Moving patients doesn’t have to be hazardous to staff health
Despite improved training and device technology, health care workers continue to suffer injuries from lifting and moving patients who need assistance. Health care facilities are hazardous workplaces, and caregivers have among the highest rates of musculoskeletal injuries across all occupations.
Experts say these injuries can be prevented, but not with training and assistive devices alone.
Meaningful change requires both deep commitment from leadership and a comprehensive strategy across units and departments, according to hospital executives, safety experts, unit managers and frontline caregivers who attended an all-day conference presented last month by the Massachusetts Health & Hospital Association, Massachusetts Nurses Association and the Massachusetts Department of Public Health.
KEYTAKEAWAYS
The problem
Staff members and caregivers in all health care settings are vulnerable to injuries from lifting and repositioning patients and helping them be mobile.
The background
Lift-assist devices and training can help, but sustaining comprehensive, reliable programs to reduce staff injuries remains a challenge for many organizations.
KEYTAKEAWAYS
The solution
Leadership and organizational culture are key to preventing injuries and maintaining a safe workplace.
The future
Programs for handling patients have moved from nursing homes into acute care hospitals and need to be developed for ambulatory and home health care settings.
Photo credit: Beth Israel Deaconess Medical Center
Leadership is key
Engaged leadership was a recurring theme at the conference, “Pathways to Safe Patient Handling in the Modern Hospital Setting.” Operational details — such as having the right equipment in the right place and providing staff members with proper training — matter, but the culture of the organization must encourage and support staff members to use assistive devices and good techniques consistently. And organizations must demonstrate that the safe handling program is a priority, for example by making time available for training during normal work schedules.
Compliance is a leadership problem, not a staff problem.
Kim Hollon, Chief Executive Officer at Signature Healthcare in Brockton, says, “Compliance is a leadership problem, not a staff problem.” Hollon explains that staff members need information and training to understand that they risk injury, and they need to see a consistent, organizational expectation that safe handling policies are the norm. Signature Healthcare has maintained a 70% to 80% decrease in staff injuries from 2015 to 2019 compared to rates in 2011.
Staff members may think that using lift-assist equipment, for example, is a heavy burden when they don’t perceive a high likelihood of risk. Until those perceptions change, it is difficult to get people to change their habits. Hollon says, "We need to raise the bar on our cultural expectation about using technology, coaching each other and intervening when co-workers need support. People learn from each other, not from leadership."
Sandra Wettergreen, Safe Patient Handling and Mobility Coordinator for the VA Boston Healthcare System, agrees. “Management demonstrates its commitment by endorsing program components, being visibly involved, and providing motivation and resources to effectively implement and sustain the program.”
Management demonstrates its commitment by endorsing program components, being visibly involved, and providing motivation and resources to effectively implement and sustain the program.
Many factors contribute to workplace injuries
Demographics and human nature are contributing factors, not root causes, for workplace injuries and need to be considered by facilities as they evaluate their policies and need for equipment. The average age of the nursing workforce has risen to 51. On average, patients are getting heavier. The number of frail and complex elderly patients and disabled individuals in nursing facilities or receiving care at home is increasing. And the benefits of early mobility and rehabilitation, even for critically ill patients, are well-documented, leading to more patients needing assistance to transfer out of beds or wheelchairs or to walk in the hallway after surgeries and other treatments.
Health care workers’ familiar routines, which may not include using assistive devices, are hard to change, and incremental injuries may not be apparent until major harm has occurred.
To understand each department’s needs and barriers to proper use of equipment, staff input is essential. And, when positive change is achieved within an organization, further efforts are needed to ensure the new habits are sustained over time. This may be especially true in organizations with high staff turnover, a fragmented workforce spread across multiple facilities, and urgent caregiving scenarios.
Based on presentations and discussions at the conference, here are a few things organizations can do to improve the safety of lifting and moving patients.
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1. Evaluate current practices and injury rates to understand the scope and details of the problem
Patient handling practices may vary from one unit to another and among different professional groups and situations. Routines and expectations also can vary by time of day and day of the week. Common practice during a weekday shift may not match what typically happens overnight or on the weekend.
Unit or shift-based injury reports should be collected and communicated to executive leadership. As with all incident reporting related to safety, leadership must establish a culture that encourages personnel to come forward. Surveys can be used to learn where staff members see problems, such as ineffective equipment or inadequate supplies, that can be addressed to help prevent injuries.
2. Make sure appropriate assistive devices are maintained and available to staff members when and where they are needed
This can mean the difference between whether or not staff use the devices. To sustain a safe patient handling program, supplies must be managed consistently and equipment maintained. For example, managing the cleaning, storage and use of fabric slings for ceiling lifts was discussed repeatedly at the conference. One facility reported finding that deploying slings at all times under patients who need assistance improves compliance. Another group had difficulty getting their slings laundered properly and switched to using disposables.
3. Train new staff proactively
Southcoast Health System, headquartered in New Bedford, identified an elevated risk for injury among newly hired staff members. Since January 2019, all prospective new hires who will be involved in patient handling and mobility are screened for ergonomic technique during the physical exam. During onboarding, those who would benefit from further training take a one-hour ergonomics class. Later, everyone goes through a class focused on proper use of the equipment used at Southcoast.
In the VA Healthcare System, medical residents and students get hands-on training and experience in safe patient handling as part of rotations. The VA uses its simulation center in Orlando, Florida, to provide training for facility coordinators and rehab staff in all aspects of implementing comprehensive safe patient handling and mobility programs.
Tim Quigley, Senior Vice President and Chief Nursing Officer at South Shore Health in South Weymouth, described his organization’s efforts to reduce injuries by collecting data and identifying trends. The hospital found, for example, that obstetrics nurses embraced using power stretchers for transporting patients — an effective solution to a particular challenge at the facility — with a resulting 40% decrease in staff injuries.
When good data became available, Quigley said, South Shore also worked to address staff injuries in the emergency department. Many of those occur when patients in distress arrive by car and must be extracted quickly, often single-handedly, without assistive devices. South Shore is now developing an “extraction team” to respond to those situations. Quigley says the program is still in development, last year, they had 19 staff injuries of various kinds in the ED. So far this year, they have had one.
He also notes that South Shore uses an incident reporting system within Epic for staff injuries and manually flags those events for leadership review.
Photo credit: Beth Israel Deaconess Medical Center
Extensive resources are available
Modern-day patient handling programs gained momentum around 2002, with U.S. Occupational Safety and Health Administration (OSHA) guidelines for the nursing home industry. Those principles have been modified and applied to inpatient hospitals. Increasingly, the need for safe patient handling practices in home care and ambulatory settings, where local challenges can be dramatic, is becoming clear.
OSHA offers information about safe patient handling programs tailored for workers in different settings, including acute, home and long-term care; physical therapy; radiology and more.
Massachusetts offers good resources to help organizations improve their safe handling and mobility programs.
UMass Lowell has expertise and resources in ergonomics and workplace safety. In addition to full-time academic programs, the university’s Center for the Promotion of Health in the New England Workplace offers a continuing education program in ergonomics specially designed for nurses, nursing assistants and health care managers.
DPH-OHSP is available to help hospitals develop systems for collecting and analyzing data on injuries related to patient handling and mobility. The department will also attend relevant committee meetings at hospitals to talk about safe patient handling programs and how to use data to focus injury prevention efforts.
Reflecting on the day-long conference she helped organize, Angela Laramie, an epidemiologist with the DPH-OHSP and co-author of the report, said, "I was pleased to see that representatives in a variety of positions from so many hospitals — more than 30 — registered to attend the conference. Attendees were willing to share information about their own hospital’s experience with each other. One goal of the day was to provide an opportunity for people to make connections and learn from one another, and I think we accomplished that."
