Home based care
information and checklists
September 09
Introduction
How are workers getting hurt?
WorkSafe in 2009 completed an
inspection campaign in the home based
care industry, with a view to reducing
injuries and illness in this industry.
In the most recent (2006-2007) WorkCover data, Health and Community
Services sector account for 12.4% (or between 2000 and 2500 injuries
per year) of all lost time injuries. This injury rate has remained relatively
stable in recent years. Each lost time claim within the Health and
Community Services sector results in an average of almost 89 days lost
time from work.
The checklists used by WorkSafe
inspectors during this campaign are
included in this newsletter.
Please use the checklists to ensure your
workplace meets the occupation safety
and health legislation.
What are the
issues in the
home based care
industry?
A checklist has been developed which
may assist you assess your workplace
for common hazards. This checklist is
included in this publication (from page
five onwards). Hazards covered in the
checklist include:
•
Manual tasks
•
Slips, trips and falls
•
Occupational Violence/ Aggression
•
Psychosocial issues/ stress
•
Biological hazards
•
Hazardous substances
•
Electrical hazards
•
External hazards
•
Vehicle hazards
•
Working alone
•
OSH Systems
From WorkCover and WorkSafe data, the most common injuries within
home based care organisations are from:
•
manual tasks;
•
slips, trips and falls; and
•
aggressive incidents.
Manual tasks
What are manual tasks?
Manual tasks cover any activity that requires a person to use their
physical body (musculoskeletal system) to perform work. It includes
manual handling, performing repetitive actions, adopting awkward &
sustained postures, and being exposed to vibration while working.
Manual tasks can result in both acute (immediate or sudden from a
specific incident) or chronic (develops over time) injury.
Workers in home based care are most at risk from transfers and
handling of clients (who may potentially be resistive to care);
working in awkward/sustained postures (for example in a confined
bathroom while assisting a client with showering tasks) and
handling heavy loads (for example loading/unloading wheelchairs,
shopping or other equipment from vehicles; carrying washing
baskets; moving vacuum cleaners). However, the above tasks are
only a few of the manual tasks that may cause injury. Any task that
involves high force, use of awkward or sustained postures, or
repetitive movements may result in injury to employees. These
tasks need to be identified and addressed through a risk
management process to reduce the likelihood of injury.
Cont page 2
Westcentre 1260 Hay Street
West Perth WA 6005
Telephone:
1300 307 877
Facsimile:
(08) 9321 8973
Email:
[email protected]
2
Manual tasks (cont…)
What is the current legislation on manual
tasks?
The Occupational Safety and Health Act 1984
contains general duties and responsibilities placed
upon employers and workers to ensure their own
safety at work, and that of others who might be injured
by the work. These duties extend to the prevention of
manual handling injuries.
The Act also requires employers to investigate
matters reported to them by workers, determine the
action to be taken (if any), and notify the worker who
made the report of the action to be taken.
The Occupational Safety and Health Regulations
1996 require the employer to identify each hazard that
is likely to arise from manual tasks and to assess the
risk of injury or harm.
WorkSafe WA also has a Manual Tasks Code of
Practice which provides practical guidance on manual
tasks, including information on the risk management
process, risk factors for manual tasks, ways to control
risks associated with manual tasks and information on
training for manual tasks.
How do I reduce the risk of injury from manual
tasks?
The first step, in consultation with workers, is to identify
the manual task hazards for your organisation. This can
be done via review of reviewing past hazard or incident
forms; analysing previous injury records for staff; talking
with workers about tasks they find difficult or demanding;
reviewing previous pre-service home risk assessments
and observing staff while they complete common tasks to
collect information.
Next, in consultation with staff, identify trends and determine
which tasks are higher risk/priority. For each task, complete a
risk assessment to identify which risk factors are present for
that task. Risk factors may be actions & postures; forces &
loads; vibration; work environment; systems of work; and
worker characteristics – please refer to the WA Manual Tasks
Code of Practice for more information. The risk assessment
should also determine what consequences/harm may result
from performing that task, and how likely it is that this harm
occurs.
Finally, for each hazard, determine what controls are
needed to minimise risk. Controls may involve:
1. eliminating the hazard or hazardous task
•
What should be covered in manual tasks
training?
Training should include information on:
•
Risk Management process (empowering
workers to report hazards)
•
Common hazardous manual tasks in the
industry, what types of injuries may result
and general information on how the body
works/ responds when performing these
tasks
•
Risk factors for manual tasks (so that
employees are able to identify when a task is
hazardous)
•
Available controls to manage risks
•
Task specific training (specific techniques for
working safely – for example client handling;
safe pushing/pulling; loading/ unloading
vehicles)
Training should occur as part of induction, and be
refreshed on a yearly basis. Further training may be
needed whenever tasks are changed or new tasks are
introduced (for example, hoist training for employees
who are starting work with a client using a hoist).
It should be emphasised to support workers that any
observed change in a client’s level of function is a
potential hazard. Any changes in function should be
reported immediately to allow timely re-assessment
of the client to determine if any changes are needed
to their care plan and prevent injuries to staff.
May be difficult given the people handling
requirements of this industry, but one example is
where some organisations have advised clients that
the domestic support workers will not move
furniture for cleaning tasks (and clients will have to
arrange for an alternative person to be present to
move furniture if they wish this to be done for their
home cleaning).
2. re-designing, modifying, altering or substituting the
hazard or hazardous task
•
Using mechanical aids/ lifting devices (eg hoists/
slide sheets; wheelchair loaders for vehicles)
•
Use of trolleys for equipment, laundry baskets,
shopping
•
Installation of grab rails/ shower hoses for
bathrooms
•
Use of long handled equipment for cleaning tasks
•
Adjusting bed heights to a higher level for transfers
or bedmaking
•
Liaison with client/ family to relocate furniture to
create sufficient space for care tasks
•
Storage of frequently required objects to
appropriate heights within easy reach
3. administrative controls
•
Training in safe work procedures and manual tasks
•
Regular maintenance and service of equipment
•
Planning of care jobs to alternate between heavier
and lighter activities
3
Slips, trips and
falls
Slips, trips and falls are the 2nd most
common injury (after manual task
injuries) for workers in this industry,
however they can be prevented.
A good understanding of the risk
factors that contribute to slips, trips
and falls is essential for both
management and workers to prevent
injuries. By understanding risk
factors, workers will recognise slip
and trip hazards in their work, and
are more likely to report these
hazards to the employer. Likewise,
management needs to understand
the risk factors in order to assess the
risk associated with the hazard; and
decide on, and implement controls to
manage the risk.
Slips, trips and falls risk factors can
be categorised into 10 categories:
• Floor surface & condition
• Objects on the floor
• Cleaning/ spill containment
• Floor contamination
• Ability to see floor/
walkways/ hazards
• Space and design
• Stairs & stepladders
• Work activities, pace and
processes
• Footwear & clothing
• Individual factors
A checklist that covers each individual
risk factor under the above categories
is available through our website on
www.worksafe.wa.gov.au – Go to
“Safety Topics”, then “Slips and trips”,
then “Frequently asked questions”,
then “what risk factors contribute to
slips and trips incidents”, before
clicking on the link to “slips and trips
risk factors checklist”.
Biological hazards
Workers providing home based care services are at risk of contracting
infectious diseases or transferring diseases from clients to others. Exposure
to biological hazards can occur through:
•
direct contact with blood and other bodily fluids, for example through
broken skin, splashes to mucous membranes (eyes, nose, mouth), from
skin penetrating injuries and from handling soiled linen/clothing
•
ingestion, for example, via contaminated hands, food and surfaces
•
inhalation, for example, inhalation of infectious aerosol droplets from
coughing or sneezing
All workers should be provided with training & information on universal
precautions for infection control to minimise risk of disease, as well as
information on the range of communicable diseases that they may be exposed
to through their work, including Hepatitis A and B, HIV, Influenza, and MRSA.
All personal care and domestic support workers should also be provided with
appropriate gloves as personal protective equipment against biological
hazards, at no cost to the employee.
Where workers are at risk of exposure to Hepatitis B, they should be strongly
advised by the employer to have Hepatitis B vaccination, with this vaccination
provided by the employer at no cost to workers. The employer should
manage workers’ appointments for the course of injections, and maintain
records of vaccination.
The 9th edition of the Australian Immunisation Handbook (available at
www.health.gov.au) recommends that all health care workers (defined as all
workers directly involved in patient care or handling of human tissue) should
be immunised against Hepatitis B. The National Code of Practice for Hepatitis
and HIV (available at safeworkaustralia.gov.au) states that carers for people
with disabilities, children, the aged and others who require self-injection (eg
diabetics); as well as laundry and cleaning staff, are at risk of Hepatitis B
infection and require a specific risk assessment for this hazard.
Electrical hazards
When providing care to people in their own homes, employers have very little
control over the working environment. This is especially important when it comes
to electrical safety. Many homes in older suburbs or rural areas may not be
protected by a residual current device (RCD). Even if a client’s home is protected
by a RCD in the meter board, this cannot be relied upon to provide adequate
protection unless the client has been diligent in having the RCD inspected and
tested on a yearly basis (and can provide documents to support this).
All support workers using hand held electrical devices such as vacuum
cleaners, kitchen appliances and personal grooming appliances must be
provided with a RCD at no cost to the employee. These RCDs must be
inspected and tested by a competent person on a regular basis
(recommended yearly) to ensure that they continue to provide the required
level of protection.
Working alone
Support workers providing home based care are often working over large geographical distances and visiting several
clients per day. There are risks associated with working alone in the community from potential vehicle breakdowns/
accidents to possible exposure to aggression or violence from a client or family/visitors at a client’s home during care
services. Employers must ensure that all support workers working alone in the community have access to a means of
communication (and are aware of emergency numbers) in the case of emergency while performing their work duties.
A system that ensures regular contact (for example a daily “end-of-shift” phone call) is maintained with workers helps to
ensure appropriate supervision, communication and early response where a worker may be in an emergency situation.
Further, this system should also ensure that employers know the locations of workers at all times, to allow a fast
response should concern be raised regarding the safety of one of their staff.
4
Client’s home = workplace
Who’s responsible for OSH?
Information to help you
meet the OSH laws
Clients do have some responsibilities to providing a
safe workplace for support workers coming into their
home, in terms of those hazards within their control.
The WorkSafe website contains a number of publications
which may assist you in making your workplace a safer
place. Go to the WorkSafe website www.worksafe.wa.gov.au
It is recommended that home based care
organisations advise clients and/or their
representative of these OSH responsibilities towards
support workers. WorkSafe suggests that OSH roles,
responsibilities and rights are defined in a care
agreement, provided to (and discussed with) the
client prior to commencement of services. The
agreement should also outline the organisation’s
hazard reporting process and advise of possible
consequences (eg suspension or termination of care
services, or specific tasks within care services)
should hazards be reported and are not resolved.
Codes of practice
•
•
•
•
•
•
Guidance notes
•
Examples of items that may be covered in a care
agreement include:
•
•
•
•
•
•
•
•
restraint of pets during support visits
smoking policies for clients and staff
equipment provision and maintenance, eg
hoists, commodes, shower chairs, mops,
vacuum cleaners, washing machines
aggression, abuse or harassment
addressing identified safety issues (eg trip
hazards, lighting, faulty equipment)
visitor restrictions during support visits
emergency use of telephones
leaving access doors unlocked during visits
Regular updates on
OSH
Manual tasks
National code of practice: Hepatitis and HIV
Violence, aggression & bullying at work
First aid, workplace amenities and personal
protective clothing
National code for control of hazardous
substances
Working hours and risk management guidelines
•
•
•
•
•
•
•
General duty of care in Western Australian
workplaces
Formal consultative processes at the workplace
Alcohol and other drugs at the workplaces
Dealing with bullying at work
Preparing for emergency evacuations at the
workplace
Provision of information on hazardous
substances (MSDS)
Assessing risks of hazardous substances
Working alone
Bulletins
•
•
•
•
Tips for investigating accidents and incidents
Gloves-selection use and maintenance
Driver fatigue
Electing safety and health representatives
Other
WorkSafe has a service that provides information on
occupational safety and health direct to your email. To
subscribe to receive this service go to
www.worksafe.wa.gov.au ÆservicesÆmailing lists
•
•
•
•
•
•
Working safely with challenging behaviours
Slips and trips prevention guide
Slips and trips risk factor checklist
Electrical safety
The first step
The next step
ThinkSafe Small Business Assistance Program
If you are a small business owner or manager (employing less than 20 full-time employees) and want to make your
workplace safe, the ThinkSafe Small Business Assistance Program can help you.
The good news is that the help you get is:
•
free (up to three hours assistance);
•
easy to obtain;
•
provided by an independent and qualified osh consultant; and
•
is a simple process with clear and immediate outcomes.
To apply download and complete the online form from www.worksafe.wa.gov.au or call 1800 429 273.
5
Checklist for home based care organisations
Manual tasks safety checklist
check
Have all manual task hazards been identified?
• driving vehicles
• loading/ unloading vehicles
• carrying equipment to homes
• client transfers (bed, wheelchair, car, commode, shower chair, hoist)
• client movement (in wheelchairs, wheeled equipment, bed mobility)
• unsafe equipment
• change in client function
• bariatric care issues
• moving furniture
• cleaning, gardening, shopping, food preparation tasks
• other?
Has a risk assessment been completed for all identified hazards, in consultation with
workers?
Are control measures in place for risk factors?
• adequate lumbar support in vehicles
• equipment to store items in vehicles and/or load equipment (eg wheelchair
loaders)
• trolleys for movement of equipment to/from and within homes
• sufficient and adequate client handling equipment as per assessed needs
• regular maintenance of home-based equipment
• reporting mechanisms for unsafe equipment
• procedures for clear response and action to client function changes
Are implemented control measures regularly reviewed, in consultation with staff, to
ensure continued appropriateness & effectiveness of control over time?
If client provides equipment for domestic support workers (eg vacuum cleaners, mops), is
information given to clients regarding appropriate equipment choice?
If employer provides equipment for domestic support workers, is it appropriate for
minimising manual task risks? (eg light weight, easy to use, regularly maintained)
Is training provided to all staff for manual tasks and regularly refreshed on a yearly basis?
Does training in manual task follow a risk management and competency-based
approach?
Is training regularly reviewed/ evaluated?
Does training allow for workers to raise manual task issues (as a method of hazard
identification?
yes
no
n/a
6
Slips, trips and falls safety checklist
check
yes
no
n/a
Does pre-service client home assessment cover:
• presence & condition of stairs, ramps and steps?
• presence & condition of rails or other safeguards on steps, ramps, stairs etc?
• surface type (slippery vs slip resistant)?
• surface condition (any holes, wear, tears or other issues)?
• presence of any obstructions in walkways (mats, electrical leads, furniture,
hoses)?
• adequate lighting of internal & external areas?
• any issues with changes between floor surface types?
• Sufficient space to complete tasks?
Does the organisations dress code specify that footwear should be well fitting,
supportive, fully enclosed (heel and toe) with a slip resistant sole?
Are workers provided with adequate information and training in management of spills?
Do past incident investigations of slips/trips identify all relevant risk factors (floor surface,
lighting, footwear, contaminants, floor condition etc) with action identified to prevent
future incidents?
Are workers trained in slips, trips and falls? Does training cover risk factors and controls
to manage risk factors?
Occupational violence & aggression safety checklist
check
Are there systems in place to identify potentially aggressive clients?
Does care contract/ service agreement specify implications of aggressive behaviour on
continued services?
Are workers trained in recognition of, communication for and management of aggressive
behaviour?
Is there adequate communication with referring agencies/ parties regarding potential
aggression risks?
Are procedures in place to ensure timely and appropriate counselling is provided to
workers following a violent/ aggressive incident?
Is there a policy in place regarding pets in the home? Are clients advised of
policy/procedures?
Is there a policy in place regarding restrictions to visitors at the home during support
visits?
yes
no
n/a
7
Psychosocial issues/ interpersonal conflict/ stress safety checklist
check
yes
no
n/a
Have hazards related to stress been identified in the workplace, in consultation with
workers?
Is there a grievance resolution procedure in place for workplace/ interpersonal conflicts?
Are workers provided with information regarding resolution of conflict and grievance
procedures?
Are there clearly identified contact people in conflict resolution/ mediation roles?
Do people with responsibilities/ roles in resolving conflict have appropriate skills and
training in this area?
Biological hazards safety checklist
check
Have workers been provided with adequate information on communicable diseases? (eg
symptoms, long term health effects, risk factors and controls to minimise risk, including
immunisation)
Are workers trained in universal infection control procedures?
Have all at-risk workers been advised to have Hepatitis B vaccination, as protection
against Hepatitis B infection?
Does the employer have an employer-managed vaccination protocol in place, to ensure
at-risk workers are vaccinated against Hepatitis B? (vaccination funded by the employer)
Does the employer maintain records of vaccination of workers?
Does the employer provide adequate PPE (eg range of gloves for both personal and
domestic support workers), at no cost to workers?
Is there a sharps procedure in place to manage the handling of sharps in clients’ homes?
yes
no
n/a
8
Hazardous substances safety checklist
check
yes
no
n/a
Are systems in place to control cleaning products used in clients’ homes? (eg employer
provides safe substances OR guidelines given to clients about appropriate selection of
chemicals)
If hazardous substances are used, is there a register of hazardous substances, including
MSDS sheets no more than 5 years old?
Is register readily available to staff? (do they know where to find it)
Has the risk management process been applied to control of hazardous substances (ID,
Assessment and Control)?
Are staff trained in hazardous substances? Does training cover:
• identification of hazardous substances
• health effects
• controls
• safe work methods
• appropriate PPE and clothing
Are there policy/procedures in place for smoking in the workplace? (both by clients AND
workers)
Electrical hazards safety checklist
check
yes
no
n/a
Are electrical hazards assessed in clients’ homes? (pre-service assessment)
Are regular inspections completed to re-assess electrical hazards?
Are portable RCDs provided to all staff for use with handheld equipment? (at no cost to
employees)
Are portable RCDs regularly maintained and tested by an appropriately qualified person?
(yearly testing is recommended)
External hazards safety checklist
check
Does the organisation provide external services (eg gardening, general maintenance)?
Are external workers provided with appropriate PPE, such as steel capped boots,
sunscreen and hats?
If pesticides are used, is information provided to workers for safe use? (see Hazardous
Substances checklist)
yes
no
n/a
9
Vehicle hazards safety checklist
check
yes
no
n/a
Is there a motor vehicle policy in place?
Does motor vehicle policy cover:
• use of mobile phones while driving?
• disclosure of changes to license status?
• regular checking of car registration and insurance details for privately-used
vehicles?
• insurance/ theft of personal belongings from vehicles during work hours?
• care seat adjustments to maximise comfort?
• procedures in case of motor vehicle accident?
• regular servicing, maintenance and care repair procedures?
• maximum driving time before break (to prevent prolonged sitting)?
• loading/unloading of vehicles?
• equipment provided to minimise vehicle hazards? (eg wheelchair loaders,
storage crates, lumbar supports)
Do employer-owned vehicles provide adequate lumbar support and other cushioning?
Working alone safety checklist
check
Is there a system in place for communication with workers working alone?
Does the system ensure that employees have means of communicating in the event of
emergency (eg mobile phones, duress alarms)?
Does the system ensure regular contact is maintained with workers to ensure safety and
supervision?
Does the employer have a system to ensure knowledge of the location of all workers at
all times during work shifts?
yes
no
n/a
10
OSH systems safety checklist
check
Are there systems in place to identify hazards, assess & control risks in client homes?
(eg hazard forms, inspection checklists, risk assessments)
Is there a hazard reporting system that workers can access to report hazards?
Do employees have access to forms to report hazards and incidents?
Have all workers received induction & ongoing training on:
• safety procedures
• manual tasks
• infection control and communicable diseases
• slips, trips and falls
• aggression/ violence
• grievance/ conflict resolution procedures
• communication and emergency procedures
• hazardous substances
• electrical safety
Are training and induction records maintained?
Does the employer have consultative mechanisms in place? Eg OSH reps, safety
committees, safety newsletters, regular staff meetings
Is there a designated contact person(s) for OSH and Injury Management?
Have notifiable accidents been reported to WorkSafe, as per legislative requirements?
Are all reported hazards and incidents investigated by the employer?
Are the investigations adequate? (identify all potential risk factors and recommendations
made for further action to control risk; investigation of client-related incidents consider
client factors – eg size/weight, communication, potential aggression/ resistive behaviour)
Are workers reporting hazards/ incidents given feedback regarding outcome of
investigations?
Is a comprehensive assessment of potential clients and their homes/ environment
completed PRIOR to commencing services to identify, assess and control hazards and
risks? Assessment should include:
• level of physical and cognitive functioning/ diagnoses
• history of resistive behaviour/ aggression
• language/ communication abilities of client
• physical characteristics of client (size, weight)
• services to be provided
• slip/ trip hazards
• manual task hazards
• equipment needs and equipment condition
• phone locations
• lighting
• security
• presence of animals and other people in the home
• emergency evacuation and exit points
Are care contracts or service agreements provided to and discussed with clients that
cover safety matters; roles, rights and responsibilities; and process for resolution of
identified safety hazards (including implications of non-resolution)?
A2332321
yes
no
n/a