Will Beverly settlement guide OSHA approach?

Collaboration produces good outcome, expert says

The settlement between the Occupational Safety and Health Administration (OSHA) and Beverly Enterprises of Fort Smith, AK, the nation’s largest nursing home chain, could be a model for a cooperative approach to ergonomics, asserts leading ergonomics expert Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester.

"This demonstrates an approach to an ergonomics program that’s acceptable to OSHA and acceptable to the health care industry," explains Fragala, who helped author the guide that became part of the settlement.

OSHA had cited five nursing homes in Pennsylvania under the "General Duty Clause" for failing to protect workers from patient-handling hazards. Beverly contested the citations in a case that languished in appeals for 10 years. Beverly eventually decided to resolve the litigation and did not acknowledge wrongdoing as part of the settlement.

However, Beverly did agree to buy mechanical lifts, lift walkers, two-handled transfer belts, and friction-reducing devices at each of 275 facilities under federal OSHA jurisdiction to conform to the guidelines in the guide. Each facility also will designate and train a manager to oversee compliance with the program.

A Beverly spokesman noted that the company had already launched a major ergonomics initiative at all of its 475 facilities.

"Ten years ago, the industry may not have bought into the concept of an ergonomics management program for patient handling that involved lifting aids, equipment and devices, and a program to make it work," Fragala says. "Over time, the industry has realized this is the direction to go in. We need to come up with new ways to assist patients in facilities."

The lifting guide uses the existing patient classification system to determine ergonomic needs. For example, "totally dependent patients," who are given a rating of 4, would need a full-sling mechanical lift. "Extensive assistance patients," with a rating of 3, would use the mechanical lifts but could be candidates for a stand-assist lift, based on their weight-bearing capabilities. Combative or mentally impaired residents would require the same lifts but might need more caregivers to help them, the guide states.

"This method works very well for the long-term care industry," he says. "For hospitals and acute care, we might look at similar systems."

OSHA’s ergonomic standard was written for general industry. It required employers to respond to musculoskeletal injuries with ergonomic interventions. However, if OSHA were to develop industry-specific guidelines, the Beverly guide may provide a foundation.

The guide states, "The key to your successful lift program is the correct assessment of residents for the [lifts]; clear and consistent communications regarding the need for assistive devices for individual residents; and the skillful use and familiarity of the lift by your associates."

It provides checklists to measure caregiver knowledge of the lifts and key questions to use to select the best equipment. "To make this work, there are two key elements," Fragala says. "You need the engineering controls, the redesigned methods of lifting. And you need a program to make this work in the facility."

Fragala says he hopes OSHA and health care facilities can work in a collaborative fashion. "If the industry recognizes this is a good direction to go in, we may see further progress [in reducing injuries]."