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Nurses, aides, orderlies and therapists have some of the highest numbers of nonfatal occupational injuries, many of which are musculoskeletal injuries arising from unsafe patient handling, experts say.
With health care workers projected to contribute to about one-fifth of all new jobs by 2026, instituting policies to ensure safe patient handling is crucial, they say.
Nearly 60,000 health care and social assistance workers reported recordable musculoskeletal disorders, and nearly half of the injuries were attributed to a health care patient or resident of a health care facility, according to the U.S. Bureau of Labor Statistics. Nursing assistants suffered the highest proportion of injuries at 43%, followed by nurses at 20% and personal care/home health aides at 14%.
Safe patient handling is an issue that “virtually everybody” in health care must deal with on a daily basis, said Tim Davidson, co-thought leader of health care consulting practice and senior consultant at Aon Global Risk Consulting. While some health care organizations, like the senior care and long-term care market, have well-developed safe patient handling programs, in acute care and walk-in clinics — where the need to move patients is not a constant condition — they may be less likely to have a plan in place, Mr. Davidson said.
Eleven states have mandated safe patient handling policies or programs, but the laws vary substantially, with some states only requiring a safe patient handling committee while others, like New York, outline specifics to be included in each program, including requiring health care facilities to outline the availability of safe patient handling equipment, patient assessments and initial and annual training for all employees on safe patient handling.
“In my experience, the majority of the more severe types of injuries in health care organizations is as a result of patient handling,” said Darrell Toenjes, senior client adviser for health care at Midwest Employers Casualty Co., a unit of W.R. Berkley Corp. “If an organization wants to focus on reducing their workers compensation costs and wants to reduce injuries to their very precious workers, the way they can do that most effectively and most substantially is through developing a safe patient handling program.”
In October 2004, Buffalo, New York-based Kaleida Health, a not-for-profit hospital system with about 20,000 employees, rolled out its safe patient handling program across the entire hospital system and trained thousands of hospital staff through three-hour courses.
The program eventually became the basis of New York’s Safe Patient Handling Act, which became law in 2014, according to Paula Pless, Kaleida’s director of health safe patient handling and ergonomic workforce safety.
The hospital saw a significant improvement in musculoskeletal disorder claims almost immediately, said Ms. Pless. She said the hospital system saw a full return on investment for the safe patient handling program and equipment purchase in less than three years.
She said musculoskeletal disorders and other injuries among staff continue to decline. In 2010, which was six years post implementation, Kaleida recorded 408 compensable injuries.
For the first quarter of 2019, the hospital system has seen only 13 claims. Last year, the hospital also saved $1.5 million in insurance costs toward its workers comp premium because of the safety program, she said.
“We’re constantly monitoring our approach to safety, and this rolls into other areas, such as ergonomics and the enhancement of worker safety in other departments,” she said. “We keep pushing that needle toward less and less risk and exposure.”
However, Ms. Pless noted that in any organization, there are the few staff members who don’t follow patient handling protocols. This led the hospital to implement a progressive disciplinary system that includes for initial offenses the requirement to reattend the three-hour safe patient handling training program.
Another challenge of ensuring compliance with a safe patient handling program is the time it takes to properly assess a patient. “The key is to make the program as simplistic as possible,” Mr. Davidson said. “If you’ve got a program that has multiple metrics to it and you have to work a puzzle before you go in, that’s a problem.”
Successful organizations have medical providers go through a checklist or evaluation, such as a Bedside Mobility Assessment, also known as a BMAT, which includes fall assessments, medication and acuity, and incorporate that information into a patient care plan, which gives staff as much information as possible to plan a lift or movement before entering a room, said Mr. Davidson. Simple antecedents — such as a sign that notifies the care provider of a potential risk before they enter the room — can also be enormously helpful.
For instance, putting a sign with leaves falling off a tree on the door can symbolize a fall risk, he said.
Staff also needs to have an understanding of the patient’s mental condition, such as if they’re on medication that will severely affect their ability to ambulate or make them agitated, he noted.
Training is also key, as is having a multidisciplinary safe patient handling committee that includes front-line workers, said Mr. Toenjes.
“They know their jobs better than anyone else, they know the hazards better than anyone else, and they can come up with the best solutions,” he said. “The engagement of front-line folks will also help with buy in. Rather than having management telling you what to do, if your own co-workers are watching out for you and have your back, it sets up a more positive culture.”
A key component to a safe patient handling policy is having the right equipment to assist health care providers in mobilizing patients and ensuring workers use it, experts say.