Managing Health and Safety in Healthcare Legislation and Risk Assessment

MODULE OUTLINE (INTRODUCTION)

In this module, you learn about the main law covering safety and health at work and how to

conduct a risk assessment.

The module topics cover the law governing safety and health at work, hazard identification, risk

assessment and the General Principles of Prevention.

TOPIC 1: LEGISLATION

The aim of this topic is to introduce the main requirements of the Safety, Health and Welfare at

Work Act 2005. Click below to find out more about these legal requirements and how they

apply.

THE LAW

Health and Safety laws are aimed at protecting you, your employees and the public from

workplace dangers.

The main laws are the Safety, Health and Welfare at Work Act 2005 (referred to after this as the

Act) and associated Regulations.

APPLICATION

The Act applies to all employers, employees in all employments and to the self-employed. It also

has implications for persons who control places of work.

It provides the general framework for health and safety management, risk identification and

prevention.

EMPLOYER DUTIES

Under the Act employers have responsibility for the safety and health of their employees.

General duties include providing a safe place of work, safe systems of work and safe equipment.

Employers are required to assess risks and take practical measures to protect the safety and

health of their employees and anyone who may be affected by their work activities.

In healthcare settings, the "employer" is usually either:

the Board of the Hospital

the Health Service Executive, or

a private individual, company or partnership.

EMPLOYEES IN HEALTHCARE

In healthcare, employees include agency staff, temporary employees, part time employees, fixed

term employees and locums.

EMPLOYEE DUTIES

All employees have a duty to take care of their own safety and the safety of others while at work.

They must co-operate in enabling the employer to comply with the law. Employee duties under

Section 13 of the Act also include:

Reporting hazards or hazardous activity to management.

Attending any safety and health training provided by the employer.

Taking full account of training and instructions given by the employer or any person

acting on the employer's behalf.

Not being under the influence of an intoxicant at work to the extent that they may

endanger others.

MANAGEMENT RESPONSIBILITIES

Employers, directors and senior officers, which includes line managers and department heads,

have specific responsibilities under Section 80 of the Act.

They can be held personally responsible for failure to control health and safety. So they must be

in a position to prove that they have proactively managed the safety and health of their staff and

anyone who may be affected by the work activities.

RISK ASSESSMENT

By law, employers and those who control workplaces to any extent, must identify hazards in the

workplaces under their control and assess the risks presented by the hazards.

Employers must write down the risks and what to do about them. This is known as a risk

assessment.

GENERAL PRINCIPLES OF PREVENTION

The Act lays down a hierarchy of prevention to controlling risks known as the General Principles

of Prevention.

There are nine Principles of Prevention and these will be covered later in topic 3.

SAFETY STATEMENT

The Act requires that employers prepare a written programme to safeguard the safety and health

of employees and other people who might be at the workplace.

This written programme is known as a safety statement and will be covered in more detail in

module 2.

REASONABLY PRACTICABLE

Many of the employer's requirements under the Act are to do as much "as is reasonably

practicable" for example, to manage work activities, provide a safe place of work and systems of

work.

It means balancing the degree of risk against the time, trouble, cost and physical difficulty of

taking measures to avoid the risk. So if a risk is high, a lot must be done to eliminate or control

it.

ENFORCING OCCUPATIONAL HEALTH AND SAFETY LAWS

The Health and Safety Authority (HSA) is responsible for enforcing occupational health and

safety laws. Inspectors may visit your workplace without notice but you are entitled to see their

identification before they enter.

Inspectors have the right to talk to employees and safety representatives, take photographs and

samples and even, in certain cases, to impound dangerous equipment. They are entitled to co-

operation and answers to questions and can prosecute the employer or an individual for breaking

health and safety laws.

PATIENTS AND VISITORS (INCLUDING VOLUNTEERS)

Patients and visitors in the healthcare setting are protected under Section 12 of the Act. This

states that as far as is reasonably practicable, the employer must ensure that individuals at the

place of work are not exposed to risks to their safety, health or welfare.

ASSOCIATED REGULATIONS

Other health and safety regulations exist such as the Safety, Health and Welfare at Work

(General Application) Regulations (which cover specific topics such as manual handling, display

screen equipment, pregnancy at work, work equipment and noise) and the biological, chemical

and carcinogen regulations.

These regulations are all based on a risk assessment approach to managing the hazard .

PREGNANCY AT WORK

Pregnancy is part of normal everyday life; it is not an illness or a workplace hazard.

Many women work during pregnancy and return to work whilst breastfeeding. Because there are

some hazards in the workplace which may affect either the health of the woman or her

developing foetus there is specific protection under health and safety law during this period.

CONCLUSION

This topic provided an overview of the Safety, Health and Welfare at Work Act 2005.

Risk assessment and the General Principles of Prevention are covered in more detail in the

upcoming topics of this module.

TOPIC 2: IDENTIFYING HAZARDS & RISK ASSESSMENT

This topic explains the terms 'hazard' and 'risk', it also outlines the risk assessment process and

identifies the four main hazard categories in healthcare.

RISK ASSESSMENT

Prior to learning about risk assessment, you should be familiar with the terms: risk, risk

assessment, hazard and control measures. Click below to find out about these terms.

RISK ASSESSMENT

A risk assessment is a careful examination of what in the workplace could cause harm to people

so that preventative measures can be taken. The aim is to reduce the risk of injury and illness

associated with work.

HAZARD

A hazard is anything with the potential to cause harm in terms of human injury or ill health but,

for your purposes, this must be workplace generated for example, dangerous chemicals or poor

housekeeping.

Some hazards are obvious and cause immediate health effects such as electricity whilst others

may be less obvious with delayed health effects for example, exposure to harmful viruses.

RISK

A risk is the likelihood that somebody will be harmed by the hazard and how serious the harm

might be.

When considering risk, you should also consider the number of people at risk from the hazard.

CONTROL MEASURES

Control measures or controls are the precautions taken to ensure that a hazard will not injure

anyone.

When implementing control measures account must be taken of the Principles of Prevention and

any control measures put in place should not create an additional hazard.

THE RISK ASSESSMENT PROCESS

There are three steps to carrying out a risk assessment.

Identify the hazards.

Assess the risks.

Put control measures in place.

CARRYING OUT A RISK ASSESSMENT

If you are carrying out the risk assessment yourself, systematically walk around your workplace

and look at what could be expected to cause harm. Review related data, such as incident reports

and health and safety reports, and observe work processes.

Prioritise the significant hazards that could result in serious harm or affect several people. If your

premises are small, you may be able to carry out the assessment as a whole. In larger premises it

is probably better to divide the risk assessments up via areas, topics or tasks.

STEP 1: IDENTIFY THE HAZARDS

Within healthcare, hazards can be broadly classified into 4 main categories:

1. Biological, for example, exposure to infected blood and body fluids or air borne pathogens.

2. Chemical, for example, exposure to sterilising agents.

3. Physical, for example, slips, trips and falls.

4. Psychosocial, for example, violence and aggression and work related stress.

STEP 1: IDENTIFY THE HAZARDS

When identifying hazards, consider the hazard types, work materials, work methods / practices

and work design. Consider:

Employees who work away from the main workplace.

Hazards that may present a risk during pregnancy.

How the work should be carried out.

All aspects of work, include shift and night work.

Non-routine as well as routine work tasks.

Any accidents or incidents.

The foreseeable - what the employer could reasonably be expected to know.

Remember that not all injuries are immediately obvious.

INVOLVE EMPLOYEES

Consult and involve employees and safety representatives.

They may have noticed things that are not obvious to you.

STEP 2: ASSESS THE RISK

Think about the hazard, who could be harmed and how this might happen.

Examine whether you have complied with the general duties under the Act.

Identify what action is already being taken to prevent harm.

Decide whether this is enough.

If it is not, decide what more should be done.

Risk matrices may be used to help prioritise risk and the actions required.

WHO COULD BE HARMED?

Remember it's not just employees who may be harmed - patients, visitors and contractors can

also be harmed by unsafe work activities.

In addition, think about hazards that may be a risk to susceptible employees such as those who

are pregnant or immune-suppressed.

STEP 3: CONTROL THE RISK

If you have identified a hazard, and you decide it poses a risk, you need to act to prevent that

hazard causing an accident or harm.

Start with the hazards that have the greatest risk.

Remove the hazard, if reasonably practicable to do so.

If you cannot remove the hazard, reduce the risk so far as is reasonably practicable.

When removing or reducing the hazard or risk you must ensure that the actions you take

do not introduce another hazard or risk.

Satisfactory control of risk is often a gradual process involving trialling and refining

measures, taking account of employee feedback, changes in patient behaviour and needs

and new technology.

DOCUMENTATION

Keep a written record of the significant findings of the risk assessment, the actions to be taken as

a result of the assessment (your action plan) and the details of anyone especially at risk.

ACTION PLAN

Your action plan should detail who is responsible for implementing the action and a time-frame

for completion of the action. Where the management of any identified risks are beyond your

control, for example if there are budgetary constraints, the risk assessment should be brought to

the attention of senior management and appropriate actions agreed upon.

Record the date of completion of any actions on the plan.

UPDATING YOUR RISK ASSESSMENTS

Risk assessments and control measures must be reviewed whenever there is:

evidence that the risk assessment is no longer valid, or

an injury or illness due to a particular hazard, or

a significant change proposed in the workplace, either to the premises, plant and

equipment, work practices or procedures.

MONITOR AND REVIEW

Once a control measure has been implemented, its effectiveness should be monitored. Checking

that your risk controls are working and that there are no new hazards is essential.

Ask your employees how well the safe work procedures are working or if there are any new

hazards they are aware of.

CONCLUSION

This topic introduced risk assessment terminology and explained what is involved in the risk

assessment process.

TOPIC 3: GENERAL PRINCIPLES OF PREVENTION

The aim of this topic is to outline the General Principles of Prevention and their importance in

implementing control measures.

PURPOSE OF THE GENERAL PRINCIPLES OF PREVENTION

The General Principles of Prevention provide a methodology for implementing control measures

- a hierarchy of control.

When putting control measures in place, consideration needs to be given to this hierarchy.

The hierarchy requires that where the hazard cannot be avoided, for example by elimination of

the hazard, that it is reduced so far as is reasonably practicable.

GENERAL PRINCIPLES OF PREVENTION

There are nine principles of prevention.

1. Avoidance

2. Evaluation

3. Combating

4. Adaptation of work to the individual

5. Adaptation of place of work

6. Replacement

7. Giving of priority

8. Development of policy

9. Training

USING THE HIERARCHY

The further up the hierarchy you take action the better. You start at the top and work down until

you have done everything reasonable to protect the safety, health and welfare of your employees.

For example, development of policy is an example of an administrative control and is rated lower

because it limits employees' exposure to hazards by rules, procedures and instructions which can

be difficult to implement and maintain.

As a result it is not as reliable a way to reduce exposure as combating a risk at source.

PRINCIPLE 1: AVOIDANCE

The first option you must consider is avoidance of risk. If you can, remove the dangerous item or

rearrange things so that the risk no longer exists.

PRINCIPLE 2: EVALUATE

When you cannot remove a risk, you must evaluate it by carrying out a risk assessment.

This allows you to analyse the situation and helps you to come up with solutions.

PRINCIPLE 3: COMBATING

After evaluation, try to deal with the hazard at its source.

This might mean, for example, avoiding needle stick injuries by using needles that retract into

the syringe after use.

PRINCIPLE 4: ADAPTATION OF WORK TO THE INDIVIDUAL

This is the principle of arranging the workplace and the tasks to take into account your

employees and to reduce the affect of work on health - adapting work to the employee.

For example, it may mean providing a height adjustable chair for a laboratory technician

working at a fixed height bench.

PRINCIPLE 5: ADAPTATION OF PLACE OF WORK

The adaptation of the place of work to technical progress means taking account of and keeping

up to date with new technology, equipment or developments.

For example, use digital radiography instead of photographic film and avoid the use of

chemicals.

PRINCIPLE 6: REPLACEMENT

This involves replacing dangerous items, materials, substances or systems of work with safer

alternatives - replacing a hazard with one that has a lower level of risk, replacing the dangerous

with non dangerous.

For example, use a laundry trolley to transport heavy laundry bags instead of carrying them.

PRINCIPLE 7: GIVING PRIORITY

Give priority to collective protective measures (measures that protect more than one person) over

individual protective measures.

It is better to put controls in place that protect everyone and only to use individual controls such

as providing personal protective equipment, when other controls are not possible.

PRINCIPLE 8: POLICIES

Develop clear and well enforced policies on hazards for example, a policy on the management of

work related violence and aggression.

Administrative or procedural controls such as scheduled work breaks, job rotation, permits to

work and safe working procedures can reduce or eliminate exposure to hazards but they require

strict adherence to procedures and instructions.

PRINCIPLE 9: TRAINING AND INSTRUCTION

If you cannot eliminate or reduce the risk sufficiently, training and instruction should be

introduced on safe work practices including policies and procedures.

Each employee who works with or near a recognised hazard must be trained to work safely.

Manual handling and patient handling training are examples where training may be required.

COMBINATION OF MEASURES

In some cases a combination of the above measures may be required to minimise the risk to the

lowest level that it reasonably practicable if no single measure is sufficient for the purpose.

For example, a policy on patient handling and also training and instruction in patient handling

equipment may be required when using a hoist.

CONCLUSION

This topic outlined the nine principles of prevention a hierarchy of control measures.

SUMMARY

In this module, you learned about the main laws in relation to health and safety at work and how

to conduct a risk assessment and implement control measures using the General Principles of

Prevention.

First, you learned about the main requirements of the Safety, Health and Welfare at Work Act

2005 and associated Regulations. You also learned about the four main categories of hazards in

healthcare and the importance of risk assessment in managing these hazards.

Finally, you learned about the risk assessment process and the three steps involved in carrying

out a risk assessment: identifying the hazards, assessing the risks and, putting control measures

in place. You also learned about the General Principles of Prevention and their importance in

implementing control measures.

LEARNING OBJECTIVES

The learning objectives of this module were:

to understand the main requirements of the Safety, Health and Welfare at Work Act

to know the four main categories of hazards in healthcare

to understand the risk assessment process, and

to know how to apply the General Principles of Prevention.

Click Next to test your knowledge of Legislation and Risk Assessment.