Home based care information and checklists

Transcription

1 Home based care information and checklists September 09 Introduction WorkSafe in 2009 completed an inspection campaign in the home based care industry, with a view to reducing injuries and illness in this industry. The checklists used by WorkSafe inspectors during this campaign are included in this newsletter. Please use the checklists to ensure your workplace meets the occupation safety and health legislation. How are workers getting hurt? In the most recent ( ) WorkCover data, Health and Community Services sector account for 12.4% (or between 2000 and 2500 injuries per year) of all lost time injuries. This injury rate has remained relatively stable in recent years. Each lost time claim within the Health and Community Services sector results in an average of almost 89 days lost time from work. From WorkCover and WorkSafe data, the most common injuries within home based care organisations are from: manual tasks; slips, trips and falls; and aggressive incidents. What are the issues in the home based care industry? A checklist has been developed which may assist you assess your workplace for common hazards. This checklist is included in this publication (from page five onwards). Hazards covered in the checklist include: Manual tasks Slips, trips and falls Occupational Violence/ Aggression Psychosocial issues/ stress Biological hazards Hazardous substances Electrical hazards External hazards Vehicle hazards Working alone OSH Systems Manual tasks What are manual tasks? Manual tasks cover any activity that requires a person to use their physical body (musculoskeletal system) to perform work. It includes manual handling, performing repetitive actions, adopting awkward & sustained postures, and being exposed to vibration while working. Manual tasks can result in both acute (immediate or sudden from a specific incident) or chronic (develops over time) injury. Workers in home based care are most at risk from transfers and handling of clients (who may potentially be resistive to care); working in awkward/sustained postures (for example in a confined bathroom while assisting a client with showering tasks) and handling heavy loads (for example loading/unloading wheelchairs, shopping or other equipment from vehicles; carrying washing baskets; moving vacuum cleaners). However, the above tasks are only a few of the manual tasks that may cause injury. Any task that involves high force, use of awkward or sustained postures, or repetitive movements may result in injury to employees. These tasks need to be identified and addressed through a risk management process to reduce the likelihood of injury. Cont page 2 Westcentre 1260 Hay Street West Perth WA 6005 Telephone: Facsimile: (08) safety@commerce.wa.gov.au

2 2 Manual tasks (cont ) What is the current legislation on manual tasks? The Occupational Safety and Health Act 1984 contains general duties and responsibilities placed upon employers and workers to ensure their own safety at work, and that of others who might be injured by the work. These duties extend to the prevention of manual handling injuries. The Act also requires employers to investigate matters reported to them by workers, determine the action to be taken (if any), and notify the worker who made the report of the action to be taken. The Occupational Safety and Health Regulations 1996 require the employer to identify each hazard that is likely to arise from manual tasks and to assess the risk of injury or harm. WorkSafe WA also has a Manual Tasks Code of Practice which provides practical guidance on manual tasks, including information on the risk management process, risk factors for manual tasks, ways to control risks associated with manual tasks and information on training for manual tasks. What should be covered in manual tasks training? Training should include information on: Risk Management process (empowering workers to report hazards) Common hazardous manual tasks in the industry, what types of injuries may result and general information on how the body works/ responds when performing these tasks Risk factors for manual tasks (so that employees are able to identify when a task is hazardous) Available controls to manage risks Task specific training (specific techniques for working safely for example client handling; safe pushing/pulling; loading/ unloading vehicles) Training should occur as part of induction, and be refreshed on a yearly basis. Further training may be needed whenever tasks are changed or new tasks are introduced (for example, hoist training for employees who are starting work with a client using a hoist). It should be emphasised to support workers that any observed change in a client s level of function is a potential hazard. Any changes in function should be reported immediately to allow timely re-assessment of the client to determine if any changes are needed to their care plan and prevent injuries to staff. How do I reduce the risk of injury from manual tasks? The first step, in consultation with workers, is to identify the manual task hazards for your organisation. This can be done via review of reviewing past hazard or incident forms; analysing previous injury records for staff; talking with workers about tasks they find difficult or demanding; reviewing previous pre-service home risk assessments and observing staff while they complete common tasks to collect information. Next, in consultation with staff, identify trends and determine which tasks are higher risk/priority. For each task, complete a risk assessment to identify which risk factors are present for that task. Risk factors may be actions & postures; forces & loads; vibration; work environment; systems of work; and worker characteristics please refer to the WA Manual Tasks Code of Practice for more information. The risk assessment should also determine what consequences/harm may result from performing that task, and how likely it is that this harm occurs. Finally, for each hazard, determine what controls are needed to minimise risk. Controls may involve: 1. eliminating the hazard or hazardous task May be difficult given the people handling requirements of this industry, but one example is where some organisations have advised clients that the domestic support workers will not move furniture for cleaning tasks (and clients will have to arrange for an alternative person to be present to move furniture if they wish this to be done for their home cleaning). 2. re-designing, modifying, altering or substituting the hazard or hazardous task Using mechanical aids/ lifting devices (eg hoists/ slide sheets; wheelchair loaders for vehicles) Use of trolleys for equipment, laundry baskets, shopping Installation of grab rails/ shower hoses for bathrooms Use of long handled equipment for cleaning tasks Adjusting bed heights to a higher level for transfers or bedmaking Liaison with client/ family to relocate furniture to create sufficient space for care tasks Storage of frequently required objects to appropriate heights within easy reach 3. administrative controls Training in safe work procedures and manual tasks Regular maintenance and service of equipment Planning of care jobs to alternate between heavier and lighter activities

3 3 Slips, trips and falls Slips, trips and falls are the 2 nd most common injury (after manual task injuries) for workers in this industry, however they can be prevented. A good understanding of the risk factors that contribute to slips, trips and falls is essential for both management and workers to prevent injuries. By understanding risk factors, workers will recognise slip and trip hazards in their work, and are more likely to report these hazards to the employer. Likewise, management needs to understand the risk factors in order to assess the risk associated with the hazard; and decide on, and implement controls to manage the risk. Slips, trips and falls risk factors can be categorised into 10 categories: Floor surface & condition Objects on the floor Cleaning/ spill containment Floor contamination Ability to see floor/ walkways/ hazards Space and design Stairs & stepladders Work activities, pace and processes Footwear & clothing Individual factors A checklist that covers each individual risk factor under the above categories is available through our website on Go to Safety Topics, then Slips and trips, then Frequently asked questions, then what risk factors contribute to slips and trips incidents, before clicking on the link to slips and trips risk factors checklist. Biological hazards Workers providing home based care services are at risk of contracting infectious diseases or transferring diseases from clients to others. Exposure to biological hazards can occur through: direct contact with blood and other bodily fluids, for example through broken skin, splashes to mucous membranes (eyes, nose, mouth), from skin penetrating injuries and from handling soiled linen/clothing ingestion, for example, via contaminated hands, food and surfaces inhalation, for example, inhalation of infectious aerosol droplets from coughing or sneezing All workers should be provided with training & information on universal precautions for infection control to minimise risk of disease, as well as information on the range of communicable diseases that they may be exposed to through their work, including Hepatitis A and B, HIV, Influenza, and MRSA. All personal care and domestic support workers should also be provided with appropriate gloves as personal protective equipment against biological hazards, at no cost to the employee. Where workers are at risk of exposure to Hepatitis B, they should be strongly advised by the employer to have Hepatitis B vaccination, with this vaccination provided by the employer at no cost to workers. The employer should manage workers appointments for the course of injections, and maintain records of vaccination. The 9 th edition of the Australian Immunisation Handbook (available at recommends that all health care workers (defined as all workers directly involved in patient care or handling of human tissue) should be immunised against Hepatitis B. The National Code of Practice for Hepatitis and HIV (available at safeworkaustralia.gov.au) states that carers for people with disabilities, children, the aged and others who require self-injection (eg diabetics); as well as laundry and cleaning staff, are at risk of Hepatitis B infection and require a specific risk assessment for this hazard. Electrical hazards When providing care to people in their own homes, employers have very little control over the working environment. This is especially important when it comes to electrical safety. Many homes in older suburbs or rural areas may not be protected by a residual current device (RCD). Even if a client s home is protected by a RCD in the meter board, this cannot be relied upon to provide adequate protection unless the client has been diligent in having the RCD inspected and tested on a yearly basis (and can provide documents to support this). All support workers using hand held electrical devices such as vacuum cleaners, kitchen appliances and personal grooming appliances must be provided with a RCD at no cost to the employee. These RCDs must be inspected and tested by a competent person on a regular basis (recommended yearly) to ensure that they continue to provide the required level of protection. Working alone Support workers providing home based care are often working over large geographical distances and visiting several clients per day. There are risks associated with working alone in the community from potential vehicle breakdowns/ accidents to possible exposure to aggression or violence from a client or family/visitors at a client s home during care services. Employers must ensure that all support workers working alone in the community have access to a means of communication (and are aware of emergency numbers) in the case of emergency while performing their work duties. A system that ensures regular contact (for example a daily end-of-shift phone call) is maintained with workers helps to ensure appropriate supervision, communication and early response where a worker may be in an emergency situation. Further, this system should also ensure that employers know the locations of workers at all times, to allow a fast response should concern be raised regarding the safety of one of their staff.

4 Client s home = workplace Who s responsible for OSH? Clients do have some responsibilities to providing a safe workplace for support workers coming into their home, in terms of those hazards within their control. It is recommended that home based care organisations advise clients and/or their representative of these OSH responsibilities towards support workers. WorkSafe suggests that OSH roles, responsibilities and rights are defined in a care agreement, provided to (and discussed with) the client prior to commencement of services. The agreement should also outline the organisation s hazard reporting process and advise of possible consequences (eg suspension or termination of care services, or specific tasks within care services) should hazards be reported and are not resolved. Examples of items that may be covered in a care agreement include: restraint of pets during support visits smoking policies for clients and staff equipment provision and maintenance, eg hoists, commodes, shower chairs, mops, vacuum cleaners, washing machines aggression, abuse or harassment addressing identified safety issues (eg trip hazards, lighting, faulty equipment) visitor restrictions during support visits emergency use of telephones leaving access doors unlocked during visits Regular updates on OSH WorkSafe has a service that provides information on occupational safety and health direct to your . To subscribe to receive this service go to services mailing lists ThinkSafe Small Business Assistance Program If you are a small business owner or manager (employing less than 20 full-time employees) and want to make your workplace safe, the ThinkSafe Small Business Assistance Program can help you. The good news is that the help you get is: free (up to three hours assistance); easy to obtain; provided by an independent and qualified osh consultant; and is a simple process with clear and immediate outcomes. To apply download and complete the online form from or call Information to help you meet the OSH laws The WorkSafe website contains a number of publications which may assist you in making your workplace a safer place. Go to the WorkSafe website Codes of practice Manual tasks National code of practice: Hepatitis and HIV Violence, aggression & bullying at work First aid, workplace amenities and personal protective clothing National code for control of hazardous substances Working hours and risk management guidelines Guidance notes General duty of care in Western Australian workplaces Formal consultative processes at the workplace Alcohol and other drugs at the workplaces Dealing with bullying at work Preparing for emergency evacuations at the workplace Provision of information on hazardous substances (MSDS) Assessing risks of hazardous substances Working alone Bulletins Tips for investigating accidents and incidents Gloves-selection use and maintenance Driver fatigue Electing safety and health representatives Other Working safely with challenging behaviours Slips and trips prevention guide Slips and trips risk factor checklist Electrical safety The first step The next step

5 5 Checklist for home based care organisations Manual tasks safety checklist Have all manual task hazards been identified? driving vehicles loading/ unloading vehicles carrying equipment to homes client transfers (bed, wheelchair, car, commode, shower chair, hoist) client movement (in wheelchairs, wheeled equipment, bed mobility) unsafe equipment change in client function bariatric care issues moving furniture cleaning, gardening, shopping, food preparation tasks other? Has a risk assessment been completed for all identified hazards, in consultation with workers? Are control measures in place for risk factors? adequate lumbar support in vehicles equipment to store items in vehicles and/or load equipment (eg wheelchair loaders) trolleys for movement of equipment to/from and within homes sufficient and adequate client handling equipment as per assessed needs regular maintenance of home-based equipment reporting mechanisms for unsafe equipment procedures for clear response and action to client function changes Are implemented control measures regularly reviewed, in consultation with staff, to ensure continued appropriateness & effectiveness of control over time? If client provides equipment for domestic support workers (eg vacuum cleaners, mops), is information given to clients regarding appropriate equipment choice? If employer provides equipment for domestic support workers, is it appropriate for minimising manual task risks? (eg light weight, easy to use, regularly maintained) Is training provided to all staff for manual tasks and regularly refreshed on a yearly basis? Does training in manual task follow a risk management and competency-based approach? Is training regularly reviewed/ evaluated? Does training allow for workers to raise manual task issues (as a method of hazard identification?

6 6 Slips, trips and falls safety checklist Does pre-service client home assessment cover: presence & condition of stairs, ramps and steps? presence & condition of rails or other safeguards on steps, ramps, stairs etc? surface type (slippery vs slip resistant)? surface condition (any holes, wear, tears or other issues)? presence of any obstructions in walkways (mats, electrical leads, furniture, hoses)? adequate lighting of internal & external areas? any issues with changes between floor surface types? Sufficient space to complete tasks? Does the organisations dress code specify that footwear should be well fitting, supportive, fully enclosed (heel and toe) with a slip resistant sole? Are workers provided with adequate information and training in management of spills? Do past incident investigations of slips/trips identify all relevant risk factors (floor surface, lighting, footwear, contaminants, floor condition etc) with action identified to prevent future incidents? Are workers trained in slips, trips and falls? Does training cover risk factors and controls to manage risk factors? Occupational violence & aggression safety checklist Are there systems in place to identify potentially aggressive clients? Does care contract/ service agreement specify implications of aggressive behaviour on continued services? Are workers trained in recognition of, communication for and management of aggressive behaviour? Is there adequate communication with referring agencies/ parties regarding potential aggression risks? Are procedures in place to ensure timely and appropriate counselling is provided to workers following a violent/ aggressive incident? Is there a policy in place regarding pets in the home? Are clients advised of policy/procedures? Is there a policy in place regarding restrictions to visitors at the home during support visits?

7 7 Psychosocial issues/ interpersonal conflict/ stress safety checklist Have hazards related to stress been identified in the workplace, in consultation with workers? Is there a grievance resolution procedure in place for workplace/ interpersonal conflicts? Are workers provided with information regarding resolution of conflict and grievance procedures? Are there clearly identified contact people in conflict resolution/ mediation roles? Do people with responsibilities/ roles in resolving conflict have appropriate skills and training in this area? Biological hazards safety checklist Have workers been provided with adequate information on communicable diseases? (eg symptoms, long term health effects, risk factors and controls to minimise risk, including immunisation) Are workers trained in universal infection control procedures? Have all at-risk workers been advised to have Hepatitis B vaccination, as protection against Hepatitis B infection? Does the employer have an employer-managed vaccination protocol in place, to ensure at-risk workers are vaccinated against Hepatitis B? (vaccination funded by the employer) Does the employer maintain records of vaccination of workers? Does the employer provide adequate PPE (eg range of gloves for both personal and domestic support workers), at no cost to workers? Is there a sharps procedure in place to manage the handling of sharps in clients homes?

8 8 Hazardous substances safety checklist Are systems in place to control cleaning products used in clients homes? (eg employer provides safe substances OR guidelines given to clients about appropriate selection of chemicals) If hazardous substances are used, is there a register of hazardous substances, including MSDS sheets no more than 5 years old? Is register readily available to staff? (do they know where to find it) Has the risk management process been applied to control of hazardous substances (ID, Assessment and Control)? Are staff trained in hazardous substances? Does training cover: identification of hazardous substances health effects controls safe work methods appropriate PPE and clothing Are there policy/procedures in place for smoking in the workplace? (both by clients AND workers) Electrical hazards safety checklist Are electrical hazards assessed in clients homes? (pre-service assessment) Are regular inspections completed to re-assess electrical hazards? Are portable RCDs provided to all staff for use with handheld equipment? (at no cost to employees) Are portable RCDs regularly maintained and tested by an appropriately qualified person? (yearly testing is recommended) External hazards safety checklist Does the organisation provide external services (eg gardening, general maintenance)? Are external workers provided with appropriate PPE, such as steel capped boots, sunscreen and hats? If pesticides are used, is information provided to workers for safe use? (see Hazardous Substances checklist)

9 9 Vehicle hazards safety checklist Is there a motor vehicle policy in place? Does motor vehicle policy cover: use of mobile phones while driving? disclosure of changes to license status? regular checking of car registration and insurance details for privately-used vehicles? insurance/ theft of personal belongings from vehicles during work hours? care seat adjustments to maximise comfort? procedures in case of motor vehicle accident? regular servicing, maintenance and care repair procedures? maximum driving time before break (to prevent prolonged sitting)? loading/unloading of vehicles? equipment provided to minimise vehicle hazards? (eg wheelchair loaders, storage crates, lumbar supports) Do employer-owned vehicles provide adequate lumbar support and other cushioning? Working alone safety checklist Is there a system in place for communication with workers working alone? Does the system ensure that employees have means of communicating in the event of emergency (eg mobile phones, duress alarms)? Does the system ensure regular contact is maintained with workers to ensure safety and supervision? Does the employer have a system to ensure knowledge of the location of all workers at all times during work shifts?

10 10 OSH systems safety checklist Are there systems in place to identify hazards, assess & control risks in client homes? (eg hazard forms, inspection checklists, risk assessments) Is there a hazard reporting system that workers can access to report hazards? Do employees have access to forms to report hazards and incidents? Have all workers received induction & ongoing training on: safety procedures manual tasks infection control and communicable diseases slips, trips and falls aggression/ violence grievance/ conflict resolution procedures communication and emergency procedures hazardous substances electrical safety Are training and induction records maintained? Does the employer have consultative mechanisms in place? Eg OSH reps, safety committees, safety newsletters, regular staff meetings Is there a designated contact person(s) for OSH and Injury Management? Have notifiable accidents been reported to WorkSafe, as per legislative requirements? Are all reported hazards and incidents investigated by the employer? Are the investigations adequate? (identify all potential risk factors and recommendations made for further action to control risk; investigation of client-related incidents consider client factors eg size/weight, communication, potential aggression/ resistive behaviour) Are workers reporting hazards/ incidents given feedback regarding outcome of investigations? Is a comprehensive assessment of potential clients and their homes/ environment completed PRIOR to commencing services to identify, assess and control hazards and risks? Assessment should include: level of physical and cognitive functioning/ diagnoses history of resistive behaviour/ aggression language/ communication abilities of client physical characteristics of client (size, weight) services to be provided slip/ trip hazards manual task hazards equipment needs and equipment condition phone locations lighting security presence of animals and other people in the home emergency evacuation and exit points Are care contracts or service agreements provided to and discussed with clients that cover safety matters; roles, rights and responsibilities; and process for resolution of identified safety hazards (including implications of non-resolution)? A