Occupational physicians have a duty to promote health and wellbeing in the workplace regardless of geography Commercial pressures can impact on occupational physicians, but do not justify breaches of ethical or legal rules Occupational physicians must not contract for work outside their own or their organization \200\231s competence Competitors must not be denigrated, and information gleaned by OH staff through their work should not be used for personal advantage Care must be taken that contracts or agreements for services do not contain unethical provi sions such as a requirement to release con \201 dential medical information to the employe r When services are being transferred, the occupational health and safety of client organizations and their workforces must take primacy over commercial consi derations. Medico-legal work Occupational physicians may be required to give evidence: \200 As a fac tual witness, e.g. on some aspect of OH procedure or their personal input in a case. A fact ual witness does not give an opinion, just a statement of the facts or events as they occur red. As an Expert witness. An Expert witness gives an educated or expert opinion on a question e .g. the relationship between a workplace exposure and a particular health effect: \200 th e expert witness is responsible to the court, not to the party who has funded the report. independence and expert knowledge are paramount \200 never stray outside your area of exp ertise \200 expect to be challenged on your views; be prepared to produce evidence to justify your position. Legal report writing and giving evidence in court requires particular skills; ensure you ha ve the appropriate training. The Expert witness Institute provides training programs for do ctors (M http://www. ewi.org.uk). 18_Smedley_Chap18.indd 364 1/2/2013 12:28:52 PM 365 Chapter 19 Policies Writing a policy 366 Health and safety policies 368 Sickness absence policies 370 Wellness/ wellbeing policies 372 Immunization policies 374 Mental health policies 376 Substance abuse policies 378 Travel policies 1: general travel policy 382 Travel policies 2: expatriate po licy 386 Violence management policies 388 Workplace smoking policies 390 19_Smedley_Chap19.indd 365 1/2/2013 12:30:27 PM CHAPTER 19 Policies 366 Writing a policy The purpose of any policy is to set out how an organization plans to condu ct that aspect of its business in compliance with relevant legislation and current best pra ctice. Behind the organizational policy may lie one or more operational procedures/protocol s which document how the policy will be delivered. Well written, up to date, OH policies an d procedures are one element of good clinical governance (see Fig. 19.1). 2 To be effective , these policies must have support at the highest level of the organization. A comprehensiv e policy sets out organizational intention, and explicit arrangements (who does what, and w hen) with respect to the manage- ment of any given organizational risk. An effective policy should \200 De \201 ne the purpose of the policy \200 De \201 ne responsibilities from the top of the organization down the management tree Identify a director or senior manager responsible for that policy \200 Describe the respo nsibilities of managers and supervisors \200 Describe the responsibilities of employees \200 Describe the responsibilities of other parties where relevant, e.g. Occupational Health and Wellbeing service \200 Human Resources \200 Health and Safety D epartment \200 Training and Education Department Describe arrangements for: monitoring and review of the policy \200 monitoring of the effectiveness of the policy Allocate appropriate resources \200 Ensure the organization has access to competent advic e \200 Set a date for policy review. Relevant legislation and guidance \200 HSE (1997). Successful health and safety managemen t , HSG65. HSE Books, Sudbury. TSO (2003). Chapter 37. In: Health and safety at work, etc. Act 1974 . TSO, Norwich. HSE (2003). Management of Health and Safety at Work Regulations 1999. Approved Code of Prac tice and Guidance, 2nd edn, L21. HSE Books, Sudbury. 19_Smedley_Chap19.indd 366 1/2/2013 12:30:28 PM WRITING A POLICY 367 Define aims and objectives: why do we need this policy? Risk assessment Review current practice: what if anything do we currently do? Define best practice: what should we be doing? Identify legislative requirements, HSE, indu stry or other authoritative guidance. Draft policy 1. Agree and assign ownership of policy e.g. Health and Safety committee, OHS 2. Describe m anagers \200\231 and supervisors \200\231 responsibilities 3. Describe employees \200\231 r esponsibilities 4. Define how the desired aim will be achieved in keeping with best practic e 5. Agree the necessary resources (staff, equipment, maintenance) to deliver the policy \200\231s desired aims 6. Where there are specific, detailed, duties placed on one departme nt by the policy, this may be better defined in a related Standard Operating procedure (SOP ) 7. Describe audit and monitoring arrangements 8. Define review arrangements 9. Include ke y references e.g relevant legislation, other policies and procedures Consult key stakeholders: HR, OHS, line management, staff side representatives, legal advis ers on draft policy Revise policy in light of feedback Staff training Disseminate final, controlled, document in hard copy or, ideally, on the organization \200 \231s intranet Publicize Audit compliance with policy and monitor its effectiveness Fig. 19.1 Flow chart showing the key steps in drafting a policy. 19_Smedley_Chap19.indd 367 1/2/2013 12:30:28 PM CHAPTER 19 Policies 368 Health and safety policies The purpose of a health and safety policy is to set out how an o rganization plans to conduct its business in compliance with health and safety law. It expr esses commitment to sustained improvement in the management of health and safety risk. 2 Al l employers with more than \201 ve workers are required by the Health and Safety at Work etc. Act 1974 to have a written health and safety policy, and to communicate it to employee s. Under the Health and Safety Information for Employees Regulations 1989 employers must di splay a health and safety poster or provide lea \202 ets with health and safety informa- t ion for the workers. Health and safety policy 2 To be effective, a health and safety policy must have support at the highest level of the organization. The prevailing culture should give supervisors and staff a clear message that health and safety is an important organizational priority. A com pre- hensive health and safety policy sets out organizational intention, and explicit arran gements (who does what, and when) with respect to the management of health and safety risk. The policy should specify the owner of the policy, the scope, de \201 nitions/glossary, r elevant reference documents including legislation, regulations and other internal policies e.g. COSHH, First Aid, Noise. Many large organizations will require that draft policies are subject to Equality assessment prior to implementation. A health and safety policy should \200 Be signed (and dated) by the chief executive \200 De \201 ne responsibilities from the top of the organization down the management tree Identify a director/senior manager responsible for health and safety \200 Describe the re sponsibilities of managers and supervisors \200 Describe the responsibilities of employee s \200 Encourage the involvement of safety representatives \200 De \201 ne how health and safety issues will be communicated effectively \200 at board level: health and safety on the agenda of all meetings \200 to all staff: toolbox talks/team brie \201 ng, newsl etters, and circulars Describe arrangements for: monitoring and review of health and safety performance \200 monitoring of the effectivene ss of the policy \200 Allocate appropriate resources to health and safety \200 Ensure t he organization has access to competent health and safety advice Commit the organization to review and revise the policy regularly, and set a date for policy review. Principles of health and safety management: \200\230 \201 ve steps \200\231 The Health an d Safety Executive describe \201 ve steps 1 to effective health and safety management. 19_Smedley_Chap19.indd 368 1/2/2013 12:30:28 PM HEALTH AND SAFETY POLICIES 369 1. Produce a health and safety policy 2. Develop a safety culture through control, competence, cooperation, and communication \200 Control: senior managers should lead by example \200 a senior manager should chair the health and safety committee \200 allocate and communicate health and safety responsibilities \200 company organizational chart \200 clear job descriptions \200 allocate appropriate reso urces (time, staff, \201 nance) \200 identify especially hazardous tasks or jobs, and e nsure that these workers receive appropriate additional training monitor health and safety performance against agreed standards Competence: recruit and train competent staff \200 provide or obtain specialist advice where required Co-operation: work with safety representatives and trade unions \200 liaise with contractors to manage health and safety \200 consult with staff on health and safety issues Communication: provide information, instruction, and training to staff, including short-term or agency workers make health and safety a priority issue. 3. Planning and standard setting 4. Measure health and safety performance 5. Review and revise health and safety policy Relevant legislation and guidance \200 HSE (1997). Successful health and safety managemen t , HSG65. HSE Books, Sudbury. TSO (2003). Health and safety at work etc. Act 1974 , Chapter 37. TSO, Norwich. HSE (2003). Management of Health and Safety at Work Regulations 1999. Approved Code of Prac tice and Guidance, 2nd edn, L21. HSE Books, Sudbury. Information from HSE \200 HSE Health and safety made simple: the basics for your business . Available at: M http://www.hse.gov.uk/simple-health-safety/write.htm HSE Do you have any information on how to compile a health and safety policy? Available at: M http://www.hse.gov.uk/contact/faqs/ policy.htm 19_Smedley_Chap19.indd 369 1/2/2013 12:30:28 PM CHAPTER 19 Policies 370 Sickness absence policies All employers should have a written policy, agreed between manage ment and staff representatives, describing how the organization will manage absence attribu ted to sickness. 2 Well-managed organizations record and monitor sickness absence and act o n it at all levels \200\224individual workers, departments, and work sites. Purpose To inform employees and managers about how the organization manages sickness absence. Main requirements The sickness absence policy should: \200 Give a working de \201 nition of sickness absence \200 Describe the arrangements for recording and analyzing absence r ates in the organization (see b p. 402, Sickness absence: general principles). \200 De \201 ne the roles and responsibilities of senior managers, line manager, human resources (H R) advisers, occupational health service (OHS), and the employee in absence management Outline employees \200\231 rights to sick pay. Discretionary sick pay (not statutory sick p ay (SSP)) may be withdrawn if the employer has information that the employee could do some work, but does not return to work despite appropriate adjustments (check employee \200\231s contract allows this) Enable the employer to seek a medical report with the employee \200\231s consent if there is no OH service Describe the practical arrangements to support \200\230return to work \200\231: rehabilitation plans should be mutually agreed between employee and employer, including any temporary adjustments to duties or hours of work pay arrangements during \200\230phasing-in \200\231 periods should be explicit \200 moni toring and review of rehabilitation programs should be planned in advance De \201 ne training in sickness absence management for managers. Managers \200\231 roles Senior managers Overall responsibility for absence management strat egy, ensuring fair and consistent implementation. Line managers Day-to-day absence management is a fundamental part of a line manager \200 \231s role. The line manager should: \200 Monitor their team \200\231s attendance records , compare with absence levels in other teams/departments, and manage individual cases proac tively Maintain contact with those employees on sickness absence and consider any work modi \201 cations/adjustments suggested by health professional in Fit Notes to hasten employee rehabi litation 19_Smedley_Chap19.indd 370 1/2/2013 12:30:28 PM SICKNESS ABSENCE POLICIES 371 Hold a brief informal return to work interview with all employees following any sickness ab sence. This is a supportive fact- \201 nding approach separate from any disciplinary proce ss in poor attenders \200 Refer to the OHS for medical input. Late referral to OH is asso ciated with a poor prognosis for return to work. Therefore, early referral, within 4 \200 \2236 weeks after absence begins, should be encouraged. Ideally a referral form or letter s hould include: \200 employee \200\231s details \200 job description \200 sickness abs ence record for last 12mths (causes and duration) \200 workplace adjustments/modi \201 c ations already in place \200 speci \201 c queries to be addressed \200 con \201 rmati on that employee has given informed consent to referral. Role of the human resources team HR representatives have special expertise in managing abse nce. Their primary role is to advise managers on the correct and equitable imple- mentation of absence policies and associated procedures. They play an important part in helping to r esolve disputes or poor relationships bet-ween employee(s) and managers. HR representatives can be valuable in overcoming barriers to implementation of OH advice. Role of the occupational health service The OH professional aims to ensure that for all abs ence referrals: \200 medical reasons for absence are assessed fully, whilst protecting th e con \201 dentiality of sensitive information both employer and employee receive impartial objective advice \200 advice about adjustmen ts to work are justi \201 able and appropriate. Employees \200\231 responsibilities Clarify employees \200\231 responsibilities in the even t of sickness absence. \200 When to inform the employer if they are ill \200 Whom to in form \200\224usually their line manager \200 Requirement to maintain contact while off si ck \200 When to provide a self-certi \201 cate (SC2) \200 When to provide a doctor \200\231s Statement of Fitness for Work. Further information HSE (2004). Managing sickness absence and return to work. An employers \200\231 and managers \200\231 guide , HSG249. HSE Books, Sudbury. Available at: M http://w ww.cipd.co.uk/default.cipd. See absence management section. Fit for work: the complete guide to managing sickness absence and rehabilitation . ISBN 190 3461715. National Institute for Health and Clinical Excellence. (2012). Management of long- term sickness and incapacity for work , PH19. NICE. Available at: M http://guidance.nice.org.uk/PH19 19_Smedley_Chap19.indd 371 1/2/2013 12:30:28 PM CHAPTER 19 Policies 372 Wellness/wellbeing policies Purpose Workplace wellbeing aims to take a holistic approach to wellness at work by preventing occupational illness and accidents while enhancing wellbein g in the workplace, but also addressing the physical and social factors that in \202 uence health such as: \200 Poor nutrition \200 Lack of exercise \200 Work/home con \202 i cts. There are clear economic bene \201 ts for those employers achieving effective health promoting workplaces. These include reduced sickness absence rates, improved morale, and a better public image. 2 The National Institute for Health and Clinical Excellence (NICE) has produced evidence-ba sed guidance for employers including; \200 Promoting physical activity in the workplace ( PH 13) \200 Workplace interventions to promote smoking cessation (PH5) \200 Promoting m ental wellbeing at work (PH22). Workplace wellness/wellbeing There are several aspects to a workplace wellness program incl uding physical, social and health initiatives. A healthy physical environment \200 Enhance the physical environment with better lighting , noise abatement, and action to reduce the risks of violence to staff Develop a Travel Plan: encourage walking or cycling to work (provide bike lockers, shower facilities) allow home working \200 encourage the use of stairs \200 promote walking to meetings ne arby Organize lunch time walking groups, allow exercise groups to use rooms for yoga or aerobics, and offer discounted membership to gyms Participation in national or corporate challenges to increase physical activity among employees Workplace smoking controls including developing a Smoking policy A healthy social environme nt \200 Promote an open organizational culture \200 Meet stress/mental health policy \200 Employee assistance program (EAP) or a staff counseling service \200 Family friendl y work policies e.g. Home working \200 Flexi-time 19_Smedley_Chap19.indd 372 1/2/2013 12:30:28 PM WELLNESS/WELLBEING POLICIES 373 Staff \200\230climate \200\231 surveys to assess employee satisfaction Health initiatives \200 Health education for example on; safe drinking; time management; maintaining a healthy work-life balance Smoking cessation clinics \200 Offering healthy eating options in the staff canteen and f ruit as a snack \200 Promote exercise/weight management \200 Executive health checks. Workplace wellbeing in the UK The UK government \200\231s white paper Choosing Health has h ighlighted pri- ority areas for lifestyle change in the interests of improving the public h ealth. Key areas include healthy eating, stopping smoking, sensible alcohol drinking, and e xercise. The importance of OH professionals in promoting healthy behaviors within the workp lace is explicit in the document. \200 The Healthy Workplace Initiative (HWI) is sponsore d by the Department of Health and HSE and aims to promote workplace health in England and Wales. A similar initiative in Scotland is called Healthy Working Lives. Main requirements \200 To be successful a workplace wellness policy must involve all work ers \200 The policy must have the active support of senior managers \200 The organizati onal culture should encourage employee participation \200 The draft policy should be disc ussed and agreed by a working group of managers and staff before being circulated to staff for comment and feedback The \201 nal policy should commit the organization to integrating workplace wellbeing into its management systems The policy should af \201 rm that all wellness initiatives are to be project managed and s o require a needs analysis, priority setting, project implementation, continuous monitoring , and audit HR policies should re \202 ect the wellbeing objective by embracing wellness issues, e.g. encouraging work \200\223life balance The wellness policy should include the provision of a fully integrated occupational health and safety service. Further information M European Network for Workplace Health Promotion (ENWHP) http://www.en whp.org Creating a Healthy Workplace. A Guide for Occupational Safety and Health Profession als and Employers . Faculty of Occupational Medicine and Faculty of Public Health Medicine, London, 2006. NICE (2012). Promoting physical activity in the workplace . Available at: M http://www.nice .org.uk/ PH13 NICE (2012). Workplace interventions to promote smoking cessation . Available at: M http:// www. nice.org.uk/PH5 NICE (2012). Promoting mental wellbeing at work . Available at: M http://guidance.nice.org. uk/PH22 HSE Management Standards for work related stress. Available at: M http://www.hse.go v.uk/ stress/ 19_Smedley_Chap19.indd 373 1/2/2013 12:30:28 PM CHAPTER 19 Policies 374 Immunization policies Immunizations are commonly carried out by OH departments: \200 To p rotect workers against vaccine preventable occupational infections \200 To protect patien ts/colleagues (in health care setting) against infection \200 For employees who are requi red to travel abroad. Occupational health department policies If immunization programs are offered, a written imm unization policy should be developed. As a minimum the policy should outline: \200 The li st of immunizations that are given \200 The broad indications for immunization including staff groups who will normally be immunized and others according to a risk assessment \200 Who will give immunizations, and arrangements for their training \200 Arrangements for record keeping/advising worker of vaccination status Arrangements for storage and disposal of vaccines \200 include arrangements for monitorin g and recording of the cold chain, e.g. refrigerator temperatures safeguards to protect expensive vaccines in the event of refrigerator power failure. Arrangements for recalls (e.g. for scheduled doses and boosters) \200 Arrangements for re porting adverse events related to immunization report to in-house adverse event monitoring system \200 report to Committee on Safety of Medicines (CSM) via \200\230yellow card \200\231 scheme (reports can be made electronically to Medicines and Healthcare Produc ts Regulatory Agency (MHRA)). Arrangements for communication of \201 tness for work/necessary restrictions in light of outcome of immunization to the employer \200 Arrangements for those who decline immunizat ion or fail to attend \200 Arrangements for monitoring including audit of immunization po licy. Vaccination procedures These are usually outlined in a separate document or as an appendix to the main immunization policy. Checklists should include: \200 Gaining and recording em ployees \200\231 consent \200 Protocol for the safe administration of vaccines \200 Rec ording immunizations in OH records, and communicating information to GPs (with employee \200\231s consent) Management of adverse events including anaphylaxis (see b p. 814, Management of anaphylaxis). Patient group directions (PGDs) OH nurses usually carry out immunizations under generic ins truction from OH physicians. By law (Statutory Instrument 2000 No. 1917) vaccines that are given in this way must be the subject of written PGDs. The legal de \201 nition of a PGD is: a written instruction for the supply and/or administ ration of a licensed medicine (or medicines) in an identi \201 ed clinical situation, sign ed by a doctor or dentist and a pharmacist. 19_Smedley_Chap19.indd 374 1/2/2013 12:30:28 PM IMMUNIZATION POLICIES 375 PGDs should be developed by: \200 a senior OH physician \200 a senior OH nurse \200 a senior pharmacist \200 the clinical governance lead \200 as a matter of good practice, local drugs and therapeutics committees and area prescribing committees should also be involved \200 Each vaccine should have a s eparate PGD, which should include: name of the body to which the PGD applies \200 dates of commencement and expiry of PGD \200 description of vaccine \200 class of registered health professionals who may admini ster vaccine \200 signature of a doctor and a pharmacist \200 signature by appropriate health organization \200 indications for vaccine \200 patients who should be excluded \200 description of circumstances when advice should be sought \200 dose, route, and sch edule of administration \200 potential adverse reactions and actions to be taken \200 r ecords to be kept for audit purposes. Minimum training requirements OH nurses who are giving immunizations must receive appropria te train- ing. A set of national standards, de \201 ned by the Health Protection Agency, o utline the basic training requirements including: \200 Professional quali \201 cations \200 Speci \201 ed training content, duration of baseline training and frequency of updates, post-training assessment \200 Access to national immunization policies \200 Inclusion of training in formal audit of immunization programs \200 Content of training for trainers. Further information and guidance Department of Health (2007). Immunization against infectio us disease \200\224 \200\230The Green Book \200\231 . Available at: M http://www.dh.gov.uk/ en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_079917 Nursing and Midwifery Council (2008). Standards for Medicines Management . NMC, London. Ava ilable at: M http://www.nmc-uk.org/Documents/Standards/nmcStandardsForMedicinesMan- agement Booklet.pdf National Prescribing Center: guidance and framework of competencies for the use of PGDs. 20 09 M http://www.npc.nhs.uk/non_medical/resources/patient_group_directions.pdf Guidance and core curriculum for training on immunization delivery. M http://www.hpa.org.uk / Publications/InfectiousDiseases/0506CoreCurriculumforImmunisationTraining/ 19_Smedley_Chap19.indd 375 1/2/2013 12:30:29 PM CHAPTER 19 Policies 376 Mental health policies Purpose To assist the organization in ful \201 lling its responsibi lities to maintain the mental health and wellbeing of employees at work. Development Must have support from senior management, ideally at board level. Set up a stee ring group, chaired by a senior manager and include representatives from: \200 Management \200 Human resources \200 Occupational health \200 Safety \200 Union(s) or other e mployee representatives. Framework Physical hazard model (see b p. 134, Organizational psychosocial factors; b p. 31 1, Stress 2: interventions/risk control). A mental health policy should describe local arrangements for the prevention and management of mental ill health under the following headings. Assessment of risk \200 Discussion between interested parties: satisfy HSE \200\231s requirement to consult \200 structured discussion around six key ar eas (HSE Management Standards) give picture of current work situation \200 identify processes causing stress \200 faci litate practical recommendations, especially from employees Staff satisfaction surveys \200 Sickness absence rates \200 Employee turnover \200 Bu siness trends. Prevention/risk reduction Primary \200 Supportive management culture \200 Reporting outcome of risk assessment and resulting action plan to directors/board Effective leadership and management skills \200 Appropriate management systems: resource and project management \200 process management \200 interdependency and infras tructure management Change management \200 Communication \200 HR-related policies and procedures: appraisal and training; work \200\223life balance; \202 exible working, including home working; bu llying and harassment; violence at work; shift work; alcohol and drugs 19_Smedley_Chap19.indd 376 1/2/2013 12:30:29 PM MENTAL HEALTH POLICIES 377 Ergonomics: job design, etc. Secondary \200 Mental Health First Aid or similar training \200 Effective sickness absence policy \200 Early referral of cases to OH; option of sel f-referral to OH \200 Easy access to appropriate psychological treatment \200 General h ealth promotion: regular exercise program/relaxation regime \200 smoking cessation support \200 healthy eating/sensible alcohol consumption. Tertiary An effective rehabilitation policy has a joint approach towards individual case ma nagement through round-table discussions (see b p. 311, Stress 2: interventions/risk contro l), where: \200 OH advise on: functional capacity \200 temporary or permanent nature of disability \200 types of reas onable adjustments Management consider: business requirements \200 health and safety issues \200 training requirements \200 p reparation of colleagues for return of employee \200\231s return to work HR co-ordinates program. Monitoring and auditing policy \200 Trends in employee satisfact ion \200 Action plans for effecting appropriate interventions to address recognized dif \201 culties Compliance with and effectiveness of the policy in managing employees \200\231 mental ill health. Further information and guidance HSE Work-related stress \200\224together we can tackle it. Available at: M http://www.hse.gov.uk/ stress Mental Health First Aid. Available at: M http://mhfa.org.uk/en/ 19_Smedley_Chap19.indd 377 1/2/2013 12:30:29 PM CHAPTER 19 Policies 378 Substance abuse policies Epidemiology of substance abuse Alcohol and drug misuse is common in the UK (See Fig 19.2) with major societal costs. Drug misuse is more common in younger people: 50% of 16 \200\22325-yr-olds have misused dru gs and 15% currently do so. Cannabis accounts for 80% of illicit drug use. Each year there are 7100,000 offenders under the Misuse of Drugs Act 1971, 50,000 adults attend treatment a nd 72000 suffer drug- related deaths. Statistics for alcohol abuse are much higher but are dif \201 cult to determine accurately. Why have a policy? Substance misuse has important implications for personal health, work pe rform- ance (particularly if safety critical), protecting business probity and complying wi th customer requirements. A policy forms the framework for managing alco- hol and drug misu se, ensuring clarity, consistency, and legal compliance (see Tables 19.1 and 19.2 b p. 758, Methods for alcohol and drug screening). Alcohol use 90% Drug use 25% Alcohol intake harmful 20% Drugs used in past year 6% Alcohol Dependency 2% Fig 19.2 Population statistics show patterns of alcohol and drug use. Table 19.1 The main substance abuse policy components Purpose Safe working arrangements, employee support Roles and responsibilities Management leadership, employee cooperation Application Applies to managers, employees, and contractors Procedures Communicated and understood by all Discipline Possible job termination for policy breach Support Managed as \200\230sickness \200\231 when worker seeks help Testing De \201 ned testing reasons and Chain of Custody for quality assurance 19_Smedley_Chap19.indd 378 1/2/2013 12:30:29 PM SUBSTANCE ABUSE POLICIES 379 Table 19.2 Legal obligations Health & Safety at Work Act 1974 Employers have a duty to protect employees and others involved in their business. Employees have duty to cooperate in health and safety matters Transportation & Works Act 1974 Bans safety critical railroad operations whilst under the in \202 uence of alcohol or drug s Work in Compressed Air Regulations 1996 Prohibits working in compressed air whilst under the in \202 uence of alcohol or drugs Road Traf \201 c Act 1984 Employers must assure safe driving arrangements. Employees must not drive under the in \202 uence of alcohol or drugs Misuse of Drugs Act 1971 Employers must not allow the use, possession, or production of any controlled substance, in cluding cannabis on their premises Policy components A supportive approach should be taken, encouraging those with health prob lems to seek help. Principles should be aligned with the employer \200\231s values, the law , good employment, and medical practice. Ethical considerations These cover the right to personal privacy and the con \201 dential manage- ment of sensitive personal information. \200 International organizations need to respect legal and cultural differences between the countries in which they operate Observe reasonable standards of enquiry and respect privacy in searching personal belongings etc OH staff undertaking tests must avoid giving medical advice to individuals, to avoid confusing their testing and occupational health roles Disciplinary action following substance misuse testing should not involve OH staff: this wo uld compromise employee relationships. Roles and competencies \200 Managers are responsible for the implementation of the policy \200 Medical Review Of \201 cer (MRO) is a physician with specialist knowledge and training in specimen collection, chain of custody, analytical procedures, and alternati ve explanations for positive analytical results OH practitioners may advise on policy and test arrangements. They have a separate role in a dvising employers and managers in support and rehabilitation arrangements and assessing \201 tness for work. 19_Smedley_Chap19.indd 379 1/2/2013 12:30:29 PM CHAPTER 19 Policies 380 Treatment and rehabilitation Workers who volunteer a substance misuse problem may receive a dvice and support to seek treatment and rehabilitation. Subject to their co-operation, many organizations will maintain their employment. Further information Faculty of Occupational Medicine (2006). Guidance on Alcohol and Drug M isuse in the Workplace . FOM, London 19_Smedley_Chap19.indd 380 1/2/2013 12:30:29 PM This page intentionally left blank CHAPTER 19 Policies 382 Travel policies 1: general travel policy Employees who travel on company business should be assessed, screened, prepared, and cared for during and after their trip. Most business tri ps will be low risk, but the following factors i risk. \200 Travel to remote or underdeve loped areas \200 Poor local infrastructure \200 Restricted access to medical facilities \200 Extreme climatic conditions \200 Transportation challenges \200 Individual \200 \231s behaviors. Travel policy Implementing a corporate travel policy can mitigate risk. Such a policy shoul d include the following headings: Risk assessment Risk assessment should include work activity; location; security situation; health care facilities; disease prevalence. Insurance \200 Comprehensive cover, appropriate to the individual and destination(s) \200 Include insurance for emergency medical evacuation for remote areas \200 Use insure rs that provide remote access to health resource information, and identify and source medical assistance if required. Security \200 2 Awareness and understanding of local security issues are vital \200 Inc lude 24-h contact for emergency advice \200 Give advice on personal behaviors that affect individual \200\231s risk \200 2 Road traf \201 c accidents are a common cause of morbi dity and mortality due to poor vehicle maintenance; driving skills; and roads. Immunizations: dependent on risk assessment \200 Carefully de \201 ne locations of count ry/region to be visited as there can be large differences between urban and rural disease v ectors and risks Refer to regularly updated travel advice, on-line if possible (e.g. MASTA, Travax). Ascerta in accurate immunization history Maintain documented mandated immunizations (e.g. yellow fever), to avoid entry denial or non-sterile local vaccination at borders. Psychological stressors Stressors include: \200 Complex and long travel itineraries \200 High expectations by the business \200 Jet lag \200 Cultural dysphoria \200 Family separation. Recognize the challenges and legitimize mitigating behaviors: \200 Encourage adequate rest before meetings \200 Consider Employee Assistance Program for this high-ris k group. 19_Smedley_Chap19.indd 382 1/2/2013 12:30:29 PM TRAVEL POLICIES 1: GENERAL TRAVEL POLICY 383 Personal guidance \200 Ensure traveler is aware of potential health challenges that may b e encountered Con \201 rm traveler understands strategies to preserve health during trip \200 Highligh t potential i risk behaviors during travel for business traveler \200 Pay particular atte ntion to alcohol, drug use, and sexual behaviors \200 Give traveler resume of essential h ealth tips as a simple guide. Health screening \200 Organizations may advise formal medic al evaluation +/ \200\223 additional tests (e.g. ECG, CXR) for frequent business travelers \200 Quantify the potent ial impact of pre-existing health issues that may deteriorate during travel De \201 ne medication carried (also cold storage for drugs e.g. insulin) \200 Consider t he availability of health resources at the destination. Malaria and insect borne diseases \200 Malaria is a signi \201 cant risk factor for travelers to endemic areas \200 Chemo prophylaxis starts before trip to assess compliance issues \200 Promote ABCD: Awareness; Bite prevention; Chemoprophylaxis; Diagnosis and treatment. 2 Travelers perceive malaria risk as small and may not follow advice. Circadian desynchrony (jet lag) ( b p. 144, Time zone changes) \200 Starts to have an effect after three time zones \200 Resulting fatigue affects concentration and decision-making \200 Allow time to acclimatize on arrival at destination in travel plans. Travelers \200\231 deep vein thro mbosis (DVT) \200 Probably an effect of travel for >5h \200 Risk factors include smokin g, recent surgery (10 days), pregnancy, family history of DVT, malignancy, medication (oral contraceptive pill (OCP), hormone repla cement therapy (HRT)). Advice on maintaining mobility and exercising during travel \200 Discourage tranquilizing medication \200\224may d mobility during \202 ights \200 Encourage adequate hydration +/ \200\223 compression stockings for journey. Traveler \200\231s diarrhea The most common traveler \200\231s health problem. Avoid/mitigate by advice; (cid:5) Eating freshly cooked food (cid:5) Eating fruit that can be washed or peeled (cid:5) Drink safe potable water/ice ; use boiled or reputable bottled water \200 Consider self-treatment antibiotics (cipro \202 oxacin etc.) in travel kit. Travel medical kits \200 Content varies in relation to d estination \200\224from simple over-the-counter painkillers, insect repellents, and skin dressings to more comprehensive k its with stand-by antibiotics, anti-diarrhoeals, and malaria prophylaxis Instructions should be clear and comprehensive. 19_Smedley_Chap19.indd 383 1/2/2013 12:30:30 PM CHAPTER 19 Policies 384 Post-trip precautions \200 Early reporting of post-travel fever or illness \200 2 Need to complete the full course of malaria prophylaxis, if prescribed EAP to be available for problems related to the stressors of travel. Further information MASTA. Available at: M http://www.masta.org/ Travax. Available at: M ht tp://www.travax.scot.nhs.uk/ CDC. Travelers health . Available at: M http://www.cdc.gov/tra vel/ 19_Smedley_Chap19.indd 384 1/2/2013 12:30:30 PM This page intentionally left blank CHAPTER 19 Policies 386 Travel policies 2: expatriate policy De \201 nition of the expatriate worker An employee w ho resides in another country for occupational purposes, but returns to their original coun try upon completion of the assignment. Expatriate policies Policies should include general travel advice ( b p. 382, Travel policy 1: general travel policies). However, prolonged residence requires extra considerations. T herefore, expatriate worker policies should also include the following sections. Selection process \200 Avoid pressing workers to accept postings i.e. for career progress ion \200 Encourage spouse to be involved in decision-making, as family problems are a com mon reason for expatriate posting failure. Pre-posting orientation Family orientation visits are helpful before acceptance of posting. The employee and their family should consider lifestyle factors that will be affected by t he move, including environmental, cultural and social changes, medical care, family adjustm ents, security, and schooling. Fitness for duty \200 Fitness for duty assessments should contain the following elements: