By: Mary Thomas Scott, RN, BC; Antonia Maria Clark, RN, MSN, BC; Mary Agnes Andreano, RN, MSN, CHPN, CCRC; Emily Ann Cooper, RN, BSN; Linda Ivey, RN; and Cynthia McArthur-Kearney, RN, MSN, NE-BC
The number of employees injured while lifting or moving a patient is a major issue throughout healthcare. When our insurance provider showed how our hospital overall injury-related claims had gradually increased to above the national average, we knew we had to act not only to address the provider’s concerns, but also to protect our employees—according to the American Nurses Association’s “Handle with Care” initiative, nursing personnel are among the highest at risk for musculoskeletal disorders.
Our organization formed a multidisciplinary task force to address safety issues related to patient handling. The task force included representatives from nursing performance improvement, physical therapy, bariatrics, employee health, and safety, as well as direct care nursing staff. A task force member suggested adding a representative from the Nursing Education and Research Council (ERC) be included. We found the council eager to participate in conducting a research study that could support the development of a safer work environment.
Preparing the foundation
In its extensive literature review of evidence-based practices used by other healthcare organizations for safe patient handling, the ERC learned that steps could be taken to avoid injuries. For example, a study conducted by Lynch and Freund reported a 30% decline in the rate of back injuries over a 3-year period after an ergonomic evaluation of patient handling and the development of a train-the-trainer program for staff. Siddharthan noted reduced incidence and severity of patient handling injuries after the implementation of a safe handling program. The program included an ergonomic assessment protocol, patient handling technology, and decision algorithms used for selecting appropriate equipment. The literature suggested that a multifactor approach is crucial to the success of a safe patient handling program. The approach must not only include the education of staff, but also the assessment of the work environment and the use of appropriate lifting devices.
Patient movement algorithms
Below are algorithms developed and used by staff at Southeastern Regional Medical Center in Lumberton, North Carolina. Reprinted with permission. (A PDF version is available by clicking the PDF icon at the top of the page)
Based on the literature review, the ERC devised and implemented a multifactor patient handling program in collaboration with the multidisciplinary task force committee. The ERC obtained IRB approval to conduct a study to evaluate the effect of the program on musculoskeletal injuries of direct care staff. The ERC started a multicomponent pilot project on the skilled nursing unit at our agency’s long-term care facility. The program took a three-pronged approach.
First, the task force committee revised policies and procedures to include an admission assessment with a patient movement algorithm (see end of article) used to identify high risk handling needs of the individual patients. Members of the ERC served on the committee and provided input and recommendations on the policy and procedure revisions and development of the algorithm. The assessment was performed on admission and during each patient’s minimum data set (MDS) review. The MDS Review Nurse coordinated the completion of the required minimum data set with other members of the inter-disciplinary team develops and implemented a plan of care that meets the individual needs of each patient. Based on the results, staff placed the appropriate color on the outside of each patient’s room on the door to alert other staff members of each patient’s handling needs.
Second, the ERC evaluated the equipment to determine if staff had the tools necessary to provide safe patient handling. It was decided by the ERC to use the lifting devices and gait belts currently owned by the facility. No new purchases were required.
Third, the ECR developed staff education materials that included injury statistics, revised policies and procedures, and the patient movement algorithm. The ECR provided education for all staff members using lecture and demonstrations of the use of the equipment. Staff were required to provide a return demonstration and complete a survey to validate their understanding of the training content. This training was also provided as part of new employee orientation and during annual competency review. Injury prevention champions on the nursing unit reinforced training.
The employee health nurse provided data on Occupational Safety and Health Administration (OSHA) reportable injuries. In the year before implementing the pilot study, 13 patient handling injuries occurred resulting in a total cost of $39,000.00 to the organization. The year after the program, only three OSHA reportable handling injuries occurred, representing a 76% reduction in injuries.
A total of $7,940.36 was spent in the implementation of the program. This included the cost of the 282 worked hours necessary for the development of policies, procedures, algorithms, tools, and the training and monitoring of staff. The return on investment was valued at a total savings of $93,000.00 over a three-year period.
Several factors contributed to our program’s success. We identified and resolved barriers during the pilot study, such as the increased time requirements and staffing ratios necessary for the handling needs of complex individual patients. We structured communication among staff to capture any change in patient handling needs on a day-to-day basis. Education and subsequent staff compliance with policies and procedures and the safe use of equipment contributed to a culture change that led to a safer work environment. Finally, management support, visibility, frequent reinforcement, and the creation of a blame-free environment provided staff members with the autonomy to communicate concerns, experiences, and suggestions to have successful culture change.
Mary Thomas Scott (physician practices), Antonia Maria Clark (nurse educator), Emily Ann Cooper (staff nurse), Linda Ivey (care manager), and Cynthia McArthur-Kearney (manager, educational services department and facilitator, nursing shared governance education & research council) all work at Southeastern Regional Medical Center in Lumberton, North Carolina. Mary Agnes Andreano is the program coordinator for the MSN online program at Ohio University, College of Health Sciences and Professions, School of Nursing in Athens. For additional information, email Mary Scott at Scott03@srmc.org.
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de Castro AB. Handle With Care. American Nurses Association. 2004; http://www.NursingWorld.org/handlewithcare/. Accessed April 10, 2006.
Lynch RM, Freund A. Short-term efficacy of back injury intervention project for patient care providers at one hospital. AIHAJ 2000; 61:290-294.
Siddarthan K, Nelson A, Tiesman H, et al. Cost effectiveness of a multifaceted program for safe patient handling. Agency for Healthcare Research and Quality. 2005; http://www.ahrq.gov/downloads/put/advances/vol. Accessed April 10, 2006.