Is your practice as safe as it needs to be? When Congress created the Occupational Safety and Health Administration (OSHA) in 1971, the intent was to decrease the number of workplace injuries, illnesses and deaths. In 1999, there were over 5.7 million occupational injuries and illnesses in the United States. Approximately 6.3 employees out of every 100 experienced a job-related injury or illness.
All medical practices are expected to comply with the regulations regardless of the number of employees. Some of the critical areas emphasized over the years include injury and illness prevention, employees’ right to know about hazardous material, bloodborne pathogen protection and repetitive stress injuries. The current OSHA focus includes emergency preparedness and preventing workplace violence.
Although there are a number of ways of making sure you are complaint, I have distilled them into eight key steps for compliance.

Review The Regulations
1. Know the regulations. The laws are written with the expectation that business owners know the requirements for compliance. Keep in mind that some states have recognized OSHA programs that might be more stringent than the federal requirements. The rule that applies is the more stringent law, regardless if it is from the state or the federal government.
The U.S. Department of Labor is the parent agency that administers the OSHA program. The Web site www.osha.gov has a wealth of information, including numerous publications that you can either download or purchase from the agency. Some of the more relevant publications for healthcare include:
• Blood Borne Pathogens and Acute Care Facilities (Publication 3128)
• Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers (Publication 3148)
• How to Prevent Needle Stick Injuries (Publication 3161)
OSHA also has produced a number of online web-based education programs. The most relevant would be the OSHA eTool program for hospital staff. You can find the list of these programs at www.osha.gov/dts/osta/oshasoft/index.html.

Make Sure All Staff Have Appropriate Safety Training
2. Perform workplace orientation for each new employee. The law requires that all employees are properly oriented to their work environment. This orientation will vary with the job description. Obviously, a receptionist would have a slightly different orientation (and different work place injury or illness risks) than a back office person. One problem that commonly occurs is when a longtime employee moves from the front office into the back office, but never receives the back office orientation.
3. Perform annual OSHA training for all staff. There is wide flexibility in how this can be accomplished. You can opt for an in-service format, videotape training, a CD-ROM or Internet-based education. There are numerous companies that produce these types of educational material. As previously mentioned, the federal OSHA program has developed Web-based training courses that could assist small businesses.
There should also be some sort of post-training quiz and evidence to prove that education was provided to the staff. One can store the evidence of education document in individual employee files or in an education binder that can be pulled out for review in the case of an OSHA audit.

Are You Monitoring Your Own Compliance?
4. Review your safety plan, policies and procedures regularly. In many of the facilities that I visit, policies and procedure manuals are covered with a thick coat of dust over the cellophane wrapper. These facilities purchase template or “canned” manuals, but fail to update or tailor the information for their practice.
The expectation is that your safety, injury and illness prevention plan, policies and procedures should be reviewed once a year for currency. Your binder of Material Safety Data Sheets (MSDS) of all the hazardous materials in your office as well as the inventory sheet at the front of the binder should be reviewed on a regular basis. Any new material deemed hazardous by OSHA needs to have a MSDS and this documentation needs to be readily accessible to staff in the event of an exposure. However, pharmaceuticals that are kept in their original containers do not require a MSDS.
Consider having different members of the management team review these documents just to help familiarize everyone with the components of your program.
5. Perform regular safety audits of your practice. Part of ensuring compliance is the process of periodically reviewing your practice’s compliance with the regulations. Some of these elements would include checking the MSD sheets, the OSHA log 300 posting for the month of February, and federal- and state-required posters. You do not have to be a veteran safety consultant to recognize that blocked fire exits and numerous power strips attached to one outlet are not safe practices.
You might consider making arrangements with the safety officer from the hospital or surgery center to inspect your practice for safety. There are numerous consultants available who can also perform this service. For an idea of the essential safety equipment and processes you should be checking, see “A Guide To Conducting An Office Safety Audit.”
6. Have a process for reporting safety-related incidents. If there is a workplace injury, make sure the employee is taken care of immediately. As a practice owner, you do have a direct say in where the staff member goes for workplace injury care. Have a process in place for staff to notify you if there is an injury in the workplace. If there is a serious injury or death as a result of the workplace injury, that might require reporting to the local OSHA office.
After the incident, it would be to your advantage to perform a root cause analysis (RCA) to determine what caused the accident. Root cause analysis is an engineering term that is used to investigate the reason why an adverse event occurs. The concept has been applied in aviation and healthcare to get to the specific root causes of an accident. Many times we blame the staff, but sometimes we can find other contributing factors, such as malfunctioning equipment, inadequate lighting or ventilation, inadequate staff orientation or training, or improper storage of material.

Seek Advice On How To Reduce Your Risk
7. Consider taking advantage of the OSHA consultation program. This program is funded to assist businesses in obtaining free or low-cost consultation from federal or state OSHA departments. The intent of the program is to provide reviews of OSHA programs for compliance. The advantage of the program is you are not only getting an accurate assessment of your practice, but the consultation will also provide guidance on how to comply.
8. Work with your general liability and worker compensation carriers. In the event of a workplace injury, you will have to engage your worker compensation carrier and, sometimes, your general liability insurance carrier. The insurance carrier has risk management departments that can provide education to the insured on ways of preventing problems. Once an incident has occurred, working with the insurance company will be important to manage the employee’s injury properly and within the scope of the law.

In Conclusion
Ultimately, the intent of the OSHA program is to ensure that all employees are working in a safe environment. As a practice owner, your responsibility is to make sure that occurs and that you are compliant with the law. With the eight steps I have outlined in this article, you should be well on your way to compliance.

Dr. Chinn is the Chief Compliance Officer and Director of Performance Improvement and Risk Management at the Fremont Hospital in Fremont, Calif. He is a Certified Professional in Healthcare Risk Management by the American Hospital Association. Dr. Chinn is also a JCAHO hospital surveyor and a consultant for Apex Healthcare Consulting Group, Inc. in Millbrae, Calif. He can be reached at sdchinn1@aol.com or (650) 652-7943.