Occupational Safety and Health Act General Duty Clause / Patient Restraint
With another year complete, many people have moved on to 2010 with a new set of New Year's resolutions. One potential suggestion is resolving to prevent injury to practitioners and employees, and minimize the financial impact of related medical attention and Worker's Compensation claims, by focusing attention on workplace safety in the new year.
The Occupational Safety and Health Act of 1970 (Act), administered by the Occupational Safety and Health Administration (OSHA), covers all employers with one or more employees who affect interstate commerce. As such, almost every business is covered by the Act.
Under the General Duty Clause of the Act, each employer, "…shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm to his employees.” In addition to the General Duty Clause, employers must comply with any specific standards put into effect under the Act, including those that relate to hazardous substances; housekeeping; radiation; sharps; slips, trips, and falls; and biological hazards. Individual standards that might be applicable to different employers can be found in the Code of Federal Regulations (CFR) under Title 29, Part 1910.
Even with all the standards listed in the CFR, not every potential obligation that a practice may have regarding protecting its employees is specifically found in the regulations. For example, OSHA does not have a specific standard dealing with procedures for patient handling to prevent injury from patient kicks, bites, and scratches. Those handling patients in a veterinary practice are exposed to these hazards when dealing with patients in pain or distress, boarding patients, providing bathing and grooming services, and providing routine patient services. Although there is no specific standard dealing with handling patients in a veterinary practice, each employer has an obligation under the Act to assess its workplace and to determine if there are hazards present, or likely to be present, which may require the use of personal protective equipment (PPE). If such hazards are present, or likely to be present, the employer must provide such PPE and require its use. To the extent that any training is necessary to use the PPE properly, employees must also be trained in such use.
In addition to providing PPE, such as gloves and forearm protection, or providing other safeguards, such as hobbles, tethers, squeeze chutes, catch poles, or muzzles, additional steps can be taken to insulate staff from potential harm. Each employee should be trained in how to approach and handle a patient and what to do if a patient becomes aggressive. Inexperienced employees should not be allowed to handle aggressive patients. Many practices utilize stickers, tags, or other means to identify aggressive patients or those who have been problematic in the past. In some cases, more than one staff member may be required to safely control a patient. At some point, a patient may need to be sedated before it can be properly treated or handled.
Failure to properly address patient restraint in a practice with all employees involved could have very significant bad consequences. In the newyear, each practice should focus on reviewing existing procedures, writing new procedures, training on such procedures, and ensuring that all those working in the practice handling patients have appropriate PPE and other necessary equipment for each task performed. Although restraining and treating a patient may seem like basic "blocking and tackling," focusing on eliminating risks to staff associated with handling patients can reduce legal exposure, insurance premiums, time off for injuries, and employee Worker's Compensation claims. Focusing on reducing such risks will also demonstrate practice compliance with mandated safety and health requirements, as well as a concern for the well-being of those employed by the practice.