I. Summary AB1136 II. Forming labor/management committee III. AB1136 Legislative Counsel Digest IV. Resources AB 1136 (Swanson) Employment Safety: Health Facilities This act shall be known and cited as the Hospital Patient And Health Care Worker Injury Protection Act. Safe Patient Handling Policy Implementation I. Summary ON January 1, 2012 the recently passed Hospital Patient and Health Care Worker Injury Protection Act - AB 1136, goes into affect. This law amends the California Occupational Safety Act of 1937 and for good reason: There is not a nurse among us who hasn t had one injury or another while caring for a patient. For many of us, that injury took us off work either temporarily or permanently. This law attempts to provide us with a preventive measure to the all too known chronic pain in our backs, necks and shoulders.
SEIU Nurses have been tireless in getting this law passed but the work now takes a different phase. We need to understand the specifics and the nuances of this law to be certain that our employers comply with these new requirements and implement effective Safe Patient Handling programs and policies at our facilities. For example, the law has language to make certain that union nurses are at the table when it comes to developing newly mandated safe patient handling policies, including assistance in creating trained lift teams. Some Other Key Matters of Fact AB 1136 amends the California Occupational Safety and Health Act of 1973. AB 1136 requires that each general acute care hospital* employer maintains a safe patient handling policy for all patient care units. AB 1136 does not apply to general acute care hospitals within* the Department of Corrections and Rehabilitation or the State Department of Developmental Services. However, unions can still bargain with these employers for safe patient handling programs and policies. AB 1136 requires replacement of manual lifting and transferring of patients with mechanical lift and transfer devices, or lift teams (trained to use lift equipment). AB 1136 requires that there are trained lift teams or staff trained in safe lifting techniques, and requires union members are consulted with in this area. What AB 1136 Means for Safe Patient Handling in California With the recent passage of safe patient handling legislation in California, many healthcare workers have questions about the details of the bill and what these will mean for them. The following answer some key questions. On page X following this is the full language of AB1136. What is AB 1136? This legislation require an employer to maintain a safe patient handling policy, as defined, for patient care units, and to provide trained lift teams (defined in the law), or staff trained in safe lifting techniques in each general acute care hospital, except for specified hospitals. The safe patient handling policy would require the replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, or lift teams (as specified in the law). The safe patient handling policy must be included in the employer s injury and illness prevention program already required by California OSHA regulations. Employers are be required to adopt a
patient protection and health care worker back and musculoskeletal injury prevention plan, which shall include a safe patient handling policy component (as specified in the law), to protect patients and health care workers (as defined in the law), in health care facilities. As part of the injury and illness prevention programs required by existing OSHA regulations, employers would be required to adopt a patient protection and health care worker back and musculoskeletal injury prevention plan, which now includes a safe patient handling policy component. To that end, the employer is now mandated to maintain a safe patient handling policy at all times for all patient care units providing trained lift teams or other trained support staff. The employer is responsible for providing training that includes, but is not limited to, the following: The appropriate use of lifting devices and equipment. The five areas of body exposure: vertical, lateral, bariatric, repositioning, and ambulation. The use of lifting devices to handle patients safely. When will the law go into effect? The bill goes into effect January 1, 2012. Does the law require lift teams? Yes, but the definition of lift team has been expanded to include healthcare workers with training on safe patient handling equipment. Facilities can develop their own program models so long as certain staff members are proficient with lift equipment. How does the law define lift teams? Under this law, lift team means hospital employees specifically trained to handle patient lifts, repositioning, and transfers using patient transfer, repositioning, or lifting devices as appropriate for the specific patient. Lift team members may perform other duties as assigned during their shifts. A general acute care hospital shall not be required to hire new staff to comprise the lift team so long as direct patient care assignments are not compromised. Who coordinates and monitors lift teams and their interactions with patients? As the coordinator of care, the registered nurse shall be responsible for the observation and direction of patient lifts and mobilization, and shall participate as needed in patient handling in accordance with the nurse s job description and professional judgment. What is a Safe Patient Handling policy?
A policy that requires replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, and lift teams, as appropriate for the specific patient and consistent with the employer s safety policies and the professional judgment and clinical assessment of the registered nurse. Who is a Health Care Worker? A lift team member or other staff responsible for assisting in lifting patients who is a hospital employee specifically trained to handle patient lifts who is a hospital employee specifically trained to handle patient lifts, repositioning, and transfers using patient transfer, repositioning, and lifting devices as appropriate for the specific patient. What happens if a Health Care Worker refuses to lift, reposition or transfer a patient? If a health care worker has concerns about patient or worker safety or the lack of trained lift team personnel or equipment shall not, based upon the refusal, be the subject of disciplinary action by the hospital or any of its managers or employees. II. Forming a Labor/Management Committee addressing safety issues and developing Collective Bargaining Unit language that lays out the elements of a good policy. Examples: DRAFT CONTRACT CLAUSE Implementation of a safe patient handling policy for all shifts and units of the hospital, using lift teams that use mechanical lifting, transfer and repositioning devices to reduce back, neck and shoulder injuries. Recognizing that back, neck and shoulder injuries are caused from manually lifting patients, the medical costs and lost workdays associated with these injuries, the aging nurse workforce, the need to recruit and retain more nurses, and the need to reduce workers compensation costs, management is committed to working with their employees to evaluate the number of injuries caused from manually lifting and transferring patients, and will work together with its employees to implement a comprehensive program utilizing lift teams trained to
use mechanical lifting, transferring and repositioning devices to reduce such injuries over the next twelve months. Mechanical lift programs can offer hospitals significant savings and reduce skin tears suffered by patients by threefold. The physical demands of the nursing profession and workplace injuries lead many nurses and healthcare workers to leave the profession. Considering the present nursing shortage in California, measures must be taken to protect nurses from disabling injury. Local Unions can work to insure their employer has an effective Safe Patient Handling Program and Policies. It should include, but will not necessarily be limited to the following elements: 1) Creation of, or presentation to, a joint labor management (JLM) committee composed of equal numbers of union members (selected by the union) and managers who will meet at least on a monthly basis to discuss the planning, implementation, and monitoring of the success of a safe patient handling policy using lift teams and/or mechanical lifting and transfer devices. The hospital will maintain a detailed written description of the policy/program and its components. 2) Hiring a mutually agreed upon outside consultant with experience in working with management and labor in implementing programs utilizing lift teams with mechanical lifting, transferring and repositioning devices to assist the Safe Lifting committee. 3) Dedicating staff to work with the committee and manage a program utilizing lift teams with mechanical lifting, transferring and repositioning devices. 4) Providing a copy of the OSHA 300 logs for the past three years to the members of the committee. 5) Providing data to the committee on the number of lost workdays caused by, and how much the employer has spent on medical costs and workers compensation on patient related back, neck and shoulder injuries over the past three years. 6) Recruit and properly train an adequate number of lift team members to provide patient lifts, transfers and repositioning on a 24/7 basis. 7) Bring in mechanical lifting, transfer and repositioning device vendors to demonstrate their products to the committee members and members of the lift teams in order to obtain input from front line patient care givers.
8) Based on the recommendations of the committee members and lift team members, purchase sufficient numbers of the chosen lifts, transfer and repositioning devices to meet unit and patient needs. 9) Provide lift team members with cell phones or other form of instantaneous communication equipment to respond to requests for responding to requests for performing lifts, transfers and repositioning. 10) Provide training to nurses and other staff that formerly performed lifts on the advantages of, and how to contact lift team members to provide patient lifts, transfers and repositioning, in order to create an atmosphere and culture of safety. Ensure that the patient handling training for a health care worker required is conducted prior to any use of the safe patient handling equipment by the healthcare worker, and at least annually thereafter. Provide that training shall be at least two hours in duration and shall be held during paid work time. Provide appropriate interim training for health care workers beginning work between annual training sessions; and provide refresher training, as needed. A covered facility shall require all health care workers responsible for patient handling to participate in the annual safe patient handling training. Training shall be mandated for supervisors, all equipment users, members of the committee and all departments and staff that are engaged in patient handling activities. Training shall include: An explanation of the covered facility's safe patient handling policies and practices; Causes and prevention of musculoskeletal injuries and disorders; How to recognize and address early indications of musculoskeletal injuries and disorders before serious injury develops; Identification, assessment and control of patient handling risks, including use of assessments of patient need for assisted patient handling and appropriate communication with patients; A demonstration of safe, appropriate and effective use of patient handling equipment; Trainee participation in operating unit-specific patient handling equipment and demonstration that they are proficient in using such equipment for patients with a range of physical limitations; The facility's procedures for reporting work-related injuries and illnesses following California s Injury and Illness Prevention Program regulation (Section 3203 of Title 8 of the California Code of Regulations) Explanation, demonstration and practice of researched and proven methods and techniques that one or more health care workers may use for patient handling of a patient who refuses assisted patient handling. 11) Provide reviews of the success of the program, looking at OSHA 300 logs, the number of neck, back and shoulder injuries and the number of lost workdays
due to patient lifting, transfer and repositioning injuries, and any savings in workers compensation costs that have resulted. 12) At the end of the first year, and each year (some have other time frames) thereafter, compile and make available a report highlighting the successes of the program/policy, and include recommendations of the committee for improvements to be implemented during the following year. 13) Supervisors (or committee and lift team) will ensure that mechanical lifting devices and other equipment/aids are accessible to staff. Supervisors shall ensure that mechanical lifting devices and other equipment/aids are maintained regularly and kept in proper working order. Supervisors and staff shall ensure that mechanical lifting devices and other equipment/aids are stored conveniently and safely. 14) In a facility or health care system where health care workers are represented by one or more collective bargaining agents, the management of the facility or system shall consult with the collective bargaining agents regarding (the lift teams and RNs may well be represented by more than one union) 15) A statement that patients shall have the right to refuse the use of assisted patient handling. Develop a process to identify the appropriate use of the safe patient handling policy based on the patient's physical and medical condition and the availability of lifting equipment or lift teams. The policy shall include a means to address circumstances under which it would be medically contraindicated to use lifting or transfer aids or assistive devices for particular patients. 16) The policy shall be easily accessible to staff, patients, and visitors. 17) When developing architectural plans for constructing or remodeling a hospital or a unit of a hospital in which patient handling and movement occurs, consider the feasibility of incorporating patient handling equipment or the physical space and construction design needed to incorporate that equipment at a later date. 18) A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement.
III. Assembly Bill No. 1136 CHAPTER 554 An act to add Section 6403.5 to the Labor Code, relating to employment safety. [Approved by Governor October 7, 2011. Filed with Secretary of State October 7, 2011.] AB 1136, Swanson. Employment safety: health facilities. Existing law regulates the operation of health facilities. Existing law, the California Occupational Safety and Health Act of 1973, establishes certain safety and other responsibilities of employers and employees, including the requirement that employers provide safety devices and safeguards reasonably necessary to render the employment safe. Willful or repeated violations are a crime. This bill would make findings and declarations concerning the lifting, repositioning, and transfer of patients in acute care hospitals and resulting injuries to hospital personnel. This bill would amend the California Occupational Safety and Health Act of 1973 to require an employer to maintain a safe patient handling policy, as defined, for patient care units, and to provide trained lift teams, as defined, or staff trained in safe lifting techniques in each general acute care hospital, except for specified hospitals. The safe patient handling policy would require the replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, or lift teams, as specified. As part of the injury and illness prevention programs required by existing regulations, employers would be required to adopt a patient protection and health care worker back and musculoskeletal injury prevention plan, which shall include a safe patient handling policy component, as specified, to protect patients and health care workers, as defined, in health care facilities. By changing the definition of a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. The people of the State of California do enact as follows: SECTION 1. This act shall be known and cited as the Hospital Patient and Health Care Worker Injury Protection Act. SEC. 2. The Legislature finds and declares the following: (a) In 2008, there were 36,130 occupational musculoskeletal disorder (MSD) cases in private industry where the source of injury or illness was a health care patient or resident of a health care facility. This accounted for 11 percent of the 317,440 total cases of MSDs that resulted in at least one lost day from work in 2008. Almost all (98 percent) of the cases involving patient handling occurred within the health care and social assistance industry, composing 55 percent of the 64,300 total MSD cases in that industry. (b) For MSD cases involving patient handling, almost all (99 percent) were the result of overexertion. A sprain, strain, or tear was the type of injury that was incurred in 84 percent of the MSD cases involving patient handling. (c) Nursing aides, orderlies, and attendants incurred occupational injuries or illnesses in 52 percent of the MSD cases involving health care patients. Registered nurses accounted for 16 percent and home health aides for another 6 percent. Other occupations with MSD cases involving health care patients included licensed practical and licensed vocational nurses, emergency medical technicians and paramedics, personal and home care aides, health care support workers, radiologic technologists and technicians, and medical and health services managers. (d) Over 12 percent of the nursing workforce leaves the bedside due to back injuries each year. California s nursing workforce is aging at the same time patient acuity and obesity are rising. It is
imperative that we protect our registered nurses and other health care workers from injury, and provide patients with safe and appropriate care. At a cost of between sixty thousand dollars ($60,000) and one hundred forty thousand dollars ($140,000) to train and orient each new nurse, preventing turnover from injuries will save hospitals money. SEC. 3. Section 6403.5 is added to the Labor Code, to read: 6403.5. (a) As part of the injury and illness prevention programs required by Section 3203 of Title 8 of the California Code of Regulations, or any successor law or regulation, employers shall adopt a patient protection and health care worker back and musculoskeletal injury prevention plan. The plan shall include a safe patient handling policy component reflected in professional occupational safety guidelines for the protection of patients and health care workers in health care facilities. (b) An employer shall maintain a safe patient handling policy at all times for all patient care units, and shall provide trained lift teams or other support staff trained in safe lifting techniques in each general acute care hospital. The employer shall provide training to health care workers that includes, but is not limited to, the following: (1) The appropriate use of lifting devices and equipment. (2) The five areas of body exposure: vertical, lateral, bariatric, repositioning, and ambulation. (3) The use of lifting devices to handle patients safely. (c) As the coordinator of care, the registered nurse shall be responsible for the observation and direction of patient lifts and mobilization, and shall participate as needed in patient handling in accordance with the nurse s job description and professional judgment. (d) For purposes of this section, lift team means hospital employees specifically trained to handle patient lifts, repositionings, and transfers using patient transfer, repositioning, or lifting devices as appropriate for the specific patient. Lift team members may perform other duties as assigned during their shifts. A general acute care hospital shall not be required by this section to hire new staff to comprise the lift team so long as direct patient care assignments are not compromised. (e) For purposes of this section, health care worker means a lift team member or other staff responsible for assisting in lifting patients who is a hospital employee specifically trained to handle patient lifts, repositioning, and transfers using patient transfer, repositioning, and lifting devices as appropriate for the specific patient. (f) For the purposes of this section, safe patient handling policy means a policy that requires replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, and lift teams, as appropriate for the specific patient and consistent with the employer s safety policies and the professional judgment and clinical assessment of the registered nurse. (g) A health care worker who refuses to lift, reposition, or transfer a patient due to concerns about patient or worker safety or the lack of trained lift team personnel or equipment shall not, based upon the refusal, be the subject of disciplinary action by the hospital or any of its managers or employees. (h) This section shall not apply to general acute care hospitals within the Department of Corrections and Rehabilitation or the State Department of Developmental Services. SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution. http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_1101-1150/ab_1136_bill_20111007_chaptered.pdf
IV. For more information and assistance for your Local Union on Safe Patient Handling Programs and Policies, including draft contract language, contact: SEIU Nurse Alliance of California: Kathy Hughes, RN hughesk@seiu121rn.org Erika Moody-Gilliard, SEIU UHW Health and Safety Coordinator: egilliard@seiu-uhw.org Bill Borwegen, SEIU Director of Occupational Health and Safety: bill.borwegen@seiu.org Enforcement: Because this bill is an amendment to the California Occupational Safety and Health Act of 1973, enforcement of compliance will be the responsibility of CAL OSHA. 1-800-321-OSHA (6742) www.osha.gov http://www.osha.gov/index.html http://www.osha.gov/recordkeeping/new-osha300form1-1-04.pdf. California s Injury and Illness Prevention Program regulation (Section 3203 of Title 8 of the California Code of Regulations) http://www.dir.ca.gov/dosh/dosh_publications/iipp.html http://www.dir.ca.gov/title8/3203.html