The good shepherd: Small facility gets big results

Rural hospital saves backs — and nurses

It's not always easy to attract nurses to a small, rural hospital. But they're more likely to stay at a hospital that has a safe work environment. That has been the experience at Good Shepherd Medical Center in Hermiston, OR, which found that a comprehensive safe patient handling program boosted the hospital's recruitment and retention.

"Like all rural hospitals, we don't have any extra people," says public relations director Mark Ettesvold, MS. Safe patient handling "extends their careers and enhances their safety at work — and the safety of patients."

Good Shepherd is a 25-bed critical access hospital with a medical-surgical unit, an ICU, and some ancillary departments. A small staff means fewer people with the expertise to plan a patient handling program and limited resources to buy lifts.

But small hospitals often can tap into assistance from state grant programs or workers' compensation carriers. Good Shepherd was able to receive free consulting from ergonomist Lynda Enos, RN, MS, COHN-S, CPE, a nurse practice consultant who works with the Oregon Nurses Association (ONA) in Tualatin. Armed with a plan to create a minimal lift environment, the hospital won a $390,000 grant from Oregon's Occupational Safety and Health Division as part of a demonstration project to create a Safe Patient Handling 'Facility of Choice' for Critical Access hospitals in Oregon.

"Nearly half of our hospitals in Oregon are critical access, with 25 beds or less," Enos says. "They don't know where to start with these programs." ONA's consulting services provide that missing piece.

As with larger medical centers, small hospitals must first have strong support from senior leadership and a "champion" of the program. At Good Shepherd, the vice president of nursing was committed to safe patient handling, and senior nurse manager Vicki Horneck, RN, MSN, devoted herself to making it happen.

Even before they knew they would get financial help, Good Shepherd drafted a "business plan" that included ceiling lifts, sit-to-stand and transfer devices. They developed patient assessments and considered the different needs of various units. They provided for maintenance and ongoing training with peer leaders or "superusers."

When the money became available, Good Shepherd was ready to roll. That initial planning is critical to success, says Enos. In other states, hospitals may be able to obtain consulting assistance from a workers' compensation carrier, OSHA, or a local university that has an ergonomics or safety degree program, she says.

'Superusers' save the day

Even though Good Shepherd knew what types of equipment to purchase, the hospital wanted buy-in from employees. They were able to try out and evaluate equipment at a vendor fair.

"A lot of facilities think we can just get all this equipment and [the program] will happen," says Horneck. "You have to get employees involved and you need superusers who will teach the staff [how to use it]."

Good Shepherd developed a timeline for purchasing and installing the equipment. The hospital now has 10 ceiling lifts on medical-surgical floor, three lifts in the ICU, and four in the Emergency Room. There's a lift in the diagnostic imaging area and even a lift above the pool in physical therapy, which allows paraplegics and quadraplegics to be lowered into the pool. There are sit-to-stand lifts, floor lifts and air assist lateral transfer equipment. There are even lifts to help patients out of their cars at the ER and portable lifts for home health nurses.

About 200 of the hospital's 526 employees use them regularly, including 142 nurses. They receive annual training, but they also can get ongoing help from "superusers" in each unit. "Those are the people who promote the program and encourage people to use the equipment," says Horneck.

The equipment, of course, just provides the tools. With Enos' help, Good Shepherd adapted algorithms that nurses could use to assess patients as totally dependent, partially dependent, or independent. Their status is written on white boards in the patient rooms.

The safe patient handling committee included representatives from physical therapy, med-surg, maintenance, and frontline nurses. They sought input from infection control and environmental services.

Some of the challenges were logistical. Battery failure could disable a ceiling lift motor. So now maintenance workers check the lifts every six months and replace batteries every year. Slings were being washed with the hospital laundry by a local prison, and sometimes slings got mixed with other laundry from other facilities. Now, two aides check the slings in the units every three months, sorting ones that have been misplaced. And some slings are being washed in an in-house laundry.

Not all vendors will provide ongoing service to hospitals in rural areas, so hospitals need to factor that into their selection, advises Enos. "They need to do their homework about the vendors they choose and get references and service commitment in writing," she says.

Good Shepherd is conducting surveys to gauge the acceptance of the program. So far, the patients have responded favorably. The hospital also is evaluating the impact not just on staff injuries, but on back pain and discomfort.

It takes time for nurses to get accustomed to the new way of lifting, says Enos. Sometimes they still think it's easier to ask a fellow nurse to help with a manual lift.

But she points to a common scenario that illustrates how much more efficient it is to use a lift. Recently, she observed as two caregivers helped a 400-pound dependent patient who was sitting in a chair but needed to return to bed. They hooked her sling up to the lift and within 45 seconds she was in the bed. Previously, it would have taken several employees to lift and move her.

"Lifting with this equipment is amazingly quick because it's easily accessible in the patient's room," she says.