How you will benefit by implementing an early reporting system

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1 Introduction How you will benefit by implementing an early reporting system Early reporting and action for musculoskeletal discomfort and pain directly assists workplaces wishing to prevent and manage discomfort, pain and injury. It fosters adoption of a stay at work approach to discomfort and pain. The main aim of early reporting and action is to control pain, while avoiding withdrawal or inactivity. Early reporting means staff reporting discomfort or pain to supervisors and managers in the workplace at an early stage. It does not mean advising all employees with discomfort or pain to rush to their GP, although this must always remain an option. A successful early reporting programme avoids pushing people into the patient role too soon, and does not attempt to diagnose conditions. Remember that a majority of discomfort or pain occurs in the absence of injury and tissue damage. Early reporting can also lead to the quick identification of problem tasks, plant, equipment, work organisation, workstations and tools. Once recognised, they can be redesigned or modified. While a few employees will freely report problems, most are reluctant to do so. Some may be anxious about job security, and the non-assertive may not want to cause trouble. An early reporting system is only successful if employers and employees create a work climate that is positive, supportive and encourages openness. Initially, if non-traumatic discomfort and pain in muscles and bones is reported, you can encourage your staff to attempt the self help strategies (see Help Yourself Prevent and Manage Discomfort, Pain and Injury in the toolbox section). Self management is often an effective management strategy for discomfort and pain especially in the early stages. Employees also need to know that their employer wants to help, and has a policy of early reporting. This is best communicated early, in the workers induction. If you are having problems working because of discomfort or pain, we want to help. Please, come and talk to us. Employers also need to be aware of who is off work and why. There needs to be a case manager at work who monitors progress, plus a standing group who address persistent reasons for absence. Supervisors and managers must respond quickly to reports of discomfort and pain, because rapid action often prevents discomfort from worsening. Failure to act may have serious consequences for the staff member who makes the report, and for others. If fellow employees perceive a lack of interest from management, they will be less likely to report their own symptoms at an early stage. They may also see a lack of action as a sign of low management commitment, which can affect morale. 1

2 So respond quickly. At the same time, take care to avoid over-reacting to mild or resolving episodes. Serious muscle and bone injuries are relatively rare, and are usually accompanied by Red Flags. Red Flags are symptoms and circumstances which indicate the presence of, or potential for, serious illness. These must be identified as early as possible, and eliminated or addressed quickly. The red flags are: Significant trauma (e.g. fall from a height, MVA7, crush, etc) Severe unremitting night time pain Severe burning pain with associated pins and needles Significant loss of weight over a period of weeks to months Feeling systemically unwell experiencing fevers, night sweats, flu-like symptoms Obvious swelling or lump/s Redness especially around joint/s Several different joints being affected at the same time Skin rash associated with joint pains Significant visible bruising in the affected area Paralysis or significant loss of function of the limb or part of the limb. Red Flags indicate the need to consider referral to an appropriate health professional for further investigation. Early intervention means continued activity, involvement and coping, promoted in the first instance by friends, family and employers. Only if there is concern or no improvement, do clinicians become involved. The focus is on reassurance and empowerment, heading off negative beliefs and behaviours, and preventing withdrawal from activity and resultant physical de-conditioning Motor vehicle accident

3 Generic early reporting process Scope Any new episode of non traumatic musculoskeletal discomfort or pain that interferes with work and lasts more than a day or two if severe, or up to a week if not severe. Note Over-reaction to mild or resolving episodes should be avoided. Stage 1: Within one week of onset: Initial discussion, assessment and planned action with employer or their services Activity modification considered Involvement of health professional (if concerned) Stage 2: Within two weeks of onset if not recovered: Reassessment and revised action plan for recovery Monitoring and amendment of recovery plan together with employer, and with particular attention to activity and function (as distinct from pain alone) until recovery achieved. 3

4 Early reporting process the employer s role Stage 1: within one week of onset: Use the Early Report Form Have initial discussion with employee about the problem and its nature Plan the initial action with employee Make notes on the initial discussion and action plan for future monitoring. Listen to the employee 1. Listen to the employee s story and concerns. 2. Identify: the nature of their problem any associated issues or unhappiness at work how demanding their job is how much personal control they have at work. 3. Investigate: whether the employee is off work or having difficulty at work for non-work reasons the duration of the current problem whether the problem has an improving, worsening or fluctuating course aggravating and relieving factors other health problems employee beliefs and expectations about work in general specific work issues and recovery. Investigate what contributory factors are involved There are seven questions to ask: Has the employee s workload (physical and/or mental) increased recently? Have there been changes in the way the employee s work is organised? Have the employee s work tasks been repetitive and unvaried? Has the employee been having psychosocial problems at home or at work? 4 Has the employee s health status changed recently, and how well are they?

5 Has the employee been working in awkward postures and/or positions? Has the employee s working environment and/or conditions changed lately? Give reassurance and information, make a plan 1. Communicate positive messages and reassurance to the employee, about: Their value to your organisation Your commitment as an employer to overcoming the problem Why it is best for them to remain at work if possible. 2. Give information relating to: Help Yourself To Prevent and Manage Pain and Discomfort At Work How they will know if they need to consult an appropriate health professional e.g. for pain control, problem-solving, feelings of uncertainty or worry. 3. Planning: Be willing to arrange temporary activity modification, job rotation or job sharing Do a risk assessment Reach agreement on a plan for recovery that includes initial work-related changes Arrange a follow-up discussion. Stage 2: within two weeks of onset if not recovered: Get input from health provider if needed. (Use Health Provider Referral Form.) Review and if necessary amend work activity and/or modifications, again considering job rotation or job sharing. Monitor, review and modify the plan for recovery with employee (and health professional if involved). Pay particular attention to activity and function. Do this regularly, until full recovery occurs. This could be an occupational health practitioner, or the personnel officer or the employer themselves, depending upon the size of the organisation. 5

6 Early reporting process the employee s role Stage 1: within one week of getting the problem (it s best to start early!) Most muscle and joint problems are harmless and clear up on their own, and of course many have nothing to do with work or injury. If you do need help, start your recovery plan early! You re more likely to make a good recovery if you can control your pain, stay at work (even with some pain), and keep active, perhaps with modified activities. Tell your employer, line manager or human resources manager about the problem. Discuss the effect of your activities and work. If you are worried, decide whether you want to see a health professional at work (if available), or a health provider in the community. They will provide effective physical treatments, advise you about what kind of changes to make to your activities, and help you to manage your condition. 8 Remember to arrange a follow-up discussion with your employer (or other manager) within the next week, so you can check progress. Stage 2: if you have not recovered within two weeks of getting the problem: Hang in there! Make a plan to overcome the problem. Do this together with your employer, and if you re seeing a health professional include them too. Use any of the following actions: pain control, modified activities at work and/or other treatment. Regularly talk with the people you made your plan with to make sure that it is working. Your activities at work should be increasing by stages back to normal. If this is not happening, get together again and alter your plan, to see if you can get a better result You may have to pay for this.