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

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(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

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