Text For Citation: 01 Item/Group: 001 Hazard:

OSH ACT of 1970 Section (5)(a)(1): The employer did not furnish employment and a place of employment which was free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that the employer delayed evaluation, care, and/or treatment from a medical provider, which could result in health hazards such as, but not limited to, increased risk of infection, prolonged healing and/or scarring, exacerbation of pain, and limited recovery from work-related injuries/illnesses that required medical treatment. a) Throughout Facility - On or about May 22, 2015, an employee who was treated and/or evaluated at the onsite medical clinic for a hand laceration was exposed to health hazards such as, but not limited to, increased risk of infection, prolonged healing and/or scarring, exacerbation of pain, and limited recovery from injuries/illnesses that required medical treatment. b) Throughout Facility - On or about July 6, 2015 and at times prior to, an employee who was treated and/or evaluated at the onsite medical clinic for skin blisters on both hands, wrists, and forearms was exposed to health hazards such as, but not limited to, increased risk of infection, prolonged healing and/or scarring, exacerbation of pain, and limited recovery from injuries/illnesses that required medical treatment. Among other methods, some feasible and acceptable means of abatement to correct this hazard would be: 1. Establish and utilize protocols outlining clear roles for the nurse, physician, provider, and employer to follow. Such protocols should be developed as a collaboration between nursing staff and the physician and should follow Georgia Board of Nursing and Georgia Medical Practice Act standards and any applicable rules and regulations. 2. Implement the Georgia RN Scope of Practice Decision Tree as a guide in determining if an activity or a task is in his or her scope of practice as an RN (Georgia Registered Professional Nurse Practice Act O.C.G.A. 43-26-1). 3. Develop and utilize additional written clinical protocols that: a. Are up-to-date and evidence-based for common symptoms, complaints, or injuries/illnesses and are consistent with national standards and guidelines; b. Include written procedures for nursing triage to include when the physician/provider must be consulted, verbal/telephone orders, dispensing medications, referrals for offsite care, delegation of duties to unlicensed assistive personnel, appropriate documentation, and other duties as appropriate; c. Promote early referral for definitive diagnosis and medical treatment (e.g. to a physician, either or offsite); and d. Include early evaluation of workers? job duties and work station to prevent workers? returning jobs that aggravate their symptoms and injuries. 4. Provide training from a physician to educate the clinic staff and EHS Superintendents on triage of injuries/illnesses and when first aid is inappropriate (e.g. injury/illness requires treatment beyond first aid) and document the training. 5. Arrange a formal review and update of written protocols at least annually or more frequently if needed. It should ensure that the review is undertaken by a physician with formal training and/or certification in occupational medicine. 6. Include provisions in the physician?s contract that the Supervising Physician will have oversight over the RN to include reviewing an appropriate sampling of nursing notes (paper and electronic, e.g. OHM). 7. Include provision in the physician?s contract that the Supervising Physician will review, countersign with original signature, and date all verbal/telephone orders given to the nurse within a specified timeframe as well as all associated paper/electronic nursing notes. 8. Include provision in the physician?s contract that the Supervising Physician will review all notes resulting from referrals to off-site physicians within a specified timeframe.