Anyone who practices occupational medicine or nursing needs to know what
injuries and illnesses must be recorded on an OSHA 300 Log and what makes
them recordable (Exhibit 15–2). Many large employers use the OSHA 300 Log
as a measure of safety and/or quality of medical care. It is common for
managers to be evaluated on the injury rate in their plant and bonuses often
depend on this rate. Employees may also have a financial stake in not getting
hurt. There are often incentives for groups of workers that do not have any
serious injuries during a specific time period.
This does not mean that physicians should collude with employees or the
company to conceal the severity of an injury. The first duty of the physician is
to provide all necessary and appropriate care to the injured worker. However,
the physician should be cautious about providing care beyond what is
necessary, particularly if it is only done to appease an angry patient.
The OSHA act requires that all work-related deaths and illnesses be recorded
on the OSHA 300 Log, but it limits the recording of injuries to specific types of
cases. The act states that all injuries must be recorded unless they are “minor
injuries requiring only first aid treatment, and which do not involve medical
treatment, loss of consciousness, restriction of work or motion, or transfer to
another job.” In other words, an injury must involve at least one of these four
conditions to be recordable.
Two of the four triggers are beyond the control of the medical care provider. If
the worker lost consciousness from the injury it is recordable, even if no
medical treatment is required. Also, if the employer chooses to move the
worker to another job because of the injury or the treatment, that is their
decision. It is the need for medical treatment and the restriction of work or
motion that the treating nurse or physician can control.
The simplest condition for the physician to evaluate is the need for restriction of
work or motion, but it is also the most contentious. Years of careful research
by the National Institutes of Occupational Safety and Health have shown
clearly that rest and/or splinting is not appropriate treatment for mild to
moderate sprains, strains, or tendinitis. The appropriate treatment is
antiinflammatory drugs and exercise. Unfortunately, the average worker thinks
that the best thing for a sore back is a few days sitting in front of the
television. Physicians should limit the use of rest, restrictions, or splinting to
injuries that have clear signs (not just symptoms) of moderate to severe
injury. This is good medicine not just good politics.
All restrictions should be very specific about the limits on activity and the time
these limits will be in effect. A physician doing occupational medicine should
never say, “Mr. Smith is on light duty.” The restrictions should say such limits
as “no lifting over 20 pounds,” or “no typing,” or “no use of the left arm.”
The last trigger for recordability is that the injury requires medical treatment,
not just first aid. This does not mean that seeing a doctor triggers
recordability. It is the nature of the treatment, not who gives it, that makes an
injury recordable. Because the distinction between first aid and medical
treatment is vague, OSHA has established some specific guidelines.
The list is long, but there are some general rules that make sense. Second and
third degree burns, fractures, and wounds that become infected or require
surgical treatment such as sutures or debridement are severe enough that they
should be recorded. In addition, sprains and strains that require physical
therapy or repeated treatments past the first visit are requiring medical
treatment, not just first aid.
Prescription medications are also clearly medical treatment. A worker can take
over- the-counter ibuprofen without a prescription. This is not considered
medical treatment even if he or she takes 800 mg three times a day. If a
doctor writes a prescription for 800mg ibuprofen, the injury is recordable.
Physicians who do occupational injury care only occasionally should be careful
about overtreating simple injuries and making them recordable. Prescription
nonsteroidal anti-infalammatory drugs (NSAIDs), narcotics, antibiotics, and
physical therapy should be reserved for injuries that are severe enough to
warrant such treatment. If the physician gives a prescription just to appease a
troublesome patient, the physician should note in the chart that the injury was
not severe, but the medication or therapy was given for patient comfort. But
remember, if the physician would not be comfortable explaining a narcotic
prescription to the Drug Enforcement Administration (DEA) then it shouldn’t be
given at all.
It is clear from this discussion of what makes an injury recordable that not all
workers’ compensation injuries are recordable. The reverse is also true. Not all
recordable injuries are covered under workers’ compensation. Many states do
not require payment under workers’ compensation until an injury has limited
the worker’s activity or required care for a specific number of days. A laceration
that is sutured by the plant doctor is a recordable injury, but there may not be
a workers’ compensation claim filed. In contrast, a worker with a strained back
may be treated in an emergency room and given heat treatment, massage,
Advil, and exercise instruction. This would be billed to the workers’
compensation insurance but it would not be recordable.
In summary, there are very specific rules about what injuries and illnesses
should be listed on the OSHA 300 Log. Physicians and nurses who frequently
treat work- related injuries should be familiar with these rules. The U.S.
Department of Labor publishes Recordkeeping Guidelines for Occupational
Injuries and Illnesses (O.M.B. No. 1218–0176), which answers most of the
questions that arise.