As the COVID-19 pandemic exacerbates the national nursing shortage, healthcare workers are finally seen as a valuable commodity that should not be routinely lost to injuries trying to manually lift and mobilize patients.
Lynda Enos, RN, BSN, MS, COHN-S, CPE, addressed this critical issue at a webinar1 presented by the Association of Occupational Health Professionals in Healthcare (AOHP).
“Maybe the one silver lining from this pandemic is we’re now really focused on retaining healthcare workers and keeping them safe, both physically and psychologically,” said Enos, an occupational health nurse and certified professional ergonomist with more than 25 years of work and consulting experience. “That leads to better [patient] safety, comfort, and increased satisfaction.”
Ultimately, understanding worker safety equals patient safety improves the “well-being” of an organization.
“I think now more than ever, we have to make this link,” Enos said. “I am glad that we’re finally taking worker safety seriously in healthcare. Certainly, we cannot have patient safety without worker safety.”
This argument preceded the pandemic, as healthcare workers suffered career-ending injuries trying to manually lift patients.
“Musculoskeletal disorders, such as back strains, are the leading cause of injuries to healthcare workers across the continuum in the U.S.,” Enos noted. “The numbers are likely underreported by 50% — that’s very concerning. We know that if patients cannot help move themselves, or they’re unwilling to assist, then there is no safe way to lift them manually. [This is] regardless of gender, how fit you are, or the age of the healthcare worker. We have a lot of science to support that.”
Looking under the iceberg, there is considerable evidence of downstream damage when staff suffer from musculoskeletal disorders.
“We know we have presenteeism, fatigue, higher turnover, poorer patient outcomes,” Enos said. “Tying your safe patient handling programs to patient outcomes is critical.”
Thus, in addition to protecting healthcare workers, using safe lifting and mobilizing equipment is safer for patients than trying to move them manually.
“Before COVID, we were looking at patient safety in the U.S. and saying we’re not No. 1 in the world,” Enos said. “Why is that? Over the last decade, many bodies, like OSHA, NIOSH, The Joint Commission, AHRQ, and the Institute for Healthcare Improvement have started to look at the impact of worker safety on patient safety.”
While manual lifting and injured workers certainly could put patients at risk, the realization that safe lifting equipment also could protect patients was slower to come about. For one thing, there are few data on patients becoming injured while they are manually lifted or mobilized.
“There’s no reporting system for that,” Enos said. “There are lawsuits around this, but they’re often settled out of court, and those of you in employee safety may not know what’s going on in the risk management side in your facility. But it is worth trying to find out. If you’ve had cases where patients have been injured during manual handling, [try to get details on] the incident and the cost. That helps you establish a baseline when you’re looking at the impact of safe patient handling [equipment] on these patient safety outcomes.”
Change is slow to come. Enos said the “hook-and-toss” method remains standard. “This is when we put an arm under the patient’s arm and we drag them up or out the bed, and we try to stand them that way,” she explained. “We still teach students that in schools of nursing. You can dislocate a patient’s shoulder.”
One of the trailblazers in making the worker-patient connection is Good Shepherd Medical Center (GSMC) in Hermiston, OR. The hospital implemented safe patient handling systems for worker and patient protection in 2008. GSMC reduced worker injuries and safely lifted patients without injuring them, using such equipment as ceiling lifts, hover mats, sliding mats, and a wheelchair mover for bariatric patients.1
Enos, who helped implement the program at GSMC, sought patients’ feedback before discharge on their experience of being moved with safe lifting equipment.
“We wanted to know when they were lifted and moved with equipment, did they feel safe and comfortable? Actually, 98% of the patients who were lifted with lift equipment said they did feel safe and comfortable, and the 2% that did not were in so much pain, it wouldn’t matter how we were moving them,” Enos recalled. “Their pain levels were just too high.”
In consulting at other hospitals, Enos has worked on similar survey assessments, advising not to conduct the surveys after discharge because patients might not remember details about their lifting and mobilizing experience. She has since enhanced the survey to include audits, asking patients if healthcare workers explained the equipment and what they were doing to lift the patient.
“We want to know if staff are actually telling the patients what they’re going to do before they do it, and we want to know what [patients are] feeling about that experience at that moment in time while they can remember it,” Enos said.
If patient movement with safe lifting equipment became the norm across healthcare, it could become an expected standard of care for both occupational health and patient safety.
“We should be using safe patient handling mobility to protect our patients,” Enos emphasized. “We know if we keep healthcare workers safe, we’re probably going to have better patient outcomes and better patient experiences. When you’re making the business case for safe patient handling programs, think about making it in the context of [the patient and worker].”
For example, early mobility is critical for the patients’ improvement. Safe handling equipment is the best way to achieve it.
“This is a very hot topic right now in the U.S., especially related to safe patient handling and mobility [SPHM],” Enos said. “I think this is where SPHM really comes into its own. Unequivocally, you cannot early-mobilize a patient without the right equipment and trained staff.”
Early mobility can start from raising the head of the bed, turning, boosting the patient, getting them to the edge of the bed, into a chair, and them ambulating.
“There’s a whole progressive sequence of events,” Enos said. “We know that if we have early mobility programs — this has been well researched — we decrease ventilator time; length of stay is shortened; we reduce the risk of deep vein thrombosis, muscular weakness, and falls. Then, we mitigate the long-term disability and decrease patient mortality.”
Falls are another potential cause of patient injury and mortality. Safe handling equipment has been underused in preventing this common occurrence. An average fall might extend patient stay by almost a week, resulting in non-reimbursable lost revenue.
“Some 80% of falls are unassisted, and usually the patient’s trying to get to the bathroom,” Enos said. “Here is a group of falls that we could prevent through safe patient handling.”
Devices like powered sit-to-stand devices and ceiling lifts with an ambulating harness can prevent falls. Similarly, all the major wound care organizations agree dragging patients up in bed creates friction and shear that could harm the patient.
“They advise the use of lift sheets, friction-reducing devices, or lift equipment” Enos explained. “We’ve got the evidence base, but I still see nurses and aides drag patients up in bed because they think it’s the quickest way to move them.”
Employee health professionals must work with other medical groups to contribute to the best outcomes in workers and patients.
“We have to work with our falls prevention teams, wound care staff, risk management, and quality,” she said. “It can’t just be employee health and safety in a silo. Find one thing you think you can measure well. Definitely try to measure something that is a hot topic to your organization. Then, [determine] who can help you — quality, risk, finance, wound care, a falls prevention committee. Find out who looks at these patient safety outcomes, and get them on your team. Try pilot studies, self-reports. Start small.”
- Enos L. Enhancing patient safety and outcomes: The safe patient handling connection. Association of Occupational Health Professionals in Healthcare. Aug. 11, 2021.
- Mesaros M. Safe lifting: A small hospital builds a model program. Oregon Health and Safety Resource, August-September 2015.