Overcoming Common Barriers to Successful Safe Patient Handling Programs

Overcoming Common Barriers to Successful Safe Patient Handling Programs

Strategies for Gaining Support with Leadership at All Levels Ed Hall, Chief Operating Officer, The Risk Authority

Strategies for Gaining Support with Leadership at All Levels Senior Leadership Buy In Committee Buy In Nursing and Staff Buy In Multi System Buy In

Risk Retention = Mitigation Risk Response Strategies Avoid Risk Mitigate Mitigate, then Transfer Transfer Exit risk area Organizational solutions (Enhance management processes to better manage risk) Risk management and mitigation Financing solutions Strategy Capital People Process Systems Insurance Hybrid Markets Source: The Economist Intelligence Unit, Enterprise Risk Management - Implementing New Solutions 5

Top 7 Cause of Injuries Top 7 Total Gross Incurred by Cause of Injury CY2003-2007YTD Patient Handling 29% $13,899,032 Trip/Fall 18% $8,595,195 Cause of Injury Push/Pull/Lifting/Object 16% Slip 15% Struck/Hit/or Injured By/Against 6% $3,045,740 $7,403,973 $7,149,907 Other 5% $625,008 Combative Patient 4% $2,546,756 $- $3,000,000 $6,000,000 $9,000,000 $12,000,000 $15,000,000 Total Gross Incurred Costs

SHC Patient Handling Injuries SHC Patient Handling Injuries Days Restricted Duty & Days Absent 2002-2007 3000 2500 2000 1500 Restricted Lost 1000 500 0 2002 2003 2004 2005 2006 2007

Stanford Patient Mobility This graph represents the inpatient acuity and corresponding patient care strategy 18% 31% 18% 33% Independent: Minimal Assist: Extensive Assist: Total Lift:

Transfer Patient Handling Equipment Options CY2003-2007YTD Cause of Injury PH - Repositioning - Up in Bed / Stretcher PH - Transfer To & from - Bed to Stretcher,Trolley PH - Repositioning - Side to Side/ Bed / Stretcher PH - Other Manipulation - Falling Patient PH - Transfer To & From - Bed to Chair PH - Transporting - Stretcher / Bed PH - Transfer To & From - Chair to Stretcher PH - Other Manipulation - Lifting Pt off of Floor PH - Transfer To & From - Chair to Chair PH - Transfer To & From - Chair to Toilet PH - O Man-Pt Hdling Task Req Sustd Hold of a limb PH - Repositioning - Bathing PH - Transfer To & From - Car to Chair PH - Transporting - Wheelchair PH - Transfer To & From - Chair to Exam Table PH - Repositioning - Wheelchair PH - Repositioning - Chair or Dependency Chair 28% 11% 11% 9% 9% 7% $228,254 $194,138 $192,885 $109,338 $44,200 $43,336 $609,577 $597,598 $382,838 $344,457 $1,016,856 $783,607 $1,185,626 $1,182,418 $1,582,798 $1,525,207 Total Gross Incurred Costs for Patient Handling: $13,899,032 $3,874,424 $- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 Total Gross Incurred Costs

Repositioning & Transfer Patient Handling Equipment Options CY2003-2007YTD Cause of Injury PH - Repositioning - Up in Bed / Stretcher PH - Transfer To & from - Bed to Stretcher,Trolley PH - Repositioning - Side to Side/ Bed / Stretcher PH - Other Manipulation - Falling Patient PH - Transfer To & From - Bed to Chair PH - Transporting - Stretcher / Bed PH - Transfer To & From - Chair to Stretcher PH - Other Manipulation - Lifting Pt off of Floor PH - Transfer To & From - Chair to Chair PH - Transfer To & From - Chair to Toilet PH - O Man-Pt Hdling Task Req Sustd Hold of a limb PH - Repositioning - Bathing PH - Transfer To & From - Car to Chair PH - Transporting - Wheelchair PH - Transfer To & From - Chair to Exam Table PH - Repositioning - Wheelchair PH - Repositioning - Chair or Dependency Chair 28% 11% 11% 9% 9% 7% $609,577 $597,598 $382,838 $344,457 $228,254 $194,138 $192,885 $109,338 $44,200 $43,336 $1,582,798 $1,525,207 $1,185,626 $1,182,418 $1,016,856 $783,607 $3,874,424 $- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 Total Gross Incurred Costs

Show Successful Process of Methodology Net Present Value ($ '000) Expected value = $5,184 $3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000 Base Value Reduction in Turnover 0% 20% 2% Increase in Patient Press Ganey Score (% pt) Workers Comp Growth (baseline) Increase in Staff Gallup Score (% pt) Percentage of Ulcers in Stage 1 or 2 Lost & Restricted Days Growth (baseline) 0% 3% 2% -17% 19% 0%.002% 33% 0% 2% 1% 80% 70% 75% -17% 36% 0% Reduction in Workers Comp 60% 82% 60% Ulcer Reduction Rate 30% 40% 30% 4 Year Cost Savings of $470,447.89 Percentage of Patient Referral 1% 20% 1% Patient Volume Growth -1% 5% 0% Yes Yes 11

We Look at the Uncertainty in Rate of Return Cumulative Probability 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 40% 60% 80% 100% 120% 140% 160% 180% 200% IRR (EV = 111%) 12

Safe Patient Handling Program $476,740.37 (32.56% of gross incurred CY2004-2006) INSTITUTE-WIDE Patient Handling ranked as top common cause in 2004 and 2006 Safe Patient Handling/Minimal Lift Program Phase of Implementation Institute Wide Implementation Institute Wide Implementation Institute Wide Implementation 1. Appoint Organizational Champion: Good Compliance Good Compliance Good Compliance 2. Equipment Available per Allocation and Slings in Use Some Compliance Good Compliance Good Compliance 3. Transfer Coaches on Each Shift and Each Unit Little Compliance Good Compliance Good Compliance 4. Annual and New Hire Training Conducted Little Compliance Some Compliance Good Compliance 5. Successful Communication of Safe Patient Handling in Patient Care Plan Little Compliance Good Compliance Good Compliance 6. Use of Safe Patient Handling Techniques Some Compliance Good Compliance Good Compliance 7. Effective Accountability Program with Six-Month Awareness Little Compliance Some Compliance Little Compliance 8. Analysis of Annual Return on Investment Little Compliance Some Compliance Good Compliance 12/31/2005 12/31/2006 22007 YTD Hospital Score 25.00% 81.25% 87.50% Peer Average Score 36.69% 49.19% 54.03%

Overcoming Common Barriers to Successful Safe Patient Handling Programs Anthony Donaldson, National Environmental, Health & Safety Senior Project Manager, Kaiser Permanente

Objectives Discuss requirements for CA AB1136 Discuss requirements of Cal/OSHA regulations for AB 1136 for SPH Programs Discuss Safe Patient Handling Program at Kaiser Permanente

SPH Legislation Background 2012 CA Legislation: AB 1136 (effective Jan 2012) States in blue currently have SPH legislation. (as of Jan 2012)

This image cannot currently be displayed. California AB 1136 This image cannot currently be displayed. State Law Health Care Worker Back and Musculoskeletal Injury Prevention Licensed Acute Care Hospitals Effective Jan 1, 2012 Enforcement Cal/OSHA 5120 Regulations

Required Training Initial Training Annual Refresher Training at least every 12 months (Health Care Workers only) Awareness Training Staff not directly involved with SPH tasks Training must begin when program is established (Oct 1, 2014)

Safe Patient Handling Program Focus Managing Patient Handling Tasks Safely Across the Continuum of Care Outpatient/Ambulatory Emergency Medical Services Home Care Acute Care Long Term Care 19

Kaiser Permanente SPH Program Acute Care Hospitals Nov 2012, adopted national SPH policy and guidance for hospitals Ambulatory Care Settings Aug 2014, adopted national SPH policy and guidance for ambulatory care settings

Establishing a SPH Culture as an Outside Entity Eric Race President and Founder, Atlas Lift Tech, LLC

The Problem Six of the top ten most dangerous occupations for back injury are found in the hospital setting. Over 50% of all nurses complain of severe back pain, with nearly two out of five requiring time off from work for back pain. One in eight nurses leave the profession prematurely due to debilitating injuries, resulting in increased replacement costs to facilities that average $40K to $60K in recruitment and training expenses. US annual Workers Comp claims for SPH handling injuries totaled $7.4B. In short, hospitals are turning their staff into the very patients they serve.

An epidemic of care providers becoming patients % risk of injury for each manual lift Patients larger Nursing shortage Longer shifts Aging nurses 95% Female The aim has been to change the worker instead of the task. Typical nursing school teaching methods have focused on manual lifting and proper body mechanics, despite the fact there is over thirty years of evidence that these approaches are not safe. *William Charney Back Injury Among Healthcare Workers

Historically Minimal-Lift vs. Lift-Team 0 Specialists Nurses work with each other Must be trained annually Must find other staff to preform Lifts Transfers Repositions Boosts 2 Specialists Work for nurses and patients Assists ancillary departments From admission to discharge Lift Transfer Reposition Boost

Old Solutions Aren t Effective in Today s Environment The Problem with Lift Teams: Facilities feel - Nurses are demanding lift-teams, nurses become entitled, Nurses will become dependent. And also very Costly. The Problem with Minimal Lift programs: Costly to train all care staff annually. Programs have a very low user compliance rate. The Opportunity: A model that is a hybrid of the Minimal Lift and Lift-Team program that empowers nurses. The Solution: Atlas Lift Tech has developed the Lift Coach model: Draws from both approaches. 1 Specialist Work with nurses, patients & equipment Assist ancillary departments From admission to discharge Lift Transfer Reposition Boost

Minimal Lift Program: Training Cost Indirect Cost of Minimal Lift SPHM Program 2,000+ Care staff requiring SPHM training for AB 1136 2 hrs SPHM training Class 4,000 hours Minimum training hours required each year $569,000+ Annual In-Direct Training Cost with minimal fees

Contracted Safe Patient Handling Programs Outsourced SPH programs can include the following components depending on client needs: PRIMARY SERVICES: Staffing component: on-site Lift Coaches to train and assist hospital personnel to meet newly legislated SPHM standards Technology component: mobile-based application called Lift Tracker to assist hospital staff with SPHM scheduling and tracking SUPPORT & SECONDARY SERVICES: (added onto existing primary service) Consulting component: to develop policies, training curriculum, and program design Specialized Safe Patient Handling Services: Laundry, Preventative Maintenance, Certification, RFID Asset Tracking & Management Data analysis and reporting capabilities: To guide management s efforts

Culture is the Most Challenging Hurdle Fundamental Issue with Patient Handling: Source of risk is unseen (Effects everyone, yet is owned by no one) Significant incentives to not comply (time pressure, productivity, frustration, knowledge) Large numbers of staff with other externalities (union pressures/competency considerations) Care staff are faced with limited resources with increased responsibility Integration Challenges: Equipment inventory, availability, placement, maintenance, battery charging, sling inventory/laundry, management support, physician support, PT/rehab push back (and training/monitoring in support of above) Economic Constraints: Cost of equipment, cost of laundry support, staffing ratios, cost of training, cost/attention of program management, awareness and support of program

Program Structure Creates Sustainability Program needs to be customized to meet the immediate hospital and/or unit needs High-risk target areas are agreed/schedule of coverage implemented Program needs to be delivered by a dedicated resource (ie: Lift Coach), who have a continuous presence in the facility Phase 1 Phase 2 Phase 3 Foundation & Development Implementation & Training Maintenance, Compliance training & Sustainability Designed to solidify the program structure and foundation either augmenting elements of what is already in place or adding new components as necessary. The program is delivered to the facility, with coaches performing the lifting tasks with the nursing staff. Designed to train new hire staff, continually train existing nursing staff, and sustain nurse involvement in the SPHM program. Conduct on-going training reinforcement and support for all patient handling staff in order to assure sustainability.

How is Value Qualified Injury Reduction Cost Savings Workers Compensation Lost & Restricted Workdays Reserve adjustment benefits & Premium Reductions) Regulatory Compliance Satisfaction Training Savings* Equipment Inventory Optimization and Increased Usage Benchmarking competencies against industry peers, norms, and best practices Patient & Nursing Satisfaction Improved Clinical Outcomes: CMS Non-reimbursable *Bedside training occurs such that a productive hours saving is delivered because nurses remain at bedside **Mobility being at the core of patient outcomes, our goal is to see improvements

Keys to Success Goal is to build a program that delivers exceptional results from injury reduction, nurse and patient satisfaction and economic perspective. Success is usually a function of: A genuine sense of collaboration The development of the interdisciplinary Regular & Transparent communication Appropriate requirements gathering data The commitment of executive leadership The dedication of program champions The development and implementation of sound training practices The effective use of equipment SAFETY, SATISFACTION, SUSTAINABILITY, SAVINGS

Using Consultation and Posted Feedback in your SPH Program Elise Condie, B Physiotherapy, MS, CPE Senior Consultant, EORM, San Jose, CA

Outline What is consultation? Why consult? Launching an employee consultation process Using posted feedback for engagement and to drive desired results

What is consultation? Consultation is a two-way exchange between employers and employees: sharing information about SPH giving employees a reasonable opportunity to express their views, and taking those views into account. Employees can be consulted in a variety of ways, including by setting up a SPH committee or by holding regular meetings.

Why consult? Allows for effective decision making Increases program awareness Increased engagement and compliance A proven way of dealing with safety problems Increases openness, respect and trust between managers and employees Essential to achieving a sustainable SPH program

Launching a consultation process Determine the scope and develop a procedure that will work for your location Consultation needs to be planned- but this does not equate to scheduling meetings

Launching a consultation process (cont d) Consultation involves: Sharing of information Allowing employees to express their views Taking those views into account Can be done at handover, as part of another standing meeting, through email, or some other way

Using posted feedback Feedback on program performance should be shared A combination of posted feedback and discussion on the results is most effective This can be integrated into consultation processes (feedback should happen both ways!)

What feedback to give? Discuss program metrics that directly impact staff: Program compliance Training completion rates Fall/ pressure ulcer rates FIM scores on discharge (if applicable)

Consultation in real life Safe Patient Handling committees Morning handovers Professional development sessions Staff meetings Email inbox Unit safety representatives