Pregnancy Risk Assessments

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Pregnancy Risk Assessments

• Vanessa Davies
• Head of Occupational Health
• Hywel Dda NHS Trust
• Carmarthen

RCN UK Safety Representative Conference October
2011
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Personal history

• Head of OH for Hywel Dda Health Board
• Joint Chair of Welsh NHS OH Forum for 6 years
• Twelve years OH experience both in and outside of
  NHS
• Awarded by RCN Best OH Nurse 2006

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How do you become a occupational health nurse?

• Usually by accident

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Qualifications

• Minimum Registered Nurse (Adults)
• Occupational Health qualification, i.e. Diploma
  or Degree in OH, ideally Specialist Practitioner
  qualification
• Masters for nurse managers
• Essential A sense of humour
• together with lots of life skills
• experience!

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What is Occupational Health..

• DEFINITION Occupational Health is the promotion
  and maintenance of the highest degree of
  physical, mental and social well-being of workers
  in all occupations by preventing departures from
  health, controlling risks and the adaptation of
  work to people, and people to their jobs.
  (ILO/WHO 1950)

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That is the accepted definition, what do we do?

• We are advisors on just about everything that
  relates to people and their jobs.
• What ever job that may be
• And that includes any
• employee who becomes pregnant!

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Initially.

• Lets confirm the obvious..
• Pregnancy, just had a baby or breastfeeding are
  not illnesses!!
• It is a perfectly normal event, however.

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Pregnancy risk assessment

• The legal responsibility for health and safety
  rests primarily with the employer

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Pregnancy risk assessment

• Aims of today's workshop
• To provide a brief overview of pertinent
  legislation
• Provide an opportunity to explore the issues
  relevant to you?
• Conclude by identifying a framework for PRA

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First thing. Lets start by

• Form groups in 5 10 minutes
• Identify the present practice in relation to
  pregnancy risk assessment in your organisation
• Identify what works?
• Identify what are the
• problems?

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Relevant legislation /Directives

• Equality Act 2010
• European Directive
• Management of Health and Safety at Work
  Regulations Health and Safety at Work etc Act
  1999
• Control of Substances Hazardous to Health
  regulations
• Employment rights Act 1996

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To whom do the regulations apply?

• Any woman who is, or in the future could be, a
  new or expectant mother
• Which is women of child bearing age
• who are or in the future could be
• pregnant, have given birth within
• the previous six months, or are
• breastfeeding (HSE, 2004)
• Given birth
• is defined in MHSW Regs as delivered a living
  child or, after 24 weeks of pregnancy, a
  stillborn child

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Equality Act 2010Pregnancy and maternity
discrimination work cases

• Section 19(5) identifies
• A person discriminates against a woman if in the
  protected period in relation to a pregnancy of
  hers, A treats her unfavourably
• Because of the pregnancy, or
• Because of illness suffered by her as a result of
  it
• Because she is on compulsory maternity leave
• Is seeking or has exercised the right to ordinary
  or additional maternity leave

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Management of Health and Safety at Work
Regulations 1999

• These require an assessment of risk
• Where there are persons in an undertaking which
  include women of child bearing age and
• The work is of a kind which could involve risk by
  reason of her condition, to the health and safety
  of a new or expectant mother, or to that of her
  baby, from any processes or working conditions,
  or physical, biological or chemical agents to
  encourage improvements in the safety and health
  at work of pregnant workers and workers that have
  recently given birth or are breastfeeding..
  (Management of Health and Safety _at_ work, 1999)

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What does that mean

• Management of Health and Safety at Work
  Regulations 1999
• by regulation 3 (1)
• an assessment of such risk
• Which is part of routine occupational health
  surveillance

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health surveillance is.

• Identification and assessment of the risks from
  health hazards in the workplace. Which involves
  surveillance of the factors in the working
  environment and working practices which may
  affect the workers health. It also requires a
  systematic approach to the analysis of
  occupational accidents and occupational diseases
  ILO 1985

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What do you need to do?

• A competent person is required to undertake a
  risk assessment!
• In most organisations that is not the OH nurse or
  the HS manager, however most managers are always
  a little apprehensive of undertaking the
  assessment!

Stage one- initial assessment NO

Yes
Are there any hazards present?
Inform employee of outcome
Assess risks, reduce or remove if possible
This is a good place to start HSEs guidance
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On notification of pregnancy

• Specific risk assessment
• NO YES
  Yes
  
  
  
  
  
• No
• Yes
  
  
  
  
  
  
  No
• No
  yes

Has a risk been identified
Can the risk be removed
Remove the risk
Monitor and review
Action 1 Can the mothers hours/conditions of
work be adjusted
Adjust conditions /hours
Give suitable alternative work on same terms and
conditions
Action 3 Suspend her from work on paid leave for
as long as necessary to protect her or/ child
Action 2 Can she be given suitable alternative
work
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Health surveillance

• The range of
• potential hazards
• risks to
• health is truly
• awesome
• in a NHS environment..
• There are the
• obvious.

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And the not so obvious

• Chemicals use and storage
• Workload, demands and stress
• Working relationships
• Environmental risks
• Manual handling of people and objects
• Aggression and violence
• Radiology
• Infection control issues..

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How are the hazards identified.

• Epidemiological evidence, we know some products
  have been found to be potentially hazardous to
  health and that their use needs to monitored
• Annual health surveillance programmes to look at
  respiratory sensitizers and other hazards
• Health issues identified during day to day
  collaboration between different agencies in the
  Health Board i.e. Health and safety manager,
  infection control department, the staff or a
  manager raises a concern

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The European directive lists the following
hazards

• Physical risks
• Movements postures
• Manual handling
• Shocks and vibrations
• Noise
• Radiation
• Chemical agents
• Toxic
• Mercury
• Cytotoxic drugs
• Biological agents
• Infection

• Working conditions
• Facilities
• Mental/physical fatigue
• Stress (inc postnatal depression)
• Temperature
• Working with visual display units
• Working alone
• Travelling
• Violence
• Working and PPE
• nutrition

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• Please form groups and for about 10 minutes
  consider the following scenarios!

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How are they managed.

• For the pregnant, newly delivered or breast
  feeding woman
• There are the responsibilities
• of the
• Employer
• employee

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Employee

• To notify the employer that she is pregnant,
  newly delivered or breastfeeding
• Or
• Advise further if she continues to breastfeed
  beyond six months
• May need to provide certificate from midwife or
  general practitioner

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Employer responsibilities

• To ensure that appropriate and current policies
  related to staff health and safety are formulated
  and implemented
• Competent person to undertake the risk assessment
  to identify hazards ideally in collaboration with
  the employee
• To implement any adjustments to address any
  identified hazards

• The employee should be offered a health
  assessment during her pregnancy
• Re-evaluate any risk assessments if there are any
  changes
• When an employee is breastfeeding, the employer
  should ensure she has access to appropriate
  facilities and be protected from identified
  hazards
• If in doubt then contact your occupational health
  service

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Employer Management of health and safety
regulations 1999

• If following risk assessment, these hazards
  cannot be avoided, the employer will need to
• Alter working conditions or hours of work, if not
• Identify and offer suitable alternative work, if
  not then the employee is to be suspended on full
  paid leave from work!

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Special considerations..

• Breastfeeding
• Provide appropriate rest areas for pregnant
  employees
• Recommended to provide an appropriate environment
  for mothers to express and store milk

• Night work
• any new or expectant mother who works at night,
  who has a medical certificate stating that night
  work could affect her health and safety
• Offer suitable alternative daytime work or
• Suspend her from work, on paid leave as long as
  is necessary to protect her health and safety
• If the risk arises from work!

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The Management of Health Safety at Work
Regulations 1992 and 1999 specify these
responsibilities

• All employers have a statutory responsibility
  under Section 2 (1) of the Health and Safety at
  Work Act (1974) 1 to create as safe an
  environment as is reasonably possible.

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Summary

• The relevant legislation requires
• Safe environment for pregnant employees
• Ensured by a risk assessment undertaken by
  competent person
• If suitable adjustments or an alternative role
  cannot be identified, suspend on full pay
• Documented and evaluated as needed by responsible
  manager

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Any questions.?
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References

• HSE (1992) Management of health and safety at
  work, management of health and safety regulations
  1999 Approved code of practice and guidance, HSE
• HSE (2002) New and Expectant mothers at work. HSE
• Lubick, N (2011) Advising parents in the face of
  scientific uncertainty An Environmental Health
  Dilemma. Environmental Science and Technology,
  Nature and Earth
• HSE Biological agents Managing the risks in
  laboratories and healthcare premises The
  advisory Committee on dangerous pathogens