For more than 40 years, nurses have had the highest jobrelated injury rates of all healthcare personnel. In a 2011 survey conducted by the American Nurses Association:
• 62% of nurses expressed concerns about experiencing a disabling musculoskeletal injury
• 56% reported musculoskeletal pain caused or exacerbated by their work
• 42% reported being injured at work at least once during a 12- month period
• 52% reported chronic back pain
• 38% said they’d had to take time off work due to occupation-related back pain
• 20% said they’d changed their unit, position, or employment setting due to lower back pain.
The costly and seemingly intractable problem of work-related injuries among nurses and other healthcare professionals prompted Sage Products to convene a June 2015 meeting with leading experts in safe patient handling and mobility (SPHM) to better define the problem, clarify risk factors, and identify risk-reduction strategies. Panel members reached a consensus that the term patient handling injury (PHI) is an accurate, well-recognized term for identifying nurses’ injuries stemming from direct patient care. This term promotes awareness and knowledge about specific causes of injuries, establishes a shared understanding of the problem’s magnitude, and helps identify solutions to enhance nurse and patient safety.
The overarching goal of SPHM programs is to support nurses’ efforts to provide the right care for the right patient at the right time. Nurses must be aware of PHI risk factors and participate fully in efforts to ensure their patients’ and their own safety through consistent use of SPHM practices. This article examines leading risk factors for PHIs and reviews strategies for designing and implementing effective SPHM programs at healthcare facilities.
The following factors contribute to PHIs in nurses:
• prolonged work hours
• longer shift duration
• longer duration of exposure during a shift
• more consecutive days worked
• preexisting health conditions
• excessive sleepiness
• social and familial disruptions
• psychological disorders
• an older nurse workforce
• greater use of complex technological innovations
• increasing numbers of critically ill patients.
Certain organizational factors also contribute to high PHI rates—inadequate staff education in SPHM, failure to commit resources to technology to support safety, and limitations of systems that promote and reinforce SPHM.
Based on a literature review and professional experience, Sage’s expert panel identified four major risk factors linked specifically to patient handling that increase nurses’ PHI risk. (See Risk factors for patient handling injuries.)
Multifaceted approach to injury prevention
Multifaceted SPHM programs are more effective than any single intervention in reducing or preventing PHIs; research shows such programs reduce PHI risk. A comprehensive effort to achieve sustained PHI reductions and improve patient safety hinges on multimodal strategies that take into account available human and equipment resources, as well as how these resources interact with work systems in diverse healthcare settings (such as perioperative, long-term care, and critical care and other acute-care environments). Successful SPHM programs must encompass appropriate technology along with worker education, a culture of safety, commitment from the top down, and routine periodic program evaluation.
Technological advances and assistive devices aid the critically important work of promoting patient movement and mobility while reducing or eliminating PHI risk factors. Proper use of assistive devices to lift, move, reposition, and transport patients is the foundation of a successful SPHM program. Assistive devices include mobile mechanical patient lifts, ceiling-mounted lifts, friction-reducing devices, lateral transfer aids, in-bed turning and repositioning devices, and height-adjustable electric beds. Ideally, this equipment should be located at or near the bedside of all patients.
All staff involved in patient handling activities must embrace and endorse integration of tools and technology into the care delivery process. Where nurses have easy access to appropriate equipment, evidence-based SPHM programs are crucial— but these alone are insufficient to guarantee program success (for instance, some nurses may choose not to use SPHM equipment). What’s more, SPHM programs may reduce injuries initially, but if nurses eventually revert to old, familiar patient-handling behaviors, injury reductions may not be sustained.
Also, assistive devices must match patients’ physical, cognitive, and clinical needs; nursing tasks to be performed; workplace design; and nurse characteristics. Furthermore, nurses must work within the structure of their organization to be effective agents of change for SPHM. An organizational investment in SPHM equipment and integration of this equipment into daily patient care is vital to a successful program.
Competency-based employee education on use of SPHM devices and associated work practices is crucial. Both new hires and permanent staff involved in patient handling should receive education on an ongoing basis to promote, sustain, and increase their proficiency.
Successful design and implementation of SPHM programs requires meaningful, sustained changes in the workplace culture. Establishing a culture of safety at the individual, group, and organizational levels rests on understanding the complexity of healthcare delivery systems with tightly interwoven and constantly changing work processes. The organization’s current culture and SPHM program design must be evaluated from a systems perspective to ensure that the program has a sustained favorable impact on PHI rates.
In an organizational culture of safety:
• nurses feel a sense of responsibility and are willing to report adverse events, injuries, and near misses
• administrators respond to these reports consistently and effectively
• everyone involved is treated fairly, with the cause of the event viewed from a systems perspective rather than assigning blame to individuals. (See Activities that promote a culture of safety.)
To build and sustain a successful SPHM program, leaders, managers, and clinical staff must demonstrate a consistent commitment and nurse and patient safety must be integrated into clinical and business goals. Frontline nursing staff must be actively engaged and participate in planning, implementing, and evaluating the program. Visible active support of all program elements by senior leaders, mid – level managers, and engineering and construction staff can overcome barriers and promote changes in ways that frontline staff may be unable to achieve. Also, a well-designed and supported SPHM mentoring or coaching program at the unit or department level continuously reinforces SPHM principles and use of appropriate equipment, which are crucial to maintaining cultural changes.
SPHM program outcomes and processes must be evaluated objectively on a routine basis. Relevant outcome measures include decreased PHI rates, improved patient safety, reduced direct costs (including medical costs for injury treatment and rehabilitation, as well as compensation to injured workers), fewer days of lost work, increased employee satisfaction, and ongoing identification of opportunities for refining SPHM processes and policies. Outcome metrics at the system and unit levels can be disseminated through the facility’s intranet or “dashboards” that display safety data in real time. Employees should be encouraged to share stories of safety events with full transparency.
Thoughts, words, and actions
An industry-wide effort to prevent PHIs through SPHM programs requires partnerships and coalitions, staff education, increased access to and use of assistive devices, and ongoing education—all supported by federal and state SPHM initiatives in development. Numerous resources are available to assist organizations on their journey to SPHM.
Organizational change to support and promote SPHM occurs only when all organization members focus on three key questions: What are we are doing? Why are we doing it? What’s my role? Full engagement and cultural transformation can occur only when everyone responds effectively to these questions in thoughts, words, and actions.
Guy Fragala is a senior advisor for ergonomics at the Patient Safety Center of Inquiry in Tampa, Florida. Teresa Boynton, an occupational therapist, previously served as an ergonomics and injury prevention specialist and workers’ compensation consultant at Banner Health, Western Region, in Greeley, Colorado. Marlyn T. Conti is a patient safety initiatives manager at Intermountain Healthcare in Salt Lake City, Utah. Lee Cyr is director of insurance services with Synernet, Inc. in Portland, Maine. Lynda Enos is a certified professional ergonomist and ergonomics/human factors consultant with HumanFit, LLC, in Portland, Oregon. Devon Kelly is an injury prevention project manager in the safety department at OSF Saint Francis Medical Center in Peoria, Illinois. Nancy Mc- Gann is system manager of ergonomics and safe patient handling for SCL Health in Colorado, Kansas, and Montana. Kathleen Mullen is the safe patient handling coordinator for CoxHealth in Springfield, Missouri. Susan Salsbury is system lead for safe patient handling and mobility at OhioHealth and Associate Health and Wellness in Columbus, Ohio. Kathleen Vollman is a clinical nurse specialist/consultant for Advancing Nursing, LLC, in Northville, Michigan.
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