Hospitals, be forewarned: the Occupational Safety and Health Administration is preparing an enforcement push targeting the high rate of injuries in healthcare.
Rather than allowing the National Emphasis Program in nursing homes to expire as scheduled in April 2015, OSHA informed its regional offices that the agency will “soon issue updated guidance that instructs OSHA offices to allocate enforcement and other resources to additional inpatient healthcare facilities, such as nursing homes and hospitals that have occupational illness and injury rates above the industry average.”
OSHA cites the hazards of musculoskeletal disorders from lifting patients or residents, exposures to tuberculosis, bloodborne pathogens, workplace violence, and slips, trips and falls. The additional OSHA guidance was pending as this issue of Hospital Employee Health went to press.
The OSHA announcement comes as injuries in healthcare remain persistently high. In 2013, the most recent data released by the U.S. Bureau of Labor Statistics showed that one in five injuries were in the health and social services sector. State-run nursing homes had the highest injury and illness rate among all worksites — higher even than police and firefighters.
Hospitals had an overall injury rate about twice as high as the private industry average—5.9 injuries per 100 full-time workers, compared with 3.1 for private industry. In a recent report on an injury surveillance program, the National Institute for Occupational Safety and Health found a rate of patient handling injuries of 11.33 per 10,000 worker-months, with the greatest rate of injury occurring while repositioning patients in bed.1
The mismatch between enforcement and injuries has been most glaring in patient handling. About 11,000 nurses have musculoskeletal disorder injuries each year that are serious enough to cause them to miss work, a number that has budged little in the past three years. OSHA has never issued a general duty clause citation related to patient handling injuries in a hospital.
That seems likely to change, especially since OSHA has successfully used the “general duty clause” of the Occupational Safety and Health Act to cite nursing homes for injuries due to resident lifting.
“The groundwork has been laid in the skilled nursing industry,” says Lori Severson, CSP, Vice President and Senior Loss Control Consultant at Lockton Companies, a Kansas City-based insurance brokerage firm. Severson has worked with nursing home clients who were cited by OSHA for failing to have an adequate program to prevent musculoskeletal disorder injuries.
“It’s a new day for OSHA in healthcare,” she says.
The high cost of patient handling injuries
Pressure is growing on hospitals to address patient handling injuries, but progress toward safer lifting varies greatly.
Risk managers named patient management (including handling and lifting) as their number one concern and reported that patient handling results in the highest average workers’ compensation claims in a survey of 44 hospital systems by Aon, a global risk management consultant and insurance broker.2
“We were able to identify that the average indemnity paid for patient handling was far and away higher than all other causes of loss,” says Martha Bronson, ASA, MAAA, associate director and actuary for Aon in Philadelphia.
The average cost per claim — $15,800 for patient handling claims — was calculated from five years of loss data, she says. Patient handling represented one-third of all claims, she says.
The costs should be a concern of hospital leadership, as well as for risk managers, she says.
“There’s so much they’re able to do to prevent or mitigate these types of claims,” she says.
Yet one-fourth of the respondents (26%) said their hospitals did not have a safe patient handling program. Of those with a program, 88% said they were concerned about sustaining the program and 12% were not satisfied with the program at all. None said they were fully satisfied with their safe patient handling program.
Funding is often cited as an obstacle to investing in patient handling equipment and training, but the Aon survey found that was not a major concern. Some 88% of risk managers said they had adequate funding.
No written policy at many hospitals
Many hospitals are beginning to respond to the annual toll of patient handling injuries. A survey of 88 Massachusetts hospitals found that about half of the hospitals with safe patient handling programs developed them in the past four years.
Yet one-third (34%) of the Massachusetts hospitals did not have a written safe patient handling policy, and one in five (19%) did not have a written policy or a committee working to prevent patient handling injuries.
Hospitals are accustomed to considering patient mobility as a patient safety issue, but haven’t put the same emphasis on worker safety, says David Wegman, MD, MSc, professor emeritus of the Department of Work Environment at the University of Massachusetts Lowell and chair of the Massachusetts Hospital Ergonomics Task Force.
“I don’t think we will have progress until it becomes intuitive that the benefits outweigh the cost — that you can save money by preventing injuries,” he says. “It’s a well-known conundrum in preventive medicine.”
The survey revealed gaps that could affect the success of safe patient handling programs. While mechanical lifts were common in the medical/surgical units of acute care hospitals (90% of hospitals), they were less likely to be found in other units, such as the emergency department (59%), intensive care unit (33%), and the operating room (54%).
Only half of the hospitals had provisions for maintenance in their safe patient handling policy. About one in five (18%) offered safe patient handling training only upon hire.
Hospitals are evolving in the development of their safe patient handling programs, says Angela Laramie, MPH, epidemiologist and program coordinator with the Massachusetts Department of Public Health Occupational Health Surveillance Program.
“We started with thinking about patient handling mostly in the inpatient med-surg units,” she says. “Now we’re really thinking about functional mobility across all areas of service within the hospital.”
ANA standards gain traction
Finding a path forward to implement safe patient handling has become easier. OSHA provides extensive resources on safe patient handling on a special website (http://1.usa.gov/1K8kBKg). Ten states have laws or regulations that require healthcare facilities to have a safe patient handling program.
A year ago, the American Nurses Association released national standards and an implementation guide for safe patient handling (http://bit.ly/1GjCHsT).
ANA surveyed the purchasers of the standards and found most sought to strengthen or validate their existing programs, says Jaime Dawson, MPH, senior policy analyst at the ANA in Silver Spring, MD. Following the standards produced immediate results for about two-thirds of those responding to the survey. They reported reduced healthcare worker injuries, positive patient outcomes, and reductions in injury-related costs, Dawson says.
“Safe patient handling requires a culture change and culture change takes a long time, but we are seeing progress,” she says. The ANA is continuing to explore how safe patient handling is being implemented, through focus groups, interviews and other data, she says.
Increasingly, safe patient handling is coming to the forefront. The Massachusetts Hospital Ergonomics Task Force was succinct in its first of 14 recommendations: “Massachusetts hospitals should implement comprehensive and sustainable SPH programs to minimize manual lifting and mobilization and provide the patient handling equipment needed to protect workers and patients.”
Other recommendations encourage the Massachusetts Department of Public Health to provide additional resources to hospitals and convene meetings to enable hospitals to share ideas. The task force also said SPH should be a part of healthcare worker education and facility design.
The Massachusetts Nurses Association continues to push for a legislative mandate.
In the meantime, the task force report provides important momentum, says Christine Pontus, MS, RN, COHN-S/CCM, associate director for health and safety for the MNA in Canton and a member of the task force.
“We’ve got to move this issue the best way we can,” she says. “It’s just taken far too long.”
- Gomaa AE, Tapp LC, Luckhaupt SE, et al. Occupational traumatic injuries among workers in healthcare facilities – United States, 2012-2014. MMWR 2015; 64:405-410.
- Aon Risk Solutions. Health Care Workers Compensation Barometer. December 2014: http://bit.ly/1KDIMOA.
- Massachusetts Department of Public Health Occupational Health Surveillance Program. Moving into the future: Promoting safe patient handling for worker and patient safety in Massachusetts hospitals: Report of the Massachusetts Hospital Ergonomics Task Force. 2014: http://1.usa.gov/1IekUng.135639.