'A pitch' for safety, a homerun for employees

Patient handling injuries drop dramatically

Ergonomics is a science of workplace design. But in practice, it also presents a mathematical puzzle and a behavioral challenge. How will you pay for new equipment? How will you change years of habits?

Provena Health, a system with six hospitals and 12 long-term care facilities based in Mokena, IL, found the answers to those questions and was rewarded with a rapid payback. In just one year at Provena St. Joseph Medical Center in Joliet, the first facility to launch the program, patient handling injuries dropped from 65 to 19.

"We didn't think we'd see such a reduction in injuries in such a short period of time," says Michelle Koscik, PT, inpatient therapy supervisor at St. Joseph and one of the coordinators of the safe patient handling program. Koscik and her colleagues will be presenting their success story at the sixth annual Safe Patient Handling & Movement Conference to be held in Tampa, FL, in late February.

Success came from a comprehensive effort that included a significant investment in both equipment and training. ARJO, a patient handling equipment firm based in Roselle, IL, offered to provide the training, ongoing consulting services, and a guarantee that the health system would achieve a reduction in patient handling injuries or receive a partial refund. ARJO also conducted a needs analysis to advise Provena on the appropriate mix of lifts and assistive devices.

From the beginning, top administrators supported the program, but there were concerns about where to find the funding. The investment was huge: $1.2 million initially, an amount that grew to about $3.5 million with the purchase of additional equipment. The breakthrough came when coordinators received approval to take the money from the workers' compensation trust fund, a fund developed by the self-insured system to address the health and safety needs of employees.

"Being self-insured adds to the motivation for us to do something," says Matt Klebenow, MS, OTR/L manager of the industrial rehab program. "Every injury comes off our bottom line."

An analysis of patient handling injuries showed that 80% occurred during lateral transfers or repositioning of patients. So the health system purchased Hovermats and Maxi Slides, which reduce friction, in addition to mechanical lifts.

St. Joseph, the first to launch the program, set up a room with beds for employees to evaluate the equipment choices. They took turns acting as patients or caregivers and then completed a survey indicating their preferences.

A new three-page minimal lift policy detailed when the equipment should be used, including exceptions in the case of emergency or if a patient refused. Equipment shouldn't be used if the patient needs to support his or her own weight as a part of therapeutic rehabilitation. The policy outlines the maintenance and storage of the equipment, and it includes a skills checklist. Training was a critical component of the program, says Wanda Dillberg, RN, manager of employee health services. Diligent Services, a division of ARJO, trained 140 "transfer mobility coaches," or TMCs. They each received eight hours of training at an off-site location. There are at least three TMCs on each shift.

It took six to eight weeks for the TMCs to train about 1,500 employees in the system's new minimal lift policy and newly purchased equipment. "Employees are not allowed to use the equipment unless they had training and they had a competency check," says Koscik. "We had them sign off that they were aware that we had a minimal lift policy."

St. Joseph unveiled the program with a baseball-themed promotion: Make a pitch for safety. The launch date was hailed as "opening day," and the TMCs wore baseball jerseys. Newsletters and flyers touted the new policy and equipment. In the "Beeper for Cash" program, TMCs logged each use of the equipment and called a beeper number to report it. The first three people to log 50 uses of the equipment received $50.

The incentives built excitement, but the program itself carried a deeper message. "It's really a morale booster for our employees," says Dillberg. "They understand that Provena is committed to their health and safety. It's also a statement to our patients that we're concerned about their safety and their dignity. It no longer takes six or seven employees to transfer a bariatric patient."

Still, it's difficult to change longstanding habits. The hospital removed draw sheets and minimized the use of bed pads to prevent those from being used for lateral transfers. In one case, an employee suffered a shoulder injury when she failed to use the Maxi Slide that was actually sitting at the end of the bed. (She received a disciplinary warning for that.)

Over time, the patient handling program is becoming a part of the culture of the hospital. TMCs meet quarterly to talk about any patient handling issues. Program coordinators attend meetings of the nursing operations council. The Diligent consultant comes by at least once a month.

"It's not just another initiative," says Klebenow. "This is not going to go away. This is going to be a way of life at Provena."