Through a collaboration in 2002 between occupational medicine specialists at the WSIB and the Ministry of Labour, a work history-taking tool was created for use by primary care physicians. It consisted of a 4-page document covering various exposures and risks the working individual might encounter. The intent was for this information to be collected historically and stored in a patient's file. When that patient presented with symptoms that might be work related, this information would help inform treatment and secondary prevention options.
The problem was a very limited uptake of the work history-taking tool by physicians in Ontario. They did not have time to fill out a long form, especially one that only provided a potential to enhance treatment. Our approach to this problem was to create a pilot project in a primary care group practice for the purpose of understanding what might be possible and relevant to front line practitioners. That project was undertaken in a group practice of physicians, nurses, nurse practitioners and social workers. As the knowledge broker, we supplied a student nurse practitioner with a background in occupational health nursing. She spent 2 days a week for a couple of months on site at the group practice. She also had the back-up and support of occupational medicine specialists through he Network.
The pilot was structured as a continuous improvement project, beginning with a file review to determine current practice in ascertaining work related health information. That process analysis, which is usually the first step in any continuous improvement model, led to a clear identification that occupational information was generally missing and that patient care could be compromised as a result. The problem however still remained that routinely filling out that work history form on thousands of patients was way beyond the capacity of the clinic.
The solution crafted by the pilot was to reduce the history taking down to 5 essential questions that could routinely be asked of every patient and entered into the electronic medical record. Those questions then became the basis for the current, universally available Work Health Exposure Screening Tool which you can find at http://www.stmichaelshospital.com/pdf/programs/occupationalhealth_work_exposure_screening.pdf This tool, or some variation of it, would go on to be applied in numerous, additional group practices in Community Health Centres and Family Health Teams in Ontario.
In subsequent years this approach of piloting new knowledge through local, continuous improvement projects, would extend to many areas. OOHSN conducted pilots in noise induced hearing loss and occupational asthma and dermatitis.
I'm sure this brief story will resonate with a lot of people involved in knowledge dissemination. It promotes the mechanism of continuous improvement projects to refine knowledge components, especially tools, to make them relevant and useful. This would mean that any KT strategy should include resources to engage target audiences in test pilots on uptake and outcomes.
Hal De Lair
To cite:
MLA format
De Lair, Hal, "Knowledge broker stories: Work history-taking tool." Weblog Entry. Knowledge Mobilization Works Blog. Posted October 19, 2009. Accessed (enter date). http://bit.ly/2eDwGX
APA format
De Lair, H. Knowledge broker stories: Work history-taking tool. Retrieved (enter date) from http://www.knowledgemobilization.net [http://bit.ly/2eDwGX]
If you would like to contribute a story to the Knowledge Broker Series, please contact Peter Levesque
No comments:
Post a Comment