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Federal patient-handling legislation gains momentum
U.S. senators hear about lift injuries
Safe patient handling moved to the national stage for the first time recently as a U.S. Senate subcommittee held a hearing on a bill that would create new injury prevention requirements.
Almost a dozen states have passed legislation related to safe patient handling, but the proposed federal law would trigger a new regulatory standard. The law would require the U.S. Occupational Safety and Health Administration to issue a rule within two years of enactment, and health care employers would then have two years to purchase "an adequate number of safe lift mechanical devices." The bill also requires health care employers to implement a safe patient handling and injury prevention plan. It would provide $200 million in grants, including $50 million for home health care.
"We have the evidence that safe patient handling devices reduce injuries and save money, but the unsafe nursing practice of manual patient lifting is still being tolerated in many areas," says Anne Hudson, RN, a back-injured nurse from Coos Bay, OR, who founded WING USA (Work Injured Nurses' Group USA), which has been lobbying for safe patient handling legislation in the states and the nation. "The loss of nurses, nurse assistants, and other healthcare workers to disabling injuries from lifting hazardous amounts of weight is a shameful public health crisis. Many healthcare workers are routinely required to lift dangerous amounts of weight not permitted to be lifted by hand in other industries."
Politically, the bill still faces an uphill battle as Congress wrestles with other high-profile issues and November elections loom. At presstime, the Nurse and Health Care Worker Protection Act of 2009 (SB 1788) had one sponsor in the Senate Sen. Al Franken (D-MN). In the House, HR 2381 was sponsored by Rep. John Conyers (D-MI) and had 20 co-sponsors.
"I think it's going to gain some traction. I think we're finally getting attention by the appropriate legislative committees," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU). "As more people realize how this bill saves backs and bucks, it's going to attract additional cosponsors."
The Coalition for Health Care Worker and Patient Safety (CHAPS), a group of unions, nursing associations, hospitals and others, has been lobbying for the bill. "Each state has gone off and done something different. A lot of them don't cover [all health care workers]. I believe that one federal rule is the way to go," says Marsha Medlin, RN, MPA, founder of CHAPS and president of Safe Lifting Solutions, a consulting firm based in Mechanicsburg, PA.
NIOSH: Lift limit is 35 pounds
The research basis for safe patient handling is solid, James W. Collins, PhD, MSME, association director for science in the Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati, told the senators.
Collins noted that NIOSH recommends a lifting limit of 35 pounds for caregivers performing a vertical lift, such as transferring a patient from a bed to a chair. The aging of the health care workforce and the "obesity epidemic" makes patient handling even riskier, he said. In a six-year study, NIOSH found a 61% reduction in workers' compensation injuries involving patient handling with the implementation of lift devices.1
"Our efforts have shown that there are effective alternatives to manual patient handling that are safe and cost-effective to implement," he said in his statement.
Sen. Johnny Isakson (R-GA) asked Collins how long he thought it would take hospitals to install lift equipment. Collins noted that he was working with a 600-bed hospital that installed ceiling lifts in a year and a half.
Yet Douglas S. Erickson, FASHE, HFDP, CHFM, CHC, who chairs the committee that drafted the 2010 Guidelines for Design and Construction of Health Care Facilities, asserted that hospitals need more time to accommodate lift devices in their often aging facilities.
"The safe-patient handling and lift standards as presented will not allow enough time to alter the built environment and install mechanical lifting devices before the no-lift policy is mandated. This will create havoc in the health care industry as organizations will panic and do somethinganythingto avoid impending OSHA fines, ultimately wasting a tremendous amount of health care resources," Erickson, who is vice president/secretary of the Facility Guidelines Institute in Chicago, IL, said in his statement. He is also deputy executive director of the American Society for Healthcare Engineering, which is an affiliate of the American Hospital Association.
June Altaras, RN, BSN, MN, administrative nursing director at Swedish Medical Center in Seattle, noted that safe patient handling requires a long-term effort with a strong commitment from the hospital leadership. "Safe patient handling is not an initiative. It is a culture change," she told the senators.
And it is cost-effective, she said. Last year, Swedish Medical Center saved more than $2 million by reducing lost and restricted work days due to injury, she said.
Hospitals in Washington state were able to successfully implement a safe patient handling directive within three years of the passage of a mandate in 2006, said Barbara Silverstein, MSN, PhD, MPH, CPE, research director of the Safety and Health Assessment and Research for Prevention (SHARP) program of the Washington State Department of Labor & Industries in Olympia. The federal law is patterned after the legislation in Washington state.
When hospitals implemented new lift devices, "nursing staff may have at first been reluctant," she said. "But once they became used to using the equipment, they were absolutely delighted and were glad their careers could last longer."
[Editor's note: Statements from the hearing are available at http://help.senate.gov/hearings/hearing/?id=6a53554d-5056-9502-5da3-4d68be6b9f48.]
1. Collins JW, Wolf L, Bell J, and Evanoff B. An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes. Injury Prevention 2004; 10:206‐211.