Hospital discovers smarter way to lift

Physical ability tests plus lifts = safety

At Georgetown (SC) Hospital System, preventing injuries begins with an equation: The physical abilities of newly hired employees must meet the physical demands of the job.

That plan not only addresses the potential for injuries, but it also shines a light on the needs of the job tasks compared to the abilities of the workforce. So when it turned out that too many prospective nurses couldn't attain the medium/heavy requirements of the job, Georgetown Hospital System reduced the job's exertion level through a new program called Smart-Lift program.

Now, more newly hired nurses pass the physical agility tests — and fewer are injured, says Kathy Dowling, RN, BSN, manager of Employee Health Services. "Our injuries have decreased, and our workers' compensation premiums have gone down," she says.

New hires and those who are transferring into a new position take the physical agility test with an isokinetic machine, which provides resistance equivalent to the force applied to the machine. The test requires specific movement patterns, such as knee and shoulder flexion and extension. It is then analyzed by Industrial Physical Capability Services (IPCS), Inc., of Hudson, OH.

"It's a workout," says Dowling. "It gives us a physical picture of that person's strength. It shows you where there might be some weakness in an extremity."

For example, initially new nurses were required to be able to exert 35 to 50 pounds of force occasionally, 15 to 20 pounds of force frequently, and 10 pounds constantly to move objects using an isokinetic machine. But only about 70% of newly hired nurses were passing, Dowling says.

"We would give them conditioning and strengthening exercises and allow them to come back and retest after 90 days, after they had time to exercise and increase their strength," she says.

Red, yellow, green mark patient needs

The solution: Lower the lifting requirements of the job. With the Smart-Lift program, the pass rate rose to 92%.

Smart-Lift is incorporated into the routine patient assessments and electronic medical record. At admission, each patient receives a mobility score, which indicates what type of lift equipment should be used. That score is updated by a reassessment every 24 hours.

The results are color-coded. If a patient's score is zero, then they need no assistance with transferring. A green magnet is placed on their door.

A score of 1 to 5 indicates the need for some assistance, typically a gait belt. The door magnet is yellow. Patients with a 6 to 10 need help rising to a standing position, which indicates the use of a sit-to-stand lift. The magnet is red with an ST.

Those with intermediate lifting needs (scores 11 to 14) are indicated with a red magnet, and those who need full lift assistance, using the Arjo Maxilift, are indicated with a red magnet and MT.

"We used a very visual system so anyone going into the room knows immediately by looking at the magnet what level of assistance the patient needs," says Sandra Raynes, RN, MEd, nursing operations director at Waccamaw Community Hospital in Murrells Inlet, SC, one of the system's two hospitals.

The patient assessments are based on a number of factors, including: the patients' medical condition, the medications they receive, their ability to support their weight, their ability to follow instructions, or whether they're experiencing dizziness, and their weight and body mass index. Patients with respiratory compromise or fatigue also may need more assistance. With a computer-based algorithm, nurses simply answer a series of questions and receive a score total for the patient.

By mid-2011, Waccamaw Community Hospital had only seven patient handling injuries among its 600 employees. That compares to 26 such injuries in 2009 and 19 in 2010. The Smart-Lift program was implemented in mid-2009. Georgetown Hospital System also fares well in comparison with the most recent available national data from the U.S. Bureau of Labor Statistics, which shows a rate of 6.7 injuries per 100 employees for hospitals nationally in 2009. The hospital system's rate is 2.56.

Although the system purchased some new lift equipment, hospitals already had much of the equipment needed to reduce injuries. They just needed a consistent and easy way for nurses to know when to use it and additional training to help nurses become comfortable with it, says Raynes.

"We've worked really hard to make it a [safety] culture," she says. "Once something becomes a culture, it's expected. They realize how important it is for them to use it."