OccupationalHealthCheck Flashcards
(22 cards)
Work related injury assessment?
a history of the presenting injury
any associated symptoms including red flags
previous similar injuries or past injury in the same anatomical location
an understanding of the injured worker’s day-to-day tasks and responsibilities
details about how these symptoms prevent the individual from completing their job requirements safely.
What does a certificate of capacity include?
the injured worker’s name, address, date of birth, job title and employer
details of the injury including diagnosis, date of the injury, date that the worker was first reviewed by the NTD, a description of the injury and any pre-existing risk factors
a management plan for the injured worker, including referral to any third parties (ie physiotherapist, orthopaedic surgeon etc)
capacity for activities; typically this would include restrictions on lifting, carrying, bending, twisting, pushing and pulling as well as weight limitations (this is important in roles that involve manual labour)
a determination of capacity for work; typically the options include: fit for pre-injury duties, has capacity for some type of work (with time duration included, ie for 1–4 weeks) or no capacity for any work
a follow-up review date
a signed declaration that the injured worker will not engage in any other form of paid employment if they are deemed to have no capacity for work.
Some employers have organisation-specific paperwork with a list of suitable work duties that the NTD can select from as well.
key stakeholders in the injury management process
Key stakeholders involved in the injury management process include:
the injured worker
the NTD (nominated treating doctor) (usually a GP or occupational medical practitioner)
other allied health or medical service professionals
the employer
the insurer
a case manager acting on behalf of the insurer.
What is a workplace rehab provider?
A workplace rehabilitation provider is often engaged by the insurer to assist the injured worker in the return to work process. Their role may include:
conducting a workplace or functional assessment to determine suitable duties
providing advice on work-related tasks and working with the employer to implement these
facilitating case conferences with the NTD to assess the progress of the injured worker.
how do you manage the relationship between patient, employer and third parties like rehab providers
Making appointments to see the injured worker first and alone. This reinforces the therapeutic relationship and allows the injured worker to be as honest as possible regarding their injury, work environment and interaction with other stakeholders. While it is important to be their advocate, be aware that the return to work process can sometimes be used for secondary gain (eg to obtain better work conditions, reduced workload etc) or there may be a psychosocial dynamic (eg workplace bullying, sexual harassment).
Ensuring your patient is aware that while they are entitled to confidentiality, you also will need to document the nature of the consultation for medico-legal purposes.
Setting a clear timeframe for the expected recovery from the injury sustained. This should be done at the first consultation with a note that it will be reviewed at each progress consultation. This allows both the worker and employer to undertake any necessary adjustments in the workplace.
Using evidence-based decision making informed by clinical guidelines for treatment of injuries so that all stakeholders can understand your plan.
Being aware that the patient, employer or insurer can request an independent medical examiner review. This is usually conducted by a specialist occupational physician or a specialist in the field associated with the worker’s injury (eg an orthopaedic surgeon for a musculoskeletal injury). This is often requested if the worker’s return to work is prolonged or against expectation or if there is a concern that an alternative treatment option may be required (ie major surgery).
Aspects of a clearnce to return to work asessment
it is important to assess the injury, the worker’s progress on the prescribed treatment plan and whether the worker is fit to return to pre-injury duties.
Aspects of an occupational history?
It is important to consider working conditions known to contribute to work-related psychosocial stress such as:
excessive workload
poor work–life balance
lack of involvement in decisions that affect the worker
lack of autonomy or influence over the way the job is done
lack of role clarity
poor communication related to changes to the workplace
job insecurity
lack of support from management
colleagues’ poor social relationships
working with the public, or with difficult clients, students or customers.19
The history needs to elicit details of how long Yvette has been in her current role, if she works full time or part time and the hours she is working. It is important to try to understand the workplace culture and Yvette’s workplace relationships. Assess whether there have been any changes at work and try to gain an understanding of Yvette’s perception of the problem.
It is also important to have an understanding of Yvette’s educational history, her past roles and occupational skill set.
Which occupations have highest work stress claims
Defence members, first responders, health workers, transport workers and prison workers are the groups with the highest rates of claims
What does it mean to be fit for work
To be ‘fit for work’ means that the worker:
is able to attend regularly, reliably and sustainably
can perform with quality and efficiency
can behave appropriately in the workplace.
what considerations in ‘fittness’ for work
structure/routine: sleep/wake cycle, activities of daily living and management of other commitments
energy/endurance: energy levels and ability to persist throughout the day
cognitive capacity: ability to concentrate, focus, remember and organise activities
interpersonal function: ability to engage appropriately with others
coping: ability to manage frustration and work stresses
evidence of work capacity: any engagement in study, work or volunteer work
medication: effects on daily routine.
Plan for work related stress return to work?
Where appropriate, set up an expectation of return to work and engage the workplace from the initial phases of management to facilitate return to work and gain access to additional supports where available.
Establish a return to work plan and regularly assess progress. Access appropriate supports such as the Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice, and for complex cases consider referral to an occupational physician.
EAP counselling sessions at work place
History in a patient with occupational exposures?
A full employment history should be taken, along with a history of more well-known lifestyle risk factors, such as smoking. The history should include:29
job title, working hours, location of work site, a full description of the duties performed and the frequency of exposure to identify potential carcinogens and causes of bone marrow failure, for example: ‘Can you tell me the name of your role, your employer and the type of tasks you performed?’
start and finish date of each job, as the duration of a role affects potential exposure, for example: ‘Let’s list each role in time order, going back to when you first started working’. It is important to also ask specifically about secondary employment (eg part-time weekend work).
the identity of any chemical exposures or other hazards, for example: ‘Do you know the names of the metals, dusts, fibres, chemicals, fumes or radiation that you were exposed to?’
possible routes of uptake of the potential carcinogen, including inhalation, ingestion or absorption through the skin, for example: ‘Did you inhale the material? Did you get the material on your skin or clothing? Could you smell the chemical or material you worked with? Did the smell persist even after washing? Did you eat at the workplace? Did you ever wash parts in petrol? Did you ever siphon petrol by mouth?’
work practices and standards to control workplace hazards and mitigate exposure, for example: ‘Did you work in a closed workplace? Were there ventilation systems in the workplace?’
the availability and use of personal protective equipment (PPE), including the type of PPE, how frequently it was worn and whether or not it was appropriate to the situation, for example: ‘Did you use protective equipment such as gloves, masks or a respirator? What type? How often? Was it mandated?’
workplace and out-of-work hygiene practices, such as prompt washing to remove material from skin and clothes, provide further information on possible exposure: ‘Were your work clothes laundered at home? Did you shower at work? Did you eat at work? Was there opportunity to wash before eating (and did you do it)? Was the eating area separate from the worksite?’
exposure to additional agents known to cause cancer and/or bone marrow failure: ‘Did you smoke at the workplace or at home? Were you exposed to second-hand tobacco smoke at the workplace or at home? What other agents were you exposed to at the workplace or at home (eg glues, resins)?’
More broadly, an occupational history would assess for any symptoms related to exposure. These questions are less relevant for Byeong-Ho as his symptoms have only occurred after ceasing work. A comprehensive occupational history would also include questions such as:
Do you know of any co-workers experiencing similar or unusual symptoms?
Are family members experiencing similar or unusual symptoms?
Has there been a change in the health or behaviour of family pets?
Do your symptoms seem to be aggravated by a specific activity?
Do your symptoms get either worse or better at work? At home? On weekends? On holidays?
Has anything about your job changed in recent months (such as duties, procedures, overtime)?
Sources of Benzene exposure
Benzene exposure occurs primarily through exposure to fuels (occupations at risk include mechanics, delivery and taxi drivers, firefighters, oil and gas industry workers) and through manufacturing using products with small amounts of benzene (occupations at risk include steel workers, printers, rubber workers, shoemakers).
Dose relationship with benzene and myelodysplasia
Benzene uptake is by inhalation and absorption, both routes of exposure evident on Byeong-Ho’s history.
The latency between first benzene exposure and diagnosis of a related haematological malignancy is commonly at least five years and often many years longer.
What are the Risk factors for non melanoma/keratinocytic cancer
fair complexion, light eye colour, light or red hair colour
skin with multiple lentigines or solar keratoses
age >40 years
family history of skin cancer
immunodeficiency
high cumulative ultraviolet (UV) exposure, especially as a child
previous history of non-melanoma skin cancer
occupational UV exposure in outdoor workers with extensive solar exposure, and possibly in welders
Arc welding risks? Precautions?
Arc welding can result in significant UV exposure to the welder or people nearby, especially if there are inadequate safety precautions.
People operating arc welding machines and those assisting them should wear suitable gloves, long-sleeved clothing, long trousers, a full-face welding helmet with a UV filtered lens and protection for the neck area. These precautions not only guard against UV radiation but also protect from burns from flying sparks and hot metal. Broad spectrum sunscreens including those with a UVC filter should be used. Most sunscreens do not filter UVC, as it is filtered out by Earth’s ozone layer and therefore only found in artificial UV radiation. In larger workplaces with established health and safety standards and monitoring mechanisms, the use of personal protective equipment may be mandated
COnditions associated with sillica exposure
silicosis (Table 1)
scleroderma, Sjögren’s syndrome, mixed connective tissue disease, systemic lupus erythematosus, rheumatoid arthritis and other rheumatological autoimmune conditions54
diffuse dust-related pulmonary fibrosis
COPD
cancers of the lung and airway
Management of a patient who has work related dust expsoure
You should notify SafeWork of the names of employers whose practices exposed Daxton to dust.
Other actions taken may include:
advising Daxton to minimise his exposure to moulds
commencing a salbutamol MDI if it provides symptomatic benefit, and regular paracetamol
addressing smoking and alcohol intake as a priority
assessing and treating any lipid or glycated haemoglobin abnormalities
administering pneumococcal and influenza vaccines (vaccination for whooping cough may also be given)
providing doctor’s certificates and psychological and social support.
Workplace assessment and monitoring of the level of silica dust should occur with SafeWork and an occupational hygienist.
symptoms of mild pesticide poisoning
headache
mood changes
sweating
digestive symptoms, such as loss of appetite, nausea, diarrhoea
irritation of nose, throat, eyes or skin
insomnia and fatigue
thirst
weakness
restlessness and anxiety
dizziness
joint pain.
Symptoms of severe pesticide poisoning
vomiting
convulsions
loss of reflexes
unconsciousness
inability to breathe
fever
muscle twitching
thirst
constriction of eye pupils (eye pupils become small)
increased rate of breathing.
Acute pesticide poisoning info?
If a person has been acutely poisoned by pesticides, GPs anywhere in Australia should call the Poisons Information Centre, which is open 24 hours per day, on 13 11 26.
Glycophosphate in herbicides?
Despite recent media reports, pesticides with the active ingredient glyphosate are likely the least toxic of weedicides to animals (oral LD50 ca. 5.6 g/kg) and are considered by all global regulators as unlikely to be carcinogenic,67,68 consistent with the benign chemical structure of glyphosate.
Which one of the following characteristics is typical of accelerated silicosis?
Accelerated silicosis occurs 3–10 years after exposure and is associated with high-intensity silica exposure. Radiological and pathological features of both chronic and acute silicosis may be present. It is likely to be associated with a greater rate of disease progression than chronic silicosis.
