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MSD goal: Reduce the rate of injury and illness cases involving days away from work due to overexertion or repetitive motion by 10% by 2020. HealthyPeople 2020. By 2016, reduce by 25% the 2005 baseline Bureau of Labor Statistics (BLS) rates of sprains and strain injuries involving days away from work in hospitals and nursing homes where healthcare patients were listed as the source of injury in the Healthcare and Social Assistance sector. (NIOSH/NORA council.)
It has been eight years since Texas became the first state to mandate programs for safe patient handling and seven years since the safe limit for manual patient lifting was set at 35 pounds.1 Yet while many hospitals have bought lift devices, musculoskeletal disorder (MSD) injuries continue to disable health care workers and remain a pervasive problem in the nation's hospitals.
A new report offers the first glimpse into the safe patient handling practices at hospitals. A survey of 88 hospitals by the Massachusetts Department of Public Health found that many hospitals have aspects of a formalized, comprehensive program, but there is great variation in their practices.2
One-third of the hospitals (34%) did not have a written program in place or under development, and one-third (35%) did not have a committee that focuses on preventing patient handling injuries. "It's clear that hospitals have been making an effort to address this, but there's still room for improvement," says Angela Laramie, MPH, epidemiologist in the MDPH Occupational Health Surveillance Program in Boston.
Written policies and a committee review of injuries are critical aspects of a safe patient handling program, says Mary Matz, MSPH, CPE, CSPHP, National Patient Care Ergonomics Program Manager with the Veterans Health Administration. Management involvement, a facility coordinator, annual training, and competency assessment are other key components, she says. "It has to be comprehensive or it's not going to be successful," she says.
Nationally, progress in safe patient handling has been spotty, at best. After some years of decline, injuries due to overexertion began to rise again in 2008, according to the Bureau of Labor Statistics. MSD injury rates among registered nurses also rose from 2009 to 2011.
Yet research has demonstrated that safe patient handling can bring a rapid return on investment. With a sustained focus on safe patient handling in 153 facilities, the Veterans Health Administration reduced its MSD injuries by 40% approximately six years, notes Matz. "The program the Department of Veterans Affairs has instituted is working," she says. "It is definitely decreasing injuries in these [worker] populations."
The Massachusetts study reveals barriers to safe patient handling that are common concerns: the perception that it takes more time to use equipment. Difficulty changing employees' habits. Cost of equipment and availability of storage space.
In fact, finding a lift may be difficult in some units in some hospitals. In the Massachusetts survey, only a third (33%) of acute-care hospitals reported that they had lifts in the intensive care unit and only 44% had lifts in radiology. In contrast, lift equipment was commonly provided in medical/surgical units (90%).
Training also is variable. Only 35% of the Massachusetts hospitals provided safe patient handling training on hire and annually.
It takes time for health care workers to adapt to the new way of lifting and moving patients, and they need support to make that change, Matz says. "If a caregiver isn't comfortable using a piece of equipment, they're not going to use it because they're going to be afraid for the patient and afraid for themselves," she says.
Trying to save money by limiting the scope of a safe patient handling program can actually be counterproductive, Matz notes. Employees need training and support as they adapt to safe patient handling.
"You have got to realize that you are asking people to totally change the way they do their work," she says. "They've been moving patients a certain way and they're in the habit of doing it that way. Respecting the reluctance and understanding that change is difficult is important, and I think one of the best ways to facilitate this change is to continually ask for their input."
Employees can help select equipment, suggest ways to store equipment, and serve on committees that design new spaces, she says.
How you track injuries also matters. Only 61% of the Massachusetts hospitals reported that injury reports were reviewed by the departments in which the injuries occurred.
Matz recalls one hospital that had a problem with injuries on the night shift. The hospital had a safe patient handling coordinator who investigated — and discovered that the battery for the floor lift was being charged at night. Therefore, lifts weren't available for the night shift. Preventing injury was as simple as buying a second battery.
"It's just an example of how important it is to have one person who is overseeing [safe patient handling] and working with occupational health, engineering, and safety and working with them to figure out the problem," Matz says.
Despite the gaps, there are some positive signs of change. The Massachusetts hospital survey had a response rate of 90%. After the survey, some hospitals indicated that they were going to take new action on safe patient handling, says Laramie. Just conducting the survey raised the profile of safe patient handling.
"Hospitals have liked that we've asked them what's going on and they're glad to tell us," she says. "This was a great way to get a baseline of what was going on across the state and how hospitals were addressing this issue."
Massachusetts conducted the survey to help inform a special task force on safe patient handling, which will issue recommendations.
Meanwhile, new voluntary standards from the American Nurses Association also have raised awareness about safe patient handling. Matz has heard from hospitals seeking guidance on complying with the standards. The ANA also has issued an implementation guide. (For more information on the ANA standards, see HEH, August 2013, p.89.)
In some parts of the country, safe patient handling is now a mandate. Eleven states have rules or laws regarding safe patient handling, and legislation is pending in other states, including Massachusetts.