Developing, Implementing And Evaluating Comprehensive Occupational Health And Safety Programs Flashcards Preview

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Flashcards in Developing, Implementing And Evaluating Comprehensive Occupational Health And Safety Programs Deck (144):


The process used to gather important health and safety information


Uses of assessment data

1. Describe workers
2. Describe worker populations
3. Describe characteristics of work environment
4. Identify areas of need
5. Identify areas of value and importance
6. Target health and safety's programs to specific identified needs of workers and populations


Work related assessment may involve the following...

1. Description of work and home locations
2. Demographics of workers, dependents and retirees
3. Health status of worker population
4. Health care coverage and utilization
5. Disability information


Components of worker health status often gathered in work related assessment

1. Nutritional status
2. Exercise habits
3. Personal behaviors and lifestyles related to risk (ie smoking)


Purpose of environmental assessment at the worksite

Identifies existing and potential health and safety hazards and organizational variables that can affect workers' health and safety


Examples of work related information to be collected in an environmental assessment

1. Environmental and worker exposure data
2. Worker injury and illness data obtained from workers comp, OSHA and state records


Reasons occupational health services activity reports should be reviewed

1. Identify nature of services provided
2. Who uses services
3. If non occupational concerns are overshadowing time spent on work related issues


Broad categories of information used in a workplace assessment

1. Description of the company
2. Health service models that are in place and available to workers
3. Information included in health records


Items included in a description of a company

1. Standard Industrial Classification (SIC) code
2. Number and type of facilities within an organization
3. Company vision and mission
4. Organization's culture and values


Examples of health service models that should be looked at in a workplace assessment

1. Health insurance options
2. On site and vendor services
3. Workers compensation
4. Worker programs ( EAP, wellness programs, light duty/alternative work)
5. Safety committee


Examples of information included in health records

1. Daily logs
2. Surveillance and monitoring data
3. Disability information


Workplace assessment should include input from multiple sources including...

1. Consultation with other corporate occupational health and safety professionals in nursing, medicine, safety and industrial hygiene
2. Injury and illness data from insurance company
3. Research data from area university
4. External occupational medical consultation


Assessment tools used to gather workplace data

1. Questionnaires
2. Health risk appraisals
3. Workplace walk-through reports
4. Worker health and safety records
5. Case management reports
6. Interviews with workers and management
7. Health insurance claims
8. Workers compensation records/reports
9. OSHA records/logs
10. Life insurance records
11. Medical utilization data


Specific focuses of workplace assessments may include...

1. Workplace hazard analysis
2. Health evaluation
3. Behavior analysis or social concern
4. Legal/regulatory program compliance issues
5. Cost savings for the company
6. Public relations/ goodwill benefits


Program planning

The recipe for implementing health services goals and objectives and is the blueprint or detailed guideline for directing activities and evaluating all programs and services conducted by or for the occupational health department


Program planning includes:

1. Analyzing assessment data and targeting/prioritizing areas where programs and services need to be developed
2. Determine what resources are available to meet program and service needs
3. Developing goals and objectives that blend with organizational philosophy and company culture


Components of analyzing assessment data and targeting/prioritizing areas where services need to be developed

1. List strengths and limitations of worker population and organization
2. Review computerized materials and organize data in a manner that will assist in decision making
3. Select programs and services that will benefit most individuals and/or the organizations long term goals
4. Clarify the process and activities that will provide benefits and assist in reaching short and long range goals


Types of resources to look at for meeting program and service needs

1. Personnel
2. Financial resources
3. Equipment
4. Supplies and other resources
5. Facilities and space


What personnel resources do you need to look at for program planning?

1. Number of professionals and workers needed to develop and implement
2. Expertise of the professionals and workers needed to develop and implement
3. Are any additional workers or consultants needed


Financial resources for program planning- what do you need to do?

1. Develop a budget that will include expenditures for each program
2. Divide budget into sections
3. Determine direct and indirect costs that will add to existing or expected expenditures
4. Identify potential sources of funding
5. Identify the ideal vs the minimum costs required


How should you divide a budget into sections?

Sections should be consistent with workplace yearly categories


How should you evaluate equipment resources needed for program?

List equipment needed for implementation and final evaluation


Examples of equipment that might be needed for various programs/services

1. Audiovisual materials
2. Medical equipment
3. Computers and software
4. Other miscellaneous materials


Examples of audiovisual equipment that might be needed for various programs/services

1. Television set
2. Videotape/ DVD player
3. Camcorder
4. Audiotape recorder/player
5. Portable overhead projector


Examples of medical equipment that might be needed for various programs/services

1. Pulmonary function measurement devices
2. Syringes
3. Needles
4. Materials for blood analysis
5. Materials for blood pressure measurement


Examples of items you would need computers and software for when planning programs and services

1. Health risk appraisals
2. Questionnaires
3. Reports
4. Program correspondence
5. Educational literature
6. Internet access


How should you evaluate supplies and other resources needed for program?

Determine what other provisions are needed to develop and implement the program


Examples of supplies and other resources needed for programs and services

1. Paper
2. Computer and fax supplies
3. Mailing costs
4. Public relations materials


Examples of public relations materials that may be needed for various programs and services

1. Brochures
2. Posters
3. Television ads
4. Special incentives for participation like t-shirts and caps


How should you evaluate facilities and space for various programs and services?

Determine if in house facilities are available and adequate or if outside space will be needed


Costs to consider when evaluating facilities and space

1. Cost of using the facility
2. Heating
3. Air conditioning
4. Lighting


Goals and objectives should be developed ------- presenting a program plan to others for discussion and approval



Goals should be....

1. Presented in broad, general terms
2. State the expected results of implementing the program


Objectives should....

1. Be much more specific
2. Measurable
3. Limited to a given time period
4. Relevant to attaining the goal


A program begins with ------- goals for the health services departments and then ------- objectives are developed

Long term, general

Short term


Short term objectives are developed to.....

Identify what must be accomplished to demonstrate achievement of long term goals


Methods that will be used to accomplish goals and objectives should be identified during.....

The planning phase


Examples of methods that could be used to accomplish goals and objectives

1. Educational activities
2. Engineering controls
3. Administrative practices


Example goal for a work related program

To provide health and safety programs and services for workers to ensure compliance with all mandated OSHA standards


Examples of objectives for work related programs

Could target specific OSHA programs and services such as respiratory protection and hearing conservation


Example goal for personal health and safety program

To provide opportunities for workers to participate in health promotion activities to increase their years of healthy life


Examples of objectives in personal health and safety programs

Could target specific health issues such as:

1. Exercise
2. Smoking cessation
3. Hypertension
4. Weight control
5. Completion of recommended preventative health examinations


Following the planning and approval phases, ----------- begins

Program implementation


Implementation phase

The transition from program planning to putting the program into operation


Program execution will involve progressive monitoring of:

1. Activities
2. Personnel
3. Educational processes
4. Management support


Timetables and schedules should be evaluated periodically to:

1. Ensure operational success as the programs and services are developing
2. Identify who is responsible for their running according to schedule


Progress can be monitored by....

Routinely comparing completed activities with predetermined standards and assignments


Pros of providing in-house programs

1. Convenient for the working population, because they eliminate costly commutes
2. Current staff knows the workplace (workers, jobs and company culture)
3. Follow up is easier for those who need second visits or who fail to show up for appointments


Cons of providing in-house programs

1. Staff may be so busy with current job duties that they have little energy or motivation to take on additional program activities
2. Space is limited
3. Existing personnel may lack expertise, experience or motivation required


Pros for vendor contracted programs

1. Confidentiality may be easier to maintain
2. Interference with organizations other services and activities are less likely
3. Scheduling programs and services offsite, closer to workers homes could improve participation


Cons of vendor contracted programs

1. Extra costs including contractors travel time, overhead for workers, nonproductive time spent setting up programs and services
2. Contract workers do not share the same loyalty to the company as house workers
3. Workers may be required to commute to a distant location, requiring added time for travel


------- serve as guides to assist in achieving the goals and objectives of the health and safety programs and services

Policies and procedures


Program policies and procedures provide....

Direction and consistency for the implementation phase and can serve as the basis for program evaluation


Compliance with company and regulatory guidelines should be maintained with......

Well developed, well written and regularly updated procedures


Procedure updates should occur.....

At least annually


Procedures define...

1. Specific steps or activities that must be followed
2. Provide an excellent avenue for staff orientation
3. Ensure compliance with protocols and other activities


Protocols also provide legal backup for both nurse and company should the question arise regarding.....

Whether programs and services are:

1. Within the scope of practice
2. Consistent with company policy
3. Compliant with national standards and expectations


Possible barriers to program implementation in the business environment include:

1. Political interests that are inconsistent with the program plan
2. Seasonal variations in production and weather
3. Union strikes and bargaining or territorial turfs
4. Personnel changes, availability and expertise
5. Management changes leading to direction shifts
6. Equipment delays, availability or design flaws
7. Lack of resources needed for implementation


Evaluation process

Used to identify and improve services provided by the occupational and environmental health nurse


Evaluation in an integral component of all phases of....

Development and implementation


Methods of evaluation should be...

Appropriate to program goals and objectives as they have been defined


Classic three pronged approach to evaluation

Developed by Donabedian

1. Structure
2. Process
3. Outcome


Structural evaluative elements in quality assurance

1. Physical setting
2. Philosophy of health by management, workers, healthcare professionals
3. Organizational mission and structure
4. Unit goals and objectives
5. Human and financial resources
6. Operational resources


Process evaluative elements in quality assurance

1. Management of the operation
2. Decision making processes
3. Collaboration
4. Nursing interventions/ monitoring
5. Services provided
6. Development of records and reports


Outcome evaluative elements in quality assurance

1. Improved health
2. Compliance with treatment regimens
3. Reduced morbidity and morality
4. Positive changes in knowledge and attitudes about health
5. Satisfaction with service quality


Structural elements include such things as:

1. Management support
2. Physical facilities
3. Supplies and equipment
4. Staff and health resources
5. Worker demographics
6. Mission, goals and objectives


A knowledge of the structural elements can be achieved through the following activities:

1. Review the management reporting structure; determine who supports the occupational health program and services
2. Evaluate the suitability of physical facilities provided for occupational health programs and services
3. Identify supplies and equipment needed to deliver occupational health programs and services
4. Identify staffing requirements, qualifications, and professional development recommendations
5. Assess work-site community and ensure that programs and services, including those required by OSHA, are available to meet the needs of the workers
6. Develop mission, goals and objectives that meet the health and safety of the workers and the business needs of the company


Steps for reviewing management structure and determining who supports occupational health programs and services

1. Determine who the nurse reports to, administratively and professionally
2. Participate in the formulation and implementation of administrative procedure
3. Participate in development of policies and procedures applicable to health issues
4. Develop the philosophy and written goals and objectives for occupational health programs and services
5. Conduct periodic reviews of occupational health programs and services and ensure that goals and objectives are being met
6. Participate in meetings that address health issues
7. Communicate clearly in writing with management and department heads as needed
8. Demonstrate effectiveness of the health services department in terms of cost, productivity and return on investment
9. Communicate workplace information, distribution lists, upcoming events and plans to the occupational health and safety staff


Items to evaluate in the process of evaluating the suitability of the physical facilities for occupational health programs and services

1. Central location with easy access to workers
2. Accessible for ambulance stretchers or other wheeled traffic
3. Sufficiently spacious to provide examination, treatment and consultation needs
4. Confidentiality and privacy for clients and for the nurses to complete all aspects of work
5. Entrance clearly marked "Occupational Health Services" or "Health Unit"
6. Sink and toilet facilities available and accessible
7. Convenient and comfortable waiting area
8. Adequate ventilation, heating and air conditioning
9. Access for separate telephone lines for fax, telephone and computer
10. Space to maintain supplies and medical records


Examples of policies and procedures occupational health program should be involved in the development of:

1. Return to work
2. Case management
3. Fitness for duty


Examples of meetings that occupational health should be involved in:

1. Safety
2. Management staff
3. Department
4. Human resources


Steps for identifying supplies and equipment needed to deliver occupational health and safety programs

1. Supplies and medications appropriate for the practice are maintained in adequate supply, stored under proper conditions and are not kept past the expiration date
2. Appropriate medical equipment is available and in good working condition
3. Equipment used in performing examinations required by OSHA is maintained and calibrated according to federal standards
4. Laboratory tests are conducted in accordance with state and federal guidelines


Steps for identifying staffing requirements, qualifications, and professional development recommendations

1. Copies of professional licenses and required certifications are kept for all staff
2. Copies of updated curriculum vitae or resumes are kept on file
3. Occupational health staff takes advantage of opportunities to grow professionally and advance the speciality
4. Attainment of occupational health nursing certification is supported and encouraged
5. Nurses active membership and involvement in AAOHN is supported
6. Nurses participation in professional development seminars designed to advance individual practice is supported and encouraged
7. Occupational health staff is encouraged to continue formal and informal education
8. Professional journals and other professional resources are available
9. Nursing responsibilities are clearly defined in a position description


Steps to assess the worksite community and ensure that programs and services are available to meet the needs of the worker

1. Workforce analyses are used
2. Health and safety hazards, specific exposures and OSHA-required programs and services are identified


Workforce analyses are used to determine:

1. The number of workers and managers
2. Median age of population
3. Approximate distribution of population by gender
4. Number of accommodated workers
5. Health status of worker population


Steps to develop mission, goals and objective that meet the health and safety of workers and the business needs of the company

1. Goals and objectives need to be regularly revised and update
2. Mission, goals and objectives should reflect current issues and practices in occupational health


Process elements include such things as:

1. Delivery of nursing clinical practice
2. Methods used to provide services and programs
3. Record keeping and documentation development


Nursing clinical practice is appropriate for the occupational health setting, provided that the following requirements are met:

1. Clinical practice is consistent with practice acts, guidelines and competencies
2. A policy and procedure manual is written and reflects current occupational health practice
3. Occupational and environmental health nursing resources are used to guide clinical practice


Clinical practice should be consistent with the following acts, guidelines and competancies

1. State nurse practice act
2. Pharmacy and medical practice acts
3. AAOHN standards of practice
4. Published clinical practice guidelines
5. AAOHN competencies


The scope of the following clinical services and programs should be designed to meet the needs of the work-site community

1. Injury and illness management services
2. Health promotion and screening programs
3. Case management
4. Health and safety issues
5. OSHA surveillance programs, other required programs and services and training sessions
6. Employee assistance programs (EAP) and/or referrals
7. Immunization programs


Injury and illness management services should include the following:

1. Care and treatment of occupational injuries and illnesses
2. Care and treatment of non occupational injuries and illnesses
3. Emergency care for workers and visitors at the facility
4. Registered nurse supervision of nursing care provided to workers


To evaluate health promotion and screening programs and services, the occupational and environmental health nurse should...

1. Determine the efficacy of health promotion programs and services that have been delivered at the worksite
2. Evaluate formats used to offer health promotion and health education


Examples of health promotion and screening programs that might be offered at the worksite

1. Back safety
2. Ergonomics
3. Hearing/vision conservation
4. Occupational dermatitis
5. Hypertension screening


Examples of formats used to offer health promotion and health education

1. Formal lectures
2. Management meetings
3. Informational pamphlet distribution
4. Posters
5. Bulletin board or table displays


Case management of occupational and nonoccupational injury and illness involves the following activities

1. Nurse communicates and collaborates with others
2. Nurse is familiar with state's workers' compensation laws
3. Nurse reviews health care and response to treatment, including normal recovery times
4. Nurse recommends an independent medical evaluation when appropriate
5. Nurse has working knowledge of medical and health benefit programs and services offered by employer
6. Nurse, together with manage, identifies temporary modified jobs that support treatment goals
7. Nurse maintains contact with workers who have sustained an injury or illness
8. Nurse evaluates workers who are absent from work for more than 5 days with non work related illness or injury


Examples of people whom occupational health nurse collaborates during case management

1. Managers
2. Claims administrators
3. Workers
4. Medical providers


Recommended resource for expected normal recovery times

The Medical Disability Advisor


Examples of OSHA surveillance programs, other required programs and services and training sessions that should be offered to employees

1. Hearing loss prevention programs
2. Respirator approval
3. DOT drug testing programs


The occupational and environmental health nurse is responsible for the following EAP functions

1. Identify how EAP services are provided at the worksite
2. Assessing workers and referring them for appropriate treatment
3. In some cases, delivering some components of the EAP service such as counseling, depending on the nurses educational preparation and experience


At minimum, an emergency response program should include:

1. Biopreparedness/ disaster plan
2. AED program
3. First aid/ responder team


An emergency response/ disaster/ biopreparedness plan will provide....

Guidance and direction for the emergency response program


In order to have a successful emergency response plan the following must occur:

1. Workers responsible for coordinating and implementing the disaster plan within the facility must be identified
2. The plan must be periodically tested and revised if needed
3. The must be active workers' participation in the planning, implementation, testing and evaluation of the plan
4. The plan must be coordinated with the local community, first responders, and hospital and other health centers


AEDs are used to..

1. Assess a worker's heart rhythm
2. Determine if defibrillation is needed
3. Administer a proper level of shock


AED unit must be approved by...



Procedures for using AED must....

Meet state and local requirements


A ------ should be designated as the AED program coordinator

Registered nurse


First aid/ responder teams should be developed and may consist of ....

1. Workers
2. Managers
3. Health professionals


Members of fist aid/ responder team should include workers at --------- and from --------- who are able to respond to medical emergencies

Strategic locations
All shifts


First aid team should be trained to:

1. Provide CPR and first aid
2. Comply with blood borne pathogen requirements
3. Use AED equipment


First aid logs should be evaluated in order to.....

Evaluate effectiveness and appropriateness of care provided by the first aid/ responder team members


AAOHN's foundation block that provides a detailed description of a comprehensive AED program

Establishing an Automatic External Defibrillator Program


Ways the documenting and recordkeeping system should be regularly evaluated

1. Quality of documentation should be evaluated to make sure the records a appropriate an clear and meet legal reporting requirements
2. Type of system used for documentation should be identified
3. OSHA forms, training logs and other management reports should be evaluated in certain areas


A documentation system should have the following characteristics:

1. Documentation is timely and complete
2. Entries on the daily log reflect accurate documentation in the health record
3. Daily logs are used to summarize clinical activity and trends to report to management
4. All health records are secured in a locked cabinet/ area
5. Computerized records are secured by passwords
6. Health records are retained according to federal law
7. Disclosure of information from a worker's health record is made only with written informed consent of the individual adhering to HIPAA guidelines
8. Work related injuries and illnesses are shared with the employer only on a need to know basis


Exposure records are to be retained for

30 years


Health records are retained for

The duration of employment plus 30 years


OSHA forms, training logs and other management reports related to the following should be reviewed:

1. Blood borne pathogens training
2. Hearing conservation programs and services
3. Respiratory protection programs and services
4. Other relevant programs


Outcome elements

Programs and services provided to an individual worker or population of workers need to be evaluated in order to determine if expected outcomes have been achieved


Health outcomes resulting from the programs and services include the following

1. Illness and injury has been prevented whenever possible
2. There is evidence that compliance with treatment regimens has increased
3. Workers have increased knowledge about self care
4. Function following injury occurrence has been restored
5. Diseases are cured or successfully managed
6. Workers experience relief of discomfort


Types of functions that should be restored after injury occurance

1. Physical functions
2. Psychological functions
3. Social functions
4. Role functions


Examples of physical functions that should be restored following injury

1. Ambulation
2. Lifting


Examples of psychological functions that should be restored following injury

1. Memory
2. Cognition
3. Mood


Examples of social functions that should be restored following injury

1. Interpersonal relationships
2. Communication


Examples of role functions that should be restored following injury

1. Care of family members


A desired outcome is that workers should experience relief of discomfort such as:

1. Physical discomfort such as pain
2. Psychologic discomfort such as depression


Outcomes related to health care programs and services are compared with....

The costs


Why are program and services outcomes compared with the costs?

So that judgements about the value of e programs and services can be made for the company


Rationale for worksite influenza immunization program

Immunize healthy adults against influenza and reduce absenteeism


Expected outcome of work-site influenza immunization program

The company will have a healthier workforce, resulting in less absenteeism and improved productivity


Cost savings of worksite influenza vaccination program (as determined by Nichol in 1999 study)

Return on investment of $47 per worker


Rationale for back injury prevention program

Work related back injuries account for high volume, high cost workers' compensation claims


Expected outcome of back injury prevention program

Use of lift team extends beyond effect on injury and financial outcomes- these teams can be used for recruitment and retention strategies. Ultimately the lift team helps protect a valuable resource, the healthcare worker


Cost savings of back injury prevention program

Direct and indirect medical expenses for back injuries decreased dramatically.

Average cost per recordable back injury decreased from $6,294 to $1,099


Rationale for case management

Worker's compensation an disability cases


Expected outcome of case management

1. Workers' timely return to work
2. Quality outcomes


Examples of quality outcomes to report

1. Quality of life
2. Well being
3. Satisfaction


Cost savings with case management

1. Decreased medical costs
2. Decreased lost work days


The measurement of health outcomes begins at....

The individual level


Many individual outcomes can be pooled to assess....

Factors of interest or need for services across worker groups


Several techniques that may be used for gathering information for evaluation:

1. Retrospective chart audit
2. Concurrent document review
3. Interviewing
4. Questionnaires
5. Observations


Retrospective chart audit

1. Focuses of documented evidence of nursing care provided
2. Assumes that what is documented is what care has been performed


Concurrent document review


1. A critical examination of case management (while care is in progress) and of client outcomes
2. A review of chart, plans for care, immediate feedback



- consists of verbal interaction with workers


In order for interviewing to be meaningful, the interviewer needs to clarify....

1. Questions
2. Attitudes
3. Opinions
4. Client satisfaction
5. Management understanding of health care


Why is it important to word questions consistently from worker to worker?

To decrease bias



- the most common tool used for program evaluation

- it is important to write questions clearly and to provide clear directions for completion


Occupational and environmental health nursing managers may observe the delivery of health services in order to evaluate physical assessment skills such as....

1. Occupational history taking
2. Medication administration practices
3. Development of treatment plans


Worksites may be observed to....

Identify work hazards and working conditions


Workers may be observed to...

Determine if they are using safe work practices


Observations provide the opportunity to......

1. Provide immediate feedback
2. Validate the procedure manual for appropriateness
3. Determine the relationship of outcomes to actual nursing practices


The ------- and ------------ requires consideration when conducting a quality review

1. Staffing
2. Type of work environment


In corporate settings with a number of nurses, a quality assurance program can be.....

Developed by the nurses and used at several different sites


In settings where nurses work alone a quality assurance program should..

Develop a quality review team of interested peers located nearby or form a team of occupational and environmental health nurses representing local AAOHN constituencies


You should develop and customize an evaluation tool to....

Identify the specific needs of your company's occupational health program


AAOHN's Quality Assurance Packet includes several evaluation tools including....

1. Site evaluation tool
2. Chart audit form
3. Employee evaluation of health services form

Decks in Occupational & Environmental Health Class (49):