Back-breaking work – The Journal of Healthcare Contracting

Nurses lobby for patient-handling equipment and supplies

As you walk the halls of your facilities, no doubt you’ve seen nurses manually moving or repositioning patients. And with research showing the benefit of mobilizing post-op patients as soon as possible, nurses are making an extra effort to do that as well.

But without assistive technology, all that lifting and moving around can be hazardous to nurses and their patients, says the American Nurses Association.

Government data backs up the association’s concerns. In 2011, nursing assistants and registered nurses were among the top five occupations with the highest number of musculoskeletal-related injuries and illnesses resulting in time away from work, according to the U.S. Department of Labor Bureau of Labor Statistics.

It’s time to establish a national culture of safety around safe patient handling and mobility, says the ANA. Part of that culture should encompass patient-handling equipment and supplies. That being the case, contracting executives may very well find themselves playing a role in ensuring the health and safety of their nursing staffs.

No such thing as safe lifting
There’s no such thing as safe manual lifting or moving of patients, says Jaime Murphy Dawson, MPH, senior policy analyst, Department for Health, Safety and Wellness, American Nurses Association. “In any setting where healthcare workers are manually lifting patients, they’re at great risk.”

The ANA did a survey in 2011 in an effort to assess the occupational health and safety issues that nurses face in the workplace, explains Dawson. “One of their top concerns were musculoskeletal-related disorders.” Sixty-two percent of respondents feared they would develop a musculoskeletal disorder. In fact, 56 percent reported working with musculoskeletal pain, and 80 percent of those reported they experienced pain frequently.

Chances are, the real percentages are higher, as nurses don’t always report their injuries, says Dawson. And the problem extends across the care continuum, including home care and long-term care.
Standards, legislation

Last summer, the American Nurses Association, in collaboration with a multidisciplinary team of national experts, published suggested national standards for creating, implementing and managing a safe patient handling and mobility program.

Their efforts to establish a national culture of safety could be boosted by passage of a law by Congress that would establish an occupational safety and health standard to reduce injuries to patients, nurses and other healthcare workers by establishing a safe patient handling, mobility and injury prevention standard. Such a measure has been proposed in the past, and one is currently working its way through Congress.

Bill H.R. 2480, introduced in June 2013 by Rep. John Conyers Jr. (D-Mich.) and Rep. George Miller (D-Calif.), would require the Occupational Safety and Health Administration to develop and implement a safe patient handling and mobility standard that will eliminate manual lifting of patients by direct-care RNs and health care workers, and require health care employers to:

Develop a safe patient handling and mobility plan, and to obtain input from direct-care RNs and health care workers during the process of developing and implementing such a plan.
Purchase, use and maintain equipment, and train health care workers.
Track and evaluate injuries related to the application of the safe patient handling and mobility standard.
Make information about safe handling available to employees and their representatives.

It’s true that – as of press time – 11 states had enacted some form of safe patient handling and mobility standard, based, at least in part, on the ANA proposed standard, says Jerome Mayer, associate director for federal government affairs, American Nurses Association. “The problem is, at the state level, each process is different, and language has been changed.” As a result, there is no program applicable in all states. What’s more, it’s a slow process, and enforcement varies from state to state. A federal law would address those concerns.

Patient handling equipment
The safe-patient handling, mobility and injury prevention standard proposed by Conyers’s and Miller’s bill calls for healthcare providers to do a number of things, including train their workers on safe patient handling and mobility, track and review data relevant to the facility’s program, and annually evaluate implementation of the program. It also calls on providers to – within two years of passage of the law – “purchase, use, maintain and make accessible to healthcare workers such safe patient handling equipment, technology and accessories as the Secretary [of Health and Human Services] determines appropriate.”
According to the ANA, research shows that the use of assistive technology reduces injuries to workers and patients, and lowers costs attributable to workers’ compensation, lost productivity, and turnover. Healthcare managers and workers themselves often don’t realize that these potentially career-ending injuries don’t always occur as a single event, says the association. The cumulative effects of repetitive strains result in long-term, debilitating disorders that often require surgery.

The ANA refrains from recommending any specific products or services. That said, “there is a lot of technology available, and it is evolving by the minute,” says Dawson. Equipment is available to help lift and transfer patients; help patients sit up, stand and ambulate; and help them bathe themselves and use the bathroom. Friction-reducing sheets can ease the task of moving patients. Ceiling lifts are the gold standard for new construction, but other technologies are available to help healthcare workers perform similar functions in older facilities.

“It’s a very innovative field,” says Mayer. “New things are coming out constantly.”

Establishing a culture of safety for safe patient handling and mobility is a paradigm shift, much like wearing gloves and protective equipment for all blood and body fluid precautions was 20 years ago, says the ANA. Healthcare workers routinely practice universal or standard precautions for bloodborne pathogens. Similarly, they will get to the point where they act on the assumption that any lifting is hazardous to workers and patients alike, and that assistive technology must be in place.

The ROI of safe-patient handling
There is an ROI for the acquisition of equipment and the time spent training all healthcare workers on it, according to Jaime Murphy Dawson, MPH, senior policy analyst, Department for Health, Safety and Wellness, American Nurses Association. With a safe patient handling and mobility program in place, nurses and other healthcare workers can return to work after an injury confident that they won’t be injured again. “These are highly qualified healthcare professionals,” she says. “It can cost up to $100,000 to replace a nurse.” A safe patient handling and mobility program can help hospitals retain them.

Safe-patient handling and mobility programs not only lead to greater employee satisfaction, but fewer workers comp claims, adds Jerome Mayer, associate director for federal government affairs, American Nurses Association. What’s more, when patients are moved in a safe manner, certain hospital-acquired conditions and incidents, such as pressure ulcers and falls, decrease. “This a big concern for hospitals, because CMS has said they won’t pay for certain hospital-acquired conditions,” he says. And the average cost associated with a pressure ulcer can reach $40,000; for a fall, $20,000 or more.

“These are costs the hospitals are eating,” he says. “Getting buy-in to a safe patient handling and mobility program from the staff [provides] a return on investment.”

Standards for safe patient handling and mobility
Universal standards for safe patient handling and mobility (SPHM) are needed to protect healthcare workers from injuries and musculoskeletal disorders, says the American Nurses Association. Addressing healthcare worker safety through SPHM will also improve the safety of healthcare recipients, that is, patients.

ANA’s Department for Health, Safety and Wellness and a team of national experts established a uniform, national foundation for SPHM to prevent injuries to healthcare workers and patients. In June 2013, the association published a list of eight suggested national standards for safe patient handling and mobility.

Standard 1: Establish a culture of safety.
Standard 2: Implement and sustain a safe patient handling and mobility (SPHM) program.
Standard 3: Incorporate ergonomic design principles to provide a safe environment of care.
Standard 4: Select, install and maintain SPHM technology.
Standard 5: Establish a system for education, training and maintaining competence.
Standard 6: Integrate patient-centered SPHM assessment, plan of care and use of SPHM technology.
Standard 7: Include SPHM in reasonable accommodation and post-injury return to work.
Standard 8: Establish a comprehensive evaluation system.

The SPHM standards are open and voluntary, according to the ANA. The standards do not require use of any specific products or services. Nor do ANA or the endorsing organizations promote, endorse, or recommend any products or services.

Numbers talk
Nursing assistants and RNs were among the top five occupations in terms of the number of incidents involving musculoskeletal-disorder-related days away from work in 2011.

Nursing assistants: 25,010.
Laborers and freight- stock- and material movers- hand: 21,700.
Janitors and cleaners- except maids and housekeeping cleaners: 16,530.
Heavy and tractor-trailer truck drivers: 13,750.
Registered nurses: 11,880.
Stock clerks and order fillers: 10,250.
Light truck or delivery services drivers: 9,600.
Maintenance and repair workers- general: 9,300.
Production workers- all other: 9,250.
Retail salespersons: 8,550.

Source: U.S. Department of Labor, Bureau of Labor Statistics,
http://www.bls.gov/news.release/osh2.t18.htm

Equipment important part of pending legislation

The Nurse and Health Care Worker Protection Act of 2013 (H.R. 2480), introduced in June 2013 by Rep. John Conyers Jr. (D-Mich.) and Rep. George Miller (D-Calif.), directs the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, nurses and all other healthcare workers by establishing a safe patient handling, mobility and injury prevention standard.

Much of that standard has to do with employee training and participation in safe patient handling programs. But technology and equipment are important too. That’s because patient handling technology can reduce musculoskeletal injuries among healthcare workers, and reduce skin tears, pressure ulcers and falls among patients.

Among the bill’s provisions regarding equipment and technology are these:

“The safe patient handling, mobility, and injury prevention standard shall require the use of engineering and safety controls to perform handling of patients and the elimination of injuries from manual handling of patients by direct-care registered nurses and all other health care workers, through the development of a comprehensive program, to include the use of mechanical technology and devices to the greatest degree feasible.”
“[W]ithin 2 years of the date of promulgation of the final standard, each health care employer shall purchase, use, maintain, and make accessible to health care workers, such safe patient handling equipment, technology, and accessories as the Secretary determines appropriate.”
“[E]ach health care employer shall consider the feasibility of incorporating safe patient handling technology as part of the process of new facility design and construction, or facility remodeling.”
“Where the use of mechanical technology and devices is not feasible, the standards shall require the use of alternative controls and measures, including trained, designated lift teams, to minimize the risk of injury to nurses and health care workers resulting from the manual handling of patients.”

To read the entire text of the bill, go to http://thomas.loc.gov/cgi-bin/thomas