ANA standards seek to raise bar on SPH

A basis for future federal legislation?

New patient handling standards from the American Nurses Association provide the first comprehensive guidelines that apply to all health care facilities.

They also will form the foundation of a new effort to pass a federal safe patient handling law, says Suzy Harrington, DNP, RN, MCHES, director of health, safety and wellness for the ANA, which is based in Silver Spring, MD. Ten states have laws related to safe patient handling.

This push for safe patient handling is especially important because of the serious injuries that continue to occur each year from patient handling, said ANA President Karen Daley, PhD, RN, FAAN. In 2011, 25,000 nursing assistants and 12,000 nurses had work-related musculoskeletal disorders that required days away from work, according to the Bureau of Labor Statistics.

"We can't afford these losses and still meet the rising demands for health care services," she said. "We aim to make those a thing of the past."

The ANA seeks to eliminate manual handling, and the standards note that "[b]ased on available evidence, manual handling is unsafe in almost every situation. Safe patient handling and mobility technology and methods must be used to lift, laterally transfer, or reposition dependent healthcare recipients."

The voluntary standards outline responsibilities of both employers and health care workers in eight different areas that encompass incident reporting, purchase and use of technology, and accommodations for injured workers. (See excerpt below.)

The U.S. Occupational Safety and Health Administration created ergonomics guidelines for nursing homes in 2003 and revised them in 2009, and it has some health care ergonomics modules online, but OSHA has not issued any safe patient handling guidelines for hospitals or other health care settings.

Mary Matz, MSPH, CPE, CSPHP, an ergonomics specialist with the Veterans Health Administration in Tampa, FL, has worked for years to spread the evidence for safe patient handling through the VA's annual Safe Patient Handling and Movement conference. She called the development of the ANA standards "huge."

"The goal was to develop universal standards that raise the bar but that were attainable, evidence-based and outcomes-focused," said Matz, who chaired the work group that drafted the standards. "They would apply to all health care settings across the continuum of care."

SPH across the continuum of care

The Interprofessional Standards of Safe Patient Handling and Mobility contain eight standards, which each have specific performance items:

Standard 1. Establish a Culture of Safety.

Standard 2. Implement and Sustain a Safe Patient Handling and Mobility (SPHM) Program.

Standard 3. Incorporate Ergonomic Design Principles to Provide a Safe Environment of Care.

Standard 4. Select, Install, and Maintain SPHM Technology.

Standard 5. Establish a System for Education, Training, and Maintaining Competence.

Standard 6. Integrate Patient-Centered SPHM Assessment, Plan of Care, and Use of SPHM Technology.

Standard 7. Include SPHM in Reasonable Accommodation and Post-Injury Return to Work.

Standard 8. Establish a Comprehensive Evaluation System.

"These standards set an important foundation of safety that all nurses and health care workers deserve," says Daley.

The standards call for a written plan with stated goals and objectives, a technology assessment, mobility assessment of patients, and an ongoing evaluation of the safe patient handling and mobility program. Health care workers are expected to "actively engage" in the safe patient handling and mobility program.

Each standard includes "considerations for community settings" – suggestions for adapting the standards to non-facility settings, such as home health care. It's important for standards to be practical and useful across the continuum of care, said Matz.

"Patient-handling risk is not just limited to the nursing profession or a hospital," said Matz. "We knew the national workgroup must be multi-disciplinary."

[Editor's note: More information about the standards and ordering information ($21.95 for ANA members, $29.95 for non-members) is available at] >


SPH standards: Create a culture of safety

The Interprofessional Standards of Safe Patient Handling and Mobility released by the American Nurses Association include background on patient handling injuries, lifting limits and the need for technology. Each standard has a section for the employer and for health care workers, for example:

Standard 1. Establish a Culture of Safety

The employer and healthcare workers partner to establish a culture of safety that encompasses the core values and behaviors resulting from a collective and sustained commitment by organizational leadership, managers, healthcare workers, and ancillary/support staff to emphasize safety over competing goals.


1.1.1 Establish a statement of commitment to a culture of safety

Organizational policy will include a written commitment to a culture of safety that will be used to guide the organization's priorities, resource allocation, policies, and procedures. The written statement regarding SPHM will describe layers of accountability across sectors and settings.

1.1.2 Establish a non-punitive environment

Organizational policy will support a system to encourage healthcare workers to report hazards, errors, incidents, and accidents, so that the precursors to SPHM errors can be better understood and organizational issues can be changed to prevent future incidents and injuries. Healthcare workers know that they are accountable for their actions, but will not be held accountable for problems within the system or environment that are beyond their control.

1.1.3 Provide a system for right of refusal

Organizational policy will provide the healthcare worker the right to accept, reject, or object to any healthcare recipient transfer, repositioning, or mobility assignment that puts the healthcare recipient or the healthcare worker at risk for injury. The refusal shall be made in writing, without fear of retribution. The policy will describe steps for resolving the hazard.

1.1.4 Provide safe levels of staffing

An evidence-based system will be used to determine safe and appropriate caseloads. Adequate staffing levels will support safe patient handling and mobility, including allocated time for training and education.

1.1.5 Establish a system for communication and collaboration

Collaboration among all sectors and settings is critical. The organization will utilize a variety of communication systems to inform and engage the healthcare workers and healthcare recipients about SPHM.

1.2 Healthcare Worker

1.2.1 Participate in creating and maintaining a culture of safety

The healthcare worker will actively participate in creating and maintaining a culture of safety.

1.2.2 Notify the employer of hazards, incidents, near misses, and accidents

The healthcare worker will notify the employer of hazards, near misses, incidents, and accidents related to SPHM as soon as possible, using the reporting procedures defined by the employer.

1.2.3 Use the system to communicate and collaborate

The healthcare worker will engage, verbally and in writing, with others about SPHM.

Considerations for Community Settings

The community setting provides unique challenges for the correction of hazards. For example, in home health, the healthcare worker is a guest in the home, and the healthcare recipient is typically financially responsible for the environment of care. Hazardous conditions, broken or inappropriate technology, or unreasonable requests must be discussed with the healthcare recipient and reported to the employer. The employer is ultimately responsible for the health of employees and can determine if engineering or other controls are available to correct the hazards, or determine that care cannot be safely provided.