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Fall program keeps $ from slipping away
Slips, falls are becoming the No. 1 injury
As more hospitals tackle the injuries from patient handling, a second major cause of musculoskeletal injury is coming to the forefront: Slips, trips, and falls.
In 2008, there were about 14,000 slips and falls in U.S. hospitals that led to days away from work, second only to cases of work loss due to overexertion, according to the U.S. Bureau of Labor Statistics.
Just as you have a comprehensive program to reduce patient handling injuries, you should design a program to address slip and fall hazards, advises Jennifer Bell, PhD, a research epidemiologist with the National Institute for Occupational Safety and Health (NIOSH) in Morgantown, WV.
"Hospitals tend to look at the nature of injury. We have a lot of sprains and strains," says Bell. "But they don't necessarily look at what's causing the sprains and strains. If they looked at the events, they would find a good percentage of them are actually due to slips and falls."
Bell and colleagues found that a comprehensive approach can reduce slips and falls by as much as 59%.1 "There are so many different causes of slips and falls that any one change seems insignificant," says Bell. But the evidence shows that approaching the problem systematically can produce results, she says.
That is the approach taken by Trinity Health in Novi, MI. When workers' compensation director Terry Fisk, CIH, CSP, analyzed injury claims, she found that slips, trips, and falls were No. 1. "It was a little bit of a surprise," she says. "You'd think it would be lifting. It's starting to surface what a huge problem this is."
Hospital invests in better shoes
Fisk first reviewed the literature on slips, trips, and falls in health care, including the NIOSH research and studies by the Liberty Mutual Research Institute for Safety in Hopkinton, MA. In a study of 123 health care workers who had reported a slip, trip or fall at seven hospitals, researchers found that 36% of the incidents occurred because of "liquid contaminants," such as water or cleaning solutions.
Most slips, trips, and falls (64%) happened where there was a transition in the floor, such as uneven surfaces or one type of flooring to another. More registered nurses (27%) reported slips, trips, and falls than other occupations.2
The researchers noted "the importance of managing surface contamination and surface transitions in hospital settings."
Fisk decided to start with one intervention that would be effective regardless of the flooring type or hazard: Slip-resistant shoes.
Trinity Health selected a shoe vendor and brought different styles to the hospitals in a mobile store. "We had about 30 pairs of shoes that were prequalified in varying price ranges," she says, noting that while they were from different manufacturers, they all met a slip-resistance standard.
The health system partially subsidized the shoes, Fisk says. "When you totally pay for the shoes, the associates don't see them as having the same value as if they put their own money on the line," she says.
The effort began with the highest-risk departments: environmental services, food services, and plant operations. It then expanded into clinical areas where floor surfaces were more likely to be wet, including central processing, surgery, and the laboratory. "The idea is to eventually go house-wide with the nursing services area. I think they would really benefit from some of this footwear," says Fisk.
To do that, Trinity Health needs to involve nurses in the process and make them aware of the comfort, safety, and even style of the slip-resistant shoes, she says. Currently, the dress code requires shoes to be fully enclosed with no vents or holes and impervious to liquid. Slip-resistant shoes are not yet required in most areas. "We strongly encourage it and it's part of the dress requirement for some departments," she says.
Meanwhile, the health system is looking at other hazards. For example, the workers' compensation data shows that 22% of claims were from tripping over cords, equipment, or other obstructions. The design of workspace needs to take into account the potential trip and fall hazards, she says.
Winter weather is responsible for another 18% of slips and falls, which indicates a need to reduce the snow and ice hazards.
The slip-resistant shoes have been a good place to start, says Fisk. "We started with the shoes because this is at least one piece we can control and work on," she says.
1. Bell JL, Collins JW, Wolf L, et al. Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees. Ergonomics 2008; 51:1906-1925.
2. Courtney TK, Lombardi DA, Sorock GS, et al. Slips, trips and falls in US hospital workers- detailed investigation. Proceedings of the International Ergonomics Association 2006 Congress, Maastricht, The Netherlands.