Hospitals lag in safe patient handling

Safer lifts are better for patients, too

Patient handling is the No. 1 hazard in hospitals. More nurses are losing time from work or filing workers' compensation claims related to musculoskeletal disorder (MSD) injuries than any other workplace event.

Add to that an aging work force, a growing national problem with obesity, and a nursing shortage, and it's easy to see why safe patient handling is gaining ground as a legislative initiative around the country.

Yet about half the hospitals and nursing homes in the country haven't established a safe patient handling program that includes lift equipment and other assistive devices, estimates Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Center of Inquiry at the James A. Haley VA Hospital in Tampa, FL. Others have taken only limited steps, she says.

"We now know what to do. Our big goal now is to get an even implementation of this across the country. That has not been achieved," says Nelson, a pioneer in the field who coined the term "safe patient handling."

Nurses and nurses' aides remain among the top 10 occupations with the most MSD injuries, she notes. "If there were a lot of facilities [implementing effective programs], you would expect [nurses and nurses' aides] to come off that list," Nelson says.

Enforcement has had minimal impact on hospitals. Two U.S. Department of Occupational Safety and Health Administration regions targeted hospitals as part of enforcement efforts, and six hospitals received letters warning them of hazards. No hospital has received citations related to patient handling hazards.

With no specific standard, OSHA must issue citations under its "general duty clause," which requires employers to maintain a workplace free of serious hazards. Instead, OSHA has relied on voluntary compliance, including alliances with organizations such as the Association for Occupational Health Professionals in Healthcare (AOHP).

Those programs may be increasingly effective as hospitals recognize other incentives to implement safer programs. Recent studies show that mechanical lifts benefit patients as well as employees. And reducing injuries saves hospitals money.

"I think in the future, programs will be more comprehensive, linking patient safety and worker safety together," says Guy Fragala, PhD, senior advisor for ergonomics at the VA's patient safety center. "That way we can integrate it into the culture of an organization."

Role models boost program

In the early 1980s, Bernice Owen, PhD, RN, conducted research on back injuries among nurses and wrote an article stating that a comprehensive program — including assessing patients' needs, using appropriate equipment, and having support from management — could reduce the injuries.

The American Journal of Nursing at first rejected the article. The reason: Reviewers said it wasn't possible to prevent back injuries.

"I wrote back to the editor and said, 'Did you read the article? This talks about changes and that we were able to reduce it,'" recalls Owen, who now is professor emeritus at the University of Wisconsin at Madison's school of nursing.

The AJN eventually ran the article as a cover story, with an accompanying editorial. The American Nurses Association became a strong proponent of safe patient handling programs.

Years of research have demonstrated that body mechanics cannot prevent injuries, but that mechanical and assistive devices implemented as part of a safe patient handling program can reduce MSDs by 30% or more.

"You can't just get the equipment and expect people to use it," cautions Owen. "People have to be trained, and there has to be some kind of monitoring that it is used and used correctly."

Employees can be trained to be mentors or role models, helping others adapt to the new equipment and reminding co-workers that they should use the equipment, says Owen. "If you could empower the people who are actually doing it and let them do the surveillance themselves, it worked better than having management do it," she says.

"Safety huddles" are a method promoted by the VA safety center to allow staff to share information about near-misses or safety issues, including back injury. Everyone involved in direct care in a unit should attend. They should be held at the same time every day, and they can last as few as 15 minutes, according to a VA guide.

Allow open discussion, without seeking "blame," on these questions:

  • What happened to threaten patient or staff safety?
  • What should have happened?
  • What accounted for the difference?
  • How could the same outcome be avoided the next time?
  • What is the follow-up plan?

[Editor's note: The 2007 Safe Patient Handling and Movement Conference will be held March 12-16 at Disney's Contemporary Resort in Lake Buena Vista, FL. For more information, contact the University of South Florida, (813) 974-4296 or (800) 852-5362,]