Evaluations of health hazards in two care settings.

University Degree Subjects allied to Medicine

Dealing with

health, hazards and emergencies.

HOSPITAL WARD

My first care setting is an Adult Medical Ward in Stepping Hill Hospital, Stockport. It has twenty-five beds, which are usually full. The clients’ ages range from eighteen upward. Older people (70+) are the majority of the clients received by this ward.

Clients also vary in physical ability from completely immobile to amputees, stroke victims, unsteady and slow, to completely mobile. Another factor, which requires consideration, is the intellectual ability. For example, those with learning difficulties, impaired hearing, resulting in poor communication, confused clients from either illness or medication to these who are lucid and orientated. Being an Adult Ward certain presumptions are made with regards to intelligence and common sense, for example, plug sockets are not covered with safety caps as you may find on a Children’s Ward or nursery. However there are many other obvious and subtle risks present.

RISKS AND HAZARDS (ON HOSPITAL WARD)

Slippery Floors.

Due to hygienic lino flooring.

Due to spilt fluids.

Burns.

Due to hot drinks.

Due to hot food.

Due to cleaning chemicals.

Due to very hot water for cleaning to prevent cross infection which however increases the risks of burns.

Risk of Falls.

Cross Infection.

Drug Misuse.

Drugs sometimes left next to patient’s beds.

Notice Board above Bed.

Get well cards attached with drawing pins presenting further hazards.

Electrocution.

Vases of water stood next to electrical equipment.
Risk of faulty electrical equipment.

Risk of Fire.

Shelves in Day Room.

Overfilled and books are stored unsafely.

Shelves are wall mounted with chairs below presenting another series of hazards.

HAZARDS IN DEPTH.

Falls.

With the majority of clients being elderly, they are more likely to be unsteady on their feet and may suffer from giddy or dizzy spells. They are also more likely to have failing or poor eyesight. They cannot often turn quickly and when they do, they can momentarily lose their balance. They are particularly prone to falls as they are less likely to be able to steady themselves if they trip over an obstacle in their path. Older people are also more likely to suffer injury (particularly fractures) as their bones are more brittle.

Risks and Causes.

A large number of people and equipment in one place.

Bags of belongings lying around.

Patients clothing i.e. trousers too long, dressing gown belts.

Telephone cables across the floor.

Variety of equipment and furniture obstructing walkways.

Leads and cables from air mattresses and equipment lying on the floor.

Unstable furniture.

Mobility aids obstructing walkways and bedsides.

Bathrooms, showers and toilets inevitably wet and damp creating slippery surfaces: a dramatic increase of risks presented due to confined spaces and hard surfaces, i.e. sinks, baths, taps, toilet roll holders etc.

I.V. stands.

Dinamaps.

Visitor’s chairs or client’s chairs.

Clients personal ability.

Visitors and their belongings, i.e. handbags and coats.

Children visiting.

Broken or uneven flooring.

Inadequate footwear, socks or barefoot.

Poor lighting at night.

Unfamiliar surroundings.

PREVENTATIVE MEASURES.

(including strengths, weaknesses and suggested improvements.)

Although attempts can be made to limit and prevent hazards, a balance has to be struck. The best solution to one hazard can often create a myriad of other hazards.

Assess amount of support required for safe mobility and ensures (if required) it is provided. Care plans are drawn up on admission to the wards with questions relating to usual mobility, current mobility and support required, this is easily accessed by all care staff, which gives a (legal document) clear idea of client potential. This however is not entirely reliable as clients needs and abilities can change dramatically in a short period of time. I would suggest where possible consulting client of personal feelings of mobility. This also has weaknesses because clients may think they are stronger than they are, may be confused and could lie in order to be discharged earlier or to show how capable they think they are.

The use of correct footwear (non-slip soles on shoes/slippers and low heels) should prevent falls due to improper footwear. In case of the client not having the correct footwear, they should have bare feet. With the client having bare feet it opens further potential hazards of heightened risk of falls, cuts from any sharp objects, cross infection hazard increased and potential to pick up infection.

Cot sides can prove useful with a client who is prone to fits, immobile or disorientated and can prevent falls effectively however can create bedside clutter and limit access to the client. When not in use they are big, heavy and difficult to store often presenting further risks and hazards. The effect of cot sides to a client’s emotional welfare can also have a negative effect creating feelings of inhumanity and humiliation and infringe on their rights. This said however the pros and cons of the individual needs must be balanced with the risks and consequences.

A clear sign above the bed allows all staff and visitors to see potential hazards allowing for increased awareness, this may affect clients confidence and morale, perhaps a coloured shape clearly displayed above the bed could be used as a silent indicator. This suggestion however would not allow visitors to understand.

The use of moving and handling equipment required to be used under the Manual Handling Operations Regulations 1992 should eliminate the risk of falls when moving or transferring clients. This equipment i.e. Hoist is large bulky and angular and often to large to be stored in a separate room, thus stored in walkways or bathrooms, which in turn creates further risks. For example falling over/into the hoist. The turning aid is commonly left in situ next to the client’s bed/chair adding obstacles to the floor and presenting further hazards. Increased awareness of these potential hazards is vital in their prevention.

Restricting the number of visitors per bed reduces the potential hazards by reducing the number of people, who are either causes or casualties. However only allowing a small number of people at one time can lead to a constant stream of different people, increasing the risk times. Making visitors aware of the risks and hazards has to be seen as an effective tool for risk prevention.

Keeping clients belongings to a minimum reduces the clutter around bedsides. The use of a locker would be essential to keep their belongings all in one place, therefore increasing the movement around the bedsides. However clients often bring too much, in big bulky sport bags which cannot be easily stored so staff are forced to store these bags under the beds creating further risks. Advising clients before they are admitted on what is suitable to bring or asking relatives to take excess belongings home is a useful suggestion. This is not always possible. Some clients may not have any trusted friends/relatives or they may insist they need all their current belongings.

Storing cables and wires away from walkways and bedsides removes obstacles. Although it presents the question “where should the items be stored safely and yet in order for clients/staff to gain safe access to them?” Storing the cables somewhere else would only move the hazard to a different location. In some cases, it is not possible to remove these wires; for example, the air mattress leads are at the foot of the bed. I would suggest modification is required to the design. However, this is unlikely, due to finance. Another suggestion I would make is that if wires and cables are unable to be moved they should be marked with bright coloured tape or coloured wire/cable to be used. This would add a visual aid to prevention.

Keeping unstable furniture such as clients tables out of walkways and the feet tucked under beds, thus removing an obstacle and eliminating the use of an inappropriate walking aid. Moving the tables to the bedsides introduces more clutter to localised areas. I would suggest the use of foldaway tables fixed to beds (although further risks would be introduced i.e. trapping fingers, bulkier beds) or a more easily adjusted solution of foot operated brakes on all mobile furniture. As with most improvements it is not always feasible due to incurred costs.

Keeping walking aids such ...

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Keeping unstable furniture such as clients tables out of walkways and the feet tucked under beds, thus removing an obstacle and eliminating the use of an inappropriate walking aid. Moving the tables to the bedsides introduces more clutter to localised areas. I would suggest the use of foldaway tables fixed to beds (although further risks would be introduced i.e. trapping fingers, bulkier beds) or a more easily adjusted solution of foot operated brakes on all mobile furniture. As with most improvements it is not always feasible due to incurred costs.

Keeping walking aids such as sticks and crutches behind the bed rest removes the initial obstacle, however, keeping necessary equipment out of clients reach increases their chances of a fall because they cannot get to their aids. A possible solution could be holders or clips on lockers or wall to secure such items within reach. This however would not only incur further cost it would also demand a degree of strength and mobility from the actual client.

Routine checks of the bathroom should contain the potential hazards and see they are identified efficiently. Signs could be displayed on doors to show the potential hazards to all. Spillages in the bathroom, towels and clothing on the floor should be cleared immediately, effectively reducing the risk. Often clients do not have any footwear on or clothing making them especially nervous and jittery, supervision in this area is key to reducing risks and hazards. In is not feasible to have every client’s visit to the bathroom monitored, as there is simply not enough staff.

In an ideal world all the flooring could be of a rough texture which would give better underfoot grip for clients, staff and furniture, however, this would open up more hazards, for example cross infection and if a fall occurred more damage could be sustained i.e. grazes.

Flooring that is broken and uneven should be coned off, marked with a cone and made clearly visible. Actions to repair this hazard should be taken immediately. Although placing a cone will give a visible warning, it becomes a hazard itself because it is an obstacle placed where you may not expect.

If bedsides were cleared at night it would aid the reduction of hazards through the night caused by clients who are sleepy and/or have poor vision. Reorganising a client’s surroundings could disorientate them, thus themselves becoming a hazard. For those with poor vision, but are independently mobile, their bed light could be left on (dim setting). This could have knock on effect to other clients in surrounding beds i.e., disturbed sleep.

Clean up anything that is spilt or dropped on the floor. Liquids, paper towels, even flower petals and cotton wool can be dangerous.

Pull wheeled vehicles through doorways, this way you can lead the way and see where you are going.

Being alert, walking at safe speeds, not reading or blocking vision reduces the risk.

One of the best forms of prevention is awareness. Accident report forms and near miss forms identify opportunities to improve on outcome where these shortfalls have been identified. This form is also required to conform with the reporting of injuries, diseases and dangerous occurrences regulations 1985 (RIDDOR). This act states that if an employee or member of the general public has an accident, this must be recorded in writing.

Recording an accident/emergency, near miss can help in a variety of ways, it can:

Provide medical history for the next carer
Provide medical history should there be a delayed reaction
Monitor the number, frequency and type of accident
May be used to claim compensation at a later date
May be used in claim by client or relatives in legal action
Is legally required to comply with RIDDOR
Can help to devise procedures or policies for accident prevention

These accident report forms are then given to the Clinical Risk Manager who is responsible for reducing the risks associated with the delivery of healthcare in order to provide a safe environment. The accident report forms are just one of the sources in which the clinical risk group receive information further sources are:

Complaints and litigation handling
Clinical audit
Feedback from advisory committees i.e. Health and Safety, Infection Control, Medical Records.
Clinical risk assessment.

RIDDOR is just one of the supporting pieces of legislation to the Health and Safety at Work Act 1974 (HASAW)

Falls area a hazard directly linked to HASAW Act.

Provision of safe environment
Reporting of damaged items i.e. flooring
Employees to take reasonable care of themselves and others
Falls/procedure is in place to ensure legislation is complied with.

The Health and Safety at Work Act 1974 has been updated and supplemented by many sets of guidelines, which extend it, support it or explain it.

The law places certain responsibilities on both employers and employee. For example it is the employer’s responsibility to provide a safe place in which to work (Fire precautions COSHH, RIDDOR, Manual Handling,)

Safe equipment and systems of work (The electrical at work act 1989)

Safe handling, storage and transportation of substances (supplemented by COSHH)

Information, instruction and training- Health and safety training and employment Act 1990 and Health and safety information for employees Act 1989. (Leaflets are present throughout hospital and on every ward, to have nominated specifically trained members of ward staff, Health and Safety people. Training is undertaken annually by all staff, each of these points are stated in SHH policy statements.

Provision of personal protective equipment (the examples of this on the ward are latex gloves, aprons, sharps bins). Is compliance with personal protective equipment 1992 (A supplement of Manual Handling Regulations 1992) it is the employee’s responsibility to:

Take reasonable care of themselves and others
They must not misuse items
They must report damaged items, near misses
Particular to Stepping Hill Hospital, all incidents must be reported in compliance with RIDDOR.

In brief other legislation required to complete HASAW

Fire Regulations Act 1997

This states that any company with over twenty employees should provide reasonable means of escape, fire alarms and have current fire certificate. The fire certificate will contain a plan of the building and position of fire doors, extinguishers and break glass alarm panels et c.

Companies must post policies to inform people of what to do in a fire (situated at the front of the ward).

To comply with HAWSAW in the prevention of falls it is necessary to adhere to the Manual Handling Act (1992)

Where employers responsibilities are:

Duty to assess any handling tasks
Provide training for staff
Provide equipment to enable staff to move patients safely.

Maximum weight to lift alone for men is 25 kg and 16.6 kg for women

Maximum weight for two people is 50 kg

If a person is more than 50 kg a hoist is to be used

And employees responsibilities are:

Follow the units moving and handling policies
Use equipment provided
All persons who can safely do so must be encourages to move themselves
Staff must make sure they attend all courses regarding the use of equipment, e.g. slide boards, easy slides
Mechanical aids such as hoists specially designed beds and mattresses

In brief, other legislation required conforming to HASAW act.

Control of substances Hazardous to Health (COSHH)

COSHH is a useful tool in good management. This sets 7 basic measures that employers must take. Failure to effectively control hazardous substances could have serious risks to employees’ e.g., illness or even death.

The 7 basic measures of COSHH

Asses the risk
Devise a risk assessment
Prevention or adequately controlled exposure
Ensure controlled measures are used
Monitor the exposure of employees
Carry out the appropriate health surveillance

7) Ensure that employees are trained and supervised.

Fire Regulations Act 1997

This states that any company with over 20 employees should provide reasonable means of escape fire alarms and hold a current fire certificate. This certificate must contain a plan of the building, position of fire doors, extinguishers and break glass panels.

Companies must post notices to inform people of what to do in a fire. (these are situated at the front of the ward).

Have fire drills once per week (A Tuesday morning at 10.00 a.m. is when Stepping Hill Hospital hold their weekly drill).

Stepping Hill Hospital Fire policy

Stockport NHS Trust is committed to fire safety strategy based primarily on the avoidance of fire coupled with the provision for rapid detection, containment and control of fire with staff regularly trained to safely evacuate patients, visitors etc.

This policy follows the introduction of the NHS & Community Care Act 1990 this requires Stepping Hill Hospital to comply with the provisions of FIRECODE as well as legal requirements of the Fire Precautions Act, the Fire Precautions (Workplace Regulations) Act 1971/97.

Other precautions taken are the implementation of the Electrical at Work Regulations 1989. This says that all electrical items should be installed and maintained correctly, and tested on a regular basis.

Stepping Hill Hospital does comply with this piece of legislation and electrical engineers are employed by the Trust.

The ward evacuation procedure to be found at back of report.

A Hazard in Depth

Cross Infection

With the client group earlier specified as primarily elderly people. It is clear this client group is specifically vulnerable to risk of infection. This risk can be fatal

Where potential cross infection is found:

Needlestick injuries
Handling soiled linen
Contact with body fluids:
Blood

Faeces

Urine

Vomit

Sputum

Food poisoning – improper storage of client personal food
Confused clients climbing into one another’s beds
Toothbrushes, combs, flannels and towels issued by hospital are all same/similar in appearance, thus easily confused.
Soap, used from client to client
Poor hygiene
Chairs, tables invariably used by a variety of people, visitors, clients, care staff
Commodes, used between clients.
Contact with clients who have contagious conditions i.e. headlice, impetigo, thrush, MRSA, TB, Hep B., HIV/Aids, even coughs and colds.
Cups and water jugs all the same in appearance and easily confused.
Clients often have bags of sweets or fruit. These are offered to visitors, staff, other clients.

Cross Infection Risks

Lack of knowledge understanding into causes and precautions of cross infection.
Emergency situations which demand immediate action when no time is available when moving from client to client.
Improper use of protective items such as gloves.

Prevention (including strengths, weaknesses and suggested improvements.

As preventative measures involve use of chemical cleaning agents such as Haz-Tabs, Compliance the COSHH is required. This file contains so much information due to the nature and variety of work carried out it would be unrealistic to go into any great detail. In basic, a COSHH file must

Identify all hazardous substances
Say where each is kept
Say what the labels are
Describe the effects of the substance
State the maximum amount of time it is safe spent exposed to them
Describe how to deal with an emergency

Give handling advice including how it should be stored.

All of these preventions are in compliance with the HASAW Act providing a safe working environment.

Strict policies are in place with regards to the prevention of sharps injuries:

Let falling objects fall, avoid resheathing needles, always use a sharps bin, always wear gloves.

bleed the wound
clean the wound immediately
find out if the sharp was used
go to Occupational Health or Infection Control
report the injury (to comply with RIDDOR)

With the correct method and procedures followed, this form of cross contamination should be eliminated.

This, and coming into contact with body fluids, the risks are greatly reduced with the use of gloves and aprons. However, there is not always chance to cover yourself. Any dirty clothing should be removed and placed in the correct bag.

Soiled linen is placed in a red bag and securely tightened. This bag I placed directly into the washing machine preventing any further contact with the risk (to be undertaken as employees responsibility of HAWSAW) take reasonable care of themselves and others. For this preventative measure to be effective laminated posters could be clearly displayed to avoid any confusion. These however may not be observed and the risk would be present

Bed sheets, hospital wear and towels are all made of cotton, thus being able to be washed at 95oc effectively killing any bacteria.

The improper preparation of clients food. All kitchen staff at the hospital are trained in food hygiene in compliance with Environmental Health standards. However, it is not possible to restrict all food sources to the client, food brought in by visitors could present a potential risk of cross infection. A suggestion in the prevention of this risk is to advise against having food stuffs brought in. Although this would greatly reduce the risk, it is not a feasible suggestion.

If personal foodstuffs are brought in, clients name, Ward and the date should be put on the product ensuring the food is consumed within its ‘best before’ time and it is eaten by the intended person. Daily inspections of the fridge would be a suggestion. This would only add further responsibility to staff.

To prevent the confusion between client designated products such as combs and toothbrushes, they can be carefully stored in their personal locker immediately after use, this should prevent any one else mistakenly using the equipment. Name tapes could be secured onto either individual items or onto wash bags.

Soap should not be left at sinks or on bed sides and should be stored in soap boxes or wrapped in flannels and kept with the client. I would suggest the elimination of soap altogether and replace with baby wipes or foam spray. This suggestion would incur further costs to ward budget and is therefore not feasible.

With reference to the clients care plan and general observations on individual ability, assistance should be given to ensure adequate personal hygiene has been achieved. This is an effective form of prevention, however it could infringe the clients rights.

Ensuring that each time a client uses the toilet or bedpan, their hands are washed or wiped with a cleansing wipe. This is easily achieved with all care clients however, for those who are mobile it is not possible to ensure the same. Clear laminated posters instructing of good personal hygiene could be displayed in toilet areas, even with this it is at the clients discretion whether or not they chose to observe this.

Chairs used by clients should remain at their bedside, but if necessary to be used by someone other than the client, a sheet or protective layer should cover the chair before further use.

With commodes being shared between clients it is essential that they are cleaned after each use, with the appropriate cleanser. I would suggest to ensure this procedure is carried out the wipes or cleaner is attached to the commode.

Any client who is infectious or contagious should have a sign notifying of risk and be in a side ward. This however could lead to discrimination and isolation of the client but would prove most effective way of creating awareness. Good communication between care workers is essential. Barrier nursing is required with this client. To comply with Personal protective equipment Act 1992, which states employers must provide suitable personal protective equipment. It is in compliance with RIDDOR that any infectious or dangerous diseases must be reported.

Sweets and foodstuffs owned by clients/ visitors should be individually wrapped; this would reduce the risk of cross contamination from this source. However clients have a right to eat what they like, and do!

A crucial element in the prevention of cross contamination is awareness and information. Under the HASAW act it is stated as the employer’s responsibility to inform instruct and train staff. Stepping hill Hospital has an infection control team who are responsible to ensure such awareness and education is received. All ward staff attends annual training sessions.

To prevent infection spreading any further, different coloured cleaning cloths, buckets, mops etc are used for different purposes and areas, for example Green = Kitchen.

Summary: Effective Infection control involves:

Hand Hygiene from staff, clients and visitors.
Protection of broken skin
Safe disposal of sharps instruments
Use of protective clothing
Safe disposal of waste and excreta
Safe handling and cleaning of contaminated equipment
Safe disposal of clinical waste materials
Safe handling and disposal of linen.

Maintaining a good standard of cleanliness of the clients environment

The Care setting. A Playgroup.

Accidental injuries are the most common cause of death in children over one year. Every week three children die as a result of accidents. The children who attend this playgroup ages are 2yrs 9 months to 5 yrs. This factor places a playgroup in a high risk category. At any one session there are up to twenty children and five members of staff. The children are often very excitable as they are with friends and in a fun environment, so are very accident prone. Their small stature, natural curiosity and lack of knowledge makes them all the more vulnerable to danger. They have not developed their powers of logical reasoning to be able to know and understand what danger is and how to deal with it when it arises. Secondary to the children, there are the parents/guardians who visit the playgroup to pick up and drop off children. However, these are of secondary concern. Although as a facility it must comply with the HASAW Act which stretches to all visitors to the premises (provision of a safe environment).

Risks

Indoor

Kitchen

Risk of burns, scalds from kettle, oven
Risk of contact with sharp objects i.e. knives

Interest table

Often nature objects, raising potential hazard with relation to specific objects

Sound and Water Table

Sand could cause irritation to eyes and mouth
Water play involves risk of drowning and spills thus creating slippery floors = falls

Cloak Room

Bags and coats on floor
Hooks are at child’s eye level often used as a storage area, creating risk of falls by clutter

Toys

Choking on small parts
Sharp points can be revealed with wear
Strangulation from cords, ribbons etc.

Tables and Chairs

Present a risk of falls from a height or from tripping over

Glue and paint substances
Fire hazard
Infectious diseases
Cleaning substances
Electrocution – unsafe electrical equipment
Unsecured windows

Outdoor play equipment

Choking on foreign objects i.e. batteries
Security

A Hazard in Depth

Security

Risks

Entry and exit gates leading directly on to main road
Ensuring all children dropped off are accounted for
Strangers and visitors to building
Security of premises – windows and doors
Transfer of care from playgroup to parent/guardian
Telephone enquiries

Preventions of Security Risks (including strengths, weaknesses and suggested improvements)

The playgroup is situated on a main road, which opens a myriad of security risks primarily children getting out and secondly unauthorised persons in. Fencing surrounds the grounds and is 6ft tall with ornate spikes which would serve as a deterrent to any unwanted persons. This is also an acceptable height to retain the children within the grounds. There is one entrance/exit to the property, this gives only one focussed area which gives to easier observation. This entrance/exit gate has two methods of locking: a pull across bolt and a metal loop over the top (out of child’s reach). A traffic sign is displayed warning motorists of children and yellow chevrons painted on the road to increase awareness.

To ensure all children are accounted for when dropped off a member of staff stands at the door to observe those coming in, however it is the responsibility of the parent/guardian to ensure their child hands in their name card (kept on the child’s peg). These cards are then ticked off against a register giving a point of reference for the day and in the case of emergency, for example, fire. It does however present a risk if a card got lost. To my knowledge, there are no further measures to prevent this and so not to be relied upon in case of an emergency. Parents/guardians could sign their children in.

All visitors to the premises should be announced and are accompanied by a member of staff whilst on the property. However, in the event of this, it means that is one less person to supervise.

To maintain the security once playgroup has commenced, the internal door is locked. This is effective in keeping the children inside with no risk of escaping. However, this presents an enormous hazard in the event of a fire. The door is locked with a key. I would suggest a bolt type lock, out of reach of the children. All the windows have child restriction bars which allow the windows to only open so far, effective in preventing children climbing out and falling and effective in preventing people climbing in. This does mean it will become very hot and stuffy in the summer. I would suggest the installation of air conditioning. This is an unrealistic proposal due to lack of funds.

As with the entrance to playgroup a member of staff supervises the children leaving the property, ensuring they are with their parent or guardian. If the usual parent or guardian is not available to collect the child they must telephone to say so, or if not able to do so, verification of the collector’s identity must be taken. I would suggest a registration of children leaving. Although this would be an extra prevention it is very rushed and busy with lots of extra people and a register may not be accurate. To form a queue and ensure each child is ticked off one by one.

All telephone enquiries regarding any aspect of the child are thoroughly screened and staff ere on the side of caution, so not to disclose confidential information.

A policy of security is required under the HASAW act- provision of a safe environment.

A Hazard in depth

Risk of Injury from Sharp Objects

Toys, wear and tear revealing sharp objects
Coat hooks situated at eye level
Door locks
Angular furniture i.e. tables and chairs, cupboards etc.
Paint brushes, pencils, crayons, scissors
External hazards such as broken glass and stones
Broken equipment such as toys and furniture

Preventions

Strengths, weaknesses and suggested improvements

Toys are involved in 40,000 accidents every year and must be safe by law (The British toy and Hobby has a lion mark to indicate that toys bearing the mark meet the statutory requirements). All toys at the playgroup must comply with 1995 European directive introduced to British law by the Toys Safety Regulations Act 1987. This prescribes certain safety requirements regarding their design, construction, composition and likely risks. Toys should be periodically checked and unsafe and broken toys disposed of immediately. Toys could break at any time. Many of the equipment is donated and therefore of unknown origin.

The coat hooks are situated in the child’s available reach to promote their independence, however, this presents further risks i.e. poking in the eye, more serious injury after a fall. I would suggest the hooks be replaced with a more suitable peg with a ball on the end. It could also

The door locks are often at child head level presenting a risk of bangs and cuts. To prevent this, locks should be fully retracted. This is a weakness because it means security is not always tight.

Angular furniture such as tables, chairs and cupboards present many hazards. The tables are hexagonal in shape with rounded corners. Chair legs have rubber stoppers on their feet to eliminate severe injury. Cupboards, corner, I would suggest were painted in bright colours to make them visible or rubber/sponge protective panels over the corners. Stoppers and foam on edges could present a risk of choking.

The hazard of paint brushes/pencils is reduced by using thick handled equipment with rounded ends. Scissors are deemed child safe and also have rounded ends, although constant supervision is still required.

The elimination of injury from broken equipment by regular checks and inspection of all equipment and damaged goods removed.

External hazards such as broken glass and sharp stones can be reduced by good observation by staff and appropriate resolution. This is not only time consuming but not totally reliable.

Policies and Procedures

As with any working environment the playgroup must comply with the Health and Safety at Work Act.

The playgroup must confirm to The Offices, Shops and Railway Premises Act 1963 which falls under the umbrella of HAWSAW Act 1974, this states:

Building must be kept clean
A minimum of 16 degrees should be maintained
Adequate lighting should be provided
Adequate ventilation should be provided
Toilet, washing facilities should be provided

The playgroup must also conform to COSHH Regulations 1999.

They do this by keeping an up to date record of COSHH

All cleaning material, harmful and not is kept in a locked cupboard out of reach of children.

In all available cases a non-hazardous alternative is chosen.

Under the HASAW is a supplementary legislation, The Health and Safety (First Aid) Regulations 1981. This states the requirement of a first aid kit which the playgroup has situated in the kitchen. It also states the requirement of a first aider, who is suitably trained. Two members of staff are currently in receipt of St John First Aid certificates.

The playgroup has an accident book, conforming to the principles of RIDDOR, any injuries sustained whilst at the playgroup are recorded an procedure is followed:

Assess injury
If required seek emergency medical treatment/999
Contact parent/guardian.
Report injury in accident book

Fire Regulations

In compliance with the Fire Regulations, the playgroup has a fire procedure. The fire policy is standard to that of most

Establishments however has identifying extras for example, it is the responsibility of the co-ordinator to obtain the register.

Summary of legislation

The principles of the implementation of all legal requirements remain the same in both care settings. However, different circumstances and situations demand different actions. Each care setting has various policies and procedures geared to meet individual specification.

Comparisons of the way hazards are dealt with in both care settings.

Following my investigations of both policies and procedures in both care settings I was able to briefly evaluate how they compare.

Falls

The measures and precautions taken to prevent the hazard of falls are basically the same- this is generally due to the compliance of the HASAW act and partly due to the clients needs and abilities. (Both being of either physical or mental disadvantage.) In addition, general common sense. An example of this similarity is in the case of spillages:

The hospital ward: Any spillage is cleaned up immediately (where possible) by a member of staff. In circumstances where cross infection is also produced i.e., the spillage of urine the ward domestic will ensure proper cleaning with the appropriate substance.

The playgroup All spillages are dealt with as above and again the primary aim is to remove the hazard of falls and secondly eliminate the risk of cross infection. Any spillage is cleaned up by a member of staff and in the case of ‘accidents’ – the spillage of urine, it is the responsibility of the in house care taker to clean the area with a suitable detergent to eliminate the risk of cross infection.

Both settings have designated member of staff to appropriately remove the hazard of cross infection to the standard that is required by law.

Both setting experiences the spillage of similar bodily fluids and therefore deals with this in the same manner.

Fire Policy

Both the hospital ward and the playgroup have (required by law) a fire policy and procedure/ evacuation plan. Both documents are similar in their requests

The playgroup:

The fire procedure is laminated and colourfully displayed on the front door and is easily understood and observed by all. They hold quarterly practical fire drills.

It is the primary importance of the playgroup to safely, get all children and members of staff out of the building and to the designated fire point. It is with this drill points location that I blatantly saw the need for improvement.

The fire point is in the car park of the neighbouring retirement flats; the route is as follows:

The playgroup (fire) continued.

Given the circumstances the children would be evacuated they are likely to be distressed, panicked and confused. Leading them onto the main road under such conditions could prove fatal!

I would suggest access is applied for from the rear of the property (for emergency use only) with a gate in place as shown above. This would remove direct hazard of children being run over. Although this would be a great improvement in the event of a fire, it does however implicate further risks of security by introducing another entrance/exit point. Appropriate measures of security would have to be assigned to this gate without implicating its primary function-as an emergency exit and therefore chains, keys and padlocks would definitely not be appropriate.

Hospital ward

It is the primary importance of the hospital ward to MOVE (not evacuate) the clients from the source of the fire as it is not feasible to evacuate the clients from the building (except in extreme circumstances). The ward procedure can be found at the back of the report

It was only brought to my attention when I needed to look at the procedure did I become acutely aware of a vital improvement. I, in broad daylight, not under stressful circumstances could not find it! I eventually found the required document in small type, pinned to the notice board on the corridor that leads to the main bay, under a sea of thankyou cards.

I would therefore suggest as my improvement a laminated, bold large type procedure to be displayed clearly at the entrance of the ward, so it is visible not only to staff but clients and visitors alike. It would also be an improvement that these instructions could be displayed in other languages i.e. Pakistani.

In comparison, it is both settings objective to remove the client from the hazards and put the procedure in place.

Evaluation of comparisons.

As both settings involve aspects of care for those incapable of total independence it is not surprising their procedures are so similar, expectations of client ability relating to both mental and physical status are of the highest consideration in the assessment and employment of both procedures.