Imagine you work in a warehouse. One of your duties is to move cargo that weighs between 100 and 200 pounds. It has a variety of shapes and can move on its own, often in unpredictable ways. Its value is priceless, yet it can easily be damaged.
Health care workers are expected to do this every day, and if you think 100 pounds sounds heavy, it’s considered a light load for nurses and other caregivers. Patients who weigh 300 to 350 pounds are not uncommon, and it’s not unheard of to see even heavier patients.
On average, caregivers lift a cumulative nine tons during a 40-hour work week—the equivalent of two heavy-duty, crew cab pickup trucks. This applies to nurses, aides, orderlies, physical therapists, diagnostic imaging technicians, and all other workers who need to lift and move patients or residents as part of their job.
Generally, the safe lifting limit for a worker is 35 pounds. This implies that three workers would be required to lift a 105-pound patient. However, moving people is different than moving boxes. Patients can be unpredictable, do not have handles, and it is difficult, if not impossible, to get the load close to the caregiver’s body. In addition, patient lifting usually includes some twisting and pulling or pushing, which means there are more complex forces on the spine.
Research has shown in recent years that moving patients is risky business for patients and caregivers. If a caregiver must support more than about 35 pounds of a patient’s weight, mechanical aids such as powered lifts and friction-reducing devices should be used. This patient-centered approach to moving people using safer methods is called “safe patient handling.”
Although this approach has been shown to be safer for patients and staff, it requires a significant initial investment that can be a barrier for small hospitals and long-term care facilities. In addition, this approach is still fairly new to health care.
A two-to-three-year return on investment is well-documented, yet few Oregon facilities have adopted a comprehensive safe patient-handling program. Until health care leaders can observe the benefits of such a program first-hand, they may be reluctant to take the financial risk.
In 2007, as part of an effort to reduce injuries and claims in the health care industry, Oregon’s Occupational Safety and Health Division (OR-OSHA) awarded grants to Dallas Retirement Village in Dallas and Good Shepherd Medical Center in Hermiston to help them develop safe patient-handing programs. The grants were funded with money from the Workers’ Benefit Fund, maintained by the Department of Consumer and Business Services. Dallas Retirement Village received a $647,830 grant, and Good Shepherd Medical Center received $394,617. As a grant stipulation, these facilities serve as safe patient-handling models for other institutions that want to implement similar programs.
Dallas Retirement Village
Gail Winegar, director of human resources, and Cory Oace, health services administrator, are passionate advocates for safe patient handling.
“Dallas Retirement Village was always working to improve its procedures through traditional patient-handling techniques like good body mechanics, use of gait belts, and ongoing training,” said Tim McDonald, SAIF senior safety management consultant. “Around 2003, Deb Fell-Carlson, SAIf loss control program advisor, and I encouraged them to move toward safe patient handling.”
Cost, however, was a deterrent. Dallas Retirement Village lacked the funding to install ceiling-mounted lifts or purchase a significant amount of equipment.
The grant allowed Dallas Retirement Village to move forward, installing ceiling lifts in every room in the Health Center and in five bathing areas. It also purchased 17 portable lift motors, each with its own cart. One motor is assigned to each nursing assistant.
“The nursing assistants never have to go looking for one,” said Winegar. “Staff members were thrilled. Using the new equipment was not only safer, but it saved them time that they were able to redirect to one-on-one care of the residents.”
“What’s important to staff,” said Oace, “is being able to assist residents when they need assistance, not after they run to look for a machine or another person to help them. It was awful for them to tell a resident, ‘Just a minute; I need to get help.’ Now they can say, ‘Yes, I can help you right now.’”
Good Shepherd Medical Center
“This equipment made a big difference for us,” said Vicki Horneck, Good Shepherd medical/surgical unit manager. “We don’t have any extra nurses here, so anything that reduces injuries to nurses and keeps our staffing levels constant is a direct benefit to our patients.”
Greg Hadden, SAIF senior safety management consultant, has worked with Good Shepherd throughout the development of its low-lift and no-lift program.
“These programs benefit the medical environment in several ways,” he said. “For one thing, as the shortage of nursing staff continues, the average age of caregivers is rising. Injury prevention becomes critical in keeping experienced staff healthy and on the job longer.”
About five years ago, staff at Good Shepherd also began working with Lynda Enos, ergonomics and nursing practice consultant with the Oregon Nurses Association, who helped the medical center develop the tools it needed to implement its program.
Good Shepherd then spent two years setting up the program, with additional input from employees, before purchasing equipment.
“What equipment you buy depends on how you build your program,” said Horneck.
The medical center installed four ceiling-mounted lifts in the emergency room, one in diagnostic imaging, eight on the medical-surgical floor, and four in ICU. They purchased HoverMatts® and HoverJacks®, inflatable mattresses that help move patients; new sit-to-stand machines; and a wheelchair pusher for the hospital, as well as portable lifts and sit-to-stand machines for their home health program. In addition to the mechanized equipment, they purchased a variety of nonmechanized aids and are working with one of their vendors to develop a special sling that can lift a patient’s leg into a continuous motion machine, which is often prescribed for therapy after total knee joint replacements.
All staff members receive annual training on the equipment, and some are designated as “super users,” the ones to whom others can go with questions.
Changing the culture
While initial cost is a big hindrance to installing lift equipment, it can be even more difficult to overcome the attitude that injuries are just an expected consequence of the nursing profession.
“The main reason, in my personal opinion,” said Enos, “is that nurses don’t always give themselves the same level of care that they give to their patients. But when you are looking out for the safety of the caregiver, you also increase patient safety. Without a safe patient-handling program, patients can have increased pain, loss of dignity, and skin tears. These are important issues.”
Dallas Retirement Village restructured its safety committee, putting a focus on creating a safety culture within the organization. The company does all it can to keep safety constantly fresh and on employees’ minds.
At all-staff meetings, the safety manager will give a report, as well as short safety tips or news. For example, the report might include the number of injuries since the last meeting, coupled with a tip about using appropriate electrical cords.
“We also like to keep it fun,” said Winegar.
For one meeting, Kimberly Glover, director of environmental services, wrote a song about safety to the tune of “Battle Hymn of the Republic.”
Training and accountability are also important parts of the safety program at Dallas Retirement Village. New employees go over the safety standards at their department orientations, and expectations are set early. Employees who do not follow safe working practices receive coaching. If the unsafe behavior continues, it can lead to a progressive disciplinary process and have a negative impact on an employee’s annual performance evaluation.
Getting staff involved
Staff involvement in developing a program is critical to changing the culture. The nursing assistants at Dallas Retirement Village helped make all decisions about what equipment to buy, and, at Good Shepherd Medical Center, employees were instrumental in setting up the program and picking the equipment.
“The concept has to be sold to staff before you ever start to buy lifts or install ceiling tracks,” said Horneck.
In addition to all the other hospital staff who contributed to the program’s success, Enos gives credit to Good Shepherd’s doctors.
“Doctor engagement shows safe patient handling is really becoming part of the culture at the hospital,” she said. “If you don’t engage all the staff, you can’t change the culture.”
When the patient is a pooch
Caregivers who work with humans aren’t the only ones at risk for injuries related to lifting and moving patients. Veterinarians and veterinary technicians can also suffer strains from taking care of their animal patients, and not just vets who handle large animals like cows and horses. Small animal veterinarians are often hurt as well.
While a “small animal” may be a 10-pound cat or dog, it also may be an English pointer, German shepherd, or standard poodle—dogs that can weigh between 55 and 80 pounds. A St. Bernard or Great Dane can weigh well over 150 pounds.
Wendy Baltzer, assistant professor of small animal surgery at Oregon State University’s College of Veterinary Medicine, knows how easy it is to be injured working with small animals; she hurt her back while working as a veterinarian in private practice at an emergency hospital. Now Baltzer works at OSU’s Small Animal Rehabilitation Center, which treats dogs and other small animals recovering from strokes, fractures, or muscle or tendon tears, as well as those with osteoarthritis, diabetes, and cancer.
Treatment depends on the condition, but almost always involves lifting or moving the animal. When they are hurt or confused, animals may also bite, scratch, or behave in other ways that create a hazard for the caregiver.
“Vets are hurting themselves all the time by moving animals,” said Baltzer. “I tell my students that you can’t move a dog weighing more than 20 pounds by yourself, especially if the animal is excited, nervous, or anxious. It would take, for example, four people to move the St. Bernard that is currently in residence.”
The School of Veterinary Medicine, including the Rehabilitation Center, uses lift equipment that is similar to what is used on human patients. The lifts are smaller, but serve the same purpose. The school uses exam tables that can be raised and lowered to avoid lifting animals to the table. Most of their equipment for lifting and moving the patients, which includes lift trolleys and ramps to help dogs into vehicles, was donated to the university.
“It’s a very physical job,” Baltzer said. “When you are lifting dogs out of cages or onto exam tables, you tend to only think about the patient’s comfort, but you also need to think about yourself.”
Reprinted from Comp News, fall 2010