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Back injury claimsdrop with no-lift law
Mandate, incentives spur change in WA
The carrot and the stick have worked in Washington state to reduce the number and severity of safe patient handling injuries.
A 2006 state law requires hospitals to establish a safe patient handling program and to purchase lift equipment – and it established a $10 million fund for tax credits to help hospitals pay for the equipment. From 2006 to 2010, the lost-time workers compensation claims rates for back injuries related to patient handling declined by about 32% in the state's 95 hospitals, according to an analysis by the Washington State Department of Labor & Industries.
While it was difficult at first for some nurses to transition away from manual lifting, "it became just a way of doing business," says Barbara Silverstein, MSN, PhD, MPH, CPE, research director with the Safety and Health Assessment and Research for Prevention (SHARP) program within L&I.
The success of the Washington law is most clear when the hospitals are compared with employers who did not have a mandate. Workers' compensation claims for back injuries declined by a more modest 12.9% at Washington nursing homes, which were not covered by the law. In fact, independent nursing homes not affiliated with acute care hospitals actually had an increase in claims, the analysis found.
Mandates and incentives drove the hospitals to implement the safety program on a five-year timeframe, Silverstein says. "The legislation calls for having a joint safe patient handling committee [composed of frontline, direct care] floor staff as well as managers," she says. "They're required to meet and assess on an annual basis their safe patient handling program. They're required to have training and retraining for all staff handling patients."
In a survey used to evaluate the law, hospital direct care employees were more likely to say that safe patient handling equipment was available and routinely used in Washington than in Idaho, a comparison state that does not have a safe patient handling law or regulation.
The safe patient handling law has been a "great success story" for Washington hospitals, says Brenda Suiter, MHA, vice president for rural and public health at the Washington State Hosp Association in Seattle. "They're using the equipment, they like the equipment, and the data show it's working," she says.
One lift per 10 beds
The Washington safe patient handling law contained specific requirements related to equipment. By January 2010, hospitals were required to have at least one "readily available" lift per acute care unit on the same floor, one lift per 10 acute care inpatient beds, or adequate equipment for use by lift teams that respond to patient handling needs.
In its annual licensing surveys, the state Department of Health checks whether the hospitals have the required safe patient handling policy and committee. The Department of Occupational Safety and Health also issues citations if the program isn't being implemented, Silverstein says.
"Our goal was to have safe patient handling become the standard of care in hospitals," says Suiter. "Overall, what everyone is seeing when they go out to hospitals is safe patient handling."
The requirements in the law, and the enforcement, made a difference, according to the analysis. For example, in a survey of direct care staff, 10.8% reported that their hospital did not have a safe patient handling policy in 2007, while only 3.6% reported there was no policy in 2009. More staff reported routine use of patient handling equipment in 2009, while surveys in Idaho found fewer staff reporting use of equipment.
For example, in 2009, 40% of those surveyed in Washington said that 80% to 100% of their co-workers routinely use safe patient handling equipment, while only 16% of respondents in Idaho reported that high usage.
Interestingly, Washington nurses were more likely than their Idaho counterparts to respond that they had back pain in the survey. That could be related to increased awareness about the potential impact of patient handling, or it could be related to the cumulative nature of the injuries, says Silverstein.
Getting a lift from tax credits
Financial incentives also played a key role in Washington. Hospitals used $8.9 million of the $10 million in credits available to purchase equipment. They were eligible for tax credits of up to $1,000 per acute care inpatient bed.
These were largely used to install ceiling lifts. About 15 hospitals a year have been installing lifts since the legislation was enacted, Silverstein found. "Offering some kind of incentive is a really important component of jumpstarting programs," she says.
Hospitals have benefited from discounts in the state's workers-compensation fund, as well. Silverstein is still analyzing the impact of the 2006 law. But when the self-insured workers' compensation trust of the Washington State Hospital Association implemented premium discounts for safe patient handling, related injuries declined by 43%, says Suiter.
In Idaho, where there is no financial help available to fund safe patient handling equipment or installation, hospital investments have lagged, says Silverstein. She recalls one hospital that expressed an interest in ceiling lifts, but others that did not.
"There was one hospital in Idaho, when we were doing management interviews, that was extremely proud of the fact that they were building a new hospital and they didn't need ceiling lifts," recalls Silverstein. "They said nurses wouldn't use them and so they weren't building them."