HomeMy WebLinkAbout1992-3062.Young.96-10-18
'I
~~--'-1~
.,... -
ONTARIO EMPLOYES DE LA COURONNE I
CROWN EMPLOYEES DE L'ONrARip
1111 GRIEVANCE COMMISSION DE
SElTLEMENT REGLEMENT
BOARD DES GRIEFS
180 DUNDAS STREET WEST, SUITE 2100, TORONTO ON MSG 1Z8 TELEPHONE/TEt.EPHONE (416) 326-1388
180, RUE DUNDAS OUEST; BUREAU 2100, TORONTO (ON) M5G 1Z8 FACS/MILE/TELECOPIE (416) 326-1396
GSB # 3062/92, 3063/92, 3202/92, 3216/92, 2883/92
OPSEU # 93B067
IN THE MATTER OF AN ARBITRATION
Under
THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT
Before
THE GRIEVANCE SETTLEMENT BOARD
BETWEEN
OPSEU (Young)
Grievor
- and -
The Crown in Right of ontario
(Ministry of Health)
Employer
BEFORE: W Kaplan vice-Chairperson
FOR THE 0 wright
GRIEVOR Counsel
Ryder, Wright, Blair & Doyle
Barristers & Solicitors
FOR THE M Quick
EMPLOYER Counsel
Legal Services Branch
Ministry of Health
-
'"i"I'
ONGOING PROTOCOL FOR THE ACCOMMODATION OF CHERYL YOUNG AT
KINGSTON PSYCHIATRIC HOSPITAL
October 17, 1996
The Employer, the Employee and the Union are commItted to the terms, Implementation and the
co-operative, continued mamtenance of thIS accommodatiOn. They agree that the following
protocol wIll remam in effect unless it IS changed by the agreement of the partIes or by a
subsequent order of the Grievance Settlement Board.
1 Allergen Definition and Caution
The allergy is to mollusks and crustaceans.
The scope recogmzes that exposure nsk may anse from mgestlOn, presence ill the
envlfonment, or cross-contammatlOn.
The caution speCIfies any food or product contammg crab, shnmp, lobster, oysters,
mussels, clams, scallops, crayfish, snails, squid or shellfish byproducts, for example,
soups, sauces, and imItatlOn crab or other shellfish, as well as food prepared with utensils
or cooking Oil prevlOusly used for prepanng shellfish
2. Assignment
Ms. Young's assignment is to the Contmumg Care Male Ward known m Apnl1996 as
Ward 12.
3. Movement Outside Designated Accommodation and Designated Entrance/Exit
Ms. Young recogmzes that, m cases m which the Employer does not require her to be
outside the safe ward area, should she choose to be outSIde of this area that she assumes
the personal nsk for domg so It IS understood that thIS does not apply to trammg, fire
emergencies, required meetings with HospItal Management! AdmmistratlOn which cannot
take place m the designated area, or movement to the union office for matters that the
Umon has mdIcated It IS not able to deal wIth m the deSIgnated area such as union votes.
Ms. Young will provIde four hours' notice of any meetmg takmg place m the umon
office, and temporary sIgns WIll be posted on a route to be agreed upon by the Umon and
the Employer Whenever possible, the Employer will make alternate offices, or pnvate
locations on the ward or other deSIgnated area(s), aVailable to the Umon and Ms. Young,
The Umon WIll ensure that appropnatesIgns are posted in its office ThIS part ofthe
protocol does not restnct any nghts Ms. Young may have wIth respect to Workers'
Compensation or the making of an applicatIOn to the Workers' CompensatIOn Board.
4. Orientation
Ms. Young has completed her onentatIOn to Ward 12
5. Schedule
Ms. Young IS to remam on the regular 12-hour schedule and the 8-hour team leader
rotatIOn schedule
~!
6. Entry and Exit
Ms. Young agrees to desIgnate and make every effort to use certam
entrances/exIts m consultatlOn with the Ward SupervIsor It IS understood that
the desIgnated entrances/exits may need to b'e changed from time to time, m
consultatlOn wIth the Ward Supervisor The Ward Supervisor wIll keep the
Nursmg Co-ordmator and the Nursing Director apprised as to the current
deSIgnated entrances/exIts.
Person(s) responsible' Cheryl Y oungand Ward SupervIsor
7 Floating
Ms. Young w1l1 NOT be required to float as part of her assignments. [Addendum 1]
Person(s) responsible Ward SupervIsor and Nursing Co-ordmator
8. Off-Ward Duties and Hospital Emergencies
Ms.Young IS NOT to respond to duties or emergencies off Ward 12, CCM except to the
designated immedIate enVIrons (hallway or rotunda) of the mam entrance to Ward 12,
CCM. Should an emergency occur requirIng staff to attend off Ward 12, CCM, Ms.
Young will be the nursmg staff person who remains on Ward 12, CCM. In the event ofa
fire or fire drIll she will aSSIst WIth the evacuation of patients and carry out other
approprIate duties but WIll not be required to enter the adjacent ward, (which IS the
designated ward to which patients would be evacuated.) [Addendum 1]
Person(s) responsible Ward Supervisor, Nursmg Co-ordinator, Nursmg Staff and Cheryl
Young
9 In-Service Training for Ms. Young
PrecautlOns wIll be taken to ensure that trainmg w1l1 take place m a safe enVIronment.
A temporary sign w1l1 be posted at the entrance to the trammg area, staff will be notified
m advance and food deSIgnated on the sign w1l1 not be permItted.
The Employer will ensure that Ms. Y Olmg receIves mandatory m-servIce trammg.
The Employer will try to faCIlItate dIscretlOnary traming when requested.
10. Physical Demands Analysis
Ms. Young's FamIly PhYSICIan and PhYSIotherapist have been prOVIded WIth a copy of
the PhYSIcal Demands AnalYSIS, dated March 1988, which may be subject to change
[Addendum 2],
11 Pharmaceutical Check
A pharmaceutical check was made and a report dated October 24, 1995 was proVIded by
the ChIef Pharmacist. [Addendum 3]
12. Allergy Advisory Distribution
An adVISOry notIce dated August 31, 1995 has been dIstributed to the ASSIstant
AdmmIstrator (OperatlOns), ChIef of Psychiatry, and ASSIstant Admllllstrator Plannmg
-
and Program AdmmIstration, and Acting Food ServIces Administrator [Addendum 4]
13. Signage
The attached CAUTION dated May 1, 1996 wIll be permanently posted in the following
locatIOns for as long as Ms. Young is assIgned to Ward 12 three entrances to Ward 12,
the entrance to the staff room, staff cloak room, mam office, vlSltors' room, patIents'
dmmg room, teleVISIOn room, as well as the entrance to any room WIth a refngerator
The Ward SupervIsor and/or Ms. Young wIll report any sign removal to the Nursing
Director [Addendum 5]
14. Educational Material for Individuals Coming to Ward 12
The Allergy EducatIOnal Package [Addendum 6], articles re allergIes and allergy alert
information are to be kept m the Nurs1ng Co-ordinators' Office, and m the ClImcal Unit
Manual in the Nursing StatIon on Ward 12 and are to be available at all times, extra
packages are to be avaIlable in the dining room of Ward 12 for distributIOn by those staff
answermg the door, to staff, viSItors and all others commg onto Ward 12 for the first
time since September 1, 1995 The Allergy Educational Package will be given to staff
newly assigned to the Ward immediately at the outset of their orientatIOn. For Staff who
are not regularly assigned to Ward 12, the mformatIOn wIll be prOVIded verbally by the
Ward Supervisor or Nurse in Charge at the time of theIr mitial entry onto the Ward, and
before they proceed mto the Ward Itself. They will also be provided WIth the educatIOnal
package. A lIst IS to be mamtamed in the dming room of Ward 12 of those who have
received the Allergy EducatIOnal Package.
Person(s) responsible: Ward SupervIsor, Ward Staff.
15. Staff Allergy In-Service Information Sessions
Employees on the list [Addendum 7], as well as the Ward Supervisor, assIgned to Ward
12 have particIpated in an m-servIce allergy mformatIOn session and have receIved the
Educational Package [Addendum 6] Staff newly assigned to the deSIgnated ward,
mcludmg ward supervIsors will be proVIded WIth simIlar m-servIce trammg by a
deSignated person.
16. Questions from Staff
Ms. Young is prepared to respond to questIOns from Staff to explam the management of
her allergIC condItion. She IS also wIllmg for supervIsors to do lIkewise.
Person(s) responsible Cheryl Young and Ward Supervisor
17 Fish Tank on Ward 12
The fish tank IS to remam on Ward 12 provIdmg that it does not prove to be a source of
exposure Any problems resultmg from thIS are to be reported to the Ward SuperVIsor
The only fish food that IS to be used is Wardley Splrulena Plus, all vegetable
condItIomng flake. ThIS food has been approved by Ms. Young's FamIly PhYSICIan.
Jack Gnffin has agreed to take care of thIS. He WIll arrange for a back-up the fish food to
be avaIlable to prevent a possible introduction of other food in his absence The food wIll
be stored m Its ongmal contamer
18. Exposure Protocol
The Employer and the Employee agree to follow the attached protocol m the event of an
exposure. [Addenda 8 & 9] The protocol will be kept in the Nursing Office fihng
cabmet m a file desIgnated as "EXPOSURE PROTOCOL"
19 Accidental presence
If any shellfish, shellfish byproducts or cross-contammated foods are brought on the
Ward accidentally when Ms. Young IS present on the Ward, she will be informed
immedIately, so that she can take appropnate precautlOns. [Addenda 1, 8 & 9]
Person(s) responsible' Ward SupervIsor, Nurse m Charge, Staff and Ms. Young
Staff on the designated ward have been adVIsed that if they have recently consumed
shellfish prior to coming on to the ward, they are to have washed theIr hands pnor to
coming onto the Ward and remove any residue that may be on their clothmg; they will
also inform Ms. Young that they have eaten shellfish prior to commg onto the Ward so
that she may take appropriate precautlOns. [See Addenda 1, 8 & 9 whIch will be kept
both m the Nursing Office and the Ward Supervisor's office filIng cabinet under
"EXPOSURE PROTOCOL"]
Person(s) responsible. Ward SupervIsor, Nurse in Charge and Staff
If any shellfish, shellfish byproducts, or cross-contaminated foods accIdently come onto
Ward 12 durmg times when Ms. Young IS NOT present she will be notified to absent
herself from the Ward until it has been free of the substance for at least a 12-hour penod.
ThIS absence is to be without loss of payor credits. See Addendum 1 which w1l1 be kept
both m the Nursing Office and the Ward SupervIsor's office filing cabmet under
"EXPOSURE PROTOCOL"
Person(s) responsible Ward SupervIsor and Nursing Co-ordmator
Any new or temporary staff assIgned to the designated ward WIll be informed of these
obhgatlOns, pnor to commencing theIr assIgnment on the Ward.
20. Appointment of a Designated Physician and Post Exposure
The parties agree to desIgnate a mutually-agreed upon physIcIan who, subject to the
followmg paragraph, may examine Ms. Young and report to both her and to the Employer
wIth respect to her health and her abIhty to return to work should an exposure occur In
accordance with the Memorandum of Settlement, the partIes will, forthwIth, meet and
attempt to agree on the desIgnatlOn of thIS phYSIcIan. If they are unable to do so wIthm
thIrty days of the Issue of thIS award, Wilham Kaplan will make the choice by final offer
selectlOn. In the event that the deSIgnated doctor, chosen consensually or by final offer
selectlOn, becomes unable or unwillmg to serve, the partIes WIll meet forthWIth and
attempt to agree on the appomtment of a replacement, and m the event that they are
unable to agree that choice WIll be made by Wilham Kaplan, or by another Vice-ChaIr of
the Board, by final offer selectIOn, The mtent of thIS provISIOn IS to ensure a deSIgnated
-
_:i'
phYSICIan IS available, If reqUired, to examme Ms. Young as soon as possible after an
exposure and report on her condItion to Ms. Young and to the Employer The deSIgnated
phYSICIan will be proVIded with a copy of the "Ongomg Protocol for the AccommodatIOn
of Cheryl Young at Kingston PsychIatric HospHal "
In the event of an exposure, the partIes agree and understand that Ms. Young's return to
work WIll be dependent on her post-exposure condItIOn. Ms. Young wIll inform the
Ward SuperVIsor as soon as possible followmg an exposure, should one occur, as to the
expected date of her return. The Employer may, m accordance with the terms set out m
the CollectIve Agreement, reqUire Ms. Young to be exammed by the designated phYSICian
who WIll report to Ms. Young and the Employer with respect to Ms. Young's expected
date of return. When the deSIgnated phYSICian, or someone standing m for hIm or her, or,
should Ms. Young not be referred to the designated phYSICIan, one of Ms. Young's own
doctors, determines that Ms. Young is able to return to work, she wIll notIfy the
Employer promptly and will return to work on her next scheduled shift consistent with
the medIcal recommendation, or as agreed. Ms. Young's family phYSIcian will also be
prOVIded by Ms. Young with a copy of the "Ongoing Protocol for the AccommodatIOn of
Chery I Young at Kingston Psychiatric HospItal."
Ms. Young will follow the normal procedure set out in the Collective Agreement and use
the standard Medical CertIficate and Return-to-Work Form supplIed by the HospItal.
Person(s) responsible Cheryl Young, Ward SupervIsor, Nursing Co-ordmator, Family
Physician
In the event of an exposure resultmg m a Workers' Compensation ClaIm, Ms. Young and
the Employer, wIll submit an inCIdent form as soon as possible. As part of its
investigatIOn, the Employer will mterview those concerned mcludmg those who were
present at the relevant time The Workers' CompensatIOn status remams m effect untIl
the claIm is adjudIcated. Person(s) responsible' Cheryl Young, Ward SupervIsor,
Nursmg Co-ordmator
21 Changes to or Closing of the Chronic Care Male Ward (CCM) (currently Ward 12)
In the event of changes to the functioning or locatIOn of the Chromc Care Male Ward,
the Employer WIll, recogmzmg, however, ItS entItlement to aSSIgn work, meet WIth Ms.
Young and the Umon, to dISCUSS and negotIate any modIficatIOn to the arrangements set
out m this protocol whIch may be reqUired by such reaSSIgnment, and WIll do so pnor to
the changes or relocatIOn bemg Implemented, Ms. Young will be gIven a mInImUm of
five days notice of the changes followmg the discussions/negotiatIOns referred to above.
If the ChrOnIC Care Male Ward IS to be closed, arrangements WhICh reflect the prinCIples
of this protocol will be dIscussed and negotiated with Ms, Young and the Union m
advance of her bemg reassigned.
The purpose of these dIScussIons and negotiatlons IS to IdentIfy and deal with
Implementation problems in the new or changed work settmg, and any changes whIch
may be made are to be consistent with the general terms of thIS protocol whIch wIll
remam in effect. Put another way, it is intended and expected that any changes to the
grievor's assIgnment, or any new assIgnment, will only reqUIre refinements and/or minor
adjustments of this protocol and, m any event, that any changes whIch take place WIll be
consIstent WIth Its SpIrit and terms.
22. Annual Review'
Annually, on or about September 5th, Cheryl Young may give notice to the Associate
Nursmg DIrector of a review of the need for the prohibition of shellfish and shellfish
products Within the Hospital If the need to continue IS indicated by Cheryl Young, the
Associate Director of Nurses will communIcate this the Food ServIces Administrator It
IS understood that the accommodatIOn IS to remain m effect unless it is changed by the
agreement of the parties or by a subsequent order of the Grievance Settlement Board.
Person(s) responsible' Cheryl Young and ASSOCIate DIrector of Nursmg
((~' 1\/ /L OJLt~~
Date /c t
I I If
Judy"rawley, for the E~ployer
Date ({lc;t / f !qrc (!jj
Date ~-L1 <3- ,I Cff.o c~~~.
I
Date C)~+ ~l/qh 444ft. .~
I Michael McFadden, for the Union
The above "Ongomg Protocol" IS hereby made an order of the Grievance Settlement Board
Dated at_I U (" ^ \-z..; I tl "'t I.: i/~/, ~-
this [ ~ '~ c:A.ti' I I q..- 01 t. h L-, -( ../
1
W Kaplan, Vice-Chair
~------- ---- ---
ADDENDA
1 PROTOCOL TO BE FOLLOWED ON DESIGNATED WARD IN THE EVENT THAT
SHELLFISH, SHELLFISH BYPRODUCTS OR POTENTIALL Y CROSS-
CONTAMINATED FOOD IS BROUGHT ON TO WARD 12 WHEN CHERYL
YOUNG IS OFF DUTY
PROTOCOL TO BE FOLLOWED WHEN CHERYL YOUNG IS ON DUTY AND A
STAFF MEMBER ON THE DESIGNATED WARD HAS RECENTLY EATEN OR
BEEN IN RECENT CONTACT WITH SHELLFISH, SHELLFISH BYPRODUCT OR
POTENTIALL Y CROSS-CONT AMINATED FOOD
ASSIGNMENT OF CHERYL YOUNG
ASSIGNMENT OF DUTIES OFF DESIGNATED WARD TO CHERYL YOUNG
CHERYL YOUNG'S ROLE IN AN EMERGENCY OFF DESIGNATED WARD
2. PHYSICAL DEMANDS ANALYSIS FOR REGISTERED NURSE 2
KINGSTON PSYCHIATRIC HOSPITAL MEDICAL CERTIFICATE AND RETURN -
TO- WORK FORM
PHYSICAL CAPACITIES FORM
3. PHARMACY MEMORANDUM
4. ADVISORY MEMORANDUM
5. CAUTION ALLERGY ALERT SIGN
6. EDUCATIONAL PACKAGE
7 LIST OF PARTICIPANTS IN ALLERGY INFORMATION SESSIONS
8. MEDICAL EMERGENCY PROCEDURE FOR STAFF MEMBER ON DESIGNATED
WARD WHO HAS LIFE- THREATENING ALLERGY TO SHELLFISH, SHELLFISH
BYPRODUCTS AND SHELLFISH CROSS-CONT AMINATED FOODS
9 ALLERGY SUFFERER 911 INFORMATION
II --+-
..Y
\
PROTOCOL TO BE FOLLOWED ON THE DESIGNATED
WARD IN THE EVENT THAT SHELLFISH, SHELLFISH
BYPRODUCT OR POTENTIALLY SHELLFISH CROSS-
CONT AMINATED FOOD IS BROUGHT ON TO THE
DESIGNA TED WARD WHEN CHERYL YOUNG IS OFF DUTY
1 Immediately remove substance from designated Ward,
2 Notlfy Ward SupervIsor or Nursmg Co-ordmator
3 Ward SuperVIsor or Nursing Co-ordmator will notify Ms.Young ASAP at her home
telephone number, by speaking wIth her dIrectly, leavmg a message wIth her husband or
leavmg a message on the answenng machme, noting the time.
4 Ms, Young wIll not attend, be scheduled or assIgned to be on duty for 12 hours followmg
the removal of the substance and will not suffer a loss of payor credIts.
WHEN CHERYL YOUNG IS ON DUTY AND A STAFF
MEMBER ON DESIGNATED WARD HAS RECENTLY EATEN
OR BEEN IN RECENT CONTACT WITH SHELLFISH,
SHELLFISH BYPRODUCT OR POTENTIALL Y CROSS-
CONT AMINATED FOOD
The Staff member wIll
I Wash hIs/her hands and remove any reSIdue on clothing before commg onto the Ward.
2 Warn Ms Young so that she can take appropnate measures
3 Keep a reasonable dIstance from Ms. Young.
ASSIGNMENT OF CHERYL YOUNG
Ms. Young s assIgnment IS restricted to the CCM Ward,
Ms. Young IS NOT to float as part of her assIgnments
ASSIGNMENT OF DUTIES OFF THE DESIGNATED WARD TO
CHERYL YOUNG
Ms Young IS NOT to be assIgned dutIes off the desIgnated ward.
CHERYL YOUNG'S ROLE IN AN EMERGENCY OFF THE
DESIGNATED WARD
I Ms Young is NOT to respond to emergencies off the desIgnated ward except m the event
of a fire or fire dnll
2 Should an emergency occur off the desIgnated ward requIrIng staff to attend, Ms. Young
Will be the Nursmg Staff person designated to remam on the desIgnated ward.
"" In the event of a fire or fire dnll, Ms, Young will evacuate patIents but WIll not be
J
reqUired to enter Ward 11 which IS the deSIgnated alternate ward,
-_.~--
- ~c; ~ E: ; n .g 0 v
uO _ III GI C III a;
1II't. K ::l GI i
oCCD III ., :z (/) a: ::I
U~ ~ ::> 0 0- N CO) ~
'J
lItllng I. --r ,UU I bs (lG1- - ,-,- \XT-w\T it t Wi Ulas~ ts r.anee or -
Carrying ,. . -A toTDs \' IlJ -- X ()(.,. (other 5 taff or
Pushing - ~ l\;lVIDS~tl n---,,- 1'" ~ use Versa Lifts
'Pulling ^ lUUJDS\tl)) ---rl-,X1 .,.
fIne FInger Movements --'), .',' - -- A .. normal maximum approximately
Handling - ^ ,-- - *(200 lbs.
arlppln2.._ 1.. ~-~ *(
Above Shoulder 1.. 15\1u} - *
R.achlno
Be I owS'hO'Ui de-r A Z:,\ IUl -- '"
'oot 1 Fool X ",-- \ " ---pushing a geriatric chafr
Action 2 Feel ,-r
Th,oW\<lng ^ . ^
" \ I ,-
SlUing X 'It
X \ / -
Standing X *
Walking X \ /'--- X *
Running X \ ! --.,--- *
~C"mblng_ (Stairs) X \/ ----,-- ( *
__-1
'lendlng/Stooplng A X X ..
_";rouchlng X I \ --,--
Kneeling " / \ ----r *
Crawling X / \ - --- '--X-' \ ~..
Twlsling ^ I ,- --:- " - *
/
Balancing X \- -
X .
.. ..- -
H..rlno Conversation X J X *
Other Sounds X \ I X *
.-----.
Far X \ I X *
-
VIsIon Near X \ / X '" .
-
.Colour X \ I X it
X V -,
Depth X *
X /\ - '-!..
P~rcepllon Soatlal *
--
Form X I \ J X *
, )l 1 \ - J X *
Feeling . -
Readlno X / \ X -It
W,'rlng X I \== 4- *
-
Speech X \ ..
InsIde Work X \ I- X *
Outside Work X \ / X - patient outside activity
-
! ~OIlCotd 1. \ /
'umld/Ory X )( .-,-- "
-Oust X / \ - """"'X i
'Iapour Fumes X /' \ --rl-
No'se X I \ X .
-
I Moving Objects X \ / X
: Hazardous Machines \ / -,-- - I ..
! Electrical X \ I ----=9=
i 3ha,p Tools ele " X . -.
-- -- f RadlantlThermal Energy . /" -----.-- 9
: Slipper, - - - '1
.- - - -
Congested Workslte -~-;/ \\-+~-- -
--
I Travelling "\. /-- ^
'- Work Atone X \. / 1\ *
_.....ork Independent but Ingrov!: " V "- *
- *
O"adllne Pressures " /, )(
InieJ8Ci-;ith Public " / '\ A J ·
~Ope,ote Equip IMach. A / \l--r- X I ·
nlblllly 10 person usIng wheelchaIr 0
." hlOh.. Conald.rallon.""" .Froquonc1 (Tne frequency o. mOlllmum weIght should bo
'al Dulles .howll without .b,ack.t. and the freQuencv 01
'- uauttl weIght_ withIn brachls)
o . Not P€lr'Ofmod
1 . Seldom Par'OfmoGf Nor 0811"
I #L
I
~INGSTO" PSYCHIATRIC HOSPITAL
MEDICAL CERTIFICATE ARD RETORR-TO-WORK PORM
-.I Dat.e.
To
Re WCB RaMBER
(If applicable)
Dear Physician,
Kingston psychiatric Hospit.al has a joint Union/Management Return to Work
Program that provides an employee recovering from illness or injury with a
work opportunity (modified duties) that will facilit.at.e the employee's
successful return to work We are seeking your assistance in advising us of
the extent of limitation and length of time it is ant.icipated before he/sh~
may resume his/her normal duties and/or his/her ability to commence a Return
to Work Program to accommodate his/her limitations
Please finq enclosed a comp 1 et ed Physical Demands Analysis for this
employee's position
TO BE COMPLETED BY ATTENDING PHYSICIAN.
Employee may return to regular duties immediately
Employee should remain o~f regular duties for days weeks
Employee may return to modified duties on
'-' D/M/Y until D/M/Y
...
NOTE. If you determine the employee should return on modified duties, please
complete enclosed physical Capacities form
(x)MMENTS .
~ext Assessment Date:
-::a:.:lg Physiciu'. Rame (Please pr.-.t or type)
!~eating P~ysici&D'sSig.Dature Date:
Please give completed form to the employee for immediate return to Kingston
Psychiatric Hospital, Poatal Bag 603, Kingston, Ontario. 1t7L 4X3
~INGSTOM PSTCBIA'l'RIC BOSPI'l'AL lit REQUESTING THIS MEDICAL IRFORMA'1'IOR ACCEPTS
RESPONSIBILITY FOR PAYMEK'1' or THIS CERTIFICATE, WHER! APPLICABLE.
Thank you for your co-operation in this matter
~
94-10-/95 Co-ordinator, Return to Work Program/or Delegate
~ing5ton Psychiatric Hospital
. #z
' I';.
.
ICIII&B11II PS'tOtIAlIlC IDJ>>ITIl. ftlV'SlCM. r.wM:ITIES RIll
PATIENT'S NIK.
'-dur Doctor · i . f . 't I t fkwt'
Your (o-quwation in (OlIPle' ng tha5 or. as v. I 0 our . I an
deter.ininCJ the work potenti.1 of our etlploy...
I. In a regula, worle dll' ..,Ioy.. Clft Itlftd/~'kl
(1Ioa'[j' 011. [) . (ot,l HourI .rill' lIy) 0 0 o No Rntriction
DO 0 DOOJO~O
o 1-2 2-4 4-6 6--8 8-10 10-12 0 1-2 2.... 4 6-8 8-10 10-12
2. In a regular work day, .-ploy.. Cin sit.
J oHotrttCi 'CJ 0 0 (ohl ban .r6"9 lIy) 0 o No Rfttriction
OJ JOOO
) 1-2 2.... 4-6 6--8 8-10 10-12 o 1-2 2.... 4~ 6-8 8-l0 10-12
3. In I regullf' worle d'li' ....Ioy.. un use cOlllpUtctr keyboard.
oHourct O' 1] 0 0 <0'1 Oft fji.'(f)O 0 o No Restriction
~ 1-2 2.... 4~ 6--8 8- t 10-12 0 1-2 2.... 4~ 6-8 8-10 10-12
4. In a regu1.r work dAY, IIPloy.. un drive urltruclc or otblr Ylhiel..
o OAll " .t 01. tf:j) <Howrtit Oft. "lib o No IMtr ict ion
o 10-30 30~ 1- )3
s. Elployw un lift/CirrI' 0 No Rfttrictton
tlaxi_ Ibl: 0 5 0 15 20 ~ 30 3S 40 4S 50 55 60 ~ 70 75 10 or Ibovo
--3-3---3---3----
f"requently. _ _ _ '_' _ _ _ _ _ _ _ _ _
Occuiarwlly. _ _ _ _ _ _ _ _ _ _ _ _ _
~ &lp1OC: un UN hn. for r.etitivo: o No Restriction
_ i'!2Jo Or,ng Puolilng "!!!.. Pull ingl" I.. J!!l ipulali... -
Right _ Yft No 3vn _ :E Vn _ No - No Rntr iet ion
loft _ Yet No YH ~ Vft _ No _ No Rntriction
-
7. Elploy.. is .t)le to <in ter.. of . r.1.,. work dAy, Continucully II 67~IOOX, f"requently = 34-661,
Occ'lieHUy · 331): ..
_ Cent :,,","IY r,"":."y Ilcca~""llY IlDl at all
=: ~:
~i. _ _
~wl _ _
ReICh above shoulder lmll __
8. II IIIploy.. ,"trictlCS by InYir~tal factorl IUCh .1 heat/cold, dust, dMpMlI, height, noi., ItC?
-.
- No rntricUon
_ Vn PlUM indicate 1 ielwtientl
,. Is IIIPl0yl'e involveclvUh t'Ht~ w/or lIIdicat,ior., th.t-eight affect hillMr abUit)' to \o'Ork?
3 No ,ntriction
Yes PINM indicMe liMlaUGH
10. WE I Nployee IHI requirld to UI4t .y ."iativ. devices or other work ICCGMOHUCIM?
- No
_ Yn PIN. indiut. U.it.UClM
tl. U ItreKl, NOtiOMI, psychological prolal... ~w CM.l1Ocl abMnce fr. wcwk, is ..,Ioyee rHdy to r.turn
~. to wort? Yn 0 No o Pl... indicate U.itationll .
Additionll cOlelntSI
Physician's Signature. Dah.
,;. .
#~
KINGSTON PSYCHIATRIC HOSPITAL
PHA1~MACY MEMORANDUM
October 24, 1995
TO. Shirley Gowdy
Supervisor CCM!Ward 12
FROM Douglas Down
Chief Pharmacist.
RE SHELL FISH ALLERGY
-----------------------------------------------------------------
-----------------------------------------------------------------
In reference to your request for information regarding the
likelihood of shell fish allergens being present in any of our
pharmaceutical formulations we have the following to report I t is
noted that Breaded seafood has a much greater likelihood ofcausing
a reaction because of the extra ingredients added, and at least
some of the protein allergen~ known to be in shellfish are quite
heat stable
It would be of some help if you could be a little more
specific about the allergen we are looking for At your request I
could provide an article by Taylor and Nordlee describing
microorganisms as a major source of adverse reactions
Unfortunately I can not predict what ingredients new
pharmaceuticals entering the market may have We also can not
anticipate the likelihood of contaminants being undocumented
I have contacted the Canadian Pharmaceutical Association, the
Pharmacy Manufacturers Association of Canada and Hea]th Canada
There is no data base for other than the primary ingredients of a
pharmaceutical product and these ingredients are considered trade
secrets at this time There is however some proposed legislation
which would require the disclosure of all ingredients
The only product which comes to mind as having the potential
to contain this allergen is Calcium Carbonate from Oyster Shell but
these are fi 1m coated and I know nothing about the processing
involved Calcium Sandoz is derived from a mineral source so there
should be no pot.ential for these allergins
To sum up your request there is no way of determing the
presence or exclusion of shellfish allergens in our pharmaceuticals
although I am not aware of any being documented
(i'
J~./ f), ------S
," #4
Ministry of Health
KINGSTON PSYCHIATRIC HOSPITAL
memorandum
DATE August 31, 1995
TO: Alfred O'Rourke
Assistant Administrator, Operations
Pierre Leichner
Psychiatrist-in-Chief
Elaine Van Melle
Assistant Administrator, Planning & Program Administration
Maureen Thompson
Acting Food Service Administrator
FROM Judy Frawley
Associate Director of Nursing
Clinical Planning & Programs
This letter is to inform you that the Nursing staff member with a
severe shellfish allergy is returning to duty as of Tuesday, September
5, 1995 and will be assigned to Ward 12 CCM
Cautionary signage will be posted in the immediate areas on and around
Ward 12 CCM Copies of the Shellfish Allergy Educational Package are
available from Ward 12 CCM, should you or any of your affected
personnel wisn to obtain a copy
Please direct any questions you may have to Shirley Gowdy at 5770/5772
or myself at 5632/5971
i , -; ;U<--Z."-~I..""L
J Frawley I
JF/asc
cc M K Bennett
Human Resources
Nursing Coordinators
S Gowdy
H Pinley/
H Myslivecek
..
STOP\ 1t ~ (STOP ~
& ~ &
flEAD CAUTION READ
ALLERGY ALERT
DUE TO A STAFF MEMBERS SEVERE ALLERGY TO SHELLFISH
NO FOOD CONTAINING SHELLFISH,
NO PUREED FOOD,*
NO CHINESE FOOD, **
NO FOOD PREPARED WITH UTENSILS OR
COOKING OIL PREVIOUSLY USED FOR
PREPARING SHELLFISH**
IS TO BE BROUGHT ON TO WARD '2
AT ANY TIME.
THIS INCLUDES
REAL OR IMITATION CRAB,
SHRIMP, LOBSTER , OYSTERS , MUSSELS,CLAMS,
SCALLOPS,CRAYFISH,SNAILS,SQUID,
AND
SHELLFISH BY-PRODUCTS SUCH AS
SOUPS OR SAUCES,ETC. CONTAINING THESE
*THE ONLY EXCEPTION TO THIS IS NON-SHELLFISH
PUREED FOOD PREPARED BY KPH NUTRITION SERVICES
**THIS CAN RESULT IN CROSS-CONTAMINATION
AND POSES A RISK
This sign Is not to be removed without the perml.s/on
of the nursing admlnlsfrallon.
May 1,1996
-;" #b
SHELLFISH
ALLERGY
(
EDUCATIONAL PACKAGE
CONTENTS:
1 CAUTION - ALLERGY ALERT
2 Allergy Alert on Ward 12, CCM
3. life Threatening Allergies - Helping to Make A Ward A Safer
Place for Allergic Staff
4 Possible Allergic Symptoms
5 Articles re Allergies (Bibliography List)
August 1995
,. ;;.;~ ~ ,- --- - ~ d rS~O~\
& 1 &
READ CAUTION READ
ALLERGY ALERT
DUE TO A STAFF MEIVIBERSSEVERE ALLERGY TO SHELLFISH
NO FOOD CONTAINING SHELLFISH,
NO PUREED FOOD, '*
NO CHINESE FOOD,'**
NO FOOD PREPARED WITH UTENSILS OR
COOKING OIL PREVIOUSLY USED FOR
PREPARIN',G SHELLFISH**
IS TO BE BROUGHT ON TO WARD , J!4
AT ANY TIME.
THIS INCLUDES
REAL OR IMIl"ATION CRAB,
SHRIMP, LOBSTER , OYSTERS , MUSSELS,CLAMS,
SCALLOPS,CRAYFISH,SNAlLS,SQUID,
AND
SHELLFISH BY-P~OD"CTS SUCH AS
SOUPS OR SAUCES,ETC. CONTAINING THESE
*THE ONLY EXCEPTION TO THIS IS NON-SHELLFISH
PUREED FOOD PREPARED BY KPH NUTRITION SERVICES
**THIS CAN RESULT IN CROSS-CONTAMINATION
AND POSES A RISK
This sign Is nD' to be removed wlfhouf the permission
of the nursing admlnlsfrat/on.
May 1,1996
----~_.-
>, ".
~.
ALLERGY ALERT ON WARD~,~CM
Currently a staff member on Ward 12, CCM has a life-
threatening allergy to shellfish and shellfish by-products.
An allergic reaction not only occurs by ingestion of these
products but also by air-borne allergen and cross-
I contamination which occurs most often during the cooking
process.
THEREFORE, NO SHELLFISH, SHELLFISH BY-
PRODUCTS, OR CHINESE FOOD ARE TO BE PRESENT
ON WARD 12 CCM.
All staff are expected to respect this staff member's allergy
and workplace accommodation program by not bringing
any shellfish, shellfish by-products or Chinese food to Ward
12 CCM at any time.
All visitors must be informed, by staff answering the door,
that absolutely no shellfish, shellfish by-products or Chinese
food can be brought to the ward for a patient or for any
other reason.
Your cooperation is very much appreciated.
June 1996
I
, .'
"
I
~THREAIEl~INfiALLERGIES
HEL~INfl_TO_MAKEA~_ASAFERPLACJLF031
ALLERGJ.C B3'AF~~~ME~MBE~RS
Allergic reactIOns ,can be a fnghtenmg expenence for those mdlvlduals who are
allergic
By workmg together, we can aSSIst a staff member who has hfe-threatemng
allergies to cope WIth hIs/her work accommodatIOn program.
SUGGESTIONS TO PREVENT EXPOSURE AND ASSIST THE
ALLERGIC STAFF MEMBER SHOULD AN EXPOSURE OCCUR
Do not bring or allow the allergy-producing substance(s), e.g. shellfish, shellfish by-
products or Chinese food on the ward at any time.
Inform all visitors than an allergic staff member is assigned to the ward and stipulate that
the allergy-producing substance(s) not be brought to the ward for patients or for any other
reason.
Become familiar with allergic reactions. Review the available articles on the ward.
(Bibhography attached)
Should an allergy-producing substance be accidentally brought to the ward, it !pust be
removed immediately by a non-allergic staff member and the allergic staff member must be
informed immediately! Remember air-borne allergens and cross-contamination.
If the staff member states that he/she is having a reaction BELIEVE IT!
An allergic person may feel the reaction long before you see any sign of it. This will
MAXIMIZE THE TIME A V AILABLE to assist the allergic staff member with hislher
emergency protocol should that be necessary
NOTE The allergIC staff member IS responsible for mformmg the Nurse-m-Charge or other staff
If he/she expenences an exposure to an allergen. Following the exposure, the allergIC staff
member wIll commence hIs/her emergency treatment by hlln/herself or wIll ask for aSSIstance
REMEMBER. By becoming familiar with and adhering to an allergic staff member's
accommodation program, you reassure that person that you are aware of hislher needs,
and that you know how to assist that person to avoid exposure to the identified allergens.
Such awareness and consideration can only serve to enhance team cohesiveness.
June 1996
~;
August 1995
POSSIBLE ALLERGIC SYMPTOMS
I
. Tingling in mouth;
. Feeling of foreboding, fear, apprehension;
. Hives, itching;
. Flushed face, body;
. Swelling - eyes, Ups, face, tongue;
. Tightness in throat, mouth, chest;
. Difficulty breathing, swallowing;
. Wheezing;
. Coughing, choking;
. V omiting, stomach upset;
. Dizziness, unsteadiness;
. Loss of consciousness;
. Coma and death.
___u_
,~
ARTICLES RE ALLERGIES
1 Aliergy Information Letter
Allergy Informatlon AssociatIOn July 1987
2. Allergy Overview for the '90s
Health News April 1993
3. Tobacco and your Health
Report of the Chief Medical Officer of Health
Mimstry of Health 1991
4. Adverse Reactions to Foods
A PatIent's GUide to Diagnosis
Treatment
Resources
Amencan Academy of Allergy and Immunology July 1984
5. Cigarette Smoking
The Lung Association September 1991
6. Adverse Reactions to Food Additives
American Academy of Allergy and Immunology
7 If You've Got the Allergy, We've Got the Information
Breathmg Space Spnng 1993
8. Common Respiratory Allergies
The Lung ASSOCiatIOn July 1991
9 Asthma Actions
The Lung ASSOCiatIOn
10. Chronic Bronchitis
The Lung AssociatIOn January 1992
11 Food Allergies and the Foodservice Industry
Canadian Restaurant and Foodservlces ASSOCiatIOn June 1989
12. Eat, Drink and Be Wary
Chatelaine, June 1996
October 1996
~ ." it ~
CHERYL YOUNG & KPH
Staff who have attended Ward 12 Educational Program.as of May 3,1996
ZenaIda Baston
Penny Champagne
Jack GrIffin
Mike Smder
Lynn HutchIson
Karen RIess
Lome Switzer
Randy Wilson
Darcy Lloyd
Ward Pointen
Barbara Wallace
LOIS Ferguson
BngId Lawrence
Margaret Winnett
Ken Graham
Brenda Andrews
Joyce Cataford
Ric SmIth
Kathy Hanna
Eddy Lloyd
Shernll Benn (deceased)
Carmen Boudreau
"
~ ,~ I -#8
:.,.
MEDICAL EMERGENCY PROCEDURE FOR STAFF MEMBER ON WARD 12 WHO HAS A
LIFE- THREATENING ALLERGY TO SHELLFISH, SHELLFISH BVPRODUCTS AND
SHELLFISH CROSS-CONT AMINATED FOODS
The staff member who has a life-threatening allergy will wear his/her Medic-Alert bracelet at all times
while on duty or within the precincts of the Hospital. I
If the Staff Member is exposed while on duty:
I 0 The individual will determine whether to take his/her personal medication and will advise
the Ward Supervisor, Nurse-in-Charge or another member of the Nursing Staff whether or not
s/he has done so.
I I Other Staff will remove the source of the exposure from the designated area and away from the
route to the Medical Entrance or other designated entrance and route.
Reporting
2.0 The allergy sufferer, or another staff member if slbe is unable, will report exposure to Nurse-in
Charge or to Nursing Staff
2 1 The Ward Supervisor, Nurse-in-Charge or a member of the N~rsing Staff will inform the
Nursing Co-ordinator
In the event of a mild reaction
JO If the allergy sufferer determines slbe needs to go to a hospital emergency department,
slbe or another member of the Nursing Staffwill telephone for a taxi to come
promptly to the Medical Entrance or other designated entrance of Kingston Psychiatric Hospital.
3 1 Ward Supervisor or Nurse-in-Charge will notify the Nursing Co-ordinator that the allergy
sufferer has had an exposure and has gone to a specific hospital emergency department.
In the event of a severe reaction
40 If the allergy sufferer becomes unconscious, or, is very obviously in difficulty, the Ward
Supervisor or Nurse-in Charge or Nursing Staffwill call 911 and convey the attached
information ALLERGY SUFFERER: 9,11 INFORMATION
4 I Life-saving measures are limited to First Aid and CPR unless otherwise indicated in writing by
the allergy sufferer
4.2 The allergy sufferer is then to be transported by wheelchair or stretcher to the Medical
Entrance by a member ofthe Nursing Staff who is to remain with the allergy sufferer until slbe
is turned over to the ambulance attendant.
May 3, 1996
--
~ ........ VlP9
"
ALLERGY SUFFERER 911 INFORMATION
When calhng 911 for an allergy sufferer on Ward 12, say the following
This is Kingston Psychiatnc Hospital
We have a medical emergency Involving an allergy sufferer
There may have been an exposure
Please come Immediately to Kingston PsychIatnc Hospital, Medical
Entrance [or other designated entrance] and s/he w1l1 be there with staff.
May 3, 1996