All Postgraduate Medical Education Policies are available here.
University of Toronto
Department of Family and Community Medicine
Resident Safety Guidelines
These guidelines are based on the “Postgraduate Trainee Health and Safety Guidelines” Faculty of Medicine, Postgraduate Medical Education, approved by PGMEAC and HUEC, January 2013
1. PURPOSE OF THIS GUIDELINE
1) To promote a safe and healthy environment that minimizes the risk of injury at all University of Toronto and affiliated teaching sites.
2) To confirm the University of Toronto Faculty of Medicine and Department of Family and Community Medicine’s commitment to the health, safety, and protection of its postgraduate trainees.
3) To provide a procedure to report hazardous or unsafe training conditions and a mechanism to take corrective action.
4) To identify and clarify the roles and responsibilities of the University and Training Sites.
The General Standards of Accreditation of The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada set out resident safety standards in Part A of the Standards Applicable to the University and Affiliated Sites. Standard A.2.6 states:
“All participating sites must ensure resident safety at all times, particularly considering hazards such as environmental toxins, exposure to infectious agents transmitted through blood and fluid, radiation, and potential exposure to violence from patients or others.”
Under the PAIRO-CAHO collective agreement between the Professional Association of Interns and Residents of Ontario (PAIRO) and the Council of Academic Hospitals of Ontario (CAHO), residents have dual status of being both postgraduate medical trainees registered in University programs and physicians employed by the hospitals. As trainees, they are entitled to secure and private call rooms and secure access between call room facilities and service areas. Residents have access to and coverage for Occupational Health services (including TB tests, immunizations and follow-up, and post-exposure prophylaxis and management), on the same terms as applicable to other hospital employee groups.
· Accreditation Canada standards indicate that member hospitals must have an operational safety and security program for staff and patients.
· The Ontario Occupational Health and Safety Act, 1990 (OHSA) outlines minimum standards for health and safety and establishes procedures for dealing with workplace hazards and protection against risks of workplace violence.
· The University of Toronto Health and Safety Policy (Governing Council October 24, 2011) states that the University is committed to the promotion of the health, safety and wellbeing of all members of the University community, to the provision of a safe and healthy work and study environment, and to the prevention of occupational injuries and illnesses. For a comprehensive list of related policies and guidelines, see Appendix 1.
The University, hospitals, and affiliated teaching sites are accountable for the personal, environmental, and occupational health and safety of their employees and have the right to make implementation decisions within their respective policies and resource allocations. Postgraduate trainees must adhere to the relevant health and safety policies and procedures of their training site. All teaching sites must adhere to the requirements of the PAIRO-CAHO collective agreement, unless specifically exempted in the agreement.
These guidelines cover all postgraduate trainees, including residents and fellows, and encompass:
· Personal Health and Safety including:
o risk of violence or harm from patients or staff;
o access to secure lockers and facilities including call rooms;
o safe travel:
§ between call facilities and service location, and
§ to private vehicle or public transportation between workplace and home;
o while working in isolated or remote situations including visiting patients in their homes or after hours; and
o safeguarding of personal information.
· Workplace and Environmental Health and Safety including:
o hazardous materials as named in the Occupational Health and Safety Act; and
o radiation safety, chemical spills, indoor air quality.
· Occupational Health and Safety including:
o blood borne pathogens;
o immunization policies; and
o respiratory protection.
The Family and Community Medicine residency program is responsible for identifying and communicating foreseeable safety risks related to education carried out within the program, educating residents about risk minimization strategies, and for making decisions about educational experiences that take into account, among other things, the educational benefit relative to any safety risk.
4. PERSONAL HEALTH AND SAFETY
The University of Toronto and Department of Family and Community Medicine (DFCM) strive for a safe and secure environment for postgraduate trainees in all training venues.
· All teaching sites, hospitals, and long-term care institutions are responsible for ensuring the safety and security of residents and fellows training in their facilities in compliance with their existing employee safety and security policies and procedures as well as the requirements outlined in the PAIRO-CAHO collective agreement. The Postgraduate Medical Education (PGME) Office will work with the Medical Education and Occupational Health Offices at these affiliated training sites to ensure adherence to these requirements.
· Locations without a formal health and safety policy or joint committee will be guided by the standards outlined in the Occupational Health and Safety Act.
· Safety and security issues related to Intimidation and Harassment are outlined in the PGME Guidelines for the Reporting of Intimidation, Harassment and other kinds of Unprofessional or Disruptive Behaviour in Postgraduate Medical Education.
Responsibility of the Program and or Training Site:
§ RCPSC-CFPC Accreditation standard B 1.3.9 requires all training programs to establish program specific safety policies to address their particular risk situations.
“The residency program committee must have a written policy governing resident safety related to travel, patient encounters, including house calls, after-hours consultations in isolated departments and patient transfers (i.e. Medevac). The policy should allow resident discretion and judgment regarding their personal safety and ensure residents are appropriately supervised during all clinical encounters.”
§ Programs must ensure trainees are adequately oriented to policies prior to initiating clinical services.
§ Programs should train residents and fellows in their ability to assess safety risks specific to each rotation.
§ Family Medicine residents will not be required to see patients alone in the clinic, on house calls, or other settings if not appropriately supervised.
i) Home Visits: Family Medicine residents are not expected to make house calls without a supervisor. When there is agreement/consent between a resident and supervisor, and adequate agreed upon support, the resident may provide care in the home to a known patient.
ii) After Hours in Isolated Parts of the Hospital/Building: Family Medicine residents are not expected to work alone or without adequate supervision in after-hours clinics. In the hospital, a resident will have access to protective services/security to enter isolated areas.
iii) Patient Transfers: Family Medicine residents, if feeling uncomfortable in a patient transfer situation and if there is no supervisor available to accompany them, may decline to go on the patient transfer. Residents should only be asked to transfer a patient by any means as the MRP if the supervisor and resident agree that s/he is competent to manage that patient.
§ Travel is a normal occurrence for residents in the Family and Community Medicine residency program, including travel between teaching/clinical sites and to Rural and Teaching Practice sites. In all cases of travel, advanced safety planning and open discussion is encouraged between the resident and Supervisor/Site Program Director/Administrator, including safety in relation to: inclement weather; and walking alone for any major or unsafe distances, particularly outside of a building at night. In this instance, travel with security personnel is recommended, if available, or use of a “buddy system” with a preceptor or colleague.
In the case of Rural/Teaching Practice travel, residents choose their site, recognizing travel is involved. Once assigned, any safety issues related to Rural/Teaching Practice travel must be discussed with the resident’s Site Program Director and the DFCM Rural/Teaching Practice Director
§ Training sites must endeavour to safeguard trainees’ personal information, other than identifying them by name when communicating with patients, staff and families.
Responsibility of the Trainee:
§ Trainees must use all necessary personal protective equipment, precautions and safeguards, including back up from supervisors, when engaging in clinical and/or educational experiences.
§ Trainees must exercise judgment and be aware of alternate options when exposing oneself to workplace risks or during travel to and from the workplace (i.e., driving a personal vehicle when fatigued).
§ If a Family Medicine resident is absent due to travel safety, the resident must notify the Site Program Administrator.
§ Trainees must use caution when offering personal information to patients, families or staff.
§ Trainees are expected to call patients from a hospital or clinic telephone line. The use of personal mobile phones for such calls is discouraged; if used, the call blocking feature should be engaged.
§ Trainees must promptly report any health and safety concerns (e.g. risk of needlestick injuries, fatigue, etc.) to their supervisor.
Reporting Protocol for Breaches of Personal Safety:
§ Trainees who feel their personal safety or security is threatened should remove themselves immediately from the situation in a professional manner and seek urgent assistance from their immediate supervisor or from the institution’s security services.
§ Trainees cannot be negatively impacted for refusing to engage in clinical or educational experiences prior to reviewing with supervisors, if they truly feel at risk in doing so but it is recognized that at times (for example, in outbreaks of infectious disease such as SARS), a residual risk will remain after all known precautions are taken. Professional responsibility to patients may require engaging in care despite these risks. See University of Toronto Health Sciences Faculties Guidelines for Clinical Sites re: Student Clinical Placement in an Emergency Situation: Postgraduate Medical Education.
§ Trainees in hospital/institutional settings identifying a personal safety or security breach must report it to their immediate supervisor at the training site as well as to the Site Director to allow a resolution of the issue at a local level, and to comply with the site reporting requirements, such as completion of an Incident Report Form.
§ Trainees in community-based practices or other non-institutional settings should discuss issues or concerns with the staff physician or community-based coordinator, or bring any safety concerns to the attention of their Site Director.
§ Trainees may also report their concerns to the Director, Resident Wellness at the PGME Office and/or the DFCM Postgraduate Program Director. Efforts will be made to maintain the confidentiality of the complainant. Pending investigation and resolution of identified concerns:
o The Program Director and/or Director of Resident Wellness have the authority to remove trainees from clinical placements if a risk is seen to be unacceptable.
o If a decision is taken to remove a trainee, this must be communicated promptly to:
§ the Chair;
§ the Vice President, Education/Hospital Medical Education Lead or designate at the training site;
§ the Residency Program Committee; and
§ the Vice Dean, PGME.
§ If the safety issue raised is not resolved at the local level, it must be reported to the Director, Resident Wellness who will investigate and may re-direct the issue to the relevant hospital medical education office or University office for resolution. The resident/faculty member bringing the incident forward will receive a response within 10 days outlining how the complaint was handled or if it will require further review.
§ The Director, Resident Wellness will bring the issue to the hospital office responsible for safety and security, and may involve the University Community Safety Office, Faculty of Medicine Health and Safety Office for resolution or further consultation, and will report annually to the Postgraduate Medical Education Advisory Committee (PGMEAC) and the Hospital University Education Committee (HUEC) through the Vice-Dean, PGME.
§ Urgent resident safety issues will be brought to the attention of the Vice-Dean, PGME as well as to the relevant hospital VP Education/Hospital Medical Education Lead as appropriate.
§ The Director, Resident Wellness may at any time investigate and act upon health and safety systems issues that come to her/his attention by any means, including internal reviews, resident/faculty/staff reporting, or police/security intervention.
§ Trainees in breach of the occupational health policies of their training site are subject to procedures by that site consistent with the requirements of the Occupational Health and Safety Act. If attempts to resolve the situation by internal protocols are not successful, it may be brought to the attention of the training site Medical Education Lead.
5. WORKPLACE AND ENVIRONMENTAL HEALTH AND SAFETY
OCCUPATIONAL HEALTH AND SAFETY
In the course of their training, postgraduate trainees may be exposed to hazardous agents and communicable pathogens. Trainees, the University and teaching sites including hospitals, laboratories and community clinical settings are jointly responsible for supporting a culture promoting health and safety and preventing injury and incidents. Accidents, incidents and environmental exposures occurring during training will be reported and administered according to the reporting policies and procedures of the University, hospital or clinical teaching location.
The Family and Community Medicine residency program requires residents to engage in the following specific situations that may pose a safety risk:
§ house calls;
§ work in isolated or poorly protected environments;
§ exposure to potentially dangerous environments;
§ exposure to potentially harmful bodily fluids;
§ exposure to environmental hazards; and
§ encounters with potentially violent or aggressive patients; and exposure to potentially dangerous equipment and/or high risk transportation.
Responsibilities of the Program, PGME Office and Training Site:
§ The program commits to providing residents with a full disclosure of foreseeable potential risks associated with these activities. The program will ensure that residents receive education and preparation for these activities using best available evidence and practices for workplace safety guidelines, and assess residents for appropriate understanding prior to involvement in these activities.
§ All residents will receive information during orientation and in the site resident handbook about their local site Occupational Health and Safety requirements/ services and the DFCM Resident Safety Guidelines.
§ The program will address exposures specific to each training site and encourage residents and fellows to i) assess site and situation specific safety risks, and ii) speak to their supervisor at every new training site about protocols specific to that site.
§ The Postgraduate Medical Education Office will ensure trainees have all required immunizations (as per the Faculty’s Communicable Disease Policy) prior to initiating clinical duties. This information will be available to appropriate individuals at the training sites as required via the Postgraduate Web Evaluation and Registration (POWER) system. Trainees not meeting the immunization requirements of the faculty are not permitted to complete their registration with the PGME Office and will not be registered at the hospital.
§ The PGME Office will ensure all concerns relating to communicable diseases, including blood borne pathogens, will be reviewed by the Expert Panel on Infection Control and dealt with on a case-by-case basis prior to finalizing a trainee’s registration. Disclosure of communicable disease status of the trainee will be limited to those required to know in order to provide the necessary procedures to address the health and safety concerns of others.
Responsibilities of the Trainee:
§ Residents and fellows must participate in required safety sessions as determined by their Program or training site.
§ Trainees must follow all of the occupational health and safety policies and procedures of the training site including, but not limited to, the appropriate use of personal protective equipment.
§ Trainees must agree to report unsafe training conditions as per the protocol outlined below.
Reporting Protocol for Workplace Accident/Injury or Incident (See Appendix 2):
A) During daytime hours while working at an affiliated hospital or site associated with an affiliated hospital:
1) The trainee must go immediately to the Employee/Occupational Health Office of the institution.
2) The trainee must complete the incident report form as required by the institution’s protocol.
3) The trainee must report the incident to his/her immediate supervisor.
4) The trainee is encouraged to submit a copy of the report form to their Program office which will then forward a copy to the PGME Office.
B) During evenings or weekends or at a training site with no Occupational Health Office:
1) The trainee must go immediately to the nearest emergency room and identify him/herself as a resident or fellow at the University of Toronto and request to be seen on an urgent basis.
2) The trainee must report to the available supervisor, comply with the institution’s protocol for completion of appropriate incident report forms, and keep a copy of this form to be forwarded to their Program office.
APPENDIX 1: FAMILY MEDICINE CHECKLIST AND CONTACTS
v Policy: DFCM Resident Safety Guidelines
U of T Contact: DFCM PG Program Director, 416-978-6467
Site Contact: Site Director/Administrator
v Policy: University of Toronto, Faculty of Medicine, Postgraduate Trainee Health and Safety Guidelines
Website: PGME Safety Guideline
U of T Contact: PGME Resident Wellness, 416-978-3074
Site Contact: Site Director/Administrator
v Policy: Blood and Body Fluid Exposure Policy for University of Toronto Postgraduate Medical Trainees
U of T Contact: PGME Immunization Officer, 416-946-3753
Site Contact: Occ. Health and Safety, Site Director/Administrator
v Policy: COFM Immunization Policy
Website: COFM Immunization Policy
U of T Contact: PGME Immunization Officer, 416-946-3753
Site Contact: n/a
v Policy: PGME Immunization-Requirements
U of T Contact: PGME Immunization Officer, 416-946-3753
Site Contact: n/a
1) Ontario Occupational Health and Safety Act, 1990
A Guide to the Occupational Health and Safety Act, May 2011
2) PAIRO-CAHO agreement:
3) University of Toronto, Health and Safety Policy (Governing Council, 24 October 2011)http://www.governingcouncil.utoronto.ca/Assets/Governing+Council+Digital+Assets/Policies/PDF/ppmar292004.pdf
4) PGME Intimidation and Harassment Guidelines
5) University of Toronto Health Sciences Faculties Guidelines for Clinical Sites re: Student Clinical Placement in an Emergency Situation: Postgraduate Medical Education
1) Occupational/Employee Health Offices at all University affiliated teaching hospitals
2) PGME Office:
a. Office of Resident Wellness; or
b. Immunization Officer.
Appendix 2: Protocol for Workplace Exposure/Injury
View this appendix as a pdf flowchart
a) Daytime hours at Affiliated Hospital:
1. Trainee informs immediate supervisor and site director and reports to Occupational/Employee Health Office
2. Occupational Health protocol followed, incident report completed, copy to DFCM Program and PGME Office
b) Training site outside GTA, no Employee Health Office or evening or weekend hours:
1. GO TO NEAREST EMERGENCY ROOM. Identify self as PG trainee and ask for immediate assistance.
2. Report incident to immediate supervisor and site director, complete incident report form as per institution protocol; send copy to DFCM Program and PGME Office
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Key University Policies:
Other Resources Available:
v Resource: Community Safety Office, University of Toronto
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University of Toronto, Department of Family and Community Medicine (DFCM)
Contact: Susan Edwards, Director
v Resource: PAIRO 24 Hour Help Line
Phone: 866-HELP-DOC (1-866-435-7362)
v Resource: OMA Physician Health Program
v Resource: ePhysicianHealth.com
v Resource: Hospital Employee Assistance Program
Contact: Ask site administrator for details
v Resource: PAIRO Transition to Practice Program
v Resource: HealthForceOntario (HFO) Practice U
v Resource: Ontario Physicians Locum Program
v Resource: University of Toronto Career Centre
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