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

18 Pages·1992·3.4 MB·English

by  Alberta. Alberta Occupational Health and Safety

UNIVERSITY Of ALBERTA LIBRARY
0 0004 1779 091
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 d ivision of Alberta Labour.
CX LIBRIS
UNIVERSITATIS
ALBERT/ENSIS
"Fifteen years ago, everybody .is
In Alberta's 75 long-term eare fa-
s umed hospitals were healthy cilities—that i s nursing homes and
places," says Heather Smith, presi- auxiliary hospitals— there are close
dent oft he United Nurses of to 14,000 employees. In 1991,
Health care
there were 823 lost-time iniuries.
Alberta [UNA). "I i ospitals are
where we deliver health care, so
For every S 10 0 in payroll, long-
costs
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 Si 3.7 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.
Those costs include Workers' They may not be such healthy envi-
Compensation Board (WCB) 1 a rry Odegard, president of the
ronments."
Alberta's 125 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 iniuries. 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 c osts the
may be as high as $1 20 million University Hospitals to run an 18-
or 20-bed unit for a f ull year."
annually.
ESTIMATED LOST-TIME CLA1I9M8 7 RATE1S9 88 1989
1990
1991
4.0
Hospitals 4.0 1893
Lost-Time Cloims 1689 2048 2016
4290,3946 3 49,460
Estimated Person -Years 42,713 48,545 51,556
4.1 4.1
Average Claim Rate
Auxiliary Hospitals and Nursing H7o7m5e s
Lost-Time Cloims 38.895 771 895
Estimated Persort-Yeors 71.10, 073 971.815, 771 12.220 13,210 81233, 695
6.3 6.8 6.0
Average Claim Rate 123 97
Senior Citizens Homes 4.0
Lost-Time Cloims 91 97
UNIVERLSAIWT Y L IOBFR A RAYL BERTA AEvsetirmaagtee d C l Paeirms o Rno-tYee ors 24.047 6 42.170 4 2451 2403 32.583 5
GOVT. DOCS.
5.1
MAY -4 1993
1
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, hut 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 p atient - 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 p irtaalt eesm pl woyesr 1e, 0 g0o0i n pge o uppl e. 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 - i f w e could get
shouldn't be getting hurt. We can prevent that pain and loss."
another organization or agency to
StockweU 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 payingu tin 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
injured person back to work. But the indirect costs. Research shows
costs to the system. "When some-
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.' "
IMVERSJTY LIBRARY
UNIVERSITY OF ALGEPTtf
2
In September 1990, the WCB in- tor of A lberta Occupational Health
vited hospitals to join the Work
and Safety lAOHS), says, "It is "Wealth care staff are committed to helping pa-
Injury Reduction Program. With possible to introduce effective
tients— at any cost. I n jortunately, 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 start the program, the Hat Regional Hospital has done
That $10 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, t h ose are extras.
and safety program. "The audit
results really hurt," says Mr.
At Medicine Hat Regional, Brad
"In the health care industry, most lost-time claims
Hildehrandt. "We scored 500 out done."
Morrow manages the laundry de- are due to back injuries. And many back injuries are
of a p ossible 2,000. We said, 'This
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 $10,000 a year on
created a p lan." happen.' There's a fatalism about injuries.
safety programs," he says. "Well,
we know we can save $49,000 in
The Medicine Hat Regional Hospi-
"We have to change that way of t hinking. Alberta
tal has s ince received a $ 49,000
the first year. For a $ 10,000 invest-
refund from the WCB. It h as sig- ment, we got five times that back. Occupational Health and Safeh' (AOHS) can't
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 crazy 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, oial nd 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 / 9 70s.
"The health care industry can also be a success
story. Health care needs effective health and safet}'
programs, training, and an industry-wide commit-
ment to h ealth and safet\: 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)
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.
half of More than eight per cent of injuries
were from falling. NUMBERS TALK
hospital staff injuries are back than The Glenrose Rehabilitation Hospi-
More tLeolslt t-htei m weh ocllea i msst,o r yh.o w Ienv e trh,e Udnoint'etd tal in E dmonton has been collecting
injurieMs/' s"ays 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
beds. Most patients are day pa-
the job. A 1983 study, Back pain in
"We need some plans/' he says, the nursing profession, found that tients. In1 991, back injuries cost
the hospital $21 1,568. For the
many nurses miss work because of
"that really make a d ifference/'
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 the 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 Alberta
musculoskeletal injuries. Hospitals in 1991, hop-
Therefore, the priority for
fP%* ing to improve the
education and prevention y */ 1 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 (■ail Graham, occupational health
Back pain can start suddenly. You nurse at Medicine Hat Regional
"We need high profile attitudes towards occupational
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 safct)
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 safer}- 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 series of events, the aftermath of facilities, nursing homes and an
hospital industry — towards looking at occupational years of heavy work and back auxiliary hospital. "Our workforce
stress. While unexplamable back is a ging," says Karen. "Some staff
health and safety and bringing in the workers' con-
have spent 25 years in the nursing
pain may actually date back to an
cerns. " earlier incident that weakened the department. That's a l ot of years to
Heather Smith
back and set the stage for further
injury. put strain on your back. There's no
President, United Nurses of A lberta
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-back pain in Industry"! in
the president first asked me to take backs while mopping floors, mak- assistant's job. Nursing assistants Occeutiptaitoin.o"n al Medicine. Dr. Arun
Garg and Dr. Steven Moore explain
ing beds. Many slip a nd tall while said transferring patients was the
on this role," says Ms Stewart, "I
said — with a f air hit of c onfi- mopping floors. most stressful part of their jobs.
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 6S 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 analyzed cardiac, cardiovascular and neuro-
the activities that result most fre- surgical intensive care. I h e mure
quently ini 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.'"
NEEDLE STICK
that low-back pain and back inju- In long-term care facilities, most Phil Gaudet, president of the Good
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 jobs 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 outpatient program. Lorna Stewart,
agrees. In The Handling
"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 d ay 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 Were ' vheas h baeda t s iutpu a-
But the largest muscle group in
to break someone's fall, o r 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."
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 Heather Smith says
I v eryone 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 i s v ery difficult to find any
anecdotes ranged from being hit, ported, and s taff abuse
losers in the formula of w orkplace health and safety. I m ploy-
bit, k icked, sworn at, s pit at, h aving
may be more wide-
ees do not want to he injured and sacrifice their future and
things thrown at you, to being spread than t he
choked and sexually assaulted. statistics show. In long-
their career and disrupt their lifestyles. Employers don't want
More recently there have been inci- term care facilities, like 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 Ed- Society's nursing homes
and hospitals, 40 to 70 tual gains bargaining, say/Let's solve it.' "
monton's Royal A lexandra
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
port." Mr. Gaudet suggest>> that the With alzheimer patients, for exam-
There aren't a l ot of residents who
Association, United Nurses of Al- are aggressive, but those who are role of long-term care is c hanging. ple, certain situations and
berta, the C anadian Health Care "We need to anticipate that we are environments are 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. "1 think we have
Alberta, Registered Psychiatric
alzheimer patients," he says. And a l ot to learn," he savs.
Nurses of Alberta and the Health
Psychiatric patients, once housed in
dents."
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 Odegard
4l
WHAT'S
THE ANSV\
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
TThhee hheea lth care Stewart's challenge was to help line
management. Says Mr. Morrow,
managers recognize their responsi-
iinndduussttir y 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
complex. "We going to support.' Gerry that health and safety in this hospi-
major unions and 1 50 Hildehrandt, 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 people work, interact
with others, whether 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 started 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
safety committees encourage line
to cope with, like finding a n eedle
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
own health and safety committee.
or her story, and it b ecomes much
more real.
Medicine Hat Regional Hospital's
success also started with its s afety
committee. "The first thing I d id,"
says Brad Morrow, "was I w alked
in there and said, 'The only reason
8