Injury prevention takes some heavy lifting
You’ll have to work to maintain SPH success
Your safe patient handling program won’t run on autopilot. For two or three years, you may celebrate the reduction in injuries, but the musculoskeletal disorder injuries will climb once again without continuous monitoring, safe patient handling experts say.
"Like any other program, it requires constant energy input and constant attention to detail," says Margaret Arnold, PT, CEES, CSPHP, coordinator of rehabilitation services at McLaren Bay Region in Bay City, MI, and champion of the safe patient handling program there.
There are obvious maintenance issues torn slings that need replacing and batteries that must be constantly recharged. But occupational health and safety professionals also should be tracking injuries and reporting about successes and ongoing challenges to hospital leadership, she says.
The patient population is always changing most likely, patients are heavier and older while the nursing workforce is aging, says Anna Kay Steadman, OTR, CHSP, president and founder of Essential Ergonomics, a consulting firm based in Austin, TX. Technology needs shift, and new devices may become available to resolve long-standing problems.
Safe patient handling needs a champion, but your program can’t rely on just one person who pushes it forward, she says. "You don’t want your program to be gone when a person leaves," Steadman says.
Repositioning a major source of injury
When Vanderbilt University Medical Center launched its safe patient handling program in 2006, the hospital saw a dramatic reduction in injuries. But then after a couple of years, the improvement stalled and patient handling injuries remained at a new plateau. They even began to rise slightly.
Vanderbilt needed to dig beyond the facts of a particular incident to learning why injuries continued to occur, says Mamie Williams, MPH, MSN, FNP-BC, director of safe patient handling for the Vanderbilt Occupational Health Clinic. The key question: Why do nurses revert to manual lifting when an array of equipment is available?
Williams surveyed more than 100 previously injured nurses and found some clues. Almost half of the nurses hadn’t felt that safe patient handling equipment was needed to perform the task that ultimately led to their injury. That at least in part reflected a failing in following protocol; many nurses reported they had not conducted a patient assessment of mobility and safe patient handling, as required by hospital policy.
Accessibility of equipment was not an issue. The majority of injuries involved repositioning, and the hospital has 8,000 pairs of friction-reducing sheets. There is a variety of other equipment available, including ceiling lifts in high-risk units.
The problem is deeper, says Williams. "This is truly a change in thinking for nurses and other caregivers," she says. "We have to do the hard work of getting a cultural change so it does become second nature for folks."
With some focused re-training, Williams and her colleagues emphasized that every patient needs to be assessed for patient-handling. "It’s just like a vital sign," she says. "This becomes maybe the seventh or eighth vital sign that you assess for a patient’s needs."
The hospital also boosted the training and support of safe patient handling "champions" on the units, who help encourage and train other caregivers. In another effective strategy, injured nurses are speaking at staff meetings and raising awareness about the risks of patient handling.
"Education is not the only fix, but it is a starting point," says Williams. It has helped to have a systematic way to learn about the caregiver’s perspective, she says. "You definitely have to assess those caregivers on what’s working, what’s not working and why is it not working," she says.
Continue to make the case for SPH
In a time of tight budgets, safe patient handling competes with other hospital priorities, and that can be a challenge. It’s hard to demonstrate what hasn’t happened the injuries that were prevented and would have been costly, says Arnold. But it is important to continually make the case that safe patient handling saves money.
"One of the reasons we continue to be successful is because we track our data every single incident, no matter how small, on an ongoing basis," Arnold says. "It keeps up the awareness. We’re always looking for opportunities to celebrate when we’ve had a success story and hold people accountable when the program gets off track."
At McLaren Bay, an interdisciplinary committee meets monthly for a status check on safe patient handling. The committee includes Arnold, a nurse manager, the employee health manager, inpatient rehabilitation manager or coordinator and two frontline staff.
Arnold conducts a root cause analysis of every patient handling injury and near-miss, and the committee discusses problems that have been identified through that analysis or in facility rounds. Safe patient handling results also are shared with hospital leadership.
Every unit has one or two coaches, and those coaches meet quarterly for support and additional training. Safe patient handling is built into hospital policies, including manager responsibilities. For example, managers are expected to regularly check the battery-changing log to ensure that batteries are changed and re-charged during each shift. (That prevents the all-too-common problem of inoperable lifts.)
Equally important, Arnold makes sure to trumpet the continued success of the program. Before launching a comprehensive safe patient handling program in 2006, McLaren Bay had about 110 patient handling injuries a year. In the first eight months of 2013, there were only six such injuries, and only three of them were OSHA-recordable.
McLaren Bay calls its program Diligent, which is the name of the vendor they used but also illustrates the philosophy. At a Diligent celebration in the cafeteria lobby each year, Arnold displays the outcomes of the program. She asks for feedback from frontline staff, and everyone who responds is entered into a raffle for a prize.
Diligent also has a big cake to celebrate the anniversary of the program.
Link SPH to patient safety
Safe patient handling also gains relevance when it is connected with patient safety, Arnold says. She has collaborated with teams seeking to reduce skin tears, pressure ulcers and patient falls.
"We use every opportunity that we can to raise awareness and integrate patient handling into other things we’re doing," she says.
The Joint Commission and Centers for Medicare & Medicaid Services (CMS) are increasingly recognizing the connection between safe patient handling and patient safety, says Steadman. It is a part of the Environment of Care. "They’re starting to ask the questions Where is your safe patient handling program?’" she says.
The program needs constant updating, she says. "Unless you have a persistent, tenacious character about you, things can easily be lost along the way," she says.
Even after seven years of safe patient handling, there’s more work to do, says Arnold. "The true success is when the use of equipment is just a part of what you do in everyday activity. It’s not a separate program," she says. "We’re not quite there yet."