Exemplary Professional Practice: Culture of Safety EP18EO Workplace safety for nurses is evaluated and improved. EP18EOb: Provide one example, with supporting evidence, of improved workplace safety for nurses resulting from the safety strategy of the organization. Background/Problems(s) National Overview of Injuries Related to Patient Handling In 1970, Congress passed the Occupational Safety and Health Act that led to the establishment of the Occupational Safety and Health Administration (OSHA). OSHA s basic mission is to ensure that American workers have safe and healthy work environments that meet their standards. OSHA provides education and training to assist companies and organizations to meet the standards. OSHA monitors workplace safety by collecting data and monitoring injury trends throughout in the United States. Their data indicates that hospital workers have historically sustained significantly more injuries than non-hospital workers. In the most recently available OSHA data (2015), the average national rate of workplace injuries sustained by hospital employees was 60% higher than the average national rate for all other workers. Nursing specific data revealed that approximately 50% of workplace injuries incurred by nurses were related to patient handing and resulted in musculoskeletal injuries. Local Overview of Injuries Related to Patient Handling At Massachusetts General Hospital (MGH), Occupational Health Services (OHS) is responsible for the evaluation and management of employee illnesses and injuries, as well as regulatory reporting to a number of external agencies at the local, state, and national level. OHS staff maintains a database of all reported employee illnesses and injuries to facilitate regulatory reporting, as well as to provide data specific to role groups or practice areas as deemed necessary based on observed trends. The Director of OHS, Andrew Gottlieb, MSN/MPH, FNP-BC, also provides an OHS Annual Report at the end of each calendar year. The 2015 OHS Annual Report presentation in OOD 3 includes information about the: Rate of illness and injury reported to OSHA Number of lost work days Influenza vaccination rate Slips, trips, and falls Annual sharps-related injuries reported to the Massachusetts Department of Public Health The data presented in the 2015 OHS Annual Report presentation showed a favorable trend for all of the above metrics except sharps-related injuries. The rates of reportable injuries and lost work days, which include injuries related to moving and lifting patients,
showed a rate 44% below the national rate and 12% less than in 2014, respectively. However, despite these overall positive findings, a drill-down of the data revealed that nearly 25% of MGH s total number of injuries related to manual patient handling was incurred by nurses. Based on the annual report data, OHS staff engaged in intradepartmental discussions in March 2016 to determine appropriate goals and strategies for achieving them. They identified the following 2016 goals associated with the safety strategies of the organization: Reduce Injuries Related to Manual Patient Handling Reduce Sharps Injuries Increase Flu Vaccine Rates Improve Annual TB Compliance At this time, Gottlieb was in the process of finalizing a Safe Patient Handling (SPH) guideline that he had developed in collaboration with Vanessa Gormley, RN, MS, CNRN and Elizabeth Henderson, RN, MSN, AFN-BC, the co-chairs of the Clinical Nurse Specialist/Nursing Practice Specialist (CNS/NPS) group and Andrea Bonanno, PT, DPT, GCS, CLT, and Nancy Goode, PT, DPT, MS, from the Physical Therapy (PT) Department. This guideline was approved by the Clinical Policy and Record Committee later in March 2016 and by the Medical Policy Committee in May 2016. MGH Nursing & Patient Care Services Response When employees experience an injury related to patient handling, they are evaluated by a member of the OHS staff. A physical exam is performed and information is gathered about how the injury occurred. Despite the fact that ceiling lifts were in place on all adult in-patient units, the OHS staff were often told by nurses who had sustained injuries while moving patients that they had not used the lift. In a meeting with nursing leadership in early August 2016, Gottlieb shared this information and his concern that some of these injuries were preventable. He also reported on his work with the cochairs of the CNS/NPS group and PT to develop the SPH guideline and noted that it was ready to be disseminated for use by direct care providers. It was decided that an initiative to raise clinical nurses awareness of safe patient handling, in an effort to eliminate or reduce related injuries, would be an ideal way to introduce the SPH guideline to clinical nurses and address the concerns noted by Gottlieb. Janet Madden, RN-CNS, MS, ACCNS-N, Staff Specialist for Nursing & Patient Care Services (N&PCS), was charged with leading this effort. Goal Statement(s) The goal of this work was to reduce the rate of patient handling-related injuries by nurses as measured by the rate of such injuries per 100 clinical nurse Full Time Equivalents (FTEs) through the implementation of a safe patient handling awareness campaign. Description of the intervention(s)/initiative(s)/activity(ies) Madden partnered with Gottlieb to convene a Safe Patient Handling task force comprised of representatives from the CNS/NPS group, the CNS Wound Care Task
Force, Materials Management, the Norman Knight Nursing Center for Clinical & Professional Development (Knight Center), N&PCS Quality and Safety, N&PCS Communications, and Partners Health Care Ergonomics. In advance of the initial meeting of this group, Madden enlisted the support of Georgia Peirce, Special Projects Manager for N&PCS, to assist in communicating the key messages of the awareness campaign. Both Madden and Peirce had informal discussions with nursing directors, CNSs, NPSs, and clinical nurses to obtain additional information regarding the perceived use of ceiling lifts and barriers to use. They learned that most unit leaders indicated that ceiling lifts were consistently used to transfer patients to and from a bed to stretcher. However they were used less frequently for repositioning patients in bed or for performing wound care or other procedures. Clinical nurses shared that they would use ceiling lifts when a sling was on the bed but that the process of getting the sling under a patient to use a sling was perceived to be more time-consuming than manually moving the patient. The clinical nurses on some units also noted that slings were frequently out-of-stock. In the course of discussions, Madden and Peirce also realized that there were at least 15 different types of ceiling lift slings available, which proved confusing for staff. From these discussions, they learned that there were opportunities to: Increase awareness of the many uses of ceiling lifts Provide education on how to use the lifts for each patient situation Investigate the possibility of streamlining the number of slings Ensure an adequate supply of slings on all units Encourage proactive placement of a sling on the bed of all patients with impaired mobility The first meeting of the SPH Task Force took place in early August 2016. Gottlieb shared the OSHA and MGH data related to patient handling injuries including the baseline data rate of patient handling-related injuries per 100 full-time RN FTEs of 5.4 in July 2016. This data, in tandem with the information obtained from the preparatory discussions with clinical nurses, validated the need for this task force. It was also noted that increased ceiling lift use could benefit patients by reducing the number of shearing and friction injuries that can occur from boosting patients up in bed and that are often precursors of pressure ulcers. This group determined the key initiatives for the SPH awareness campaign during meetings held between late August and the end of September 2016. A summary of the key aspects of the SPH Awareness Campaign that were achieved by the OHS and nursing partnership is as follows: Streamlined the number of ceiling lift slings from 15 to four Developed a Ceiling Lift Quick Guide that was placed in every room equipped with a ceiling lift Developed a video for each of the four basic uses of the ceiling lifts that were embedded as links in the SPH policy, as well as sent to unit-level nursing leadership for distribution to their staff Advocated and achieved the purchase of additional ceiling lift slings so that there would always be an adequate supply accessible to clinical nurses
Collaborated with the Knight Center leadership and staff to provide refresher classes on ceiling list use and to enhance the education and hands-on experience that is included in nursing on boarding (i.e. orientation) Presented an overview of the rationale for and key aspects of the SPH initiative at the September 6, 2016 Combined Leadership meeting attended by interdisciplinary leaders and clinical staff Published a Question & Answer column in the September 15, 2016 edition of Caring Headlines Initiated the education and awareness components of the SPH initiative on September 28, 2016 by sending an email to nursing directors, CNSs, and NPSs that included the following message: As you have likely heard, an in-house group has been working to improve safe patient handling at Mass General. At the request of staff, virtually every patient room at Mass General now has a ceiling lift. These are proven to reduce the risk of pressure ulcers, and they are the best defense against injury for our staff. We are writing to solicit your help in encouraging staff to use these lifts to their full potential: when repositioning, turning or boosting a patient; moving a patient to/from the bed and a chair, commode or stretcher; and doing a wound change or procedure. To make this easier, we have evaluated and streamlined the choice of slings; adjusted the par levels and delivery system to units; and developed several refresher videos about their use that are now embedded in the Safe Patient Handling Guidelines. The email also included a draft of an email message for unit-level leaders to send to their staff, a link to the SPH policy, and separate links to each of the videos. Participated in the Safety Fair on October 19, 2016 and provided attendees with copies of the associated communications and the opportunity to view the videos Participants: Safe Patient Handling (SPH) Awareness Campaign Task Force Virginia Capasso, PhD, Clinical Nurse Specialist Institute for Patient Care APN-BC, ACNS-BC, CWS for Wound Care Andrea Bonanno, PT, DPT, Clinical Specialist Physical Therapy Services GCS, CLT Judi Carr, RN, MS Staff Specialist PCS Quality and Safety Brian French, RN-BC, PhD(c) Director The Maxwell & Eleanor Blum Patient and Family Learning Center and the Knight Simulation Program within the Institute for Sheila Golden-Baker, MS, RN-BC, CCRN Professional Development Specialist Patient Care Norman Knight Nursing Center for Clinical &
Professional Development Nancy Goode, PT, DPT, Physical Therapist Physical Therapy Services MS Vanessa Gormley, RN, MS, Nursing Practice Specialist Neuroscience (Lunder 7) CNRN Andrew Gottlieb, MSN/MPH, FNP-BC Director Occupational Health Services Patricia Hally Project Specialist Nursing & Patient Care Services Clinical Support Elizabeth Henderson, RN, MS, AFN-BC Nursing Practice Specialist Plastics/Burn ICU (Ellison 14) Marian Jeffries, MS, FNP- BC Nursing Practice Specialist Thoracic/Medicine (Ellison 19) Susan Kilroy, RN, MS, Nursing Practice Specialist General Surgery (White 7) CWS Janet Madden, RN-CNS, MS, ACCNS-N Staff Specialist Nursing and Patient Care Services Georgia Peirce Special Projects Manager Nursing and Patient Care Services Edward Raeke Director Materials Management Aaron Ross Ergonomics Specialist Partners Health Care Outcome(s) Post-intervention measurement occurred as of November 1, 2016. Following the launch of the SPH Awareness Campaign initiatives, the rate of patient handling related injuries per 100 clinical nurse FTEs has decreased from 5.4 in July 2016 to a range of 2.2 to 4.0 from October 2016 through February 2017.
This workplace safety improvement demonstrates the successful implementation of a safety strategy for nurses by the organization that was operationalized by the collaboration of the Occupational Health Department and Nursing & Patient Care Services.