Though every healthcare worker who handles patients is at risk of injury, it may be difficult to convince hospital administrators to purchase a sufficient inventory of safe patient lifting equipment.
As this issue went to press, Sandy Swan, MS, BSN, RN, COHN-S/CM, CEAS, CSPHP, program manager of Occupational Health and Ergonomics at BJC Health in St. Louis, was slated to address this issue in a talk at the annual conference for the Association of Occupational Health Professionals in Healthcare (AOHP) in September. She described the program she developed to generate the data needed to make the case for new lifting and handling equipment in an interview with Hospital Employee Health.
HEH: We know today’s healthcare market is fiscally strapped, but there have also been some high-profile reports on nursing injuries related to moving patients. Are some hospital administrators still unconvinced that safe lifting equipment is needed, or is it more of an issue that many facilities do not have sufficient stock of the devices?
Swan: I think it may be a little of both. It is, of course, key to have senior leadership support, especially chief nurse executives. They can ensure that there is funding for patient handling devices, promote front-line managers embracing the technology and holding staff accountable for using it, and allow time off the unit to train on the devices. Hospitals are in varying stages of safe patient handling program (SPH) implementation. Some have really embraced it and have strong leaders and ownership of their safe patient handling committees. Others have not made it as much a priority, or have had more difficulty with the leadership and ownership piece.
While safe patient handling equipment is obviously important, the actual policy, SPH committee, training and education, commitment to use the equipment, auditing equipment use, troubleshooting barriers to use, and evaluating effectiveness of the program are the basis for success. I would say that there still needs to be increased education not only for senior leaders, but all the way down to front-line managers and staff, on the importance to both employee and patient safety of a robust SPH program.
HEH: What are a few of the key measures and stats that employee health professionals need to show administration to justify equipment purchase?
Swan: There is a lot of talk about the use of leading and lagging indicators. Lagging indicators would be the staff injury rates and workers’ compensation costs from patient handling. Those are obviously after the fact and not proactive.
Leading indicators would be the reporting and tracking of near misses, auditing equipment use, etc. If there is a grasp of what leads up to injury, it can be addressed to prevent injuries. Most healthcare organizations are still using lagging indicators, but working toward the use of leading indicators. My [AOHP] presentation will share some data tools we use to get to an “executive summary.”
For example, the Unit Patient Handling Hazard Assessment is to be completed/updated annually on every unit where patient handling takes place. It describes the unit by type, number of beds, average daily census, number of staff, average number of dependent and partial assist patients, and number of patient handling injuries in the past year. In addition, it includes high-risk patient handling tasks performed on the unit, available equipment storage, and equipment inventory. We put pictures of all the devices on the document so staff can easily identify them. [The hazard assessment lists] reasons for not using the equipment — for example, room size, doorway width, thresholds, broken equipment, and lack of accessories.
This information is placed in a Unit Hazard Assessment spreadsheet so it is all captured/organized on one page. It is used to make equipment recommendations. We also have developed equipment recommendations charts and we use these to compare the current state of portable floor-based lifts and ceiling lifts with the recommendations. Our recommendations and charts are based on work done by Mary Matz in the Facilities Guideline Institute’s white paper in 20101 and also on an internal point prevalence study we conducted to determine on a given day how many patients were eligible for a ceiling lift.
Finally, the executive summary is a template that our SPH committees can use to present their data to senior leadership when requesting additional SPH equipment. It is customizable so the graphs/information can be modified for the specific audience since they have awareness of how their senior leadership prefer to receive data. There is a place for a “personal testimony” if the hospital has someone who wants to share. It may be a staff member who can no longer work at the bedside due to a patient handling injury or a success story of using equipment and positive outcomes. These appeal not only to the head, but to the heart.
The next section is a series of graphs. Hospitals can choose to use as many of the graphs as they feel would be effective at their site. The graphs are hospital-specific. For example, graph one is a comparison of the hospital injury rate to the Bureau of Labor Statistics rate, benchmarking both injury rate and the DART [days away, restricted, transfer] rate. Another graph shows injury costs from workers’ compensation over a four-year trend.
HEH: Can these tools can be modified to fit the culture in other healthcare organizations?
Swan: These tools can hopefully provide ideas to other healthcare organizations on effective ways to present data to senior leadership. We offer them as a starting point and encourage modifications because we know what works in one healthcare organization, or even in the same organization in different hospitals, does not work for another.
Culture varies greatly by hospital and leadership. The documents were created internally and belong to BJC HealthCare. We offer them to other healthcare organizations with the understanding that they can modify them, but also credit BJC. They cannot publish or sell them.
- Cohen, MH, Nelson GG, Green DA, et al. Patient Handling and Movement Assessments: A White Paper. The Facility Guidelines Institute. 2010: http://bit.ly/2bzxWNJ.