According to the Bureau of Labor Statistics, healthcare workers who lift and help move patients consistently report the highest number of work-related injuries among all professions. Nurses, CNAs and orderlies missed more days of work due to work-related musculoskeletal disorders than any other group. Nowhere is this truer than in the LTC setting, where a great many residents have limited mobility.
What’s more, as a large population of frontline caregivers age, and as obesity rates among LTC residents rise, there exists the potential for even more injuries in the years to come.
Most lifting injuries can be prevented. However, Lena Deter, RN, MPH, CSPHP, a board member of The Association of Safe Patient Handling Professionals (ASPHP) and clinical nurse specialist in education at the Hebrew Rehabilitation Center in Massachusetts says there is a reluctance to adopt and use proper equipment.
Despite strong evidence to support the case against manual lifting, most patient handlers say it is simply “faster” or “easier” to manually lift or move patients than it is to use patient handling equipment and devices. “Most of the people working in this field have been taught that body mechanics work if you do them ‘correctly,’ which is not surprising because this is still taught in [nursing] schools,” says Deter. “They are not being taught what we know to be true based on clinical evidence.” That is, that lifting, pushing, pulling or tugging more than 35 pounds of a patient’s weight is not safe.
But there are other obstacles as well, including the expenses associated with implementing a safe handling program, as well as a lack of buy-in, training, enforcement and oversight of safe patient handling procedures from administrators.
THE CASE FOR INVESTMENT
While it is true that quality equipment to aid in the lifting of patients is expensive, a strong business case can be made for its purchase. Investments in such programs are recouped in the form of fewer injuries, which result in fewer worker’s compensation claims and lower rates of staff turnover. A study published in Nursing Administration Quarterly found that the payback period for safe patient handling programs is about four years. Other studies suggest that the costs can be recouped even sooner. Another study in Injury Prevention found that by implementing safe patient handling practices, healthcare facilities could reduce worker’s compensation injury rates by 61 percent.1
When Provena Life Connections in Illinois launched its Safe Patient/Resident Handling Program with the purchase of $2 million in lifting and repositioning equipment for its 10 LTC facilities, it was rewarded an immediate and drastic downturn—77 percent—in staff injuries after the program’s first year. Employee turnover numbers have also improved, from a rate of 52 to 26 percent in six years. Provena’s Vice President of Risk and Facility Management Wendell Provost says, “For those companies that believe that they cannot afford to implement a minimal lift program in their facilities, the reality is that they can not afford not to.”
Implementing such a program involves more than purchasing lifts. Also required is a culture shift at both the patient care level, as well as at all levels of management. Deter believes healthcare is at this precipice. “Once there were no universal or standard precautions, no infection control departments,” she states. “Then came AIDS, and everything changed. That is what is happening with safe patient handling. Our procedures are outdated and we are moving toward a different world.”
She adds that a “no manual lifting” environment can happen in increments. To begin, an administrator should review his or her facility’s patient handling injury data for the past three years. How do most injuries occur? When boosting patients into bed? Transferring them to the toilet? Moving from bed to chair? Deter advises, “You must be specific in identifying your problem in order to prevent it. Your return on investment will come from addressing your number one injury first, then moving on to others.” This data directs equipment selections. The choices in lifts and lifting aids are numerous and complicated, from simple sit-to-stand lifts to general purpose mobile floor patient lifts and overhead rail systems. Deter suggests hiring a professional, independent consultant to help identify the products that will deliver the best return on investment.
Safe patient handling requires ongoing administration from someone certified to oversee it. ASPHP and other organizations provide handling certification. In the end, a successful “no-lift” environment must be based on strong engineering and administrative controls. Good policies must spell out what to do and how to do it, say experts, while creating consistency of care.
The value of safe patient handling extends beyond worker injury prevention. It also leads to fewer patient injuries, from skin tears to serious falls, and improved quality of care.
Gina LaVecchia Ragone is a Cleveland-based freelance writer.
Collins JW, Wolf L, Bell J, Evanoff B. An evaluation of a “best practices musculoskeletal injury prevention program in nursing homes. Injury Prevention 2004;10:206-11.