Employee Health & Safety Tracking

Business problem
Health care organizations must ensure that workers directly involved with patient care are tested for tuberculosis exposure (PPD test). These workers must also have a respirator "fit test" to ensure that they know how to use the appropriate mask. Other immunizations, such as influenza, are joining the list of things that must be tracked for various groups of workers. The employee health department needed a tool to manage this process.

PPD Testing
There are three basic types of PPD tests:

• Initial
• Annual
• Post-exposure follow-up

Each type of test follows the same basic work flow, but with some differences, as described below. The first step is to look up the specific worker (not shown). Documenting the initial test begins as shown below.

The "Plant" and "Read" dates may be input or selected from a calendar (shown below).

The date is selected by clicking on the correct date on the pop-up calendar (shown below).

If the initial test is negative and a two-step test is not used, the documentation process is complete (shown below).

If a two-step test is used, and both results are negative, the documentation process is complete (shown below).

If either test is positive, additional fields are displayed for that test (shown for second test, below). If the X-ray result is normal, documentation process is complete.

If the X-ray result is abnormal, additional fields are displayed to document follow-up steps (shown below).

Annual PPD tests follow the same workflow as initial tests (positive test with abnormal result shown below).

Post-exposure follow-up also follows a similar workflow. The only significant difference is the addition of a two-month follow-up after the first test (shown below).

A complete history of PPD tests for the selected worker is displayed with one click (shown below).

Fit Testing
Respirator fit testing documentatin is handled in much the same way, by looking up a specific worker and either adding a new test or viewing prior tests (shown below).

All prior fit tests may be viewed with a single click (shown below).

When adding a new fit test, if the worker passed the medical evaluation, the tested respirator is selected (shown below).

If the worker passed the standard N95 fit test, the fit test date field is exposed (shown below) and can be completed either by inputting or selecting from pop-up calendar.

If the worker failed the standard N95 fit test, s/he was instead trained on the PAPR (Powered Air Purifying Respirator), and the training date is recorded (shown below).

If the worker failed the medical evaluation, the reasons are selected and the date input (shown below).

Department Eligibility
Not all departments need to have PPD or Fit testing. Only departments directly involved with patient care are required to have staff tested. Those departments are identified from a list of all departments in a maintenance page for this application (shown below).

Reporting
Selecting the eligible departments (shown above) makes it possible to run compliance reports listing the workers who need testing. A sample PPD testing report is shown below.

[Click the image above to see the full size image]

Exposure Tracking
Exposures of workers to infectious diseases occur at every health care facility. When an exposure occurs, it is essential to identify all exposed workers and track their health status and double-check immunizations.

The first step in adding a New Exposure (shown above) is to select the type of exposure (shown below) and the date of the primary exposure.

The second step is creating a list of exposed workers. One method is to look up individual workers by name (shown below).

This displays fields to record details about the exposure and follow-up for each worker (shown below).

Very often, multiple workers in one department are exposed. In that case, selecting the department from the list (shown above) displays a list of all workers in that department. All exposed workers from that department can be selected (shown below) and added in a batch for tracking.

Updating details about any previous exposure is simple. Just select the exposure from the list of previous exposures and add, delete or edit the details about the exposure and any exposed workers.

• Note: E-mails are sent to the supervisor of any worker with "Expected Followup Date" in the past and null "Follow-up complete," reminding the supervisor to have the worker contact employee health.

The list of exposure types can be maintained using a maintenance page in the application (shown below).

Permissions
There currently are four roles in this application:

• PPDTest-user has read-only access to PPD testing and Exposure Tracking.
• PPDTest-superuser has edit access for PPD data, Exposure Tracking, and department eligibility.
• FitTest-user has read-only access to Fit testing.
• FitTest-superuser has edit access for Fit testing and department eligibility.

Outcomes

• All three tracking modules (PPD, Fit and Exposures) work well. However, resource constraints have slowed full implementation by employee health.
• A new module to track flu immunizations for workers is planned.
• Automated reports showing compliance for the enterprise and by department are produced and loaded into the intranet every night.

Lessons learned

• Do what it takes to make an implementation successful. Employee health lacked the resources to input existing data into the new application, so IT arranged for a temp to input all existing data, removing a barrier to implementation.

Posted 9 August 2008