Nurse Induction - Health Safety

1. Nurse Induction - Health & Safety David Mains Health & Safety Advisor Brief introduction of self. Explain that this session leads on from corporate induction earlier in the week. Aim to deal with main H&S issues affecting nursing staff. Brief introduction of self. Explain that this session leads on from corporate induction earlier in the week. Aim to deal with main H&S issues affecting nursing staff.

2. Objectives By the end of the session, delegates will be better able to: Understand the main hazards and causes of injury within healthcare settings Detail how to manage waste and understand the need for this process Record and report H&S incidents and issues

3. Hazards in the Workplace Manual Handling Slips, trips and falls Violence Needle sticks Biohazards Electricity Working at Heights Noise Respiratory sensitizers Radiation Confined spaces Stress Hot/Cold surfaces Animals Machinery/Tools Vehicles Healthcare presents a wide range of H&S hazards, explain that this may be one of the reasons why sickness rates in healthcare are higher than industry average. Also point out that both rates have been reducing in recent years. Briefly describe some/all of the hazards using personal experience and knowledge of incidents - Manual Handling, S,T&F, V&A, BBV will be covered in more detail. Highlight possible lesser known areas e.g. Electricity – damage to sockets in ward areas from beds, lights. Work at height – not just Estates, staff overstretching when standing on chairs, kick stools etc also hanging removing bedside curtains. Respiratory Sensitizers – Gluteraldehyde Radiation – sources now more widespread, specialist advisors, local supervisors. Animals – community/domiciliary staff Vehicles – sites are busy, parking issues can mean pedestrians & vehicles not always segregated. Also consider tugs and other work equipment inside buildings. Stress – explain that work related stress is a H&S issue. Difference between pressure and stress, work positive. Healthcare presents a wide range of H&S hazards, explain that this may be one of the reasons why sickness rates in healthcare are higher than industry average. Also point out that both rates have been reducing in recent years. Briefly describe some/all of the hazards using personal experience and knowledge of incidents - Manual Handling, S,T&F, V&A, BBV will be covered in more detail. Highlight possible lesser known areas e.g. Electricity – damage to sockets in ward areas from beds, lights. Work at height – not just Estates, staff overstretching when standing on chairs, kick stools etc also hanging removing bedside curtains. Respiratory Sensitizers – Gluteraldehyde Radiation – sources now more widespread, specialist advisors, local supervisors. Animals – community/domiciliary staff Vehicles – sites are busy, parking issues can mean pedestrians & vehicles not always segregated. Also consider tugs and other work equipment inside buildings. Stress – explain that work related stress is a H&S issue. Difference between pressure and stress, work positive.

4. Musculoskeletal Injuries Most common occupational illness Low back pain, joint injuries, RSI UK Health Services 2005/06 figures 51% of >3 Day Injuries 14% of Major Injuries 80,000 nurses off work every year due to back pain – 3,600 will not return to nursing. 1.5 million nursing days lost per annum due to back pain £5.4 million in permanent disability benefit due to back injuries paid in one year Compensation payments of £1K to £100K+ Define – Major Injuries and over 3 day Injury 80,000 nurses off work every year due to back pain – 3,600 will not return to nursing. 1.5 million nursing days lost per annum due to back pain £5.4 million in permanent disability benefit due to back injuries paid in one year Compensation payments of £1K to £100K+ Define – Major Injuries and over 3 day Injury

5. Musculoskeletal Injuries Employer’s Duties Assess the Risks Info & Training Equipment (suitable & sufficient) Employees Duties Attend Training Use Equipment Report Faults & Defects No Controversial Manoeuvres Training now based on 4 ½ day modules. Attendance is based on risk assessment. Individual patient M&H Assessment (Clinical governance as well as H&S) Occ. Health, staff physio & M&H resource for assisting staff back to work and retaining staff Explain background behind bed replacement programme and give examples of other equipment purchased. Explain how control book and risk assessment can be used to highlight equipment needs. Controversial Manoeuvres new term for condemned manoeuvres. Staff have a duty of care to patients as well as professional registration – both cover the use of drag lifts and other manoeuvres. Training now based on 4 ½ day modules. Attendance is based on risk assessment. Individual patient M&H Assessment (Clinical governance as well as H&S) Occ. Health, staff physio & M&H resource for assisting staff back to work and retaining staff Explain background behind bed replacement programme and give examples of other equipment purchased. Explain how control book and risk assessment can be used to highlight equipment needs. Controversial Manoeuvres new term for condemned manoeuvres. Staff have a duty of care to patients as well as professional registration – both cover the use of drag lifts and other manoeuvres.

6. Slips, Trips & Falls UK Health Services 2005/06 figures 55% of Major Injuries 19% of >3 Day Injuries Biggest source of major injuries, same for industry. Affects all groups of staff and also patients, members of the public. HSE have 2 year programme to reduce slips & trips within health services. No anti slip flooring, all floors have significant slip risk when wet. Biggest source of major injuries, same for industry. Affects all groups of staff and also patients, members of the public. HSE have 2 year programme to reduce slips & trips within health services. No anti slip flooring, all floors have significant slip risk when wet.

7. Slips & Trips Tips for Avoiding Wear suitable footwear Wet floor signs Clean up spills Keep routes clear Avoid trailing cables Suitable lighting Footwear – in accordance with local footwear policy Wet floor signs – always use, ensure positioned correctly Clean up spills – immediately, dry floors after. Soak up small spills ( tea, coffee, etc) with paper towels or other absorbent materials instead of mopping. Mopping simply spreads the hazard over a wider area. Keep routes clear – good housekeeping, Avoid trailing cables – whenever possible avoid cables on floor, if not possible position against walls use suitable covers. Suitable lighting – HTM set standards for all areas clinical & non-clinical within hospitals. Further advice from Estates, measurements can be taken by Estates or H&S. Footwear – in accordance with local footwear policy Wet floor signs – always use, ensure positioned correctly Clean up spills – immediately, dry floors after. Soak up small spills ( tea, coffee, etc) with paper towels or other absorbent materials instead of mopping. Mopping simply spreads the hazard over a wider area. Keep routes clear – good housekeeping, Avoid trailing cables – whenever possible avoid cables on floor, if not possible position against walls use suitable covers. Suitable lighting – HTM set standards for all areas clinical & non-clinical within hospitals. Further advice from Estates, measurements can be taken by Estates or H&S.

8. Patient Slips,Trips,Falls Individual Mobility Assessment Care Plan Suitable Footwear Bed position Cot Sides Persistent / Frequent Fallers Accounts for 80% of incident forms received. Number of tools/controls: Individual Mobility & care plan– Clinical Governance as well as H&S Suitable Footwear – significant number of patient falls due to footwear esp. slippers. Bed Position – usually lowest position best when not working with patient. This = lower height to fall from. Cot sides – use needs to be assessed. Can lead to patients falling from higher height as they climb over, or slide to end of bed. Cases of entrapment (rare but can be severe). Persistent/Frequent fallers – review of above. Other options include moving bed nearer nursing station for closer observation, ultra low beds available (or mattress on floor), hip protectors, movement monitors/alarms (rare in NHS). Accounts for 80% of incident forms received. Number of tools/controls: Individual Mobility & care plan– Clinical Governance as well as H&S Suitable Footwear – significant number of patient falls due to footwear esp. slippers. Bed Position – usually lowest position best when not working with patient. This = lower height to fall from. Cot sides – use needs to be assessed. Can lead to patients falling from higher height as they climb over, or slide to end of bed. Cases of entrapment (rare but can be severe). Persistent/Frequent fallers – review of above. Other options include moving bed nearer nursing station for closer observation, ultra low beds available (or mattress on floor), hip protectors, movement monitors/alarms (rare in NHS).

9. Violence & Aggression Healthcare workers up to 4 times more likely to be affected Verbal Abuse & Threats most common UK Health Services 2005/06 figures 12% of Major Injuries 15% of >3 day Injuries Figures have been rising, expected to continue over short term as awareness is raised within Acute Division. In addition national profile due to zero tolerance campaign and widespread media coverage. Make clear to staff that if in imminent danger police should be called direct.Figures have been rising, expected to continue over short term as awareness is raised within Acute Division. In addition national profile due to zero tolerance campaign and widespread media coverage. Make clear to staff that if in imminent danger police should be called direct.

10. Violence & Aggression Employer’s Duties Risk Assess Working Environment Suitable Training & Information Employees Duties Duty of Care Explain policies – V&A, lone working, withholding treatment. Each dept/area should have generic risk assessment for V&A – should include the working environment, layout of area, equipment. Hazards and controls give examples of possible controls both physical and environmental. Need to review incidents. Detail training available – conflict management ½ & 1 day, online version coming soon. Physical interventions also available. Training needs analysis for dept will determine level of training required. Duty of care starts with yourself - dynamic risk assessment. Explain policies – V&A, lone working, withholding treatment. Each dept/area should have generic risk assessment for V&A – should include the working environment, layout of area, equipment. Hazards and controls give examples of possible controls both physical and environmental. Need to review incidents. Detail training available – conflict management ½ & 1 day, online version coming soon. Physical interventions also available. Training needs analysis for dept will determine level of training required. Duty of care starts with yourself - dynamic risk assessment.

11. Blood Borne Viruses Near Patient Disposal 2L bin on tray 30l bin on trolley Both taken to point of use Near patient disposal Explain 5 phases of injury – 1. Preparation 2. In-use 3. After use, before disposal 4. During disposal 5. After (inappropriate) disposal Near patient disposal Explain 5 phases of injury – 1. Preparation 2. In-use 3. After use, before disposal 4. During disposal 5. After (inappropriate) disposal

12. Blood Borne Viruses Procedures where exposure is likely Risk Assessment determines P.P.E. required – visors/goggles etc. Must be worn! What to do if you are exposed to BBV? Possible exposure to body fluids Risk assessment will determine level of risk of exposure. Where exposure is likely – PPE must be worn. Explain PPE giving examples, explain that it is the last line of defence. Reinforce that delegates have duty under H&S legislation to wear PPE when supplied for tasks. Possibility of disciplinary action (in addition to exposure to BBV) if not worn. Post exposure procedure – explain protocol (check for understanding as Occ. Health may have already done this). Possible exposure to body fluids Risk assessment will determine level of risk of exposure. Where exposure is likely – PPE must be worn. Explain PPE giving examples, explain that it is the last line of defence. Reinforce that delegates have duty under H&S legislation to wear PPE when supplied for tasks. Possibility of disciplinary action (in addition to exposure to BBV) if not worn. Post exposure procedure – explain protocol (check for understanding as Occ. Health may have already done this).

13. Waste Management Segregate by waste stream – Clinical, Domestic, Special, Recyclables. Clinical & Domestic must be stored separately Traceability – bags & sharps bins should be labelled Give examples of each type of waste Legal requirement (EPA) to store separately in secure containers – enforced by SEPA. Explain need for traceability. In addition to legal duties it also makes environmental and financial sense to segregate at source. NHS in Scotland spends £8 million per year on waste disposal It is six times more expensive to dispose of CLINICAL waste than DOMESTIC waste – In NHS GG&C £240 per tonne of Clinical Waste compared to £40 per tonne of Domestic Waste. Recycling being introduced - recognise space constraints can hinder this especially in older buildings. Give examples of each type of waste Legal requirement (EPA) to store separately in secure containers – enforced by SEPA. Explain need for traceability. In addition to legal duties it also makes environmental and financial sense to segregate at source. NHS in Scotland spends £8 million per year on waste disposal It is six times more expensive to dispose of CLINICAL waste than DOMESTIC waste – In NHS GG&C £240 per tonne of Clinical Waste compared to £40 per tonne of Domestic Waste. Recycling being introduced - recognise space constraints can hinder this especially in older buildings.

14. Health & Safety Issues / Info Incident Form Line Manager Staff Representative’s Advisors (H&S, M&H, V&A, Fire, Occ. Health) Intranet Pages Describe journey of Incident Form, detailing importance of completing both for staff or patient and also for H&S. Only brief explanations required as should have been covered in corporate induction. Explain that local H&S issues should be taken to dept managers in first instance. Staff side reps (unions & professional bodies) also source of info and can take issues forward on behalf. New staff net site. H&S pages providing wide range of info – contact details, link to policies, training dates, external links. Describe journey of Incident Form, detailing importance of completing both for staff or patient and also for H&S. Only brief explanations required as should have been covered in corporate induction. Explain that local H&S issues should be taken to dept managers in first instance. Staff side reps (unions & professional bodies) also source of info and can take issues forward on behalf. New staff net site. H&S pages providing wide range of info – contact details, link to policies, training dates, external links.

15. Questions? Thank You!