Another 12 months have just passed and I’ll be shortly approaching my second anniversary as

Occupational Health Technician. This past year has been much busier, sometimes filled with
demanding and challenging tasks but overall, has brought a lot of satisfaction, enthusiasm and pride
to my working life. I like to think that I have become more confident, effective and pro-active whilst
building up on my qualifications and skills. I have repeatedly shown my commitment, motivation and
perseverance by tackling new challenges and implementing changes where necessary, e.g.
respiratory surveillance scheme. In October last year, after performing respiratory surveillance audit,
I have discovered irregularity in screening processes. It has come to light that due to the changes in
our internal software and control omission by client, over 100 service users didn’t have respiratory
surveillance in place as required. After few months of extensive work, respiratory surveillance has
been reintroduced to those service users and pulmonary function tests have been offered where
necessary. Most of those service users had respiratory surveillance done by Occupational Health in
the past however, a large amount of documents were still in Cohort or in our Rapid Access database.
It required manual transfer of multiple questionnaires and clinical notes extending the time needed
to set surveillance in place. That was the biggest challenge I have faced last year as it has collided
with annual skin surveillance set up. Completion of all that work followed up by clinical reviews,
pulmonary function tests, referrals to; consultants, GP’s , immunology testing has brought a lot of
satisfaction and turned out to be my biggest success.
Also, I have faced some obstacles with upper limb surveillance mainly due to the lack of clinicians
support and communication with doctors. I have flagged this up and together with my manager
we’ve been able to find alternative and successful path to a solution.
I have also actively taken part in creating educational health surveillance slides and have enjoyed
presenting them to the health care professionals. Also, I’ve played a small part in the health and
wellbeing scheme, offering peak flow readings to staff and patients (during smoke-free day) to help
raise anti-smoking awareness and introduction of smoking cessation services. This scheme also
included promoting free health checks available to UHS staff whilst reviewing upper limb surveillance
emails.
I work unsupervised at all times, both in the department and at other premises, delivering high
standards of Occupational Health services (phlebotomy, spirometry, health surveillance screening) to
service users allocated to my care. I have been running additional Hep B serology clinics when
required as an addition to my ‘news starters’ blood clinic.
Last year has been busy but exciting, I believe that I have greatly developed my clinical and practical
skills and have contributed to overall success of my team.

My job role duties haven’t greatly changed since the last appraisal. Some of the tasks have expanded
as I have been given more responsibilities. I believe that I have a good understanding of my job role
and that I always try to fulfil all my duties with great attention to detail.
In a nutshell my duties include:

- Undertaking agreed clinical activities relevant to occupational health services like:

phlebotomy, respiratory surveillance for animal house users, respiratory sensitiser
surveillance, skin and latex surveillance, upper limb surveillance, mycobacteria research
surveillance
- Assisting in undertaking a range of required services including logistic on and off site, stock
ordering and management
 - Being accountable for delivery, recording and reporting health surveillance and escalating
concerns to a specialist clinician or nursing staff
- Ensuring the delivery of the highest possible standards of quality assured evidence-based
practice.
- Being responsible for cleaning and stock checking clinical areas as per protocols and
checklists. Helping maintain clinical supplies and ensuring that clinical rooms are suitably
maintained.

Please see below for brief explanation of tasks performed last year:

Phlebotomy- I’ve been running clinics alongside nurses to help with the intake of new nursing and
medical students on both on site and off site. Throughout the year I’ve also carried out few
additional Hep B serology clinics in order to ease floating clinic pressure. Also, I have helped with
blood taking for health checks as and when required. I have become more confident and skilled in
venesection, increasing efficiency and patient safety.

Spirometry/Respiratory Surveillance - I’ve been undertaking unsupervised pulmonary function

tests; running clinics on and off site. After attending intermediate level training – ‘Lung Function Test
in the Workplace’, I have gained wider knowledge, awareness and understanding of normal and
abnormal spirometry interpretations which I’ve applied to my daily work. I have become more
independent and confident in assessing patients which have led to better patient experience and
minimised Occupational Health Physician input. I have always been working within my clinical
boundaries and have a proper understanding of a good practice, I’m honest with my patients about
what I can and cannot do; I recognise my abilities and the limitations. I’m working strictly within my
competences in collaboration with senior colleagues to ensure the delivery of high quality, safe and
effective healthcare. I’ve successfully completed respiratory surveillance audit and effectively
managed all inaccuracies and miscomprehension. In order to achieve that I have co-operated with
animal house managers, OH case managers and physicians . Also additional health surveillance has
been created in co-operation with admin and clinical manager to fulfil the need of screening service
users at risk of developing sensitisations due to exposure to a substance which, when inhaled, can
trigger an irreversible allergic reaction in the respiratory system (other than LAA). Informational
leaflets, portal instructions and questionnaires have been produced to ensure effective and safe
operation of screening.

Skin and latex/Upper Limb/Mycobacteria Research Health Surveillance - I have provided annual
skin and latex and upper limb health surveillance again this year, however with added
responsibilities. Instead of referring any reported skin problems straight to the nurse for follow ups, I
have communicated directly with affected staff members and gathered evidence (photos, emails)
first. It allowed for minor or no longer relevant problems to be solved without impacting valuable
nursing time. I have been able to assess staff members based on skin and latex assessment forms
and then either point them for direct skin review or provide them with necessary advice and
information. Similarly, with upper limb surveillance, I have been assessing affected employees based
on additional questions in order to defer significance, urgency and cause of declared symptoms. Due
to the changes in certification, data migration and lack of Dr’s availability, the screening process has
been slightly delayed and caused some frustration. However, after discussing this with my manger,
we have been able to find alternative pathway of referrals. I have been also able to refer affected
members for physiotherapy treatment and then to follow them up with further necessary
appointments/advice. This year, we have changed the way we issue fitness certificates and have
included previous year’s outcome on fitness forms. In order to achieve that, skin and latex and upper
limb surveillance outcomes from previous years had been added to employees records. Most of
those records didn’t contain surveillance outcomes and required manual assistance. Again, it has
caused delays further down the line, but hopefully once done shouldn’t require assistance in the
future. Much needed changes to the Upper Limb Health Surveillance and Skin and Latex Health
surveillance questionnaires and setting up process have also been identified this year. After
reviewing our forms and processes with senior management, upper limb and skin screening is
shortly due significant improvement. Mycobacteria research surveillance is run on a half-yearly basis
for those who work with or nearby drug-resistant TB. I have been following that screening strictly to
the guidelines and have worked in co-operation with our consultant and admin manager to tailor the
surveillance to the users needs. With all different aspects of health surveillance, I’m also responsible
for resolving issues and complaints, providing portal and questionnaire assistance, reporting
concerns to nursing or medical specialists, as well as providing advice and information for staff.

Objectives:

Production of new practical guide to lung function testing- due September 2019- extension needed. I
was unable to complete above objective due to the extended and unexpected obstacles with health
surveillance. I have prioritised accommodation and resolving of respiratory audit inaccuracies.

Update SOP for health surveillance, both skin and respiratory, and upper limb - due March 2019 -
completed and has been sent over for approval. Due to the coming changes in health screening
another review is needed.

Produce SOP for mycobacterium research- due March 2019 - extension needed due to above.

Trust values:

Great healthcare systems put patients first; the nature of its’ design and efficiency should put
patients as the top priority. However, everything is always easier said than done. Wanting something
is easy. Saying something is easy. The challenge and the reward are in the doing. For me putting
patients first simply means not to lose sight of what is most important whilst working with targets,
pressurised diaries and regulatory restraints. To put things into perspective please see below
examples:

Patient A: eopas 76974. This male patient has been identified through respiratory surveillance audit,
his last screening was performed 3 years ago. Our client hasn’t been using suitable control method
and patient has been allowed to work with animal allergen despite not having valid fitness certificate
in place. Patient has been invited to attend a well overdue pulmonary function test. After taking
clinical history and reviewing patient notes, it became evident that he has been required to work
with rats despite having anaphylactic shock reaction to rat allergen in the past. Client has been
aware of severity of patient allergy but still expected him to perform occasional lone working with
sensitising substance. In the past, the patient was bitten by a rat and developed severe allergic
reaction and since then, he carries an epipen. Allergy to rats has been diagnosed in Oxford (no notes
regarding that in our records!) and patient was told that he is fine working in the rat room but
should avoid any contact with live animals or their fluids/ bedding/faeces etc. Patient has been
responsible for changing food bowls and water bottles. However, in case of emergency like a leakage
to the cage he was required to handle rats and change their bedding etc. He was wearing elbow
length gloves whilst carrying out that task but the risk of an animal bite was still present. Standard
FFP3 mask has been deemed adequate. By asking relevant questions, gathering documentation
(Immunology report from Oxford) and reviewing clinical history, I was able to understand how and
why this was affecting his work. I acted quickly and reviewed his case with OH physician.
Recommendations were made to completely eliminate exposure to rats to avoid any risk and life
threatening allergic reaction. I have been the patient’s advocate and have acted quickly and
decisively to ensure patient safety is no longer at risk.

Patient eopas: 50300. This female patient has just come back from maternity leave and started
working with active, drug resistant TB. She has been screened as per mycobacteria research
surveillance guidelines. She has T-spot blood test done as per procedure (which originally should be
kept on file and not communicated to patient, just so it could be checked for conversion if needed in
the future e.g. in case of incident). T-spot blood test results turned out to be positive. Acknowledging
guidelines but worrying about patient health, I have consulted senior medical staff. It has become
apparent that patient needs to be informed about blood test outcome and referred for further
treatment. I have worked within my boundaries and acted in responsible but caring way. Senior
consultant has contacted our client and mutually agreed to disclose surveillance findings to the
affected patient. Patient has been referred to the chest clinic and suitable treatment has been
offered. I’ve made every effort to ensure that the patient has been followed up on even when her
infection was unlikely to be work related. Patient has been completely and successfully treated for
latent TB. I have shown my commitment and motivation, considering patient safety as a top priority.

Working together is the imperative for the whole team to succeed. By showing a mixture of skills
and behaviours—from taking the initiative to communicating effectively, I believe I have
shown that I am a reliable hard worker with a positive attitude. I am someone who insists on
knowing what the team is trying to achieve and offers the time, knowledge and help when
needed. I recognise that everyone on the team is fallible and when mistakes happen, we’ll
work together to fix it. Please see the example below:

Patient C eopas .... This middle aged, female professor has not been screened for a few years
due to not being present on our system and was found by chance during the audit. In the
past, she developed a severe reaction to mice allergen and subsequently, was withdrawn
from any contact with mice. Later on, this restriction was amended so that she was allowed
to work with euthanised mice or their tissues whilst wearing an air-fed helmet and additional
PPE. This amendment has been put into place as it played a crucial part in her research and
future career. Upon finishing this research, she ceased working with mice and started
working with insects. A few years later down the line, she began working with mice yet again,
although dead, they still presented a risk to the patient, only this time, she was not wearing
any additional PPE as required before. This whole situation has been overlooked due to the
lack of surveillance and employer’s compliance neglect. I began by reinstating surveillance
and performed the lung function test as well as clinical history review. I found a lot of clinical
data in our archives, however, I was unable to find the allergy reports. There were a lot of
documents and communication between OH, the patient, her GP as well as her employer and
no party wanted to take the responsibility for paying for those tests to be carried out. The
patient was adamant that some tests were carried out, however, there was no evidence to
support this. It was vital for me to find or repeat those tests as the patient was in the process
of applying for another grant that would require working with mice again. It was clear that
the system has failed in the past so this time, I worked closely with my occupational health
physician to obtain the necessary. I would also chase the GP in order to get this patients
entire medical history, yet this did not contain immunology test report. After reviewing all
the provided information, we decided that the patient had to be promptly referred for
allergy tests. She is now awaiting her appointment. To conclude, I focused on what was best
for my patient, I actively chased the information needed, and took the necessary measures to
make sure she is able to do her job safely. By working t, we have fixed what failed in the past.

I see ‘Always Improving’ as an opportunity; sometimes, all it takes is a smile to make a change.
Whatever the case, change is a combination of cause and effect, therefore, when I was reviewing the
upper limb surveillance this year, I understood that the way we did things was not as efficient and
effective as it potentially could be. It has also become clear that, due to the pressurised diaries of
clinicians, we needed to find an alternative way to review affected staff members. Luckily, with the
manager’s support, we’ve been able to establish alternative review pathway - by selecting urgent
cases, reviewing them with senior case managers, introducing direct physiotherapy referrals, we
have been able to change the way the workload is delegated. This also opened up the opportunity to
change the way we do the upper limb surveillance so it could benefit the patient and the
department. I have worked with the admin manager and nursing manager to put more effective
solutions in place, thus resulting in new approach, new reports, new questionnaires and new set ups
of ULD.

Attendance

The two sickness episodes in February and April have been linked due to pectoral muscle strain.
During that time, I lost most of my ability to move my right arm and shoulder. After receiving
physiotherapy and practicing the exercises given, the problem has now been resolved. So if it does
re-occur, I hope I’ll know how to treat it before it gets too severe. Unfortunately the arthritis is
spreading further in my joints on my left hand and my left foot. I have been seen by a podiatrist and
a chiropractor and hope to have it under control with insoles and exercises. The past year has been
quite tough with my personal life but I hope this will not affect my working life.
Career Aspirations

I have been informed that as of 2021, lung function testing will be regulated and necessary
accreditations will need to be obtained to perform spirometry. If the department is willing to put me
forward for this, I believe I am ready to obtain said qualifications. I would welcome the opportunity
for further development in my role.