CDC cites health system for back injury project

Frequency of injuries reduced 57% over three years

The Centers for Disease Control and prevention (CDC) has recognized St. Louis-based BJC HealthCare for its involvement in a successful project to reduce work-related injuries in its nursing homes. The CDC’s National Institute for Occupational Safety and Health (NIOSH) awarded its 2003 Partnering Award to the project partners, including BJC HealthCare, BJC Occupational Health Nurse Council, Washington University, and West Virginia University.

The CDC said the project reduced the frequency of back injuries in six BJC facilities by 57%, and also lowered injury rates by 58% and decreased workers’ compensation expenses by 71% (from $476,913 to $185,085).

The project identified movements and postures that put nursing assistants at risk for back strain, stress, and injury in lifting and moving patients. It also evaluated mechanical lifting devices for reducing those stresses and strains, and implemented a best practices program based on those results and employee input. The project was part of the National Occupational Research Agenda (NORA), developed by NIOSH and more than 500 partner organizations to stimulate and support new collaborative research in 21 priority areas of occupational injury and illness prevention.

Timing was perfect

The timing of the project couldn’t have been better, says Laurie Wolf, MS, CPE, the ergonomist at BJC Health Care, which includes 25,000 employees and 13 hospitals. "This all started in 1997," she recalls. "I had had quite a few years’ experience reducing workers’ comp claims in industrial and manufacturing environments, and BJC felt we could put the same injury prevention methods into practice in the health care environment. At the same time, NIOSH was doing a laboratory study that looked at the injury prevention impact of different lift devices in the lab, and the timing worked out great."

NIOSH was armed with recommendations about various lift devices they thought could reduce back compression, which would also reduce injuries, Wolf explains, and they were looking for a partner for the field studies. "At that time, I was doing our own field program, looking at all the literature I could find, and a lot of that was done through grants from NIOSH," she explains. "I went to a NORA conference, presented information about our program, talked with the director of NIOSH about our program and said that I had gone to them to look for a partner in nursing homes — and it’s been a great partnership."

As Wolf further explains, "We had the program and the employees, NIOSH provided funding for some of the equipment, manpower, and scientific direction. They have a scientific approach that validates the basis for our program."

The study unfolds

The study compared the injury, disability, and injury-related cost experience of nursing aides, orderlies and assistants over a 36-month pre-intervention period (1995-1997) with those of a 36-month post-intervention period (1998-2000). In addition to the two BJC organizations and the aforementioned academic institutions, the partners included equipment manufacturers Arjo Inc. and EZ Way Inc.

The study involved not only an evaluation of the devices themselves, but assessing the effectiveness of the best practices injury prevention program — which included the use of mechanical patient lifting devices, worker training on how to use the devices, a zero-lift policy prohibiting manual lifting of nonweight-bearing patients, and medical management of injured workers. "The focus of the project was to combine measures that may help reduce possible causes of injury," Wolf explains. "Movement and postures that put nursing assistants at risk of back strain, stress, and injury in lifting and moving residents were identified."

Employees had input into both the choice of devices, as well as the ergonomics policy, notes Wolf. "The safety and risk management councils developed the core policies, and then staff tweaked and adjusted them," she explains.

Here are a few of the other key elements of the program:

• Zero-Lift Core Policy: What this basic guideline means is that whenever a patient needs a lift device it should always be used. "You can’t get in too much of a hurry," says Wolf. "Yes, it tacks on extra time; someone has to go find the lift, move stuff, and so on, but everyone has to have this commitment. Our nurses are committed to it, and the techs are, too."

• Sticker System: BJC uses colored stickers to indicate patient needs; for example, a red sticker means full-body lift, and a yellow stick means stand-up lift. "Either the physical therapist or the nurse, whoever is in charge, will determine what type of lift device is appropriate for that patient," says Wolf, explaining that these determinations are made with the aid of a set of algorithms.

• The Lift Devices: The most important feature of the lift devices chosen, says Wolf, was the scale. "A full-body lift should have a scale," she insists. "I can better convince staff to use a device if it has a scale." Other important features are remote hand controls, which, says Wolf, almost all devices now have, and an ample supply of slings. "That’s our biggest problem," she says. "Slings get lost, or they have to be laundered."

• The Ergo Rangers: While the program is headed by the ergonomist (Wolf), it wouldn’t have succeeded without the 2.5 ergo rangers who assist her. "Diane Haudrich, the ergonomics specialist assigned to long-term care, was responsible for the training and problem-solving a project of this scope needs," Wolf notes.

There were other important elements, such as body mechanics classes, but with the focus being on zero lift, "You should use appropriate lift equipment whenever possible," notes Wolf. "I always try to design out the risk of injury, because no matter what perfect body mechanics you use, you still will get inured," she says. "It was also very important to get consent from the director of nursing for each home, as well as from the occ-health nurse associated with each different one," she adds.

Commitment is critical

Staff commitment to an ergonomics program is critical, but getting that commitment, Wolf admits, "is hard — particularly in acute care." So how do you get that commitment? "A big key is having management behind you — they need to support the program and be willing to give it time to succeed. Usually staff will ultimately get behind it because it benefits them."

Wolf cites these as the keys to success in any program like hers:

  • management support;
  • employee participation;
  • a good medical management program;
  • an adequate number of lifting devices;
  • a good zero-lift or safe-lift policy.

For occupational health professionals looking to reduce patient handling, injuries, Wolf also recommends Patient Care Ergonomics Resource Guide: Safe Patients handling Movement, a handbook by Audrey Nelson of the Veterans Affairs in Tampa, FL, which includes information on how to develop a zero-lift policy, as well as a number of algorithms, she notes.

For more about NIOSH and NORA, call the toll-free NIOSH information number, (800) 35-NIOSH [(800) 356-4674], or visit the NORA web site:

For more information, contact: Laurie Wolf, MS, CPE, Ergonomist, BJC Health Care, 5000 Manchester Road, St. Louis, MO 63110. Telephone: (314) 747-5860.