What Instructions Should Be Given to Patients?

Upon completion of this section, you will be able to

• Describe instructions that should be given to patients exposed or potentially exposed to hazardous substances.

Health care providers should educate patients about the many steps they can take to prevent exposure to hazardous substances in the home, other non-work and workplace settings [Association of Reproductive Health Professionals 2010]. Providers also should advise patients who work in occupations such as

• Agriculture,
• Construction,
• Gardening,
• Landscaping, or
• Pest control

about limiting or mitigating chemical exposure at the workplace. It is important for health care providers to know about exposures to potentially hazardous materials their patients have had throughout their life. To do this, patients need to describe

• Workplace exposures,
• Exposures at home, and
• Other exposures they may have had.

To obtain a complete, detailed exposure history, physicians need to be able to communicate in a way that facilitates this process. Letting the patient know the purpose and the importance of providing detailed information before and during the history taking process may increase the quality and quantity of information received. Obtaining this information is vital toward preventing exposure or exposure related adverse health effects.

Physicians should also provide patient self-care advice, clinical follow-up instructions, and fully address patient questions using appropriate risk communication messaging techniques. By utilizing effective risk communication techniques, the clinician can promote patient behaviors that may reduce risk of exposure and exposure related adverse health effects.

Preventive messages targeted to at risk populations are also important in preventing adverse health effects from exposure.

Patients need to understand that unless an exposure history is pursued by the clinician, the etiologic diagnosis might be missed, treatment may be inappropriate, and exposure can continue.

Use of effective risk communication strategies while taking an exposure history can facilitate the gathering of complete, detailed information.

When counseling patients, providers should

• Recommend that patients try to become familiar with all chemicals used or encountered in their work and non-work settings and learn about the potentially toxic properties of these chemicals.
• Direct patients to appropriate sources of information about chemicals.
• Instruct patients on steps to take to mitigate exposure or refer them to their employer or to an environmental and occupational health expert who can suggest exposure-reducing strategies (e.g., substitute a safer chemical, wash exposed skin, launder clothing from work separately to prevent contamination of other clothing, etc.)
• Ask if patients have access to and are using appropriate protective gear.
• Advise patients to avoid contact with clothing, shoes or other “take home” work items that other household members may bring home if there is a potential for toxicant exposure.
• Advise patients to take extra care to avoid exposure if they are pregnant or planning pregnancy because standard personal protective equipment may not be sufficient to guard from exposure to reproductive toxicants. Advise them to change clothes before leaving the workplace and to have potentially contaminated clothing laundered at work, if possible.

Self-care advice creates awareness and suggests actionable behaviors that may reduce the risk of exposure to hazardous substances in the work and non-work setting as well as exposure related adverse health effects. Patients should be advised to consult their physician if they or their children develop signs or symptoms that may indicate exposure related adverse health effects.

ATSDR has developed “Patient Education and Care Instruction Sheets” that can help educate and facilitate clinical follow up. More information on this resource can be found in the “What Are Additional Environmental Health Resources?” section.

There are many printed and online sources of information about exposure to hazardous substances including many federal government agencies like ATSDR, NIOSH, OSHA, and EPA. Universities and U.S. Poison Control Centers may also be able to supply information about potential health hazards.

More information on available patient education resources including ATSDR’s Patient Education and Care Instruction sheets can be found in the “What are Additional Environmental Health Resources?” section.

• Patients need to understand why an exposure history is important.
• Patients should be given instructions on how to prevent exposure to hazardous substances in both work and non-work environments.
• Primary health care providers and patients should be aware of the many publically available clinical, environmental and occupational health informational and educational resources available to them.
• ATSDR has developed Patient Education and Care Instruction Sheets that may facilitate health care provider communications and follow up with the patient.
• Physicians should provide patient self-care advice and clinical follow up instructions using appropriate risk communication messaging techniques.