Hospitals look beyond patient-handling hazards

Kaiser finds innovative solutions

While safe patient handling is gaining momentum across the country, hospitals are also turning their attention to other causes of costly musculoskeletal disorder (MSD) injuries — from housekeepers lifting loads of laundry to outpatient nurses helping patients onto exam tables.

"Approximately 60% of injury claims are related to sprains and strains. That's quite high," says Corey Bain, MPH, ASP, CHMM, REA, CIE, project manager for ergonomics with Kaiser Permanente's division of national environmental health and safety in Oakland, CA.

Kaiser has developed an ergonomics program that uses improvement goals and assessment tools as guides. Bain presented the Kaiser initiative at the HealthCare Ergonomics Conference sponsored by the Oregon Coalition for HealthCare Ergonomics and the Oregon Nurses Foundation, held in Portland in June.

The Oregon conference has become a West Coast parallel to the Safe Patient Handling and Movement conference sponsored each winter by the VISN 8 Patient Safety Center of Inquiry of the James A. Haley Veterans' Hospital in Tampa.

"Our coalition goal is [to address ergonomics in] any type of health care environment. It's broader than safe patient handling and movement," explains Lynda Enos, RN, MS, COHN-S, CPE, conference chair and chair of the Oregon Coalition for HealthCare Ergonomics, which brings together the hospital association, nurses' association, and other unions and employers. "We want to give people practical [advice]."

When an analysis of loss reports and injury trends point toward a problem, with some research, products can be found to lessen the hazard, Bain says. For example, Kaiser bought mop buckets that enable housekeepers to use foot pedals to ring out the mops. The pharmacy has assistive devices for opening caps and new cushioned matting on the floor that is easy to clean, impermeable to fluids, but more comfortable to stand on.

In a broader effort, Kaiser also requires ergonomic design to be incorporated in the construction or remodeling of hospitals.

Kaiser's northwest region in Portland has a goal of reducing the number of ergonomic-related injuries by 50% from its 2002 level. The goal of a 20% reduction in the first year came easily with the implementation of lift teams, says Marilyn Terhaar, RN, MSN, HEM, Kaiser's northwest regional workplace safety consultant.

"We found that repositioning patients in the hospital was one of our biggest [causes of] injuries," she says. "Instituting a lift team helped us reduce our injuries."

The next year's goal of a 15% reduction was harder to achieve, and the region attained only 14%. This year, the goal again is 15%.

To reduce injuries in outpatient clinics, the Kaiser region purchased lightweight mobile lifts to assist patients out of cars. A physical therapist designed a training program with a video to help employees reduce twisting, turning, and awkward postures that lead to injuries, says Terhaar.

The region also purchased exam tables that are electronically adjustable and can be lowered to 18 inches from the floor. Employees no longer have the strain of helping patients mount a step and climb to an exam table.

To keep employees current on their knowledge of the equipment, employee health and safety professionals conduct mock surveys. Kaiser also puts strong emphasis on labor management teamwork. Labor representatives work with managers to reduce injuries in a specific area, Terhaar says.

Employee input means greater employee buy-in — and greater success, she says. "It has to be their process."