Transcript Successful Occupational Health case studies

Occupational Health
Successful Case Histories
Lara Carmel (Head of Workplace Health and Wellbeing)
Sarah Lyster (Occupational Health Advisor)
Wednesday 25th March 2015
Myths regarding MSK injury
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Muscle or joint pain = Serious Injury.
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Work / Activity is the cause
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Time off work is needed as part of the treatment
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Cannot return to work until 100% pain free
Myth Busting
By Occupational Health Professionals and advisors post
assessment:
• Hurt does not equal harm
• MSK problems are common in all populations and rarely
caused by work
• Often sick leave is not required and temporary work
accommodation is usually sufficient.
• Activity leads to faster and more sustained recovery.
• MSK Conditions are rarely made worse by continuing to
work.
The risks of not Myth Busting
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Employee continues to believe that work is the cause of his
pain.
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Employee believes permanent avoidance of certain tasks
is the key to recovery.
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There can be permanent sometimes unnecessary
exclusion from certain tasks
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The employee does not return to full duties
Cognitive Behavioural Therapy CBT:
• The way patient feels about their pain affects how they feel
and subsequently behave.
• Poor Management will lead to further disability and
potentially increase pain
• Use a CBT approach to identify unhelpful thoughts and help
patient’s come out of their vicious cycles of disability.
Management Pathway
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Support Employee from day one
Manage in work on as near to normal duties as possible.
Encourage Self Management
If RTW goals not hit reassess regularly.
If no improvements in the first week refer
• Ensure line manager talks to person about workload/ tasks/
schedules to identify how employee maybe maintained in
work.
Case Study: Fred
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49 Year Old Male
Tripped over crate at work
I’ve damaged my back
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Line Manager keen to say
(Don’t come back till you are 100% fit)
GP
• Fred has pulled a muscle
• Not surprising he has a manual job
• He needs rest and stay off work
• Sick note for 2 weeks
2 Weeks Later
• No one has bothered to contact me from work
• GP has said pain should be settling by now
• Must be more serious than I thought
3 Weeks Later
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Chiropractor took an X-ray which showed severe wear and
tear in my spine. He was surprised that I had not suffered
severe pain before.
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He says I will need regular re-alignment throughout my life
due to a misalignment of my spine.
4 Weeks Later
• I was so fed up with resting so did some digging
• I only did one hour but I was in agony
• Since then I have been in bed taking more painkillers
• My uncle had pain like mine and he ended up in a
wheelchair.
• Is it Genetic?
• Pain is a warning sign to damage so I’d better not do any
exercise.
GP
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Fred is making too much of his back. He is now walking
around like a stick of rock. I have prescribed some antiinflammatories and signed him off again.
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Fred’s Wife
I am very concerned about Fred, we had to turn down a
meal with neighbours as he can’t sit for long and is
embarrassed. I am doing everything at home. Something
needs to be done urgently
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Occupational Health
We have become aware that Fred is off sick. He tells us
his GP is very concerned and doesn’t think that he will be
back for some time.
8 Weeks Later
• The Chiropractor says I am too bad and he can’t help me
any further, He says my job has a lot to answer for.
• I've been on the internet. The advice is helpful but I am also
worried that I may have cancer.
• Someone saw me out shopping and now my manager thinks
I’m swinging the lead.
Twenty Weeks Later
Fred’s Wife:
• I may have to give up my job to look after Fred
Fred:
• At last I saw a surgeon today and he has ordered a scan.
• My X-ray show that I have something called Spondylosis and
that my spine is crumbling.
• What will I be like in ten years?
Twenty Four Weeks Later
Fred’s Wife
• Fred is getting into a nice routine and beginning to accept he
will not go back to work
• Work needs to medically retire him so that we can get on
with our lives.
OH Rehab Pathway
All parties at all times should:
• Promote a stay at work culture
• Use workplace as site for effective rehabilitation
• Adopt health promotion role
• Encourage employees to help themselves maintaining
activity
• Ensure risk assessments are up to date
• Encourage all staff to think of recovery time in terms of days
and weeks not months.
GPs identified 4 key factors in their involvement
in RTW:
• Preserving the doctor patient relationship was paramount
• There was a perceived conflict between obligations to
patients and their employer or the benefits system
• Shortage of time and OH expertise
• Some GPs felt it was their role to concentrate on treatment
Phased RTW
• What are light duties?
• Phased RTW
• Functional
• Relevant to normal job
• Incremental manageable increase in duties reducing the
physical and psychological anxiety related to each task
OH Role in facilitating
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Number of shifts
Time on shifts
Time on tasks
Alternating tasks
Number of rest breaks
• Offering a buddy system
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Number of repetitions
Depth of bend/lift
Height / length of stretch
Decrease / Increase weight
• Early OH interventions is essential
Notes on the FITNOTE
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Information on the statement is advice to the patient and is not binding to the
employer.
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It recognises that GPs have little or no training in Occupational Health.
Therefore their advice is general only.
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The member of staff, manager, HR & OH should discuss how RTW will be
managed.
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The advice on the statement is not binding to the employer who may take
advice from an Occupational Health Professional.
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A final fit note is not required before the employee can return to work.
CBT
CBT 5 Systems
Environment
Thoughts
Emotions
Behaviours
Physiology
CBT Steve
Environment
CBT 5 Systems
Accident at work 3 months ago
Given different information from
health practitoners
Relationship with wife deteriorating
Employers not been in touch
Physiology
Low back pain
Poor Sleep
Emotions
Worry about back worsening
Mood Worsened
Snappy
Low
Fear of Losing Job
Thoughts
I can’t return to work yet because of
my pain
I can’t do my normal hobbies
Beliefs about needing to be 100% fit
before going to work
Beliefs about Pain being bad
I might loose my job
Beliefs that he has no transferable
skills
I need to protect my back from
damage
If I rest when I am in pain it will
protect my back
I will damage my back if I over do it
and will never be able to work again
Behaviours
Seen by GP, PT, OH Nurse
Sickness Absence
Stopped going to the gym
Stopped normal hobbies
Stopping and resting when in pain
Protecting back
Resting
Cautious Movements
CBT Cathy
Environment
CBT 5 Systems
New role in University
Finance Problems
New Flat
New Relationship
Physiology
Thoughts
Worried about debt can’t pay
Worried will lose flat
Can’t pay bills
Should not have been promoted
I might lose my job if make
mistake
Everyone thinks I’m hopeless
Ibs
Headaches
Sleep deprivation
Feeling tired all the time
Emotions
Tearful
Anxious
Short Tempered
Behaviours
Getting in Early
Staying late
Not going out
Takeaways
Not going to gym
Taking odd days out
Occupational Health
Occupational Health Service
General Enquiries
Tel: 01206 872399
Email: [email protected]
Room 3.109
Lara Carmel
Head of Workplace Health & Well being
Tel: 3793
Email: lcarmel
Sarah Lyster
Occupational Health Advisor
Tel: 4129
Email: slyster
Kate Shawcross
Occupational Health Assistant
Part-time: Monday - Wednesday
Tel: 2399
Email: kshawc
Carol Pengelly
Occupational Health Administrator
Part-time: Thursday - Friday
Tel: 2399
Email: cdpeng
Chloe Oddi
Occupational Health Administrator HHS
Part-time: Tuesday – Thursday
Tel: 07775003932 (Students)
Email: coddi