Safe patient handling reduces VA injuries

35% drop in national roll-out of program

The model for safe patient handling is now a national norm.

For years, employee health professionals have traveled to the VISN8 Patient Safety Center of Inquiry at the James A. Haley Veterans' Hospital in Tampa to learn about elements of an effective program. The Veterans Health Administration has now rolled out safe patient handling to 153 VA facilities across the country.

Those VA hospitals have become catalysts for safe patient handling in their communities. And they have seen a 35% drop in injuries related to patient handling — even though only about half the equipment is currently in place. (The VHA committed $180 million to purchase safe patient handling equipment for its hospitals and nursing homes.)

While adequate equipment is important, the key to success lies in the strategies and policies that support the program, says Mary Matz, MSPH, CPE, patient care ergonomic program manager for the VHA. "Employees are basically being asked to totally change the way they do their work. That's not easy," she says.

The VA roll-out provides for a designated coordinator in each facility. It is critical to have a "champion" who will promote the program enthusiastically, says Matz. "There are usually one or two people who become passionate about safe patient handling," she says.

That is a lesson learned from more than 10 years of research into safe patient handling at the VHA center in Tampa. In 2000, Matz and her colleagues implemented a program at VA hospitals throughout Florida and Puerto Rico, with equipment, algorithms to assess patients' needs, peer leaders to help co-workers use the devices, and "safety huddles" to share progress and setbacks. Injuries declined by 30%, modified duty days dropped by 70%, and lost-time days declined by 18%.

When the study ended, some hospitals found a way to keep their safe patient handling coordinators — and others let the position go. With no support, the peer leaders were unable to keep up a consistent program. "If you didn't have a program to support the technology and change the culture, then the equipment oftentimes was not used," says Matz.

The VA-wide roll-out of safe patient handling, which began in 2008, provides for ongoing support. A directive issued in 2010 details the responsibilities for safe patient handling and states: "It is VHA policy that a [safe patient handling] program to protect caregivers and patients from injuries due to patient handling and movement must be established and maintained in all VHA facilities and that new construction and renovation projects must incorporate appropriate and necessary patient handling and moving equipment at all VHA facilities."

"Our directive mandates a facility coordinator or champion and peer leaders in each unit or area where patient handling occurs," Matz says.

Turning around the mindset

Loma Linda (CA) VA Healthcare System illustrates why a facility "champion" is so important. When Tony Hilton, RN, MSN, FNP, MPH, CRRN, came to Loma Linda in 2009 as the new safe patient handling coordinator, she found some equipment, but it was rarely used. In fact, many of the ceiling lifts had lost their charge and needed new batteries. Slings were hard to find. The staff saw the equipment as more of a bother than a benefit.

Hilton knew that her first task was to turn around the mindset about safe patient handling and to develop an excitement about the program.

She began by building relationships, one-on-one, with employees and managers. Armed with floor plans of the facility, she identified areas where patients would enter and receive care and visited them to assess their needs. She rated the areas based on the risk of injury so she could implement her program in stages, beginning with the greatest need. The intensive care unit, emergency room, nursing home, rehabilitation, and the transport team were her highest priority.

"I spent a lot of one-to-one time with the staff and managers, trying to understand what the problems were," she says.

She also learned about safe patient handling successes. She attended staff training at the San Diego VA hospital, which had a long-standing program. She went to a national conference on safe patient handling and movement. And she started regular conference calls among the coordinators at the five hospitals within her region, so they could share their experiences and solicit advice.

She also created a business plan, detailing what she wanted to accomplish and a timeline.

Hilton knew that her first and greatest challenge would be to turn around the negative feelings about safe patient handling equipment and generate buzz for her program. As she recruited unit peer leaders, she promoted the benefits to them personally and to their patients.

Peer leaders — who could be RNs, LPNs, health technicians, or aides — could get a career boost from helping lead an initiative. They would help reduce the risk of injury to themselves or their co-workers. Patients would have fewer pressure ulcers and lower risk of healthcare-associated pneumonia. "I gave people a vision of where we could be in the future," she says.

Hilton wanted people with commitment and drive. Within three months, she recruited 63 peer leaders from various units and shifts.

Creating enthusiasm with peer leaders

Hilton knew that her peer leaders, employees, and even managers needed training, support, and "buy-in." She started with a day-long training session for her peer leaders, giving them small incentives, such as T-shirts, pens, mugs and lanyards. She provided annual training for employees, and included safe patient handling in annual competency testing.

She promoted the program on the hospital's intranet, and added prompts to the electronic medical record to ask for the dependency level of patients. The medical record also includes a link to algorithms to help employees determine which equipment is appropriate and information on use of the equipment.

The enthusiasm was infectious. Hilton held a vendor fair to get feedback on equipment. About 400 employees showed up. She responded to employee concerns by re-working ceiling lift tracks so the patient could be moved any place in the room, and she upgraded slings. "They can't spend a lot of time thinking about a piece of equipment," she says. "The equipment needs to fit the needs of the staff and the patient."

Hilton held monthly meetings on the day shift and night shift with her peer leaders, and she created a raffle with small prizes to reward employees who were "caught in the act" of using equipment appropriately. She also has a safe patient handling committee. Half of the members are frontline employees who use the equipment.

In a year, injuries dropped by more than 40% — even though Hilton was encouraging employees to report injuries. She celebrated with a cake and promoted the success on the intranet. Another cause for celebration came when Loma Linda was recognized as one of the top three VA facilities nationally for safe patient handling, she says.

Building success on success

Hilton now is focusing on "building success on success." She also wants the VA hospitals to spur safe patient handling in their communities. Hilton has already partnered with Arrowhead Regional Medical Center in San Bernadino.

The safe patient handling program is probably the biggest occupational safety and health initiative ever implemented by the VA, says Matz. It involves not just patient care, but other areas in the hospital, such as maintenance and laundry services.

Each hospital must shape the program to meet individual needs, she says. "You have a generic template, but there are so many variables, not just in a facility but even at the unit level," she says. "There has to be someone in the leadership position who has a good ability to problem-solve."

The VA research has helped influence other changes. For example, for the first time, the 2010 edition of the Guidelines for Design and Construction of Health Care Facilities calls for a patient handling assessment as part of planning for health care facility projects. The guidelines are published by the Facility Guidelines Institute in Dallas, TX, in partnership with the American Society for Healthcare Engineering of the American Hospital Association.

Meanwhile, Hilton continues her mission to promote safe patient handling. "If each of us in the VA mentored one hospital, can you imagine what a difference that would make?" she says.

[Editor's note: The 11th annual Safe Patient Handling & Movement Conference will be held in Lake Buena Vista, FL, March 28-April 1. More information on the conference and other VA resources are available at www.visn8.va.gov/patientsafetycenter/safePtHandling/default.asp.]