WA law pushes hospitals to 'no-lift' status

Tax credits offset equipment cost

This month, the nation's most comprehensive safe patient handling law takes its full effect: Hospitals in Washington state must have equipment to reduce injuries by Jan. 31. The state's Department of Health will enforce the rule through its licensing process.

The law has triggered action. Though a disparity remains between hospitals that eagerly adopted interventions even before the law was passed and those still lagging, there is widespread awareness of the hazards of patient handling, says Barbara Silverstein, MSN, PhD, MPH, CPE, research director with the Safety and Health Assessment and Research for Prevention (SHARP) program of the Washington State Department of Labor & Industries in Olympia. (National legislation patterned after the Washington law — the Nurse and Health Care Worker Protection Act — continues to work its way through Congress, with a growing number of sponsors.)

As the first part of an evaluation of the law's impact, Silverstein compared hospitals in Washington and Idaho, where there is no law or regulation related to safe patient handling.

In surveys and focus groups of direct care staff, Silverstein asked, "What does safe patient handling mean to you?" In Idaho, the health care workers mentioned protecting patients from falls or avoiding pressure ulcers. "In Washington, at least there is awareness in terms of staff knowing what safe patient handling means," she says.

It's too soon to know how much equipment was purchased by Washington hospitals or how the law affected workers' compensation claims or injuries. But based on the variable use of tax credits by November, it's clear not every hospital had adopted full-fledged programs.

"The legislature set aside $10 million for hospitals to be able to purchase equipment using that tax credit. That tax credit ends at the end of January 2010. To date, close to $6.8 million has been utilized of these tax credits," Silverstein says. "There are some hospitals that have not used the tax credit at all and others have maxed out on the tax credit."

'Really hard to change attitudes'

Ultimately, what hospitals need is a culture change, says Silverstein. A law can create mandates, and it can jump-start a program, but fundamental change comes from a new mindset for hospital, leadership as well as frontline workers, Silverstein says.

Nursing schools finally have dropped the old body mechanics in favor of safe lifting, and some hospitals have peer leaders who encourage their colleagues to use equipment, she notes. "I think it's still really hard to change attitudes," Silverstein says, noting that health care workers may say, "I've done this for the last 20 years and I'm still standing."

Disciplinary actions

At Providence St. Peter Hospital in Olympia, that attitude will lead to disciplinary action. One of the first hospitals in the state to adopt safe patient handling technology, Providence St. Peter has tracks for ceiling lifts in almost all inpatient rooms. "At one point, I think we had more ceiling lifts in place than all the other hospitals in Washington state put together," says Dan Donahue, MEd, director of employee health and wellness.

Having lifts readily available makes a difference in their acceptance, he says. "We have 21 critical care rooms, and initially we only tracked four of them. No one integrated it into their practice," Donahue recalls.

The hospital then tracked all the rooms, provided training to staff, and established peer leaders who would help their co-workers with the equipment. Four of the rooms have fixed lifts, with a maximum capacity of 600 pounds. The other rooms use portable lifts, one for every five rooms, with a capacity of 475 pounds. "All the sudden, everyone is starting to [use] it," he says.

Hospital leadership supported safe patient handling from the beginning because of its potential to decrease workers' compensation costs and improve productivity and retention of nurses, Donahue says. In 2004, the hospital installed ceiling lifts in the medical-renal floor, the unit with the highest number of patient-days with patients weighing more than 400 pounds. For two years, there was not a single patient handling injury on the floor.

A subsequent reduction in workers' compensation premiums also helped boost the hospital's bottom line, he says.

A strong safe patient handling program also is a valuable tool to recruit and retain nurses, Donahue says. "We had to reduce the physicality of the work so [nurses] won't get injured and they'll stay," he says.

Finding the money for lift equipment — even with tax credits — can pose a challenge for small, rural hospitals. Yet just as with larger hospitals, the savings on workers' compensation premiums can be quite valuable.

"When you think about putting that much money into one piece of equipment, it seems like it doesn't make sense, like it's not a good payout," says Julie Wehr, human resources director at Odessa (WA) Memorial Healthcare Center and chair of the hospital's safety committee. "Once you get the good equipment and you start using it, you realize [employees] need it. You realize it isn't something extravagant. It's what's needed to do the job correctly."

Grants or tax credits, which are available in some states, obviously help with the initial investment. But small hospitals do have some advantages when it comes to implementing a safe patient handling program.

At Odessa, which includes a 24-bed hospital, a long-term care facility, assisted living center and clinic, all employees can gather for workshops or training sessions. Leadership is deeply involved in the program and there aren't as many frontline nurses to convince.

The goal: Creating "a mindset that safe patient handling isn't just a good idea, it's the way it's done," says Wehr. Once employees become comfortable with the equipment, they'll use it regularly — even in an urgent situation, she says.