OEMAC 2014 FTW Presentaton Corbet_Fitness to Wor… · Develop standard templates, based on...
Transcript of OEMAC 2014 FTW Presentaton Corbet_Fitness to Wor… · Develop standard templates, based on...
Slide 1
OEMAC 2014
Kenneth Corbet MD FRCPC
Consultant, Occupational Medicine
Clinical Associate Professor
University of Calgary
September 28, 2014
Learning Objectives:
1. Describe the key (health-related) elements of a job
and identify relevant external medical standards
2. Outline how a screening fitness to work protocol
is developed.
3. Decide what medical information is needed to make
a fitness decision
Learning Objectives:
4. Determine whether work limitations or restrictions,
a practical assessment, or employee advice is
warranted
5. Evaluate the fitness to work process and outcomes.
Business Improvement Goal:
Fitness to work assessments are one element of
operational risk management - improve the relevancy,
validity, reliability, and efficiency of medical fitness to
work assessments.
Definitions
What does ‘Medically Fit to Work’ really mean?
“ … means the employee is able to perform the job
without danger to self or others, without reservations.”
Cowell JW. Guidelines for fitness-to-work examinations.
Canadian Medical Association Journal. 1986 Nov 1;135(9):985-8.
Has anyone in the audience dealt with problems
that arise from this definition?
What does ‘Medically Fit to Work’ really mean?
• An office-based fitness assessment does not establish
that the person is capable of performing the job
• Being ‘medically fit’ is not a ‘zero risk’ statement
• The unit of analysis of a medical fitness to work
assessment is a medical condition (i.e. a diagnosis)
Are these better definitions?
Fit = This person has no medical conditions that require
limitation or restriction of his or her work (i.e. tasks,
tools, equipment, schedules, PPE, work environment)
Limitations = can undertake the work, but not to the
usual expectations (e.g. speed, strength, schedule)
Restrictions = cannot or should not undertake a specific
aspect of the work (= serious and imminent risk).
Process Overview
� for medical conditions that
may impact health, safety, or
performance for training,
travel, or work.
SCREENINGINDIVIDUAL
ASSESSMENT
� of medical conditions to
determine whether work
limitations or restrictions are
warranted
Screening
Assessment
Key Job Elements
Key job elements can be used to characterize any job:
• postural and ambulatory demands (office- or plant-based)
• strength (light, medium, heavy)
• operation of vehicles, heavy equipment, and process controls
• regular night shifts (2400-0600 hours)
• emergency response roles
• type of personal protective equipment (PPE) required
• travel or foreign assignment (e.g. offshore, rotator)
• specific chemical, physical, or biological hazards
Relevant Medical Fitness Guidelines
Medical conditions relevant to safety sensitive positions:
o Canadian Medical Association Drivers Guide (2012)
o Canadian Council of Motor Transport Administrators (2013)
o Railway Association of Canada (2011)
Medical conditions relevant to emergency responders:
o National Fire Protection Association (2012)
Relevant Medical Fitness Guidelines
Medical conditions relevant to offshore positions:
• ILO/IMO (1997)
• Canadian Association of Petroleum Producers (2013)
• UK Offshore Oil and Gas Industry Association (2008)
• Transport Canada (2012)
Relevant Medical Fitness Guidelines
At the University of Calgary, we are developing an
on-line database that compiles and indexes, by medical
condition, the Canadian rail, motor, aviation, and marine
medical fitness guidelines …
… supplemented by clinical guidelines, citations from
indexed medical databases, and the gray literature.
http://www.ucalgary.ca/ftwguidelines/
Development of a Fitness to Work Protocol
Compile a list of medical conditions that are likely to impact
health, safety, performance in the job:
• Scope relevancy – is the medical condition relevant to the
employee’s work?
• Temporal relevancy – is the medical condition relevant to
the employee’s current fitness to work?
• Severity relevancy – is/was the medical condition severe
enough to pose a fitness to work concern?
Development of a Fitness to Work Protocol
• Identify the health history items, physical examination items,
and tests (singly or in combination) that best screen for each
medical condition = validity
• Compile the health history and physical examination items
into forms, provide testing recommendations, and identify
clinical resources for the examining physician = reliability
What about testing?
• Vision – acuity, colour (if relevant to the job)
• Blood and urine –high exertion, thermal stress, or
remote work … pre-placement vs. periodic exam
• Spirometry – SCBA/SA or asthma/COPD
• Audiometry – if using HPE or ‘noise exposed’
Remember … the screening component of
fitness to work assessment
… is a hunting trip, not a fishing trip.
Expectations
Expectations of the Candidate (Employee)
• provide an accurate history on certifying medical fitness
assessments
And while employed …
• notify their treating physician that they hold a safety
sensitive, offshore, or emergency response position
• notify OH of a worsening or new medical condition that
may impact medical fitness
Expectations of the Examining Physician
• Have qualifications or experience in the assessment
of fitness to work
• Be knowledgeable of the demands and working
conditions of the job
• Use appropriate clinical resources to assist
in the individual determination of medical fitness
Individual Clinical
Assessment
� for medical conditions that
may impact health, safety, or
performance for training,
travel, or work.
SCREENINGINDIVIDUAL
ASSESSMENT
� of medical conditions to
determine whether work
limitations or restrictions are
warranted
For each of an employee’s medical conditions, do
you need to:
• Undertake additional history and/or physical exam?
• Refer to relevant medical fitness standard?
• Discuss the case with a colleague?
• Request and review medical records?
• Refer for further assessment?
Request and review medical records
For offshore, safety sensitive, and remote positions, have
a low threshold for requesting recent medical records
that are relevant to fitness to work.
Develop standard templates, based on relevant medical
standards, to ensure you ask for the information
you need for a fitness opinion.
Request and review medical records for:
• Vision – glaucoma, cataracts
• Respiratory – asthma, COPD
• Cardiac – CAD, dysrhythmias, murmurs, abnormal ECG
• Epilepsy
• Mental Health – new medications, ‘major’ disorders
• Diabetes – insulin > oral medications
• Sleep studies or CPAP use
• Cancer – early remission
• Surgery – recent or upcoming procedures
• Medications – opioids, benzodiazapenes
Refer for further assessment
• Re-assessment of ongoing medical conditions
• High risk for specific undiagnosed conditions
e.g. sleep apnea
• Significant findings on screening (history, exam, tests)
… in most cases, referral is to the treating physician.
Fitness Opinion &
Employee Advice
Fitness Opinion
• Fit
• Fit with limitations or restrictions (specify, duration)
• Unfit (temporary or ‘permanent’)
• Pending review of further medical information
• Recommend a practical test prior to job assignment:
e.g. color vision, hearing of alarms/radio, mobility
… if not routinely assessed through training.
Health Advice and Follow-up
• Request supplemental medical reports? ( = medical
report required for a specific medical condition prior
to the next periodic medical assessment)
• Provide individual health advice and risk-based
education (duty to inform the person of results)
Program
Evaluation
FTW Program Evaluation
Input of key data for the purpose of individual tracking
and program evaluation (e.g. Medgate):
• profiles of demographics, health status, and risk factors
( = characterizing your employees as a population)
FTW Program Evaluation
• Efficiency of the assessment – can you reduce costs
and the time required for assessments, without
compromising validity?
• Effectiveness of the assessment - if an employee has
an illness, an injury, or a workplace incident within
the first year of employment, did (or should have) the
fitness assessment identified the ‘human factor’?
Discussion & Questions