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Optimizing Early Case Management of Occupational Injuries December 17, 2013

Optimizing Early Case Management of Occupational Injuries December 17, 2013. Dan R. Azar MD MPH Regional Managing Physician Lockheed Martin Corporation Sunnyvale CA. Occupational Medicine Services. Surveillance and Recertification

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Optimizing Early Case Management of Occupational Injuries December 17, 2013

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  1. Optimizing Early Case Management of Occupational InjuriesDecember 17, 2013 Dan R. Azar MD MPHRegional Managing PhysicianLockheed Martin CorporationSunnyvale CA

  2. Occupational Medicine Services • Surveillance and Recertification • Performing focused occupational testing and examinations at the Wellness Center • Coordinating these Medical Services at sites without a Wellness Center • Medical Support for Other Business Operations • Providing Medical Consultation to Business Area • Hiring Process • Fitness For Duty • Clarifying Work Restrictions • Assisting with Accommodation Process • Supporting Crisis and Disaster Management • Work-related Injury/Illness Care • Treatment • Leveraging Occupational Visits to address Personal Health issues

  3. Learning Objectives Understanding Workers’ Compensation Understanding OSHA Recordability Treating Occupational Injuries / Illnesses Optimal Medical Management Effect of Treatment Decisions

  4. What is Workers’ Compensation? State run “no fault” insurance system started in the early 1900s • Intended to provide for medical care and wage replacement for employees in event of work-related injury/illness • In return for immediate treatment, employees gave up the right to sue the employer in most cases • No direct association with OSHA

  5. Learning Objectives Understanding OSHA Recordability Understanding Workers’ Compensation Treating Occupational Injuries / Illnesses Optimal Medical Management Effect of Treatment Decisions

  6. OSHA Recordable Must post last years completed OSHA 300 Log in public area for employees to view Occupational Safety & Health Administration Federal States?

  7. Define OSHA Recordability Work Related (results from an event occurring in the work environment) New Case Treatment Provided General Recording Criteria

  8. General Recording Criteria Six (6) Areas Requiring Recording Death Days away from work Restricted work or transfer to another job Loss of consciousness Significant injury or illness Medical treatment beyond first aid

  9. Significant injury or illness • Significant Illness • Chronic irreversible disease • Cancer • Significant Injury • Fracture or “Cracked Bone” (no matter how small or well-tolerated) • Punctured eardrum

  10. Significant injury or illness Removal due to Medical Surveillance Results (e.g. elevated blood lead) Blood borne pathogen percutaneous exposure Hearing loss (>25 dB & >10 dB from baseline) Tuberculosis acquired in the workplace

  11. Defining First Aid Observation or Counseling is NOT Recordable Diagnostic Procedures are NOT Recordable Treatment specifically included in OSHA’s First Aid List is NOT Recordable Medical treatment beyond first aid

  12. First Aid List Non-prescription (OTC) medication taken in non-prescription dosage Cleaning, flushing or soaking wounds on the surface of the skin Tetanus immunization Wound Coverings

  13. Non-Rigid Support Hot or Cold Therapy Temporary Immobilization Device (for transport) Drilling to Relieve Nail Pressure or Blister Fluids Eye Patch First Aid List

  14. Using Finger Guards Removing Foreign Bodies from Eye Removing Foreign Objects (other than eye) Massage Drinking Fluids First Aid List

  15. Clearing the Air on Terms… Recordable Reportable Compensability

  16. Learning Objectives Understanding OSHA Recordability Understanding Workers’ Compensation Treating Occupational Injuries / Illnesses Optimal Medical Management Effect of Treatment Decisions

  17. Optimal Approach to Treating an Occupational Injury / Illness At first encounter these 3 issues need to be addressed Diagnosis Treatment Causation

  18. Treatment Use same standard of care regardless of causation!!! Evidence Based Guidances ACOEM Occupational Medicine Guidelines www.mdguidelines.com Agency for Healthcare Research & Quality http://www.ahrq.gov/clinic/ http://www.guideline.gov/ Specialty Societies recommendations for treatment http://www.aaos.org/Research/guidelines/guide.asp

  19. Learning Objectives Understanding Workers’ Compensation Understanding OSHA Recordability Treating Occupational Injuries / Illnesses Optimal Medical Management Effect of Treatment Decisions

  20. Impact of Treatment Decisions on OSHA Recordability Prescription medications/dosages Rigid splints (“stays” or limiting ROM) Physical Therapy with modalities/procedures Most Common Reasons a Claim Becomes OSHA Recordable Lost time beyond the day of injury (DOI) Sutures for laceration repair Work restrictions (or a job transfer to another position)

  21. Prescription Medications / Dosages Impact of Treatment Decisions on OSHA Recordability Don’t advise employees to take OTC meds in Prescription Dosages unless that is your intent Over the Counter Prescription Medication VS Acetaminophen alternating with an OTC NSAID to provide additional pain relief This also educates EE on how to care for minor injuries with OTC meds

  22. Rigid Splints Impact of Treatment Decisions on OSHA Recordability Rigid Splints (that immobilize) Elastic or Neoprene Wraps (that don’t immobilize) VS

  23. Work Restrictions Current job only requires lifting 10 lbs. maximum per lift …and unnecessarily makes incident recordable But the clinician prescribes restriction of “no lifting over 50 pounds Impact of Treatment Decisions on OSHA Recordability

  24. Sutures for Laceration Repair Impact of Treatment Decisions on OSHA Recordability Sutures, Staples & Glue Steri-Strips & Butterfly Bandages VS

  25. Physical Therapy with Modalities/Procedures Chiropractic Physical Therapy Impact of Treatment Decisions on OSHA Recordability

  26. Section 3 Review 5 Minutes

  27. Exercise OSHA Recordability Scenarios New Case? S1: Installer comes into clinic for treatment due to increased LBP that occurred after sitting in long meeting. Originally hurt back 2 years ago lifting at work. Was discharged from active care 6 months ago with “Future Medical” to address access to care for flare ups. R1: Not a new case; recorded in log 2 years ago. S2: What if increase in LBP occurred after lifting chair at end of meeting? R2: Depends on whether aggravation is significant and directly connected to new incident. Recordable Based on Diagnosis S1: Slipped & fell- landed on back. Felt disoriented but got right back up and came to clinic as instructed by mgr. Reports feeling fine. R1: No loss of consciousness (LOC), therefore non-recordable. S2: Same Hx but didn’t get right back up; EE can’t remember how long she lay there or exactly what happened right before she fell; co-worker states she was not responsive to voice or touch for 5 minutes; a little tired but otherwise feels fine. R2: Probable LOC; therefore, OSHA recordable.

  28. Exercise Dispense Ibuprofen 200 2 tab QID or acetaminophen 650 q6 alternating with IBU

  29. Exercise Dispense Ibuprofen 200 2 tab QID or acetaminophen 650 q6 alternating with IBU

  30. Exercise Dispense Ibuprofen 200 2 tab QID or acetaminophen 650 q6 alternating with IBU

  31. Section 4 Call to Action 5 Minutes

  32. Review & Discussion What makes a injury OSHA recordable? Death Days away from work Restricted work or transfer to another job Loss of consciousness Significant injury or illness • Any medical treatment not found on this first aid list (slides 22-24) • Diagnostic procedures (e.g. X-rays, blood work) are not OSHA recordable treatment • Counseling and/or Observation are not OSHA recordable treatment

  33. Call to Action • With each encounter consider whether First Aid treatment is a medically appropriate option • Educate and reassure injured workers about pathology, treatment plan, self-care and prognosis. • Use early rechecks and an “open door” policy to safely provide conservative care and avoid unnecessary restrictions • If appropriate clinical decisions generate an OSHA recordable case clearly document your reasoning focusing on severity, safety and/or treatment guidance. Consult your supervising MD/DO or a peer if you are undecided about how aggressively to treat. • If treatment is recordable, prescribe whatever else is appropriate to expedite recovery. • Best Online Resource: • http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=9638&p_table=STANDARDS • Includes: • Criteria for OSHA recordability • List of First Aid Treatments • FAQ’s

  34. Discussion What challenges do you anticipate implementing these actions into your daily practice? Questions?

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