Why JCAHO cares about hospital ergonomics

Environment of Care’ targets worker safety

The Joint Commission on Accreditation of Healthcare Organizations wants you to use ergonomic interventions. That is an argument your hospital administration will have a hard time ignoring as you promote the use of tools, equipment, and training to reduce patient-handling injuries among your staff.

The Environment of Care standard specifies that facilities should provide a safe environment for patients, staff, and visitors. To underscore the point about safe working conditions, the Environment of Care newsletter recently highlighted ergonomics with a two-part series on the hazards of repositioning. Specifically, surveyors may look for compliance with standards that require hospitals to identify risks and develop processes to minimize them, as well as a human resources standard that requires staff training.

Surveyors have been educated about ergonomic hazards as they relate to the Environment of Care standard, says John Fishbeck, RA, associate director of the Joint Commission’s division of standards and survey methods. In the new style survey, surveyors track patients through their care and may ask their caregivers about ergonomics, says Fishbeck, including: "What have you been told about how to safely move or reposition this patient? Have staff up here had any injuries related to lifting or ergonomics issues?"

Investing in ergonomics

The Joint Commission’s interest in ergonomics can provide justification for an investment in ergonomic equipment, says Deborah Fell-Carlson, RN, COHN-S, loss control consultant with SAIF Corp. in Salem, OR, a nonprofit workers’ compensation insurer. "The Joint Commission clearly wants a safe environment for everybody," she says. "If we’re not providing a safe environment for everybody, then we’re really not providing what Joint Com-mission is intending."

Hospitals can use ergonomic indicators as part of the performance improvement process that is required by JCAHO. "The Joint Commission’s 2004 rules require one failure mode effects analysis every year [that is] reported to the board," Fell-Carlson says. "Some of the facilities are using that to evaluate the cause and effect of safe patient handling strategies," she explains. At the hospital at which she previously worked, Fell-Carlson used the overall lost workday case incident rate as a benchmark.

Using the Bureau of Labor Statistics formula, she determined that the hospital’s lost workday incident rate was 6.3 per 100 full-time equivalent (FTE), compared to an industry average of 4.4. (The industry average is available at http://stats.bls.gov/iif/oshwc/osh/os/ostb1244.txt; the hospital sector is SIC code 806.)

The hospital developed a comprehensive ergonomics program, which included the analysis of workstations by an occupational therapist, education of staff on the use of patient-handling equipment, and the purchase of new devices. The hospital bought repositioning devices, total body lifts, and stand-up lifts to help patients ambulate. With the interventions, the lost workday incident rate dropped to 1.3 per 100 FTE. "It really did show that what we were doing was very effective," Fell-Carlson says.

A tour of safety

At Samaritan Lebanon (OR) Community Hospital, a safety team conducts safety tours every month in a different department, marking areas of concern on a hazard log. Ergonomics is included in that hazard review, says Joseph R. Haralson, CHE, vice president for ancillary/support services. Managers are required to address the hazards identified within 30 days, and the hazard log is a regular item on the safety committee’s monthly agendas. Items remain on the hazard log until they have been resolved, he says. A quarterly status of the environment report, including a safety report, is presented to the board.

During a Joint Commission survey in May, surveyors made some positive comments about the hazard log and reporting process, Haralson explains. "That was exactly what they wanted to see, a chain of communication and coordination between all levels of the organization," he adds.

Ergonomics may arise in Joint Commission surveys based on the new tracer methodology, which tracks the care of specific patients, he says. "Let’s say they pulled a chart, and it happened to be a patient who weighed 350 pounds. Then I would say they would probably have a lot of questions about ergonomics, employee safety, and lift devices," Haralson continues.

Training also is important to the Joint Commission. Twice a year, Samaritan Lebanon holds safety fairs for employees. They travel from station to station, receiving an update about ergonomics, security, needle safety, hazardous materials, and other safety issues. Employees must answer a quiz to demonstrate knowledge of the safety information, he says.

Beyond federal regulations

The Joint Commission, always a strong influence, has an even larger role to play in the absence of a regulatory standard on ergonomics. "Anytime we can integrate occupational health and safety into an organization’s current work, their current priorities, it breaks down some of the obstacles that are preventing them from doing this," says Chuck Easterly, loss control manager at the SAIF Corp. Oregon OSHA decided not to pursue an ergonomics rule, but wanted to focus on the hospital and construction industries to reduce MSD injuries, he explains.

A committee of labor, hospital, and insurance representatives formed the Oregon Coalition for Healthcare Ergonomics. The coalition recently held a conference to discuss "real-world solutions for people who are in the real world."

A way to demonstrate compliance

Fell-Carlson spoke about using ergonomics to demonstrate process improvement in the Joint Commission’s Environment of Care standard. "[Hospital administrators] frequently say, We would love to do that, but . . . we don’t have the money; we don’t have the resources; we’ve got to do these things first. We’ll get to it after the survey,’" Instead, they can focus on ergonomics as part of Joint Commission compliance, she points out.

"People say the Joint Commission is for patient safety. But everywhere the Joint Commission says patient safety, they also say patients, staff members, and visitors," Fell-Carlson adds.