Presentation at 4-20-07 Safe Lift Conference ... Thomas R

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An Overview of National Efforts Aimed at
Promoting Safe Patient Handling and Movement
Practices

• Thomas R. Waters, Ph.D.
• Research Safety Engineer
• Division of Applied Research and Technology
• National Institute for Occupational Safety and
  Health

"The findings and conclusions in this
presentation are those of the author and do not
necessarily represent the views of NIOSH."
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Scope of the Problem

• In 2004, MSDs accounted for 32 percent, of all
  injuries and illnesses in the US that resulted in
  days away from work (402,700 cases).
• The trunk, including the shoulder and back, was
  the body part most affected by work (35.5 of
  cases).

BLS, 2006
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Scope of the Problem

• Sprains and Strains were the leading nature of
  injury or illness in every major industry sector
  with more than 525,000 (47 of all cases).
• There were 48,710 recordable injury/illness cases
  due to repetitive motion.

BLS, 2006
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Scope of the Problem

• Two of the top ten occupations with the greatest
  number of MSD cases include nursing aides/
  orderlies/and attendants and registered nurses
  (BLS, 2006).
• The median number of days away from work for MSD
  cases was 10 days, but almost one-fourth of all
  injury/illness cases involved more than 31 days
  away from work (BLS, 2006).
• It has been estimated that occupational low back
  pain (OLBP) accounts for approximately 34 of the
  cost of all injuries and illnesses combined and
  in 1992 it was estimated to cost 49.2 billion
  dollars annually (Leigh et al., 1997)

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Emerging Problems for Health Care Workers

• Aging Workforce
• Nursing shortage
• Obesity
• Stress
• Overtime/Shiftwork

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Aging Workforce Problem

• The aging nursing workforce is big problem for
  the healthcare industry
• Average age of nurses is 46.8 years
• Older workers have more work experience, but
  typically suffer from reduced work capacity and
  increased health problems

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Nursing shortage

• Increased overtime and mandatory overtime
• Higher workloads for individual workers
• Increased stress on workers
• Potential for more errors

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Obesity Problem

• More than 30 of the population is considered to
  be obese
• More than 66 of the population is overweight
• It is common for healthcare providers to see
  patients weighing more than 400 lbs.
• Bariatric care is of increasing importance

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Obesity Trends Among U.S. Adults
BMI 30, or 30 lbs overweight for 5- 4
woman
1985
Source CDC
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Obesity Trends Among U.S. Adults
BMI 30, or 30 lbs overweight for 5- 4
woman
1991
Source CDC
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Obesity Trends Among U.S. Adults
BMI 30, or 30 lbs overweight for 5- 4
woman
1997
Source CDC
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Obesity Trends Among U.S. Adults
BMI 30, or 30 lbs overweight for 5- 4
woman
2002
No Data lt10 1014 15-19 20-24 gt25
Source CDC
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NRC/IOM Report 2001
A 2001 scientific panel concluded that (1) there
is a clear relationship between back disorders
and physical load and that (2) modification of
risk factors could reduce substantially the risk
of symptoms.
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Based on our current understanding of MSD
causation and control from the scientific
literature, a conceptual framework for prevention
has been postulated.
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Model for WMSDs
Adapted from NRC/IOM, 2001
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Anterior-Posterior and Lateral
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Body mechanics doesnt protect the worker from
exposure to work-related MSDs.
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Load-Tolerance Model
Traditional Tolerance
Safety Margin
Decreasing Tolerance
Load
Repetitive Loading
Repetitive Loading
Time
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Traditional ToleranceLimits for Spinal Force

• Disc Compression Force (DCF)
• 3400 N (770 lbs) - Published by NIOSH (Waters
  et al, 1993 NIOSH, 1994)
• Shear Force (SF)
• 1000 N (230 lbs) - Proposed by McGill and Marras
• 2 types of shear (Anterior-Posterior and
  Lateral). Total shear is vector sum.
• Tolerance limit for cumulative spinal load is not
  known.

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Evidence Manually Handling Patients is Hazardous

• There is significant evidence that manual lifting
  of patients is high risk for musculoskeletal
  disorders.
• Marras et al., 1999 indicated that, even with two
  caregivers, there is no safe way to manually lift
  a patient.(Marras et al. 1999, Garg and Owen
  1992, Zhuang et al., 2000).

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One Person Lift
Two Person Lift
Figure(s) Removed to save space
Marras et al., 1999
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Lifting a 110 lb non-weight bearing patient
3400 N DCF Limit
1000 N SF Limit
Marras et al., 1999
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A recent NIOSH publication describes the benefits
and effectiveness of a safe lifting and movement
program in nursing homes (Collins, Nelson and
Sublet, 2006).
Figure(s) Removed to save space
DHHS(NIOSH) Pub No. 2006-117 http//www.cdc.gov/ni
osh/docs/2006-117/
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Evidence of Effectiveness ofSPHM Program in
Reducing Risk

• Safe resident lifting programs reduce
  resident-handling workers compensation injury
  rates (up to 61), lost workday injury rates (up
  to 66), restricted workdays (up to 38), and the
  number of workers suffering from repeat injuries
  (Collins et al., 2004, Tiesman et al., 2003
  Nelson et al., 2003 Garg, 1999).
• Research has also shown an increase in caregiver
  job satisfaction, and a decrease in unsafe
  patient handling practices performed (Collins et
  al, 2006).

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Evidence of Effectiveness ofSPHM Program in
Reducing Risk

• Nurses ranked lifting equipment as the most
  important element in a safe lifting program
  (Nelson et al., 2003)
• Anecdotal reports of significant reductions in
  staff turnover (Joliff, 2004) and increases in
  quality of care (Garg, 1999).

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Cost/Benefits of SPHM Program
Economic analyses demonstrate that the initial
investment in lifting equipment and employee
training can be recovered in less than three
years through reductions in workers compensation
expenses (Collins et al., 2004 Tiesman et al.,
2003 Nelson et al., 2003 Garg, 1999).
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Evidence of Effectiveness ofParticipatory MSD
Prevention Programs

• Participatory programs have been shown to be
  effective in reducing risk of MSDs in hospital
  work environments.
• 50 reduction in total injuries
• 26 reduction in lost time injuries
• 19 reduction in injuries gt 3 days
• 25 reduction in low back injuries.
• (Bohr PC, Evanoff BA, Wolf LD, 1997)

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OSHA has published a Guideline for Prevention of
Musculoskeletal Disorders in Nursing Homes

• OSHA recommends that manual lifting of residents
  be minimized in all cases and eliminated when
  feasible (OSHA, 2003).
• OSHA also indicates that although these
  guidelines are designed for nursing homes, they
  hope that employers with similar work
  environments, such as assisted living centers,
  homes for the disabled, homes for the aged, and
  hospitals will find the information useful (OSHA,
  2003).

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NIOSH, ANA, and VHA have partnered to develop a
new SPHM Curriculum for Schools of Nursing (SONs)

• Curriculum teaches nursing students safe patient
  handling and movement principles.
• 27 SONs have implemented the new training in
  their schools.
• There is overwhelming positive response from the
  SONs and the students.

Draft available at http//www.cdc.gov/niosh/revi
ew/public/safe-patient/
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National Research Efforts

• National Institute for Occupational Safety and
  Health (NIOSH) Efforts
• Comprehensive research study of the effectiveness
  of SPHM programs in Nursing Homes
• Study of risk factors and solutions for patient
  handling for home healthcare workers
• Development and evaluation of a SPHM training
  program for schools of nursing.

A recent article in Orthopaedic Nursing summaries
the NIOSH SPHM research program (Waters et al.,
2006).
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National Research Efforts

• Veterans Health Administration (VHA) Efforts
• Comprehensive research study of the effectiveness
  of SPHM programs in Nursing Homes
• Study of risk factors and solutions for home
  healthcare workers
• Development and evaluation of a SPHM training
  program for schools of nursing.

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National Prevention Efforts

• AORN Guidance Statement Safe Patient Handling in
  the Perioperative Setting
• ANA Handle with Care Program
• Critical Care Nurses
• Orthopeadic Nurses
• American Physical Therapy Association

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AORN Guidance Statement Safe Patient Handling in
the Perioperative Setting

• Developed seven ergonomic tools for assessing
  physically demanding tasks in the operating room.
• Lateral transfers
• Repositioning on the OR table
• Lifting and Holding Body Parts
• Retraction
• Lifting and Carrying Equipment and Supplies
• Moving wheeled beds and equipment

AORN, 2007
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American Nurses Association (ANA) Handle with
Care Program

• National campaign to develop and implement a
  proactive, multi-faceted plan to promote the
  issue of safe patient handling and movement.
• Position Statement Elimination of Manual
  Patient Handling to Prevent Work-Related
  Musculoskeletal Disorders (ANA, 2003)

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Status of SPHM Legislation

• 3 states have passed statewide bills requiring
  safe patient handling and movement programs
  (Washington, Rhode Island, and Texas)
• 7 states have pending legislation or are
  considering legislation (Massachusetts,
  Minnesota, New Jersey, California, Florida, and
  Maryland and New York)
• Proposed Federal bill designed to protect direct
  care nurses from MSDs, has been introduced (H.R.
  6182).

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State Legislation Assistance

• Only 3 states provide explicit financial
  incentives (WA, NY, and OH)
• Only 3 explicitly include committees with at
  least 50 of members being direct care staff (WA,
  RI, NJ)
• Most have risky manual lift refusal protection, 1
  has discipline for not using equipment (CA)

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The Proposed Nurse and Patient Safety
Protection Act, (H.R. 6182)

• Designed to protect direct care nurses against
  musculoskeletal disorders related to patient
  handling.
• The standard would eliminate manual lifting of
  patients by health care providers, through the
  use of mechanical devices, except during a
  declared state of emergency.

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Requirements of the proposed Nurse and Patient
Safety Protection Act, (H.R. 6182)

• Apply to all health care facilities
• Facilities must purchase, use, and maintain safe
  lift equipment
• A program to identify problems and solutions for
  patient handling
• A system to report, track and analyze injury
  trends
• Worker Training and Program Evaluation
• Provide a grant program for needy health care
  facilities

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Incentive Efforts by States

• Ohio implemented a program in which healthcare
  providers could apply for grant money to purchase
  patient handling equipment
• Washington State implemented a similar program in
  which healthcare providers could get a reduction
  in workers comp payments equivalent to the
  amount of money spent on SPHM equipment.

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Research Gaps
There is still work to be done. More research is
needed to improve safe patient handling and
movement efforts.
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Gaps in Evidence Technology

• Equipment that has not yet been developed
• Equipment that exists, but has not been purchased
• Equipment that exists and has been purchased, but
  is not being used

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Gaps in Evidence Ergonomic Assessment Protocols

• Translate what is known from other industries to
  health care
• Identify what unique factors need to be added to
  ergonomic assessments
• Include front line staff in assessment of hazards
• Link solutions to risk assessment

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Gaps in Evidence Building a Business Case

• Incentives for Early Adopters
• Credible data on Cost-Effectiveness and Return on
  Investment when SPHM programs are implemented
• Credible data on link between Quality of Care and
  SPHM
• Credible data on SPHM and provider
  recruitment/retention

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Concluding Remarks

• Safe patient handling and movement using
  technology is effective in preventing MSDs for
  healthcare workers.
• Reliance on body mechanics is not safe and does
  not prevent MSDs.
• It is important to get the information to nursing
  students early in their careers.
• Equipment and programs are cost effective

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Thank You !