Safety in practice

first_imgRelated posts:No related photos. A survey of GP practices showed they are not practising what they preachwhen it comes to health and safety.  By TammieDaly and Penny Shuttleworth Like NHS employees, GPs and their practice staff are exposed to occupationalhazards on a daily basis: ranging from mercury spillage to needlestickinjuries, from hepatitis B to disease organisms carried by sick patients. But a survey carried out by Nottingham Occupational Health highlights a lackof awareness and commitment surrounding health and safety issues. Nursespecialist researchers reported that in terms of risk management, GP practices”could do better”. For example, only 12 per cent of practices whichresponded to the survey had done a COSHH assessment and none had addressed theissue of tuberculosis or rubella immunisations. Since the formation of Primary Care Groups, GPs need better access tooccupational health services. Nottingham Occupational Health was funded toresearch the dangers that GPs and their staff are exposed to at work and lookat how the practices comply with current health and safety legislation and NHS managementexecutive directives. The study highlighted the areas of occupational health care from which GPsand their staff could benefit and the importance of OH nurses making the mostof this need. Free advice Nottingham Health Authority and the Local Medical Committee offered all GPpractices in the Nottingham area a free visit by Nottingham Occupational Healthto give assistance and advice on health and safety issues. The visits were conducted as a broad health and safety assessment whichwould be non-threatening and non-invasive to gain the support of GPs and theirstaff. Information on specific policies and procedures – for example, alcohol,stress, and sickness absence was not included. Nurse specialists followed upeach visit with an individual report for each surgery including guidelines ongood practice. Of the 116 GP practices approached, 51 per cent responded. A postalquestionnaire was sent to the 57 non-responding practices to ascertain why theoffer had been declined and 60 per cent replied. Of these, 11 per cent assumedthat health and safety was not their responsibility because they were based inhealth authority-owned premises, 11 per cent stated lack of time as the reason,35 per cent had overlooked the letter of invitation, 20 per cent said they hadalready performed assessments, and the remaining practices gave other reasons. To examine if there was any difference in the standard of health and safetybetween responding and non-responding practices further visits were later madeto 6 of the non-responders. No major differences were found between thesepractices and those who responded initially. Comparisons made Comparisons were made between large and small practices (greater or equal toand less than a median of 12 staff), and between city (as defined by NottinghamHealth Authority) and non-city GP practices. Out of the numbers responding, 73per cent were in the GPs’ own premises and not in a health centre. More thanhalf were in the City East or City West areas. Under the Health and Safety at Work Act 1974 (HASAW), the Management ofHealth and Safety at Work Regulations 1992, and subsequent regulations, allemployers, including GPs, have legal obligations to ensure, so far as isreasonably practicable, the health, safety and welfare of their employees1, 2.Our Healthier Nation (1998) states that people with a job spend a lot of timeat their workplace so a healthy workplace is vital to their health.3. Under the Control of Substances Hazardous to Health Regulations 1994 (COSHH)GPs must identify and assess the risks to health of microbiological andchemical hazards in the workplace4. Ultimate responsibility for health and safety issues lies with the seniorGP. The GP has responsibility for the health and safety of his employees and anyoneelse using the premises. The findings revealed that the majority of the practices, (68 per cent), hada health and safety policy but only a third (31 per cent) of those were up todate. Therefore seven out of 10 did not have a proper policy in place.Practices with greater than 12 staff were significantly more likely to have ahealth and safety policy. They were also significantly more aware of the needto report under Riddor. The Nottingham Occupational Health survey shows that of the practices visited85 per cent had an accident book and although most staff were aware of the needto report accidents over half were not aware of Riddor reporting (Data 1). 1 The Management of health and safety in primary health care practices Health and safety policyno 38%                                    yes68%Riddor reportingno 52%                                    yes48%The Control of Substances Hazardous to Health (COSHH) Regulations apply towork involving substances hazardous to health (including micro-organisms) forexample, chemical agents (as may be used by cleaners and nurses) and diseaseorganisms, brought in by patients, to which staff might be exposed, forexample, an accident with a blood sample. The research revealed that only 12 per cent of practices had done a COSHHassessment. 2 Recording of hepatitis B status of staff and existence of needlestickpolicy in general practice within Nottingham Health Authority                         HepatitisB status recorded            no 71%                                    yes 29%                        Needlestickpolicy in place            no 64%                                    yes 36%Data 2 demonstrates that significantly more city practices and smallerpractices actively monitored the hepatitis B status of staff who are likely tobe occupationally exposed to hepatitis B. Similarly, city practices were morelikely to have a needlestick policy. The data indicates that notably fewer large practices, (12 per cent) wereaware of hepatitis B and the management of needlestick injuries and only (42per cent) of smaller practices were aware of the hepatitis B status of relevantstaff. Infection control is an issue of health and safety and comes within theremit of the Health and Safety at Work Act. The findings of the research also revealed that, 36 per cent had unsuitablypositioned sharps boxes 24 per cent were incorrectly assembled and 64 per centdid not have a needlestick policy. However, nine out of 10 practices disposedof clinical waste properly. The project showed that only there was little health and safety trainingundertaken to comply with relevant legislation. 3 Health and safety training to comply with legislation                         Manualhandling training            no 93%                                    yes 7%Workstation assessmentno 90%                                    yes10%Fire trainingno 45%                                    yes54%                       Conclusion The survey revealed a lack of commitment and awareness surrounding somehealth and safety issues and in terms of risk management the GP practices coulddo better. Working Together. Securing a Quality Workforce for the NHS states that:”Each local employer should have in place occupational health services forall staff by 21 April 2000″. Links with an NHS Occupational Health Service would assist in forming acollaborative partnership which would permit GPs, and their staff, access to aconfidential service which could supply advice and support on all health, safetyand welfare issues, including immunisations and COSHH. It would be beneficial to GPs and their practice managers who are alreadyoverworked and find it difficult to allocate enough time to address theseissues. Occupational health professionals are in a unique position to offer acomprehensive service for GPs and their staff as well as other primary careworkers. This unique opportunity to raise the OH profile within Primary Care Groupsand Trusts and, more importantly, promote the speciality. This will have the knock-on effect that GPs will come to understand thesupport we can provide for their patients whilst in the work situation. Partnership is the way forward and we either embrace this opportunity or, ifnot, expect the role to be taken over by the practice nurses and again OH willbecome the poor relation. Tammie Daly is occupational health nurse specialist, Nottingham OccupationalHealth, University Hospital NHS Trust. Penny Shuttleworth is senior nurse,Occupational Health Service, King’s Mill Centre for Healthcare, Sutton inAshfield. Notts. The work was undertaken when they both worked as nursespecialists at Nottingham. References 1 HSC Health and Safety at Work Act 1974 HMSO, London 1990 2 HSC The Management of Health and Safety Regulations 1992. HMSO, London.1992 3 Dept of Health Our Healthier Nation HMSO 1998 4 HSC 1997 General COSHH ACOP and Carcinogens ACOP and Biological Agents.Approved codes of practice. HSE Books, London. Further reading Chambers,R, Miller, DTweed,P and Campbell, I (1997) Exploring the Need foran Occupational Health Service for those Working in Primary Care OccupationalMedicine 1997 47,( 8): 485-490 Sen, D and Osborne, K. General Practices and Health and Safety at Work(1997). British Journal of General Practice 47 p103-107 Parker G. Attitudes of General Practitioners to Occupational; HealthServices. Journal Society of Occupational Medicine 1995 45: 61-62 Jackson, R and Sutton, G Workplace health in primary care premises. BMJ 1995311: 140-141 HSC 1957. Employer’s Liability Act. HMSO Croner’s Health and Safety at Work. (1998). Croner publication HSE (1995). A Guide to the Reporting of Injuries, Diseases and DangerousOccurrences Regulations 1995. HMSO London. Department of Health. 1996. Immunisation against Infectious Disease. HMSO,London. HSC 1992 Safe Disposal of Clinical Waste. HMSO Comments are closed. 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