< Previous20 Helping owners achieve the most productive use of every capital dollar. committed women can thrive. Women in leadership help to remove the psychological barriers women in construction face when entering a male- dominated field. A report by Big Rentz called Women in Construction: The State of the Industry in 2022 highlights the importance of mentorship to women entering the industry. Specifically, it highlights NAWIC as an organization that mentors women and promotes networking opportunities for women new to construction. Mentorships are an area where NAWIC women really shine. Whether formal or informal mentorship relationships, the women in NAWIC strive to help other women succeed and even thrive in their construction careers. Companies that want to attract women to construction are wise to include a NAWIC membership in their compensation packages. Many women on the jobsite have had to carry used sanitation products in their pockets all day because there was nowhere to dispose of these products discretely and hygienically. Nursing mothers report pumping breast milk in bathroom stalls or their cars. Several years ago, NAWIC partnered with OSHA to create best practices for sanitation on the construction jobsite specifically for women. Scan the QR code included with this article to read it. Many women in construction can relate to the problem of attempting to select company-provided personal protective equipment from an array of ill-fitting sizes. With the number of companies that now make personal protective equipment specifically for women, providing PPE designed for a woman’s body is an easy way to show a commitment to the women employed by a construction company. We have all seen the promotional posters for various tools that feature scantily clad women “selling” the product. These types of advertising should never be hung in public spaces. (And really, shame on companies that are still selling products in this manner!). Inappropriate jokes and discussions of someone’s latest Tinder conquest must not be tolerated because they are forms of sexual harassment, even if no harm was meant; these conversations can cause women to feel unsafe. Public spaces should only be used to promote the company and foster safe relationships among a diverse workforce. It is past time for construction companies to end their empty promises to women and to start putting policies in place that support female employees. Women are a substantial untapped resource if given safe and supported opportunities to utilize their talents to pursue a rewarding construction career. Karen Mitchell, CBT, CIS, CIT, is NAWIC’s National Safety & Health Awareness Committee Chair. Karen has been a NAWIC member since 2008. She is part of the Pikes Peak Chapter, and has been the chair for various national committees. She has 20 years of experience in the construction industry and is the owner and office manager of Double M Concrete LLC. Companies that want to tap into the human resource of women in construction must prioritize training for women. ‘‘22 Your organization’s benefits program can play a major role in preventing new opioid use. FEATURE T he opioid crisis continues to ravage the United States, as it has since the late 1990s when OxyContin was mass marketed. The opioid crisis is worsening by the year. Overdose deaths have more than doubled in the last five years, and in 2021, almost 108,000 overdose deaths were recorded in the U.S. Of these, over 70 percent were attributable to opioids, and fentanyl accounted for almost 75 percent of the opioid overdoses. Fentanyl is a highly lethal synthetic opioid compound. The CDC reports it is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl is cheap to produce and is being pressed into counterfeit pills contributing to unsuspecting overdoses. To teach the importance of having tough conversations with family and friends, I often refer to fentanyl as “fentakill.” The Drug Enforcement Administration (DEA) has been promoting the campaign “One Pill Can Kill.” The construction industry has been hit hard. The frequency and severity of musculoskeletal injuries is high in construction, contributing to prescriptions and surgeries. In addition to opioid prescriptions, musculoskeletal injuries are associated with a vicious cycle of chronic fatigue, which contributes to sleep deprivation leading to fatigue, which contributes to presenteeism (and absenteeism). This can cause or contribute to injuries and incidents, starting the cycle again. Many employers and labor unions report being unsure what actions to take when employees or members tell them they need surgery. Many say, “ok, thank you for letting us know. We’re family-first, so let us know when you’re ready to come back to work.” It’s important for employers and labor unions to do more and offer employees and dependent family members guidance on preparing for surgery. This is a win/win proposition for employees and family members as patients and caregivers, and for employer- and union-sponsored health plans. Conduct an analysis of surgery- related historical claims (both medical and pharmacy claims data) to identify improvement targets. Major expected findings in a Surgical Quality Analysis typically include recommendations to consider outpatient surgery vs. inpatient locations, requesting minimally-invasive procedures vs. open surgery, and opioid-sparing pain management strategies. Adopt opioid-sparing pharmacological and non- pharmacological pain management options (e.g., mindfulness, acupuncture) for medical and dental surgical procedures, including non- opioid options and multi-modal pain relief strategies. Action Steps for Employer- and Union- Sponsored Health Plans to Reduce Costs in Surgery Is Not Enough By Cal Beyer, CWP, Holmes Murphy & Associates The Same Ol’Incorporate Enhanced Recovery principles and practices into required precertification processes for inpatient surgery, outpatient surgery, and diagnostic imaging. These pre-certifications provide an opportunity to engage the patient and caregivers to begin the pre- surgical education process. Double-down on pre-operative patient and caregiver education to set the tone and expectations that recovery is expected. Using surgical nurse navigators for pre- and post-surgical education and advocacy leads to a faster recovery with fewer complications. Providing patients with a kit of useful resources to better prepare them for surgery reinforces patient and caregiver education. Adopt first dose prevention strategies to reduce opioid risk among the group health population (patients and family members), including: • Dispensing naloxone/Narcan ® with each opioid prescription’ • Dispense or provide a drug deactivation product and/or proper disposal instructions with each opioid prescription; and • Educate employees about medication lockboxes for prescription and over-the-counter medications to reduce the risk of diversion for misuse by family members or guests in the home. There are many construction contractors seeking to furnish naloxone (Narcan ® ) on jobsites. An opioid antagonist, Narcan is effective at reversing the effects of an overdose. Increasing access to Narcan ® is an effective method of “harm reduction,” essentially keeping folks with opioid use disorder alive so they can seek effective treatment for dependence and live full, productive lives. Narcan ® does not prevent a new opioid addiction. Therefore, providing Narcan ® on construction projects alone is not enough. While administering Narcan ® to a person who is overdosing can resuscitate them, what is needed is the elimination of new addictions in the first place. Harm reduction strategies and primary prevention methods are not an “either/or” proposition, nor are they mutually exclusive. Combining the two approaches is a “both/and” solution. Owners, contractors, and labor unions must unite to reduce the risks to their workers, projects, and companies. A recommended approach is to embed opioid risk reduction in employee benefit plans, and it can be addressed in both employer- and union-sponsored employee health plans. Doing so can dramatically extend the reach of these efforts to include the enrolled dependent family members of employees. Surgery in employee benefit plans is a leading gateway for new persistent opioid use leading to addiction. Figure 1 highlights persistent opioid use rates for seven common surgical procedures ranging from 6.6 percent to 17 percent, with an average of 8.7 percent. Surgery is an expensive area in employee benefit programs. For every 1,000 lives in a construction or heavy industrial manufacturing company or union health benefit health plan, approximately 50 to 70 members will undergo a surgical procedure in each plan year. Among high-cost claimants with medical bills exceeding $100,000, at least two-thirds will have had at least one surgery. Moreover, the heightened emphasis on surgery in employee benefit plans stems from the delayed preventive medical screening during the pandemic, leading to more advanced cancer cases with increasingly more complex procedures. There is a better way. Based on research and evidence-based protocols, Enhanced Recovery After Surgery (ERAS) improves pain management and minimizes opioids by emphasizing multi-modal pain relief, including non-opioid medications and/or over-the counter pain The Construction Users Roundtable 25 medications. Unfortunately, only five percent of surgeons use ERAS protocols in the United States. Surgical procedures performed according to Enhanced Recovery protocols demonstrate reduced complications and faster healing and recovery. In fact, one 2022 study from the Validation Institute showed 32-day faster recovery and return to work after surgery when supported by these evidence-based approaches. Please share this message with the personnel who are responsible for employee benefit plan designs, coordination, and administration. I would also like to encourage all project management and operations leaders and safety or risk management leaders from CURT organizations to share this article with human resources directors and employee benefit managers. Every organization can play a role in primary prevention of new persistent opioid use. Addressing opioids in employee benefit plan surgeries is a target with a major potential positive impact on human and financial capital risk management. Cal Beyer, CWP is Vice President of Workforce Risk and Worker Wellbeing for Holmes Murphy & Associates. He serves on the Executive Committee for the National Action Alliance for Suicide Prevention and the Advisory Groups for MindWise Innovations, Youturn Health, and the Suicide Prevention Resource Center. You can contact Cal at cbeyer@ holmesmurphy.com or (651) 307-7883. 1. Beyer, Cal. (December 9, 2022). How Surgery as Unusual is Like Business as Unusual. Goldfinch Health webpage. Guest Blog. https://www.goldfinchhealth.com/how-surgery-as-unusual-is-like- business-as-unusual. 2. Newland, Brand and Beyer, Cal. (Oct. 20, 2022). Optimizing Outcomes and Containing the Costs of Surgery. International Foundation of Employee Benefit Plans. https://blog.ifebp.org/ optimizing-outcomes-and-containing-the-costs-of-surgery. 3. Beyer, Cal, Jones, Richard, and Newland, Brand. (March/April 2022). Building Profits. Waging A Counterattack on Opioids: First-Dose Prevention Strategies for the Workplace & at Home. Construction Financial Management Association. https:// cfma.org/articles/waging-a-counterattack-on-opioids-first-dose- prevention-strategies-for-the-workplace-and-at-home. OVERALL – 8.7% Figure 1: Percent of newly persistent opioid patients by surgical procedure. Image based on original source by Pacira Biosciences. (2018). Exposing a Silent Pathway to Persistent Opioid Use. A Choices Matter Status Report. www. planagainstpain.com/explore-our- toolkit/2018-national-report. By percentage Rotator Cuff – 9.5% Sleeve Gastrectomy – 8.1% Hernia – 6.6% Colectomy – 17.0% Hysterectomy – 6.7% Total Hip – 9.3% Total Knee – 15.2%26 Helping owners achieve the most productive use of every capital dollar. INDEX TO ADVERTISERS Complete Professional Engineering Services Hargrove Engineers and Constructors .................inside back cover Compliancy Software eMARS Inc. ............................................25 Construction Maintenance McAbee Construction Inc. .......................6 Construction-Related Services Graycor .....................................................3 Decision Management Tool and Services Conspectus Inc. .....................................26 Dispute Resolution American Arbitration Association ............4 Electrical Construction NLMCC/Powering America ....................21 Labor Organization Operative Plasterers’ and Cement Masons’ International Association ................outside back cover Millwright Professionals Southern States Millwright Regional Council ..........................inside front cover Offsite Construction Roeslein and Associates Inc. ..................12 Precast Specialists Tindall Corporation ................................24 Safety Services HazTek Safety Management ....................18 Union Trades Programs United Association (UA) ....................14, 15 Advertise in The VOICE in 2023! 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