Regulatory Update New CA Safe Patient Handling Law December 6, 2011 Jessica Ellison, M.S., CPE, CSP EORM Principal Consultant Dr. David Rempel. MD, MPH, CPE UCSF and UCB Professor & Director
Agenda Introduction Current challenges with patient handling Why was this legislation introduced? Details of AB1136 Definitions Requirements Policy Elements How to get started developing or improving a program Suggested processes Resources available
Introductions
Our Presenters Jessica Ellison, MS, CPE, CSP Principal Consultant and Northern California Regional Operations Manager, EORM Board Certified Professional Ergonomist Masters degree in Biomedical Engineering Diverse experience in a variety of market areas including electronics, semiconductor, photovoltaics, biotechnology, healthcare, dental, software, and agriculture Works on behalf of major multinational corporations to develop ergonomic programs Supports clients with ergonomic evaluations and consulting Dr. David Rempel, MD, MPH, CPE Professor of Medicine at UC San Francisco Professor of Engineering at UC Berkeley Director of Ergonomics Graduate Training Program at UC Berkeley Board Certified Professional Ergonomist Published over 120 peer-reviewed scientific articles, 10 book chapters and 300 proceedings papers. Conducted laboratory biomechanics and usability studies on tools and devices used in the workplace Randomized controlled trials of ergonomic interventions in the office, hospital, garment, dental and construction sectors 4
Patient Handling and Healthcare Worker Injuries
Background High rates of disabling shoulder, arm and back injuries associated with patient handling Aging population with increasing hospitalizations Increasing weight of patients Increasing age of nurses and other health care providers New cost-effective technologies to assist in patient handling
Hoverjack Patient Transfer
AB1136: Sec 2. Legislative Background 36,130 occupational MSDs in private sector related to patient or resident handling in 2008 99% overexertion Nursing aides, orderlies, attendants 52% RNs 16% Home health aides 6% LVNs, EMT, paramedics, technicians, etc. 12% of nurses leave workforce due to back injuries each year (cost $60-140k for training)
Healthcare Worker Injuries NCCI RESEARCH BRIEF, March 2011 Restrepo, Schmid, Shuford, Shyong
State Legislation on SPH Ohio (2005) long term care loan fund New York (2005) - demonstration Texas (2006) - hospital and nursing homes Washington (2006) tax credits Rhode Island (2007) licensed health care facilities Maryland (2007) hospitals and nursing homes New Jersey (2009) health care facilities Minnesota (2012) provides grants California (2011)
AB1136 Hospital Patient and Health Care Worker Injury Protection Act: Safe Patient Handling
AB1136 Signed by Governor 10/7/11 www.aroundthecapitol.com/bills/ab_1136/20112012/ Applies to General acute care hospitals Excludes» Department of Corrections and Rehabilitation» State Department of Developmental Services
General Acute Care Hospital General acute care hospital means a hospital, licensed by the California Department of Public Health, having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24- hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services Not Long-term Care Facilities» Skilled Nursing Facility» Intermediate Care Facility Acute psychiatric hospital
New Section 6403.5 of Labor Code (a) As part of IIPP, employer shall adopt a patient protection and health care worker back and musculoskeletal injury prevention 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]
New Section 6403.5 of Labor Code (f) safe patient handling policy means a policy that requires replacement of manual lifting and transferring of patients with powered patient transfer devices lifting devices 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 RN]
New Section 6403.5 of Labor Code (b) -- Shall maintain safe patient handling policy at all times for all patient care units Shall provide trained lift teams or other support staff trained in safe lifting techniques Shall provide training to health care workers
New Section 6403.5 of Labor Code (d) 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 no requirement to hire new staff for the lift team so long as direct patient care assignments not compromised
New Section 6403.5 of Labor Code (e) 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
Training (b) Employer shall provide training to health care workers that includes 1. Appropriate use of lifting devices and equipment 2. Five areas of body exposure vertical lateral bariatric repositioning ambulation 3. The use of lifting devices to handle patients safely
Role of RNs (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
Refusal - Discipline (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 on the refusal, be the subject of disciplinary action
Resources Safe Lifting and Movement of Nursing Home Residents DHHS (NIOSH) Publication Number 2006-117 (February 2006) Flegal, KM, Carroll, MD, Ogden, CL, Curtin, LR.[2010] Prevalence and Trends in Obesity Among US Adults, 1999-2008 JAMA. 2010;303(3):235-241 Developing Evidence-Based Interventions to Address the Leading Causes of Workers Compensation Among Healthcare Workers Rehabil Nurs 2010 Nov; 35(6):225-235, 261. Safe Patient Handling Training for Schools of Nursing DHHS (NIOSH) Publication No. 2009-127 (March 2010) Safe Patient Handling in Washington State Implementation of Safe Patient Handling in Washington State Hospitals [PDF - 1.4MB]
Policy and Program Development
The Legislation Seems Simple But Some questions to ponder: What should be included in a program? How do you decide what lifts to purchase? Have you thought about logistics / laundry? What about storage? How do you really reduce the risk of injury?
Elements of an Effective Program Executive Commitment Safe Patient Handling Committee Plan Risk Assessment Act Do Detailed Action Plan Check Written Program / Policy Implement Controls Training / Champions Program
Executive Commitment The executive team should: Sign the policy Show involvement in the implementation Have a representative on the safe patient handling committee How to get involvement: Show executive team possible return on investment
Safe Patient Handling Committee Executive / Senior Team Representative Clinical Staff Managerial and non-managerial All units Union Representatives Facilities / Maintenance Infection Control Housekeeping Logistics Human Resources Safety / Occupational Health
Safe Patient Handling Committee Coordinates risk assessments Discusses solutions Selects or advises on equipment Creates action plan Drives action plan to completion Establishes method to secure funding / plan for investment Coordinates training activities
Safe Patient Handling Committee Establishing a Committee Recruit participants Elect committee chair & co-chair Schedule meetings Establish meeting protocols Training for Committee Role of committee Hazard assessment techniques Selection of equipment Organizational change techniques Ontario Safety Association for Community & Health Care (2005). OSACH Planning Guide for Implementation of Client Mechanical Lifts, Second Edition. Occupational Health and Safety Agency for Healthcare in British Columbia (2000). OHSAH Reference Guidelines for Safe Patient Handling.
Risk Assessment Analyze Injury Trends Units Type of injury Cause of injury (what type of transfer) Shift Body part Use methods to measure risk ISO/PDTR 12296 Draft Standard - Manual handling of people in the healthcare sector Safe Patient Handling Risk Assessment, Swedish Medical Center, 2007
Detailed Action Plan Assign responsibility Set due dates Hold team accountable for on time completion Schedule reoccurring meetings to discuss status Action Item Due Date Assigned To Status Create draft policy 12/31/11 Mary Inventory current aids available 11/15/11 Joe Complete risk assessment for ER 12/10/11 Jane
Written Program / Policy Integrated into Injury and Illness Prevention Program (IIPP) Requires replacement of manual lifting and transferring of patients with powered patient transfer devices lifting devices lift teams Examples available on VA, State of Washington, and State of MN Websites
Controls Use risk assessment to determine appropriate controls to reduce risk Move away from manual transfers even with lift teams
Lift Teams Physically fit Competent in lifting techniques Typically young men Does not reduce risk transfers it to a specific group
Lateral Transfer Devices
Lifts NCCI RESEARCH BRIEF, March 2011 Restrepo, Schmid, Shuford, Shyong
Challenges to Evaluate / Consider Space Constraints Storage Constraints Doorways Laundry / Logistics 37
Safe Patient Handling Algorithms Develop algorithms to help staff make informed decisions Examples available on VA website
Chart Coding System Use system to quickly communicate ambulatory state of patient Swedish Medical Center 2007, Safe Patient Handling Risk Assessment
Training Staff Patients How does it benefit them and their patients? How does it benefit them? How does the equipment work? When should it be used? Logistics Hands on training by peers How does it work? Instructions as needed http://www.washingtonsafepatienthandling.org/images/safe_patient_handling_brochure.pdf
Champions Program Establish unit lead to head efforts for their units Demonstrate use of lifts to peers Measure lift use / spot check Engage peers to encourage use of lifts Train new staff on lift use in the unit
Online Resources CDC Website: http://www.cdc.gov/niosh/topics/safepatient/ VA Website: http://www.visn8.va.gov/visn8/patientsafetycenter/safeptha ndling/default.asp State of Washington Website: http://www.washingtonsafepatienthandling.org/tools.html OSHA http://www.osha.gov/sltc/etools/hospital/index.html
Online Resources Linked In Hospital Ergonomics Group American Nurses Association Group ASSE Healthcare Group
Questions & Answer Session 44
Thank You!
Contact Info Jessica Ellison, MS, CPE, CSP Principal Consultant, EORM ellisonj@eorm.com 408.790.9209 David Rempel, MD, MPH, CPE Director, Ergonomics Graduate Training Program, UC Berkeley David.Rempel@ucsf.edu
About Us EORM History Founded in 1990 by Environmental, Health and Safety (EHS) managers from industry Today Six offices in US» Extensive International Partner Resources 135 employees focused on supporting EHS and Sustainability needs Servicing 350 clients -- small to very large companies Certified Professional Ergonomists (CPEs) ISO 14001 and OHSAS 18001 Certified Climate Registry participant 47