Presented byKelly Moed, MSN, RN-BC

Nursing Logic LLC

November 10,2011Quality Care Community Conference

“Transforming Nursing Homes for Generations---Let’s Make It Happen”

Identify healthcare workers who are at risk for musculoskeletal disorders.

Describe the key components of a safe resident handling program.

State the direct and indirect benefits of reduction of staff and resident injuries through elimination of manual lifting.

Not to become injured

Early in My Career (1982) High touch – Low Tech Culture Use of gloves considered an insult to the patient Blood on the uniform was “cool”Mid to late 1980’s

Blood and Body Fluid Precautionsfor fever of unknown origin (FUO)

Universal/Standard Precautions (PPE) Needlestick Safety and Prevention

Illustrations by K. Rinker, WNYCOSH

Include conditions such as:

low back pain sciatica rotator cuff injuries epicondylitis carpal tunnel syndrome

Http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

Nursing aides, orderlies and attendants are listed in the top 10 occupations for work-related musculoskeletal disorders (MSDs) according to the Bureau of Labor Statistics (2009).

The MSD rate for nursing aides, orderlies and nursing attendants is 7 times higher than the average of ALL occupations.

American Nurses Association (2004) says that over 52% of nurses complain of chronic back pain.

http://www.bls.gov/spotlight/2009/safety_and_health/data.htm#figure07_fulltime_occupational

12.5

11.9

7.9

6.9

5.9

2.6

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

Nursing and residential care facilities (NAICS 623)

Hospitals (NAICS 622)

Correctional institutions (NAICS 92214)

Construction (NAICS 23)

Police protection (NAICS 92212)

Colleges and Universities (NAICS 6113)

Incidence rate of nonfatal occupational injuries and illnesses per 100 full time workers by industry, State governments, 2008

Source: Bureau of Labor Statistics, U.S . Department of Labor, October 2009

Since 1980’s “Proper Body Mechanics” Education

(Orientation and Annual Mandatory Training) Select use of Hoyer lifts for “heavy” patients Staff accepts that an “aching back” is part of the job

Early 1990’s Battery operated patient lifts introduced Back Injury Prevention Program- BIPP

The average healthcare worker manually lifts 1.8 tons per 8 hour shift.

That is equal to lifting one sedan per shift!

Zeroliftforny.org/slidebyCathyGillingham

In one year, healthcare workers lift the equivalent of an airplane that is at 50% capacity.

*Zeroliftforny.com/slidebyCathyGillingham

Photo courtesy of http://en.wikipedia.org/w/index.php?title=User:The_Silent_Wind_of_Doom&action=edit&redlink=1

The number of manual lifting injuries to healthcare workers in one year exceeds the number of attendees at a sold-out game in the new Yankee Stadium*.

*ZeroliftforNY.org

Manual Patient HandlingIs broadly defined as the transporting or supporting of a patient by hand or bodily force, including: • Pushing• Pulling• Carrying• Holding• Supporting of the patient or a body part

Manual Handling Operations Regulations (MHOR),1992

17

Situations which may cause staff or resident injury:

• Manual lifting• Repositioning• Bedpan placement• Confined Workspaces • Awkward postures• Ambulation • Lack of Assessment

CDC,NIOSHslidebyCathyGillingham

People: Are getting larger. Have no handles! Can be unpredictable. Cannot be held close

to your body.

The amount of weight manually handled by workers in other industries is limited to 50 pounds under

IDEAL conditions.(NIOSH Lifting Equation,1993)

Researchers have reported that no caregiver should lift more than 35

pounds of a patient’s weight.(Waters T, When is it safe to manually lift a patient, American Journal of Nursing, 107(8), 53-59., 2007)

Resident handling is NOT an ideal condition!

Position statement supporting actions and policies that result in elimination of manual patient lifting to promote a safe work environment of care for nurses and patients (ANA, 2003)

IllinoisMarylandMinnesotaNew JerseyNew York* Ohio*Rhode Island TexasWashingtonwith a resolution from Hawaii*

http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/State/StateLegislativeAgenda/SPHM/Enacted-Legistation.aspx

Federal Policy regardingSafe Patient Handling

Federal Legislation :H.R. 2381 and S. 1788

Nurse and Health Care Worker Protection Act(introduced May 2009)

American Nurses AssociationHandle With Care® Campaign

Handling Residents Safely

Slide created by Cathy Gillingham, North Shore LIJ-SIUH

No Manual Lift Policy(non-punitive)

Ergonomic Hazard Assessment Investment in Equipment Staff training Care planning for resident handling

and movement Review and Evaluation Process

Residents?

WNYCOSH,2010

Frontline workers?Employers?

Improved quality of care Improved resident safety More comfortable/secure patient transfers Early mobility efforts enhanced Skin integrity improvement More skilled staff retained at the bedside

Safe workplace without a threat of injury Decreased fatigue Increased job satisfaction Not working in pain Sustainability of professional careers Retention of staff Recruitment of staff to the facility

ANA, 2004

Direct Cost Savings:$ Workers compensation $ Medical treatment costs for musculoskeletal disorders

Indirect Cost Savings: $ Lost work days$ Modified duty time$ Investigation time$ Replacement of injured employee $ Education & training$ Liability costs $ Overtime pay

ANA, 2004

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Equipment Availability

Staff Training

Caregiver Participation

What do you have? What do you need?

WNYCOSH,2010

EquipmentLateral Transfer Devices• Friction-reducing devices

– Gel filled pads/mats– Roller boards or mats– Nylon slippery sheets– Transfer boards

Slide sheets and turning discs

Friction reducing device

Slide Boards

WNYCOSH, 2010

WNYCOSH, 2010

WNYCOSH, 2010

EquipmentBathtub, Shower and Toileting

Activities• Height adjustable and easy entry

bath tubs• Height adjustable shower gurney• Bath lift• Shower/toileting chairs• Toilet Seat Risers• Grab bars/stand • Long handled tools for hygiene

Weighing• Beds and lifts with scales• Recessed floor scales

WNYCOSH, 2010

Listed in your handout

“Because the people who are crazy enough to think they can change the

world are the ones who do.”

RIP Steve Jobs

Questions?

Kelly Moed, MSN, RN-BC@Safety4Nurses (Twitter)

KMoed@NursingLogic.com

American Nurses Association Safe Patient Handling Website http://www.anasafepatienthandling.org/

NIOSH Web-based Training for nursing students http://www.cdc.gov/niosh/docs/2009-127/safe.html

NYS Zero Lift Task Force http://www.zeroliftforny.org/

Patient Safety Center of Inquiry of the Veteran’s Health Administration. http://www.visn8.va.gov/PatientSafetyCenter/safePtHandling/FacilityChampionResources.asp

Preventing Back Injuries: Safe Patient Handling and Movement Brochure http://nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/handlewithcare/PreventingBackInjuries.aspx

United States Department of Labor. Healthcare Ergonomics: http://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html

Waters T, When is it safe to manually lift a patient, American Journal of Nursing, 107(8), 53-59., 2007

Western New York Council on Occupational Safety & Health-WNYCOSH Workplace Safety through SRH and Ergonomics Programs (2010)