Doing it alone – Superman or something else?
I was flicking through random social media posts this week when I came open a video of a vet single-handedly performing a caesarean on a farm. This scene was set in history amid the COVID-19 pandemic, and the vet in question was, I assume, adhering faithfully to the social distancing guidelines set out by the relevant authorities. It unfolded that the farmers in this case were over 70, and so wrapped up safely in some cocoon or other, to the effect that this vet donned his red cape and knickers and duly performed the surgical procedure in object social distance from any form of help or support. I’ll be honest; I was not impressed. What’s more, the inclination of virtual friends and followers to congratulate him for his achievements caused me to worry just a little about the safety culture, or lack thereof, in the veterinary profession in general.
One of the issues that has received very little attention in the veterinary profession, in my opinion, is the health and safety of lone workers. Our profession is one in which workers are regularly asked to carry out their duties alone, or in the presence only of clients. Be it after-hours small animal calls into the clinic, or remote visits to farmyards, the risks associated with this type of work are undeniable. The Health and Safety Authority has defined lone workers as anyone who works by themselves without close or direct supervision, people who work outside of normal hours, and people who work away from a base. For vets, the risks for lone workers have generally been identified as the possibility of injury due to a lack of adequate help or restraint, and the risk of attack or assault.
The Veterinary Council of Ireland has outlined in the Code of Conduct for Veterinary Practitioners that we have a duty to comply with the provision of 24-hour care to our patients and has stipulated that we cannot reasonably refuse to provide emergency care when requested. It might be worth asking, from the perspective of lone worker health and safety, what exactly constitutes reasonable? Tending to animals away from the practice base, or alone in a hospital at night, can lead to foreseeable risk. An Australian survey of veterinary practices revealed that clinical work outside the practice base was associated with 55% of all injuries reported in practice. Of the cohort reporting injuries on farm, 38% said they did not take any safety precautions (such as restraint). I found this surprising. Does it allude to a cultural issue that exists within the profession? On further investigation into the reason why so many vets were willing to take risks with their own personal safety on farm visits, it arose that vet prioritise their duty to treat the animal above their own personal safety. Vets are willing to get hurt, even badly hurt, to ensure that they get the job done. I’ll be honest; I found that grim reading. Duty of care to your patient vs duty of care to your own safety (and that of the family at home that relies on you and needs you to be well) is what we are talking about here. It may well be time for a cultural shift within the profession.
Another substantial risk associated with lone working in veterinary practice is physical and verbal assault. Recent Canadian research documented that 2% of lone workers in veterinary practice reported being assaulted by a client over a five-year period, and 66% indicated said they had experienced verbal abuse from clients. A further Australian study concluded that conducting home visits and responding to emergency calls outside the practice could increase the likelihood of an attack. However, despite these documented risks to lone veterinary workers, there is little research into the issue in Ireland, and practically no formal guidelines as to how to address it. This absence of research and guidance, however, does not mean that veterinary practitioners themselves cannot take steps to address the issues.
Every veterinary practice in Ireland is governed by Section 19 of the Safety, Health and Welfare at Work Act 2005 requiring the employer to undertake a risk assessment, which will determine whether or not it is safe for an employee to work alone. As a desktop exercise in itself, this may not be of use, but formulating a lone working policy which is a living breathing document, drafted by the entire practice team, has the potential to change the fundamental safety culture of the practice. The process of doing a risk assessment and writing a safety statement is not as daunting as it sounds. Identify the hazards that exist which could cause harm to the lone worker, assess the degree of risk that the hazard actually poses, implement control or mitigatory measures for each of the risks, communicate with your staff and train them where necessary, have a procedure in place for documenting accidents or near misses, and review your safety plan regularly. In any safety policy, you will need to identify the parties involved and outline each person’s role. In a lone worker policy, you will need to outline to responsibilities of the employer in keeping the worker safe, but also identify the responsibilities of the employee in keeping himself safe. It is important that a veterinary practitioner is able to balance the requirements of his role with the needless risk-taking in what is a job at the end of the day.
When writing a lone worker policy for a veterinary practice, the following are control measures, or implementations, that I would include:
Management
Ensure that arrangements (time, resources, training requirements) are in place for identifying, evaluating and managing the risks associated with lone working
Identify accountability for the policy – identify the health and safety officer for the practice
Ensure there is the required awareness and training available on this Policy for all employees
Ensure that the hazards and risks associated with lone working are identified and assessed, and appropriate measures are put in place to eliminate, control or minimise the risk
Ensure that incidents involving lone workers are reported and managed in accordance with the Practice Lone Workers Policy and ensure that remedial measures identified through incident reviews are promptly implemented
Establish clear procedures to set limits as to what can and cannot be done whilst working alone and where appropriate, when to stop and seek advice
Ensure that lone workers receive enough information, training, instruction and supervision.
Regular reviews of arrangements to ensure that all measures are effective and continue to meet the requirements of the lone worker
Be aware of the range of employee support services available and advise employees of the services / supports available to them.
Employees
Take reasonable care to protect their own safety, health and welfare and that of others
Adhere to and apply this Policy any other safe systems of work and any associated risk assessments and risk controls
Co-operate with their employer.
Co-operate in the regular review of risk assessments and control measures
Attend relevant training as appropriate
Report any matters of concern in relation to lone working defects in equipment or the place of work and any unsafe systems of work to the line manager
Report accidents, incidents and near misses in line with the Safety Policy
Provide the line manager with personal details to include home address, mobile number, car registration make and model and next of kin details and advise of any changes to these details
Comply with all safety measures (e.g. lone worker systems /devices, buddy system etc), that have been introduced to protect the personal safety of lone workers.
The key to having a functional safety policy in a workplace is the inclusion of every single member of staff in its design. Communication between management and employees is so important in the efficient and happy running of a practice. The development of a lone workers policy is no different. Vets on call need to speak up about the issues around going on call at night or to an isolated place. Your employers will listen. In fact, in my experience managers welcome the input of their staff in the development of practice policies. So, let’s start developing lone worker policies as standard for veterinary practice in Ireland. According to the Veterinary Council of Ireland draft Strategic Plan 2019–2023, one of its main objectives is to support the health and wellbeing of registrants. Perhaps a useful contribution to the wellbeing of Irish vets would be to conduct some research into the risks associated with remote and lone working, and in particular the safety culture in the profession. Maybe it’s time to stop congratulating ourselves for doing bovine abdominal surgery singe-handily, and start taking better care of ourselves.
