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Best practice: Injuries drop with lift investment
St. Mary's program helps patients, employees
A ream of statistics and studies may prove the benefits of safe patient handling. But at St. Mary's Hospital in Amsterdam, NY, equally compelling was the story of one patient – a 450-pound woman who could not get out of the ambulance. It took about half an hour before enough employees came to lift her out and roll her into the Emergency Department.
Kelly Flewelling, CWCP, human resources specialist, could have built a case for safe patient handling by pointing to other costs of manual lifting, including 22 nurses injured in a single year, and about a million dollars a year spent replacing them with agency nurses. But the story of the woman stuck in the ambulance revealed that safe patient handling provides a better experience for patients as well as health care workers, she says.
In fact, nurses and the patient's family pitched in to buy the hospital's first air mattress to help move that obese patient. "Just imagine how she felt [when she was stuck in the ambulance]," Flewelling says. "We didn't want that to happen ever again."
That personal story reflected a trend that is impacting St. Mary's and hospitals around the country. As obesity rates rise nationally, the average weight of patients is increasing dramatically. To get a better picture of the patient handling needs, Flewelling conducted an extensive ergonomics survey with the help of safe patient handling consultant Don Maynes of Des Moines, IA.
About half of St. Mary's patients weighed more than 250 pounds. In one year, 138 patients weighed more than 400 pounds. An analysis found that employees were repositioning patients in bed 664 times a day. They were transferring patients from a bed to chair 193 times a day. Twenty-nine times a day, they were moving patients who were anxious or combative, and about twice a day, they needed to lift a patient from the floor. About 62% of the hospital's patients were partially or totally dependent.
Over all, employees at St. Mary's were manually moving patients more than 1,000 times a day, often with awkward postures due to the lack of lift equipment. "Without having that type of analysis, you don't know what kind of patient you're trying to accommodate with patient handling equipment," says Maynes. "It also helps you to make the business case for safe patient handling."
From small start to big savings
Still, Flewelling initially started modestly. She spent about $8,000 to buy a Hoyer lift, a sit-to-stand lift, and slip sheets for lateral transfers. The modest investment helped justify a greater one. "We started to see a change and that helped to get a buy-in from the board of directors," she says.
She expanded her program with $25,000 worth of equipment. Then she proposed a comprehensive program to make a fundamental shift to a "minimal lift" policy hospital-wide, and the board agreed to invest $425,000. For example, the ICU is completely tracked with ceiling lifts.
The investment proved to be a smart financial move. In the past four years, St. Mary's has had only eight patient handling workers' compensation claims. The total worker's compensation savings, based on prior history: $981,058. Back and shoulder injuries are not even among the top five reasons that employees take disability leave, Flewelling notes.
St. Mary's also has received acclaim for its safe patient handling program. This spring, the hospital received a Best Practice award from the Safe Patient Handling and Movement Conference, sponsored by the James A. Haley Veterans' Hospital and the University of South Florida in Tampa. The hospital also received the Workforce Innovation Loss-Prevention Strategies (WILS) award from its health system, Ascension Health.
The program became a tool for nurse recruitment and retention. When employees are working pain-free, "the entire environment changes," says Maynes. "It's a different feeling when you walk into that hospital. It's a much better environment, a happier environment."
'Super-users' champion lifts
This didn't happen entirely by buying equipment. The hospital followed through with an investment in training and policy changes.
The St. Mary's policy states that employees must use patient handling equipment when it's appropriate. (In some cases, such as with combative patients, securing a lift may not be possible, Flewelling notes.) "We made it a part of our manager's performance appraisal that they had to support and promote the program," she says.
Extensive training was the cornerstone of the implementation. "Super-users," who became champions of the safe patient handling program and helped their co-workers adjust to using the equipment, received a full eight hours of training. Other employees received four hours of training.
That was the key to success for St. Mary's, says Brian Trewella, vice president of sales at Martin Innovations in Raleigh, NC. He was with Barton Medical of Austin, TX, when he conducted the training.
"When you're investing in safe patient handling, the training is a key component to getting [employees] comfortable and that comfort is a key component in culture change," he says. "I would rather see a lower investment in equipment and a higher investment in training and culture change. The equipment doesn't do any good if the people don't use it."
Flewelling gave the super-users $5 gas cards that they could hand out to employees when they saw someone using the equipment appropriately. She also rewarded the super-users for their efforts with small token gifts – and even once surprised then with a $500 bonus. There are about 15 super-users on various units and shifts.
The hospital also incorporated the safe patient handling equipment in its public relations, including billboards and newspaper ads. St. Mary's worked with the emergency department and local ambulance companies to pre-load stretchers with slip sheets.