Conflicts can exist between the needs of the patient receiving care and the needs of the healthcare worker. Consideration needs to be given to the balance of these needs when assessing what is reasonably practicable.
The 3 most common instances where a healthcare worker faces the high risk of injury are:
- Medical Sharps
- Manual Handling
Medical sharps are governed by The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and can be defined as “an object or instrument necessary for the exercise of specific healthcare activities, which is able to cut, prick or cause injury” and include needles, scalpels, IV cannulae, suture needles and scissors. Such equipment that is contaminated with human blood or bodily fluids carry an additional risk of transmitting infectious diseases such as Hepatitis B and C and HIV.
The use of ‘sharps’ should be avoided where reasonably practicable but if this cannot be avoided in its entirety, then employers have a duty to take steps to make the task safer. For example, using ‘safer sharps’ which incorporate features or mechanisms to prevent or minimize the risk of accidental injury, like syringes, needles which retract, blunt or are shielded immediately following use. There should also be a suitable number of containers and instructions for the disposal of sharps in the working areas, clearly marked and secure with visible instructions as to disposal procedures.
Training is particularly important. Under Regulation 6 (including but not limited to) the employer has a duty to ensure that the employee has specific training with the equipment that the employee is using such as correct use of safer sharps, safe use and disposal methods and steps to take in the event of an injury.
It may not be possible for an employer to eliminate the risk of an assault but they are expected to take all reasonable steps to reduce the risk of assault and to the lowest level reasonably practicable.
The following specific steps could be taken to minimise the risk to a healthcare workers;
1. a system of obtaining, documenting and disseminating relevant information on patients to those working with them, particularly where there is a history of risk factors such as drug or alcohol use, mental health issues and/or violence;
2. having in place a robust risk assessment, taking into account all relevant information known about the patient and sharing this with the relevant healthcare workers;
Training is key once again, particularly with regards to de-escalation techniques and management of violent situations;
1. having lone working policies in place which would cover those who attend patient’s homes outside of the workplace;
2. drafting detailed care plans for individual patients and sharing the information contained in these with the healthcare workers;
3. Ensuring staffing levels are adequate, including specially trained staff such as security staff.
Manual handling tasks are defined as “any transporting or supporting of a loading (including the lifting, putting down, pushing, pulling, carrying or moving thereof) by hand or by bodily force”. In the context of healthcare workers this can include the handling of both patients and equipment. Manual handling tasks are covered un the Manual Handling Operations Regulations 1992 and Lifting Operations and Lifting Equipment Regulations 1998.
An employer is required to avoid the need for hazardous manual handling so far as is reasonably practicable and to assess the risk of injury from any manual handling that cannot be avoided completely.
Again, this is an area where a balance needs to be reasonably considered between the level of risk and the measures needed to control that risk, including the time involved in taking those measures, their costs and in the context of a healthcare claim any com promise to patient care.
Risk assessment is key here. Where the manual handling cannot be avoided entirely, there are many factors to consider in the context of patient handling. There may some requirement for two different types of assessments such as a generic assessment covering the workplace and the environment and an individual risk assessment, specific to the patient to be handled, which should identify specific handling needs, hazards, equipment required and number of staff necessary.
The risk assessment should deal with whether the handling operation can be avoided altogether, for example, in the context of healthcare, this could be if the treatment could be brought to the patient needing to be moved to access the treatment. If the task cannot be avoided, then consideration ought to be given as to whether it can be mechanised to eliminate or reduce the manual aspect of the handling using equipment such as hoists, mobile or fixed, slings, bath hoists and lifts, lifting platforms and stair lifts. Of course, the use of such equipment will generate further obligations on the employer to examine and maintain the equipment as suitable regular intervals.