3.2.02 Safety instruction, implementation and documentation

1 Aim and purpose

Definition of the group of addressees and the scope of safety instructions

- Goal 1: Bring employees up to a level of knowledge that enables them to recognise health hazards, enables them to work safely and puts them in a position to act correctly in the event of an emergency

- Objective 2: Refresh and update knowledge

- Goal 3: Present and practice correct behaviour

- Objective 4: Motivate employees to apply their knowledge in practice

- Objective 5: Cost savings through the avoidance of staff absences and loss events ("loss control")

- Goal 6: Fulfil legal and trade association requirements

2 Application

Managers in all areas who carry out safety instructions. Unless otherwise specified, these are the direct superiors.

3 Description

3.1 Basics

Supervisors are obliged to instruct their employees about hazards and protective measures at their workplace and to ensure correct behaviour at work. The instruction must be based on the results of the risk assessment and the proposed protective measures at the workplace (VA 3.02.13).

As part of the instruction

- Hazards of the workplace and work processes should be made clear. Experiences from accidents at work or near misses ("lucky breaks") or incidents should be taken into account (learning from incidents)

- Employees are informed about possible protective and necessary emergency measures by discussing safe working practices, such as the use of safe instruments or the correct handling of protective gloves

- correct behaviour is explained and practised and, if necessary, bad habits are eliminated

- discuss how to act in the event of accidents

- Experiences from practice - also from other areas and hospitals - are exchanged and suggestions on the current situation are discussed

- the relevant contents of the rules and regulations are explained

Every employee must be made aware of the responsibility they bear for their own occupational health and safety. In addition to their own behaviour, this responsibility includes handling work materials and equipment with care and protecting colleagues from avoidable hazards.
Instruction must be given by the direct supervisor or a person authorised by the supervisor before starting the respective activity. It must be adapted to new hazards and repeated regularly.
Operating instructions, operating manuals, service instructions and work instructions must be included here.

3.2 Instruction occasions

An instruction may be required:
- Recruitment or transfer of employees

- Change in working conditions e.g. new working methods, new working materials, changed work processes rarely occurring work

- Work assignments with particular risks to health and safety, e.g.
- Working with infectious materials
- Working with carcinogenic substances
- Lifting and carrying loads, e.g. of patients
- Work e.g. on ladders, scaffolding, on the roof or workplaces where there is a risk of falling
- Working with forklift trucks and pallet trucks

- an accident at work or a near-accident ("lucky break") or a damaging event

- New or amended statutory or trade association regulations and rules, e.g. Hazardous Substances Ordinance, Workplace Ordinance, Technical Rule for Biological Agents (TRBA) 250, BGW brochure "Risk of virus infection" (safe instruments)

- Deficiencies identified by checking the effectiveness of defined protective measures e.g. employee misconduct

3.3 Types of instruction

The instructions required by law and the regulations of the employers' liability insurance association are summarised in Appendix 1. The checklist is intended to serve as a guide for the deputy managing director responsible for occupational health and safety at St. Katharinen-Hospital. In practice, the checklist must be adapted to the situation in the hospital.ßß The following types of instruction are relevant for the hospital:

3.3.1 Initial instruction

New entrants and newly recruited employees can usually only be assumed to have limited prior knowledge. Even new employees with professional experience may not be familiar with the specific working procedures in the hospital, regulations or measures to maintain health.

An employee has to find his way around his area. They therefore need information and explanations when

- Introduction of new processes, machines, materials or devices

- Changes in the area of responsibility, e.g. when changing jobs

- Changes in the work processes

3.3.2 Instruction of employees of external companies

Employees of external companies must be instructed in the general regulations on occupational health and safety of the hospital, e.g. cleaning companies (see VA 3.2.22) or in the specific regulations of the work order, e.g. on the permit (see VA 3.2.16).
The instruction should be given by the direct supervisor of the external company. The hospital contact person named in the work order, e.g. the occupational safety specialist or a person authorised by them, must be satisfied that the instruction has been given.

3.3.3 Instruction for cause

In the event of errors, undesirable behaviour, accidents at work or incidents, instructions should be repeated or specific instructions issued. The instruction consists of a request for correct behaviour or a reprimand if the analysis of the accident/incident reveals a deliberate violation of the agreed health and safety regulations of the hospital.

3.3.4 Repeat instructions

Instruction should generally be repeated annually if the hazards remain the same. Some special occupational health and safety regulations stipulate a six-monthly instruction interval, e.g. the Radiation Protection Ordinance and the Youth Labour Protection Act.

It is not necessary to discuss the entire breadth of a topic every year. The focus should be alternated. A training plan should be drawn up for this purpose. For example, it is not necessary to discuss all hazardous substances in the area from scratch every year, but it is advisable to focus on specific topics, e.g. disinfectants or cleaning agents or cytostatics, and to document this in a (see Appendix 4).

Such a briefing does not need to last longer than 15 minutes as part of a team meeting. It is important to keep the topic of hazardous substances up to date.

3.3.5 Instruction on special topics

These include:

- Questions requiring clarification and information from employees on occupational health and safety

- Information on new occupational health and safety regulations

- Personal protective equipment for certain activities, which includes not only protective gloves, but also, for example, safe shoes (closed, impact-resistant, non-slip) and fall protection in the technical area.

- Analysing the causes of occupational accidents or near misses

- Back-friendly working, e.g. as part of a back training programme

- Handling hazardous substances or machines and equipment new to the area, e.g. kitchen appliances

- Introduction of new work processes

- Mental strain/stress

- Occupational health care/vaccinations

- Passenger transport e.g. transport of patients in care beds

- Special instructions for driving company cars e.g. commissioning Further examples of possible instruction topics are summarised in Appendix 6.

3.3.6 Instruction on hazardous work

Work involving special hazards, which may require a work permit, requires special instruction. Every work permit must be explained to the person carrying out the work on site. Such work may include

- Behaviour during troubleshooting/repair or maintenance work during which protective devices are removed

- Behaviour during fire work (welding, soldering, grinding and cutting work)

- Behaviour at workplaces at height
- Working on edge of falls, scaffolding
- Working on lifting platforms
- Slinging loads

3.4 Methodological notes

Safety instructions in occupational health and safety should be given verbally by the direct supervisor, e.g. the ward manager or head of the functional area, or by an expert, e.g. the radiation protection officer. They must always be workplace-related, which means that they should not be abstract instructions but practical explanations.

Where appropriate, the explanations should be practised in exercises, e.g. lifting patients, fire extinguisher training, etc. A training session should generally not exceed 30 minutes, as this would overtax the participants' ability to absorb and concentrate.

If possible, the number of participants should be limited to 15 for sector-related topics and should not exceed 30 for cross-sectoral topics, e.g. radiation protection.

Wherever possible, the participants should be selected in such a way that the training topics are of equal importance to everyone.

Successful health and safety training
- actively involves the participants

- takes place "on site" e.g. in the ward room

- addresses the specific workplace-related hazards

- explains the protective measures to be observed and taken

- explains the legal basis

3.5 Forms of instruction

3.5.1 Teaching dialogue

Safety training does not have to be organised as a separate event. The departments are recommended to integrate department-specific training topics, e.g. on the subject of hazardous substances, into the team meetings of the individual care and functional areas as fixed agenda items. The discussion between the supervisor and their employees should take centre stage. This method essentially aims to achieve the following objectives:

- Raising awareness of hazards

- Developing safe and healthy behaviours

- Consistent application through jointly concluded agreements

3.5.2 Lecture

Lectures have the least learning effect and should therefore be avoided as a method of instruction.

An exception may be the instruction of cross-departmental topics by an expert, e.g. the radiation protection officer on radiation protection or the hospital pharmacist on the safe handling of cytostatics or the fire safety officer on preventive fire protection or the hospital's alarm plan.

3.5.3 Individual instruction

Individual instructions in private are generally required for initial instructions, for instructions that serve to familiarise employees with the workplace or for instructions that are of an individual nature following errors or misconduct. Such instructions should take place behind closed doors.

3.5.4 Group work

The method of group work has proven its worth in the development of new or updating of existing rules or measures. This includes, for example, the development of new and updating of existing care standards, whereby attention should be paid to the integration of occupational health and safety into the standards.

In this way, the employees concerned in an area should also define the protective measures for the hazards identified in the risk analysis at the workplaces in the area itself (see VA 3.2.13).

3.5.5 Exercises

Practical exercises have the greatest learning effect and should therefore be carried out wherever possible, e.g. transferring a patient from a wheelchair to a care bed, operating lifts, transporting patients in care beds, handling fire extinguishers, handling personal protective equipment, handling disinfectants or cytostatics.

3.6 Instruction plan

The relevant instruction topics should be assigned to the individual team meeting dates with the help of an area-related instruction plan (see Appendix 5 for a sample). This has the advantage that the employees can prepare for the respective instruction topic and actively participate in the discussion. Furthermore, no additional meeting organisation is required.

3.7 Rules of conduct for the instructor

The instructor should observe the following points when carrying out the instruction:

- stick to the facts

- recognise the professional competence of employees

- Allow employees to have weaknesses

- Let the employees finish speaking

- actively listen to employees

- request employees to make statements

- not always just talking yourself

- Do not stifle uncomfortable questions

- Always respond to employees' comments

3.8 Proof of instruction

The supervisor of an area must ensure that all employees have participated in the individual training topics and can provide evidence of this.

A written record must therefore be kept of the instructions given, stating the topic of the instruction, the name of the instructor, the date of the instruction, a brief description of the content of the instruction and the names and signatures of the participants.

An example of a form for initial instructions is attached as Annex 2, a form for repeat instructions as Annex 3 and a form for the instruction of external company employees as Annex 4.

Supervisors are recommended to regularly obtain an overview of the status of instructions using an overview table (sample Appendix 7) so that they can recognise in good time whether employees have missed instructions, e.g. due to illness, holiday, change of shift plan, etc. instructions have been missed. These employees must be instructed separately. This can be done

- in the form of additional appointments or

- by staggering the training topics with other areas/wards, e.g. nursing wards A1 to A 11. This saves time and can be easily achieved by exchanging training plans or publishing them on the hospital intranet

3.9 Performance review

It is important for the success of a training programme to check whether the intended objectives have been achieved.

For the objectives mentioned at the beginning, this can be done, for example, by the supervisor observing behaviour in the workplace, by the supervisor talking to employees in the workplace or by evaluating patient praise or complaints. The supervisor's behaviour should be included in the performance review, as their role model is of crucial importance for the motivation of their employees. They should set an example of what is required of them.

4 Documentation

Instruction plan
Proof of instruction must be kept for two years.
Checklist of instructions
Overview of instruction/instruction/exercise

5 Resources

Training room
Media equipment (laptop, projector, overhead film device, screen, flipchart, index cards, felt-tip pens, etc.)
Time required by lecturers
Time required Participants

6 Responsibility, qualification

If possible, train lecturers/supervisors in rhetoric and presentation techniques

7 Notes and comments

This procedural instruction has legal relevance and should be submitted to the in-house lawyer for approval.

8 Applicable documents

8.1 Literature

Legal and trade association regulations see Appendix 1 BGW guide RGM 8 "Instruction in operational practice" Trade association information brochure BGI 527 "Safety through instruction"

8.2 Terms

Instruction Instruction is the management's explanation and instruction of employees' safety-compliant behaviour, geared to the specific workplace or area of responsibility. Special danger The term "special hazard" refers to a situation in which damage is very likely to occur without additional protective measures.

Creation date: July 2008 Creator: Stuch/Dr.Böhm

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