2019 16th Edition Getting STARTED Occupational Health in the Healthcare Setting Occupational Health Services Edited by the Association of Occupational Health Professionals in Healthcare Published and distributed by: AOHP, www.AOHP.org ©Copyright 2019 AOHP Getting Started Occupational Health in the Healthcare Setting 16th Edition Editors MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM Occupational Health Consultant Beverly Hagar, BSN, RN, COHN-S Virginia Mason Medical Center (Retired) Christine Pionk, MS, RN, COHN-S Michigan Medicine ________________________ Association of Occupational Health Professionals in Healthcare (AOHP) 125 Warrendale Bayne Road, Suite 375 Warrendale, PA 15086 www.aohp.org Tel: 800-362-4347 Fax: 724-935-1560 16th Edition © Copyright 2019, 2016, 2014, 2012, 2010, 2008, 2006, 2004, 2002, 2000, 1997, 1995, 1993, 1992, 1991, 1990 by the Association of Occupational Health Professionals in Healthcare (AOHP) ISBN 978-0-9820386-1-1 Contributors Lori Arata, MSN, FNP-BC Mary J. Ogg, MSN, CNOR Piedmont Healthcare Association of periOperative Registered Nurses (AORN) Christopher Blank, MPH Kimberly Olszewski, DNP, CRNP, COHN-S/CM, BJC Healthcare FAAOHN Bloomsburg University Mandy Bodily-Bartrum, DNP, MPH, RN, CIC, FAPIC Vibra Healthcare Sharon Peterson, MSN, MHA, RN, COHN/CM Intermountain Healthcare Barbara Brehm, RN, COHN Penn State Health Martha Polovich, PhD, RN, AOCN Milton S. Hershey Medical Center Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University Steve Burt, BS, MFA Woods Rogers Consulting & Healthcare Compliance Jennie Ryan, PhD, CPNP-AC Resources University of Michigan School of Nursing Alfred Carbuto, MSN, FNP-BC,COHN-S Martin J. Saunders, LLM, JD Montefiore Medical Center ConsultHRCS, LLC Curtis Chow, FNP, PA-C, MBA Rosanne Saunders, JD, SPHR, SHRM-SCP Dignity Health ConsultHRCS, LLC Christina Esquibel, BSN, RN, COHN-S Natalie Schwatka, PhD Presbyterian Healthcare Services University of Colorado Colorado School of Public Health Lija Gireesh, DNP, APRN, FNP-BC, COHN-S Christiana Care Health System Joy Stoddard, DNP, RN Presbyterian Healthcare Services Linda Good, PhD, RN, COHN-S Scripps Health Cindy Stutts, MS, BSN, RN Bon Secours Mercy Health Mike Hodges, MA, CHSS Piedmont Athens Regional Leslie Sutherland, MSN, RN, COHN-S DaVita Medical Group Denise Knoblauch, MSN, RN,COHN-S/CM, FAAOHN OSF Healthcare Jan Tietjan, RN, COHN Children’s Hospital of the King’s Daughters Jan Lach, MS, PE, CSP Michigan Medicine Richard Walker, MA, MSEd, RN, COHN-S Bon Secours Health Larry Lee, BSc, MPA, CIH Pacific Industrial Hygiene, LLC Matthew Walter, MPH, CIH Michigan Medicine Lee Newman, MD, MA Center for Health, Work and Environment Kent Wilson, CIE, CSPHP Colorado School of Public Health HoverTech International Welcome & Introduction Welcome to the challenging world of the occupational health professional in healthcare! This manual, Getting Started: Occupational Health in or who would like a refresher offered by AOHP Getting the Healthcare Setting, is published by the Association of Started on the Road. In addition, it is a valuable reference Occupational Health Professionals in Healthcare (AOHP). when preparing for occupational health nursing certifica- It has been specifically created for the novice occupa- tion. tional health professional (OHP) who provides occupa- tional health services for healthcare personnel (HCP). The From the time of its creation in 1990, the manual has been specialty practice of occupational health in healthcare has written and edited by members of AOHP. The members expanded over the years and continues to become more who have contributed to the manual throughout past revi- complex, with an increasing emphasis on health promotion sions are listed on the Prior Authors and Contributors page and improvement in productivity, in addition to maintain- in the Appendix. For this 16th edition of the manual, we ing a safe working environment. Several practice areas embarked on a major revision to expand the content to with requirements for specific expertise include: more fully discuss the many areas of OHP responsibility, • Regulatory and compliance requirements. including the Centers for Disease Control and Prevention’s • Health hazards associated with new technologies. 2019 revised tuberculosis recommendations. Because the • Emphasis on a safe and healthy worksite. OHP’s role has expanded significantly since the manual • Injury prevention and case management to reduce was first published, the Executive Board approved the workers’ compensation costs. use of content experts for selected information requiring • Developing and using outcomes monitoring tools. in-depth expertise. The revision process was overseen by • Risk management and loss control. a core team of editors who worked with the contributing • Emergency preparedness and response, including natu- content experts, which include AOHP members, to develop ral disasters, terrorist events, and pandemic influenza. new subject matter. The association thanks the editors and contributors for sharing their time, talent, and expertise to While providing occupational health services in the health- make the revised manual a reality. care setting, OHPs have many and varied responsibilities. Often, more than one entity is represented simultaneously. The revised content has been divided into three major sec- The role and responsibility of an OHP must be accom- tions: Fundamentals of Occupational Health in Healthcare; plished in a competent and professional manner within Essential Components of a Health and Safety Program the greater context of the OHP’s primary responsibility to in a Healthcare Facility; and Professional Advancement HCP. The OHP is also accountable to the employer, and in Occupational Health. Sample Documents* and Refer- by ensuring a healthy workforce, is ultimately contribut- ences** are located in sections four and five, respectively. ing to the critical function of providing a safe and healthy Appendices contain AOHP’s organizational documents, a environment for patients. list of acronyms, and the history of past contributors to the manual. This publication provides an overview of the essential information that the OHP requires to build a foundation AOHP is sincerely interested in the professional develop- for the provision of occupational health services for HCP, ment of OHPs, as outlined in the philosophy, vision, and to assure a safe and healthy worksite, and to assist in risk mission statement on its website, www.aohp.org. Please management and other services for the employer. The share any questions, concerns, or comments about this manual also serves as a valuable reference for the veteran manual by contacting AOHP Headquarters by telephone at or experienced OHP who is embarking on a new project 1-800-362-4347 or by e-mail at [email protected]. *Disclaimer: Samples included in this manual are neither recommended nor endorsed by AOHP. They serve as a guide to developing these tools according to facility policy, legal counsel, and current national guidelines/requirements. **Disclaimer: The links cited are current as of the date of publication of the manual. References with .com are not endorsed by the association and served only as sources to assist in content development. Table of Contents AOHP's Getting Started Manual is easy to use! With more than 260 pages of valuable content to navigate, a number of helpful links and a bookmark have been added. From the Table of Contents, just click on the chapter you need, and a link will take you there without having to scroll through the entire manual. Or, open the bookmark to access the links from the Table of Contents regardless of what page you are currently reviewing. PART I Fundamentals of Occupational Health in Healthcare 1 1 Overview and Historical Perspective 3 OVERVIEW 4 HISTORICAL PERSPECTIVE 4-5 ROLES AND FUNCTIONS OF OHPS 5-6 DEMONSTRATING THE VALUE OF THE OHP ROLE 7 2 Determinants of Occupational Health Practice 9 IMPACTS ON OH PRACTICE 10 FEDERAL HEALTH AND SAFETY REGULATIONS 10-12 STATE REGULATIONS AND STATUTES 12-13 FEDERAL HUMAN RESOURCES-RELATED REGULATIONS 13-19 VOLUNTARY FACILITY ACCREDITATIONS/CERTIFICATIONS 19-22 VOLUNTARY EVIDENCE-BASED PRACTICE RESOURCES 22-25 3 Leadership - Managing Occupational Health Services 27 LEADERSHIP IN OCCUPATIONAL HEALTH 28 MANAGEMENT SKILLS AND FUNCTIONS 28-29 LEADERSHIP APPROACHES 29 LEADERSHIP SKILLS AND TRAITS 29-30 LEADERSHIP AND FACILITATING CHANGE 30 MANAGERIAL ROLES AND RESPONSIBILITIES 30-31 VISION AND MISSION STATEMENTS 31 GOALS AND OBJECTIVES 31 HUMAN RESOURCES MANAGEMENT 31-33 4 Quality Improvement/Models and Tools 35 QUALITY IMPROVEMENT 36 QI MODELS 36-37 QI TOOLS 37-38 EVIDENCE-BASED PRACTICE AND QI 38 OUTCOMES, MEASUREMENT, AND IMPLEMENTATION 38 REPORTING QI OUTCOMES 39 PART II Essential Components of a Health and Safety Program in a Healthcare Facility 41 5 Safety Culture in Healthcare and the OHP Role 43 SAFETY CULTURE IN HEALTHCARE 44 IMPROVING HEALTHCARE WORKER SAFETY 44 ESSENTIAL ELEMENTS OF HEALTH AND SAFETY PROGRAMS 44 HEALTHCARE WORKPLACE HAZARDS 45 ROLE OF THE OHP IN HEALTH AND SAFETY PROGRAMS 45-46 6 Recordkeeping, Data Analysis, and Reporting 47 RECORDKEEPING REQUIREMENTS IN HEALTHCARE SETTINGS 48 RECORDING AND REPORTING WORK-RELATED INJURIES/ILLNESSES 48 OSHA RECORDABLE INJURIES 48-50 CONFIDENTIALITY OF WORKER HEALTH RECORDS 50 SELECTING SOFTWARE PROGRAMS FOR THE OH SETTING 50 TYPES OF RECORDS AND REPORTS 50-51 DATA ANALYSIS IN OH 51-53 7 Worker Health Assessment and Surveillance 55