Competency 5 – Relationships with patients:Recognise the potential pitfalls of inappropriate occupational health practice
Objective: to have the knowledge, skills and attitudes to cope with ethical and legal issues in the management of patients with occupational problems
RECOGNISE THE POTENTIAL PITFALLS OF INAPPROPRIATE OCCUPATIONAL HEALTH PRACTICE
This can be elicited by discussing cases of inappropriate occupational health practice.
Consider a surgical Foundation Year 1 (F1) who inadvertently pricks their finger with the needle already used in taking pre-operative bloods from a healthy patient who has been booked in for a laparoscopic cholycystectomy (removal of the gallbladder). At the time the F1 does not follow the correct procedure as outlined by his hospital regarding needle stick injuries.
- Why may this F1 take this plan of action?
- Unaware of set procedures.
- Save time.
- Fails to recognise the importance of such procedures.
- Perceives their risk to be minimal.
- What are the possible implications of taking such an action to him/her?
- Health implications; putting health at risk by inappropriate action.
- Financial implications
- Career implications
- What are the possible implications of taking such an action to his/her patients?
- Placing patients at risk.
- What are the possible implications of taking such an action to his employer?
6 months on this FY1 is diagnosed with hepatitis C.
- What issues are now raised by this diagnosis?
- Health implications; need for specialist advice and management.
- Limitations of working practices or career choices; abstaining from exposure prone procedures. This does not need to be a permanent restriction; it is dependant on the condition’s response to treatment. Redeployment or retaining may need to be considered.
- Financial implications: absence from work.
- Review of all possible transmissions and contacts; Patient notification exercises are undertaken whereby patients who are considered to be at risk are notified of the risk of transmission with the offer of serological testing.
- Incidents that involve the possible transmission of blood borne viruses should be reported under Control of Substance Hazardous to Health 2002(COSHH).
Consider a cook who has recently returned from a holiday with diarrhoea. She is due to return to work and has been informed that 2 of her colleagues are off sick. This cook had missed 2 previous required medical examinations from the occupational health department which had not been followed up. Consequently, she was unaware of the company’s policy on informing line managers of any episodes of diarrhoea or vomiting prior to returning to work.
- Why may this cook have returned to work despite having diarrhoea and vomiting?
- Work ethic, duty to employer especially with 2 other cooks off sick.
- Ignorance of implications of retuning to work with diarrhoea and vomiting.
- Financial implications.
- What are the possible implications of retuning to work to the business?
- Not adhering to correct policies.
- Placing other members of staff and customer at risk of transmitting infection.
- Risk an employer being in breach of regulation HSWA
- What are the implications of taking such an action to the public?
- Placing them at risk of food poisoning
- What are the implications of taking such action to the employer/owner of the restaurant?
- Risking own health.
- Risk of transmitting infection to other staff resulting in further employees being off sick.
- Risk being implicated in cases of food poisoning.
- Risk being inspected by Environmental Health.
- Risk closure of business and financial implications.
2 days later there is an outbreak of campylobacter and the restaurant is closed. Employees had samples of their stools sent to the local hospital which detected the campylobacter and notified Public Health Department and the Local Health Authority of their findings. The local health authority in turn sent the environmental health officers to investigate the restaurant.
The above 2 scenarios demonstrate the potential consequences of not adhering to correct occupational health advice and procedures. The impact can be on an individual level as well as an organisational level, with multiple consequences ranging from social, psychological, financial to biological effects that could be long-lasting. One salient point to make is that in most situations, such outcomes are preventable with adhering to correct occupational health policies or recommendations.
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