What Nurses Need to Know about Safe Patient Handling Nancy L. Hughes, MS, RN Director, Center for Occupational and Environmental Health American Nurses Association Joan I. Warren, PhD, RN-BC, NEA-BC Director, Professional Practice & Research Franklin Square Hospital Center Objectives Describe the problem of musculoskeletal injuries. Discuss the theory and principles of safe patient handling. Provide a review of the American Nurses Association s Handle with Care initiative. What is safe patient handling? Safe patient handling consists of policies and programs that enable nurses and other caregivers to move patients utilizing equipment in a way that does not cause strain or injury to the nurses, other health care providers or the patient while preserving the patient s dignity
Global Issue England 43% of nursing personnel suffer annually Taiwan - 69.7% prevalence Greece - 75% of nurses United States- Over 50% ANA survey- Disabling back injury second highest concern (2003 n-4826) Polling Question Have you suffered a musculoskeletal disorder injury due to manual patient handling during your career in nursing? Ergonomic Hazards for Nurses Risk factors most frequently associated with low back pain in health care workers: Lifting Forceful Movements Back and other musculoskeletal injuries are the result of repeated exposure to ergonomic risk factors rather than a single, instantaneous event
Basic Anatomy/Physiology Vertebral Body Vertebral End Plate Disc Ergonomic Hazards for Nurses Shear Force vs. Compressive Force Anterior-Posterior/Lateral Plane vs. Vertical Plane No wonder nurses are injured! In an eight hour shift, the cumulative weight that nurses lift equal to an average of 1.8 tons per day (Tuohy-Main, K. (1997). Why manual handling should be eliminated for resident and career safety. Geriaction, 15, 10-14) Courtesy of Dr. Audrey Nelson Tampa VA Patient Safety Center
Highest Injury Rates By Occupation Nursing aides, orderlies, and attendants 465 per 10,000 full time workers MSD injury case rate of 252 cases per 10,000 workers Seven (7) times the rate of the national MSD average for all occupations!!!! (BLS data, 2007 www.bls.gov/news.release/pdf/osh2.pdf) Incidence Rates Per 10,000 workers #1 Nursing aides, orderlies and attendants 252 per 10,000 workers #2 Emergency medical technicians and paramedics 179 per 10,000 workers #3 Laborers and freight, stock and material movers 149 per 10,000 workers (BLS data, 2007 www.bls.gov/news.release/pdf/osh2.pdf) Occupational Injuries and Illnesses with Days Away from Work Involving MSD, 2006 Rank #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Occupation Laborers and Freight Stock and Material Movers hand Nursing Aides Orderlies and Attendants (27,590) Truck Drivers Heavy and Tractor-Trailer Retail Salespersons Registered Nurses (9,200) Truck Drivers Light or Delivery Services Janitors and Cleaners Except Maids and Housekeeping Stock Clerks and Order Fillers Construction Laborers Maintenance and repair workers, general Source: Bureau of Labor Statistics, US Department of Labor, Survey of Occupational Injuries and Illnesses, cases involving days away from work. Bureau of Labor Statistics, 2006
Occupational Injuries and Illnesses with Days Away from Work Involving MSD, 2007 Rank #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Occupation Laborers and Freight Stock and Material Movers (27,030) Nursing Aides Orderlies and Attendants (24,340) Truck Drivers Heavy and Tractor-Trailer (16,430) Truck Drivers Light or Delivery Services (10,450) Janitors and cleaners (9,190) Construction laborers (6,920) Maids and Housekeeping (5,490) Drivers/sales workers (3,010) Welders, cutters, solderers, and brazers (2,770) Emergency medical technicians and paramedics (2,230) (BLS data, 2007 www.bls.gov/news.release/pdf/osh2.pdf) Bureau of Labor Statistics, 2006 Occupational Injuries and Illnesses with Days Away from Work Involving MSD, 2008 Rank #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Occupation Laborers and Freight Stock and Material Movers (26,720) Nursing Aides Orderlies and Attendants (23,030) Truck Drivers Heavy and Tractor-Trailer (14,360) Truck Drivers Light or Delivery Services (9,790) Janitors and cleaners (9,110) Construction laborers (7,090) Maids and Housekeeping (5,870) Drivers/sales workers (2,760) Emergency medical technicians and paramedics (2,690) Industrial machine mechanics (2,630) Source: BLS 2008 Survey of Occupational Injuries and Illnesses, cases involving days away from work, Chart 23. Bureau of Labor Statistics, 2006 Myth of Proper Body Mechanics Traditionally taught as a means to counteract the physical stress of patient handling, such as lifting Early findings of body mechanics studies were: Based on static loads (i.e., box with handles) Primarily focused on men Concentrate on the lower back for lifting Do not account for other vulnerable body parts involved in types of patient handling tasks (e.g., lateral transfers from gurney to bed along a horizontal plane) Body mechanics training does not equip nursing personnel with the capabilities to effectively compensate for loads that typically exceed recommended limits
Patient Characteristics Making proper body mechanics unsuitable: Weight No handles Uneven distribution of weight Dynamic load Altered LOC Agitated or combative Variable ability to assist Patient room Structural physical environment Type of unit Reality of Ergonomic Hazards Nursing Staff Caregivers Working Hurt Experienced Workers Sidelined Inadequate Staffing due to Work-Related Days Off Workers Decide to Leave the Job (Increased Turnover) Younger vs. Older Caregivers Employers High Direct & Indirect Costs Related To: Employee Replacement Workers Compensation Medical Treatment Patients Patients Turned / OOB Less Often = Longer Stays Falls and Injuries Related to Unsafe Lifts Evidence Exists Research studies demonstrate that manual patient handling exceeds capabilities of human body and leads to injury Using mechanical lifting equipment and transfer devices for patient handling significantly reduces injuries among direct patient caregivers Standardized patient handling algorithms have been developed and applied in real clinical settings Patient care assessment forms that consider patient ability available to help caregivers select appropriate equipment/devices
NIOSH Lift Equation for Healthcare Recommended weight limit is 35 pounds for most patient-lifting tasks (Source: Waters, T. When is it Safe to Manually Lift a Patient? AJN 2007; 107(8): 53-58.) Benefits for All Reduce the incidence and severity of musculoskeletal injuries in nursing staff Create a culture of safety and empower nurses to create safe working environments Improve patient safety & quality of care Security Comfort Dignity Realize cost-savings for employers Patient Risk Patients can be injured during movement Skin tears Dislocations Fractures Increased fall rate Discomfort Dignity
ANA Background on SPH 2003 ANA Handle with Care campaign Goal National no manual handling regulation 2003 Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders Handle With Care Campaign Goal: Establish a No Manual Lift Policy nationally Primary components: Partnerships Outreach Legislation/Regulation Education/Training The American Nurses Association s Nationwide State Legislative Agenda SAFE PATIENT HANDLING AK CA OR WA NV ID A Z UT MT WY CO NM ND SD NE KS TX OK MN IA MO WI MI IL IN OH TN AR AL MS LA KY WV PA SC GA NY M VAD NC FL VT MA CT NH R NJ I DE M E D C March 2011 HI Enacted legislation/adopted regulations to date; (9 states): IL, MD, MN, NJ, NY, OH, RI, TX, and WA, plus a resolution from HI. Legislation introduced in 2011-2012: (9 states): CA, IL, ME, MA, MI, MO, MS, NY, VT
Joan I. Warren, PhD, RN-BC, NEA-BC Director, Professional Practice & Research Franklin Square Hospital Center Objectives Describe innovative methods to implement a safe patient handling and movement program. Identify outcomes data to garner support for a safe patient handling and movement program. Franklin Square Hospital Center Serves North Eastern Baltimore County, Baltimore City and Harford County, Maryland 380 licensed beds 3 rd largest hospital for admissions in Maryland Employs >3000 persons 103,000 Emergency Department visits per year Magnet designated hospital
Safe Patient Handling Journey Hospital went live with Safe Patient Handling and Movement Program in 2007 The Journey Structure, Process, Outcome Structure Step 1 The Financial Case Identify Workers Compensation cases that are due to patient moving Access costs for Workers Compensation cases related to patient moving Your own database Third Party Administrator s database Insurer's database Structure Step 2 Mission/Vision of the Organization C-Suite integrates into the Strategic Plan Organizational goal Budget Measurable outcomes Must Be a Priority
Structure Step 3 Integrate Key Decision-Making Stakeholders Nursing Must be at the Table Other disciplines with patient handling responsibilities Physical Therapy & Occupational Therapy Radiologic Technology, Respiratory Therapy Transport, & Security Materials Management & Biomedical Engineering Support services e.g. Housekeeping Integration Into Magnet Journey Responsibilities of Magnet Organizations Compliance with all Federal Laws and Regulations e.g. State Regulations for Safe Patient Handling Safe patient handling and movement programs cited as a premier example by ANCC/Magnet for improving workplace safety for nurses based on ANA s Safe Patient Handling and Movement Initiative Process Equipment Selection Patient acuity/mobility level Unit census Equipment already available PAR levels Potential storage areas for equipment Nurse Managers & Staff Must Be Engaged
Process Policy Formation Interdisciplinary Progressive discipline Cause of injury investigated Patient movement related Other Occupational Health notifies Manager of investigation findings Occupational Health notifies Manager of investigation findings Manager agrees with findings based upon investigation Manager agrees with findings based upon investigation Manager disciplines employee as appropriate Manager follows up as appropriate Employee receives progressive discipline as follows 1st Offense - written verbal warning Remediation on use of safe lifting equipment by (person) by (timeline) 2 nd Offense Final written warning 3 rd Offense Employee is terminated INTRANET SITE
Process Education and Training Modeled after American Heart Association BLS training Coordinator Safe Patient Handling Champions Integration into orientation Annual competency Process Education and Training Train-the-Trainer: Safe Patient Handling Champions Minimum 2 per unit (days/nights) Training requirements for Champions Attend 8 hour class Teach two orientation sessions with a monitor Process Program Monitoring Safe Patient Handling Champions Monthly Education/Competency QI Audits Financials
Process Challenges Staff resistance to change Increased time to perform task with equipment Education and training Equipment tracking (especially friction reducing devices) Equipment storage issues Outcome Measures Patient Handling Worker s Compensation Cases Reported Monthly Root Cause Analyses NP interview guide developed to explore types of injuries and whether appropriate equipment use Tracking of Worker s Compensation Costs for patient handling injuries Outcome Measures Staff Education and Competency Number of staff trained in orientation Number of staff completing annual training requirements Number of Safe Patient Handling Champions
Outcome Measures Chart Audits Documentation of patients mobility level Documentation of type of equipment used Tracking of equipment usage Monthly audit of equipment monitoring devices Observation monitors of staff Outcome Measures Other Indirect Measures Falls Pressure Ulcers Pain Patient Experience
Polling Question Is there a safe patient handling program at your current workplace? Questions and Answers Thank You www.nursingworld.org
Continuing Education 1.0 contact hour will be awarded to attendees who successfully complete this CNE activity. The American Nurses Association Center for Continuing Education and Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. ANCC Provider Number 0023. ANA is approved by the California Board of Registered Nursing, Provider Number CEP6178. An email with this information will be sent to the person who registered for this event and can be distributed to individuals in attendance Online Evaluation: http://www.surveymonkey.com/s/anasafepatienthandlingwebinar-082411 Once you have completed the online evaluation, you will be able to print out your CE certificate. You must submit your completed online Evaluation Form by Thursday, Sept. 1, 2011 in order to receive your certificate.