study lifted 6<S pounds 24
natal, int he trauma unit and in the
"We've now looked at three years
times. That's 1,632 pounds in an
of data," adds Ms Stewart. "We intensive care units — paediatric,
eight-hour shift.
have pulled out trends and anal} zed cardiac, cardiovascular and neuro-
the activities that result most fre- surgical intensive care. The more
quently mi njury. That was one of demanding the patient care, the
the initial activities I k new we had
greater the risk.
to do. The organization had to
build an infrastructure so people Mr. Odegard says, "Nursing staff
could start to deal with their health frequently assist patients to turn in
bed. They choose, because of the
and safety issues."
number of other caregivers, to do
The data showed nursing staff in- this on their own rather than get
jure their backs while lifting and help. Because of the unique situa-
transferring patients. Environmen- tion they a re in, t hey may make a
tal services, that is t he
judgement call and say, 'I'll do this Heather
housekeeping staff, injure their on my own rather than get h elp.
Smith
Or, it w ill take too long to get
help.'"
that low-back pain and back inju- In long-term care facilities, most Phil Gaudet, president of the Good NEEDLE STICK
ries are c omplex. Low-back pain staff are licensed practical nurses. While taking blood samples, giving
Samaritan Society, says, "In a d an-
can even occur in sedentary jobs. Most do not have professional gerous situation, staff are better off
medicines, attaching intravenous
training. Ms Kraselnicki says that waiting until they get h elp. They
"Many different personal and job units and recapping needles, staff
factors are associated with... these have to be careful no to lead with
adds to the risk. "If you train staff risk contracting infectious diseases,
complaints," write the authors. The well enough, they understand the their hearts and get h urt." such as tuberculosis, Hepatitis B
high risk ]obs involve "lifting, low- risks. They know what their re- and AIDS. The University of Al-
The Back Pain Associa-
ering, pushing, pulling, carrying, sponsibilities are— not berta Hospitals has an HIV
tion in G reat Britain
only for themselves and
and holding." Other risk factors are agrees. In The Handling outpatient program. Lorna Stewart,
"frequent bending, twisting and their clients. They under-
director of the hospital's Injury
sudden movements." Working in a stand the i mportance of of P atients, the Associa- Awareness and Prevention Centre,
"bent-over posture" also seems to reporting even the smallest tion says, " There is a says a l ot of health care staff are
produce low-back pain. incident and they have a tendency, rooted in the
very concerned about needle stick
better basis from which to history of the profes-
The authors add that "a combina- sion, tod o everything possible for injuries. "There are people who are
leaving health care because of it.
tion of l ifting, bending, and patients, to come to their aid and
There is a l ot of anxiety around
twisting appears to be most hazard- work." save them the least exertion."
ous....lifting heavy loads
LEADING WITH YOUR HEART needle stick injuries."
Heather Smith says nurses have to
contributes to increased frequency
and severity for low-back pain. Mr. Odegard says a n urse's com- learn to ask patients to wait. "You
This is t rue regardless of whether mitment top atient care is a lso a shouldn't feel guilty if y ou have to ARE YOU IN DANGER?
wait five minutes for someone to
the lifting is p erformed over a s hort factor. "If you are helping a patient
At the University of Alberta Hospi-
transfer from a b ed to a c hair or come help you. Client education is
period or throughout the day, and tals, statistics show staff call
wheelchair or simply walking in a also important. You might have to
whether it i s p erformed a f ew times
security 1,000 times in a year - an
corridor, you can't drop that pack- say, 'Your needs are just as impor- average of three times a d ay. Not
per day or repetitively."
age and let it b reak on the tant asa nother person's needs. But all those security incidents result in
Ms Graham adds that floor. If t he person falls or I m ay not be there the minute you
nurses were trained to need me. If y ou have to get out of violence, but many do. "We are
slips, the health care per- talking about everything from
lift with their backs and son isc onditioned to look bed and sit in a c hair, does it h ave
twist. "We were taught after the patient in their to be right this minute? Or can you physical assault to sexual assault,"
to bend over our patient. care. They frequently have wait 10 minutes until there are says Lorna Stewart. "We have in-
ebriated customers who will punch
We were taught to bend
these unpredictable inci-
at the waist and twist our spine. dents where they respond by t rying people to help me?' " emergetinoncs yw he ren uar speasr.t n eWre ' vheas h baeda t s iutpu a-
But the largest muscle group in
to break someone's fall, or trying to his spouse. She is i n the hospital,
prevent them from being injured,
your body is y our thighs, and that's
and he's attacking staff to get to
the muscle group you should be
and often injure themselves."
using."
her."
6
Heather Smith says, "We did a per cent of the lost-time
random survey of nurses and their
injuries were from an- "The biggest single solution is t he recognition by employees,
occupational health and safety. And other person. But
their unions and employers that this is a win-win situation.
we heard unbelievable anecdotes 1 l eather Smith savs
Everyone gains if w e enhance the workplace and make it a
about workplace violence. The many incidents go unre-
safer, healthier place to work. It is very difficult to find any
anecdotes ranged from being hit, ported, and s tatt abuse
losers m the formula of w orkplace health and safety. Employ-
bit, k icked, sworn at, s pit at, h aving
may be more wide-
ees do n ot want to be injured and sacrifice their future and
things thrown at you, to being spread than the
choked and sexually assaulted. statistics show. In long- their career and disrupt their lifestyles. Employers don't want
term care facilities, like
More recently there have been inci- to pay the costs of t hese injuries. What we need to do is t ake
dents ofa n escalating nature, the Good Samaritan
the problem before all parties and, in some variation of m u-
including a recent incident at F.d- Society's nursing homes
and hospitals, 40 to 70 tual gains bargaining, say,'Let's solve it.' "
monton's Royal Alexandra
Hospital with knives, and in per cent of residents Larry Odegard
Calgary, with clients entering emer- have some form of cog- President, Alberta Healthcare Association
nitive impairment.
gency with g uns."
Some of these residents
In 1992, a t ask force on staff abuse are difficult to control and can be
was formed. The group has repre- long-term care facilities have to
aggressive. Says Phil Gaudet, long-term care facilities. What's
sentatives from A OHS, Alberta lagging behind is t raining and sup learn how to manage aggression.
"These are not isolated events.
Labour, the Alberta Healthcare
There aren't a l ot of residents who port." Mr. Gaudet suggests that the With alzheimer patients, for exam-
Association, United Nurses of Al- role of long-term care is c hanging. ple, certain situations and
are aggressive, but those who are
berta, the C anadian Health Care "We need to anticipate that we are environments arc calming. Others
can cause a w hole series of inci-
Guild, Staff Nurses Association of
going to have to deal with more bring on violence. "I think we have
Alberta, Registered Psychiatric alzheimer patients," he says. And a l ot to learn," he savs.
Nurses of Alberta and the Health Psdyecnhtisa.t"r ic patients, once housed in
Sciences Association of Alberta.
psychiatric hospitals, are now often
The task force travelled the prov- treated in auxiliary hospitals and
ince holding focus groups on .staff
nursing homes. "There is a c hange
abuse in the health care industry. in philosophy in psychiatric long-
term care treatment," says Mr.
Heather Smith says, "Violence is a n
Gaudet. "Rather than being ware-
issue that is b ecoming less and less
housed inp sychiatric hospitals,
tolerated by w orkers." In long-term these patients should be integrated
care facilities, more than half (53
with their peers. With intervention,
per cent) of injuries were caused by
these people can be managed in
another person. In hospitals, 32.1
Larry Odeuard
WHAT'S
As chairman of the Medicine Hat YOU MAY BE RESPONSIBLE
Regional Hospital's health and
safety committee. Brad Morrow Management commitment can't
stop with the senior staff. Ms
knows success depends on senior
Stewart's challenge was to help line
The health care
management. Says Mr. Morrow,
managers recognize their responsi-
industry is "The management of the hospital
bility for h ealth and safety. She
has said, 'This is a program we are
says, "It had never really been clear
i complex. "We going to support.' Gerry that health and safety in this hospi-
have 1 2 or 14 major unions and 1 50 Hildebrandt, our vice president, sits
tal was a l ine management
on the health and safety committee.
employers/' says Larry Odegard. He has been extremely supportive
responsibility."
"What we need to do is m ove past and has done an awful lot of work The hospital had a h ealth and
the traditional roles of discussing at on safety. He has been given that safety department and most line
mandate by t he Board of Directors. managers believed that department
the bargaining table into something
With that kind of support, how can was responsible for health and
that has maybe a d ifferent sort of
safety. "Occupational health and
safety was something
atmosphere. We need to develop
When Lorna Stewart
separate from their work.
trust and understanding and build joyionued l tohsee ? "U niversity of It w as not about how
Alberta Hospitals, she
optimism. There is a n opportunity
saw senior management wpietohp l eo t hweorrsk,, w hienttehrearc t they
here to achieve solutions, improve wanted to reduce injuries
have safety committees,
workplace health and safety and and incidents. To show what procedures they
its commitment, the hos- follow, whether they have safety
reduce costs — all with a r elatively
pital starred safety tours. Each
and personal protective equipment.
small investment/' month, the president and vice presi-
The prevailing attitude was that a
dents tour a h ospital department.
member of the housekeeping staff
Through the tours, senior manage-
could not possibly know about the
ment learns first-hand about
day-to-day operations. Says Ms safety of their work."
Stewart, "The senior team is v ery
removed from day-to-day opera-
MEETINGS CAN WORK
tions. Vice p residents don't know
what an individual housekeeper has The hospital discovered health and
to cope with, like finding a n eedle safety committees encourage line
in the garbage. They go on a s afety management responsibility. Each
tour, talk to a h ousekeeper, hear his department was asked to set up its
or her story, and it b ecomes much own health and safety committee.
more real.
Medicine Hat Regional Hospital's
success also started with its safety
committee. "The first thing I d id,"
says Brad Morrow, "was I w alked
in there and said, 'The only reason
s