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Injuries and claims are cut in half
Ergonomist Laurie Wolf, MS, CPE, spent years teaching client companies how to reduce their workers’ compensation claims by implementing ergonomic interventions. But when her own employer, BJC Health Care in St. Louis, encountered claims of more than $4 million, she realized that she needed to turn her attention close to home. After spending more than $160,000 on equipment and salaries, implementing a zero-lift policy, and conducting ongoing training and performance review, Wolf had her success: Injuries and claims dropped by half in the health system’s long-term care facilities. She is now adapting the program for use by BJC’s 13 other acute care hospitals.
In three years before the lift program, six long-term care facilities had 129 worker musculoskeletal injuries among employees, costing $476,913. In the three years after the lift equipment and policies went into place, the centers had 56 injuries, costing about $200,000.
BJC Health Care also won an award from the National Institute for Occupational Safety and Health (NIOSH) for its partnership with NIOSH researcher Jim Collins, equipment manufacturers, and academic researchers. The most important partnership, however, involved the employees, says Collins, PhD, MSME, an epidemiologist and engineer. "The staff felt a sense of buy-in and were more strongly motivated to participate in the lift program."
Employees helped select the equipment, but their involvement didn’t end with the purchase of the lifts, he notes. They continue to provide feedback to ergonomics specialists and employee health nurses who regularly visit the sites. The Occupational Health Nurse Council, comprised of occupational health nurses from all BJC facilities, discusses injury prevention at monthly meetings. "For the most part, the employees love [the patient-handling program]," Wolf says. "We’ll go up and down the hall for maintenance checks. People will come by and say, Don’t take that lift away; we love that lift.’"
At BJC, zero lift means just that. Long-term care employees are expected to use equipment to transfer a patient who is fully dependent and nonweight-bearing. That is now one of their basic job competencies, and managers are expected to monitor employee performance. Wolf and her colleagues, including Kim Gladstone, director of the WellAware wellness program, needed to build a framework to make zero lift possible. "Part of our success was getting a clear-cut policy," Wolf says.
But employees needed more than just a policy change to help them alter their daily work practices. BJC began by selecting three possible vendors of full-body lifts and arranging for a trial period. All of the trial lifts had performed well in laboratory testing at the NIOSH facility in Morgantown, WV. The lifts also had to be able to lift a patient or long-term care resident from the floor and to weigh residents while in the lift, Collins says.
Employees completed evaluations on the lifts, and BJC ended up purchasing equipment from two vendors. The health system purchased enough lifts to have one for every eight patient rooms in the long-term care centers. Training was intensive, involving just two employees at a time. "It takes 45 minutes to an hour to train them on lift devices," says Wolf. "What’s important is that they are actually lifted in the lift devices. They do it on each other. They feel what it feels like. They know it’s not going to hurt the patient."
That training is performed and reinforced by BJC’s ergorangers. For example, they go to the long-term care centers during the prime lifting time in the morning when patients are getting up and ready for breakfast. They make sure the lift equipment is being used properly and actually help nursing assistants with lifts. BJC has 2.5 full-time equivalent ergorangers that address the ergonomic needs for all hospitals and nursing homes within BJC Health Care. "The vendors tend to say, We’ll train you around the clock,’" says Wolf. "That initial training isn’t enough. You need someone who will constantly be there; someone who will come back and check."
Color-coding helps in lift use
Becoming comfortable with the lifts is only one hurdle for employees. They have another dilemma: figuring out when to use them. BJC relies on algorithms developed by the VA Patient Safety Center in Tampa, FL, to assess patients and determine what type of lift assistance they need.
In the long-term care facilities, a physical therapist or nurse assesses patients and assigns a lift category. A red sticker on the patient’s headboard or nameplate means full-body lift. A yellow sticker means the patient needs a stand-up lift, and a green sticker means no mechanical lift is needed. BJC developed the system based on successful programs that had been described by ergonomics experts Bernice Owen and Arun Garg.1
"Ideally, upon admission, someone is evaluating that patient," says Wolf. "If a therapist is not available, sometimes an RN will do the assessment. You have to be flexible. It depends on the staffing and the nature of the patient."
In hospitals, that process is challenging. While the spinal cord unit may have lift policies that are similar to those in long-term care, patients in post-intensive care or post-surgical units may be encouraged to become mobile as soon as possible, Collins explains.
Someone in the emergency department may need to make an initial lift assessment of an admitted patient, but that assessment may soon change, Wolf notes. The algorithm and coding system still can work as long as physical therapists, nurses, or other employees are given the responsibility for assessing and reassessing patient needs. Instead of stickers, a hospital may use color-coded magnets, she says. "Things change so fast in hospitals, we can’t keep up with stickers."
Hospitals also must train nurses and aides how to respond when patients or their family members request they not use the lift. In one such case at BJC, a nursing assistant who attempted a manual lift with other employees suffered a serious back injury. If a similar concern arises, ergonomic specialists will talk to the patient and family and try to allay their fears, pointing out that lifts provide greater stability and safety for the patient.
Wolf says she hopes to eventually see a significant cost savings in the hospitals with a complete ergonomics program and a campaign to prevent slips and falls. "The goal is to help our employees," she says.
1. Garg A, Owen B. Reducing back stress to nursing personnel: An ergonomic intervention in a nursing home. Ergonomics 1992; 35:1,353-1,375.