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Safe Patient Handling

BY STEPHANIE TABONE, MSN, RN, TNA DIRECTOR OF PRACTICE

No, this is not yet another story about the danger of back injuries among nurses
and the numbers of nurses forced to leave the bedside due to limitations
resulting from a back injury. A new twist has presented itself in the area of
ergonomics, “Safe Patient Handling,” which offers a solution to the problem
rather than just an identification of the burden it presents to the health care
industry. The new approach recognizes that patient transfers present clear risk
for both the patient and the nurse; and that these risks are costly and could be
significantly decreased or eliminated to the benefit of all concerned.

A review of statistics from the


U.S. Bureau of Labor Statistics
and the insurance industry finds
in OSHA-issued, comprehensive
nursing home guidelines for
preventing MSD. The rate of MSD in
numbers of injuries and lost work
time. The OSHA guidelines go
on to identify that, “facilities that
that nurses have among the highest nursing homes is twice that of any have implemented ergonomics-
estimated rates of back injury with other health care setting. The goal based injury prevention programs
an average of 40,000 back illnesses of the OSHA MSD guidelines: using effective engineering and
reported by nurses each year. “OSHA recommends that work practice controls have
Moreover, nurses have the highest manual lifting of residents should achieved considerable success
rates of compensation claims of be minimized in all cases and in reducing work-related injuries
any occupation or industry. It is eliminated when possible. and workers’ compensation costs.
estimated that 12% of nurses leave Minimizing and, where In addition, some institutions have
the profession as a result of back possible, eliminating experienced additional benefits,
injury and over 52% of nurses resident lifting is the including reduced
identify that they have chronic primary goal of the staff turnover and
back pain. The cost to the health ergonomics process associated training
care industry attributable to back in the nursing home and administrative
injury is estimated to be $20 setting and of these costs, reduced
billion per year. guidelines.”
In 2000, the Programs to decrease
Occupational patient handling-
Safety and Health related injury have been
Administration (OSHA) effective by 20-80%
issued standards for when implemented in
the prevention of lowering
ergonomic injury. The
standards ultimately
were not adopted
and now serve only
as a guideline for
the prevention of
ergonomic injury.
However, in 2004, the
numbers and severity
of Musculoskeletal
Disorders (MSD) in
nursing homes resulted

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absenteeism, increased will be most effective •Assessment of other activities
productivity, improved morale, •Understanding that proper that create ergonomic risks
reduced resident injury, and body mechanics alone will not such as: cleaning rooms,
increased resident comfort.” The eliminate ergonomic stressors waste collection, pushing
guidelines also describe model •Shifting the emphasis from of heavy carts, stocking
programs that have significantly body mechanics considering supplies, adjusting beds and
reduced the burden of back injury how a lift can be eliminated or development of control
in health care facilities. at the very least minimized methods for these activities
OHSA recommendations and  Ergonomics Training
anecdotal reports about the levels •Recognition of signs and Use of safe patient handling
of success achieved through safe symptoms of MSD so they can programs like the one OSHA
patient handling programs have be reported and response outlines clearly could have
resulted in a new ANA initiative, made to the problem before it a significant impact on
“Handle With Care.” Spearheaded is debilitating musculoskeletal disorders. ANA Safe
in Florida, the program is beginning •Assessment skills that provide Patient Handling Information can
to take off. Constituent member skills in identification of jobs and be reviewed at: www.nursingworld.
associations including Texas tasks that involve ergonomic org/handlewithcare/hwc.pdf.
Nurses Association are considering stressors The complete OSHA guidelines
legislative and other policy •Information and skills in can be accessed at the following
initiatives to decrease the threat controlling stressors URL: www.osha.gov/ergonomics/
of ergonomic injury to nurses. With •Training that encompasses guidelines/nursinghome/draft/
nursing shortage data that indicate staff exposed to stressors and nursinghomeguideline.pdf
demand will only continue to grow those that can influence the
for older nurses at the bedside, implementation of programs to
there is no doubt that policies reduce MSD
APN TITLING ISSUES
which decrease or eliminate lifting  Occupational Health continued from page 9
of patients could go a long way Management of MSDs
toward keeping older nurses in •Ongoing occupational new, national model.
the workforce. management is a necessary Since its public hearing in
So compelling are the component of implementation October, and participation at the
cost benefits associated with so that injury and time away national stakeholders meeting
implementation of safe patient from work is minimized through: in December, the BNE has now
handling that lifting equipment, lift •Effective reporting of injury is published in the February 11, 2005
teams, and sophisticated overhead made in a timely manner Texas Register some “Proposed
tracks that accommodate multiple •A trained health care New Amendments to Rules 221.2
lifting tools are becoming more professional responds to injuries and 221.7 relating to Advanced
common. But just purchasing before they are debilitating Practice Titles.” With that
equipment is not the silver bullet. •Accurate recordkeeping publication at www.sos.state.
Administrators skeptical of safe occurs to evaluate the tx.us/texreg/issues.shtml, another
patient handling would attest effectiveness of the safe 30-day public comment period
to the fact that lift equipment is patient handling program began and the work continues. A
gathering dust in many facilities. So  Control Methods include: follow-on meeting of the National
what does it take? •Evaluation of the worksite Nursing Stakeholders on Advanced
and the types of situations the Practice is to convene again in
 A change in culture/ demand patient handling early April 2005, just before the
management commitment and •Identification of equipment six-month moratorium on this issue
employee participation that could eliminate or minimize expires and, consequently, the
•Management that tailors patient handling when possible BNE revisits for adoption the newly
ergonomic interventions to the •Development of appropriate proposed new rules.
specific conditions in which lifting plans for individual
* Slides of Dr. Margretta Styles keynote
lifting occurs patients
address can be viewed at www.nursingworld.
•Employee input into the •Ongoing use of algorithms for org/news.
equipment and methods that lifting decisions

TEXAS NURSING March 2005 visit us on the web — www.texasnurses.org Page 11