While there is a general consensus that safe patient handling programs nationally suffer from a lack of implementation and enforcement, employee health professionals should be aware that OSHA is taking a close look at the issue when they inspect healthcare facilities.
In an encouraging sign to advocates of safe patient handling, OSHA made it an issue of emphasis for healthcare inspections in a memorandum issued last year.1
“It tells their inspectors that go into hospitals what to look for, and the majority of it is on patient lifting,” says Kent Wilson, CIE, CSPHP, a certified safe patient handling professional and past president of the Association of Safe Patient Handling Professionals. “There are some very specific questions the compliance officers are looking at when they go into the hospitals to inspect. Do they have a patient handling program, and what level is at operating at?”
Among the safe patient handling issues OSHA inspectors are looking for is evidence of a system for monitoring compliance with policies and procedures, and follow-up on identified problems.
“They recognize that it is somewhat of a complicated system,” Wilson says. “It’s not just a matter of having the equipment and getting it out there, but also getting people to understand the nuances so they can look at things like team leadership,” Wilson says.
OSHA inspectors are also assessing the “decision logic” for selection and use of safe lifting devices.
“For example, if I don’t have clear algorithms or implementation plans within my unit, I may have been trained on a lift a couple of months ago and now it is time to deploy it,” Wilson says. “If I don’t know when and why I deploy that, then I may default to just doing it manually because I’m uncomfortable using the equipment. Or hospitals may have different types of equipment and they never explain to staff clearly when they are supposed to use them and why. They don’t have clear assessments to know which patient needs which piece of equipment for which task.”
In that regard, OSHA tells its compliance officers to determine when and under what circumstances manual lifts or repositioning of patients occur. They are also looking for an adequate number and variety of lift devices, including batteries and charging stations. “Note that no single lift assist device is appropriate in all circumstances. Manual pump or crank devices may create additional hazards,” according to OSHA.
Another OSHA expectation is that employees have been trained and can demonstrate competency in using the lifting equipment.
“Do they understand the various clinical aspects of the patients and the need to customize by unit specificity, say with bariatric patients as opposed to pediatric patients?” Wilson says. “These types of things are skills that someone running a safe lifting program needs to have.”
While the issue is typically framed as tight-fisted hospitals versus injured nurses, some old-school healthcare workers may not use safe patient handling equipment even if it is available, according to a paper2 recently published in the journal of the American Nurses Association.
Author Roric P. Hawkins, MBA, BSN, RN, safe patient handling coordinator at Michael E. DeBakey VA Medical Center in Houston, urges healthcare workers to make use of safe patient handling equipment a standard of nursing practice.
“Some clinicians are devoted to more traditional approaches in patient care, even for tasks proven to create significant safety risks for both patients and caregivers,” Hawkins noted in the article. “For example, some nurses move patients manually because they believe technology puts a barrier between them and the patient, diminishing the human connection. However, using safe patient handling equipment doesn’t negate the value of human touch. It simply protects nurses and patients from injuries.”
Other key points by Hawkins are summarized as follows:
- Know the type and differences between your facility’s patient handling equipment, which can include ceiling lifts and portable devices like hydraulic lifts.
- Have equipment ready for use at the beginning of a work shift. Charged and ready equipment can reduce the temptation to move patients manually due to time constraints.
- Remember, safe patient handling equipment doesn’t eliminate the need to assist patients manually and use proper technique when doing so.
- When in doubt, err on the side of using lift equipment, as Hawkins warned that, “Many nurses have suffered debilitating injuries because they underestimated the equipment they would need to assist patients physically. … Trust your assessment skills and nursing instincts when determining which type of equipment provides the safest mobility option for both the patient and yourself.”