Safe Patient Handling

BY STEPHANIE TABONE, MSN, RN, TNA DIRECTOR OF PRACTICE

No, this is not yet another story about the danger of back injuries among nurses
and the numbers of nurses forced to leave the bedside due to limitations
resulting from a back injury. A new twist has presented itself in the area of
ergonomics, “Safe Patient Handling,” which offers a solution to the problem
rather than just an identification of the burden it presents to the health care
industry. The new approach recognizes that patient transfers present clear risk
for both the patient and the nurse; and that these risks are costly and could be
significantly decreased or eliminated to the benefit of all concerned.

A review of statistics from the

U.S. Bureau of Labor Statistics
and the insurance industry finds
that nurses have among the highest
estimated rates of back injury with
an average of 40,000 back illnesses
reported by nurses each year.
Moreover, nurses have the highest
rates of compensation claims of
any occupation or industry. It is
estimated that 12% of nurses leave
the profession as a result of back
injury and over 52% of nurses
identify that they have chronic
back pain. The cost to the health
care industry attributable to back
injury is estimated to be $20
billion per year.
In 2000, the
Occupational
Safety and Health
Administration (OSHA)
issued standards for
the prevention of
ergonomic injury. The
standards ultimately
were not adopted
and now serve only
as a guideline for
the prevention of
ergonomic injury.
However, in 2004, the
numbers and severity
of Musculoskeletal
Disorders (MSD) in
nursing homes resulted
in OSHA-issued, comprehensive
nursing home guidelines for
preventing MSD. The rate of MSD in
nursing homes is twice that of any
other health care setting. The goal
of the OSHA MSD guidelines:
“OSHA recommends that
manual lifting of residents should
be minimized in all cases and
eliminated when possible.
Minimizing and, where
possible, eliminating
resident lifting is the
primary goal of the
ergonomics process
in the nursing home
setting and of these
guidelines.”
Programs to decrease
patient handling-
related injury have been
effective by 20-80%
when implemented in
lowering
numbers of injuries and lost work
time. The OSHA guidelines go
on to identify that, “facilities that
have implemented ergonomics-
based injury prevention programs
using effective engineering and
work practice controls have
achieved considerable success
in reducing work-related injuries
and workers’ compensation costs.
In addition, some institutions have
experienced additional benefits,
including reduced
staff turnover and
associated training
and administrative
costs, reduced

Page 10 visit us on the web — www.texasnurses.org March 2005 TEXAS NURSING

absenteeism, increased
productivity, improved morale,
reduced resident injury, and
increased resident comfort.” The
guidelines also describe model
programs that have significantly
reduced the burden of back injury
in health care facilities.
OHSA recommendations and
anecdotal reports about the levels
of success achieved through safe
patient handling programs have
resulted in a new ANA initiative,
“Handle With Care.” Spearheaded
in Florida, the program is beginning
to take off. Constituent member
associations including Texas
Nurses Association are considering
legislative and other policy
initiatives to decrease the threat
of ergonomic injury to nurses. With
nursing shortage data that indicate
demand will only continue to grow
for older nurses at the bedside,
there is no doubt that policies
which decrease or eliminate lifting
of patients could go a long way
toward keeping older nurses in
the workforce.
So compelling are the
cost benefits associated with
implementation of safe patient
handling that lifting equipment, lift
teams, and sophisticated overhead
tracks that accommodate multiple
lifting tools are becoming more
common. But just purchasing
equipment is not the silver bullet.
Administrators skeptical of safe
patient handling would attest
to the fact that lift equipment is
gathering dust in many facilities. So
what does it take?

A change in culture/
management commitment and
employee participation
•Management that tailors
ergonomic interventions to the
specific conditions in which
lifting occurs
•Employee input into the
equipment and methods that
TEXAS NURSING March 2005
will be most effective
•Understanding that proper
body mechanics alone will not
eliminate ergonomic stressors
•Shifting the emphasis from
body mechanics considering
how a lift can be eliminated or
at the very least minimized

Ergonomics Training
•Recognition of signs and
symptoms of MSD so they can
be reported and response
made to the problem before it
is debilitating
•Assessment skills that provide
skills in identification of jobs and
tasks that involve ergonomic
stressors
•Information and skills in
controlling stressors
•Training that encompasses
staff exposed to stressors and
those that can influence the
implementation of programs to
reduce MSD

Occupational Health
Management of MSDs
•Ongoing occupational
management is a necessary
component of implementation
so that injury and time away
from work is minimized through:
•Effective reporting of injury is
made in a timely manner
•A trained health care
professional responds to injuries
before they are debilitating
•Accurate recordkeeping
occurs to evaluate the
effectiveness of the safe
patient handling program

Control Methods include:
•Evaluation of the worksite
and the types of situations the
demand patient handling
•Identification of equipment
that could eliminate or minimize
patient handling when possible
•Development of appropriate
lifting plans for individual
patients
•Ongoing use of algorithms for
lifting decisions
visit us on the web — www.texasnurses.org
•Assessment of other activities
that create ergonomic risks
such as: cleaning rooms,
waste collection, pushing
of heavy carts, stocking
supplies, adjusting beds and
development of control
methods for these activities
Use of safe patient handling
programs like the one OSHA
outlines clearly could have
a significant impact on
musculoskeletal disorders. ANA Safe
Patient Handling Information can
be reviewed at: www.nursingworld.
org/handlewithcare/hwc.pdf.
The complete OSHA guidelines
can be accessed at the following
URL: www.osha.gov/ergonomics/
guidelines/nursinghome/draft/
nursinghomeguideline.pdf
APN TITLING ISSUES
continued from page 9
new, national model.
Since its public hearing in
October, and participation at the
national stakeholders meeting
in December, the BNE has now
published in the February 11, 2005
Texas Register some “Proposed
New Amendments to Rules 221.2
and 221.7 relating to Advanced
Practice Titles.” With that
publication at www.sos.state.
tx.us/texreg/issues.shtml, another
30-day public comment period
began and the work continues. A
follow-on meeting of the National
Nursing Stakeholders on Advanced
Practice is to convene again in
early April 2005, just before the
six-month moratorium on this issue
expires and, consequently, the
BNE revisits for adoption the newly
proposed new rules.
* Slides of Dr. Margretta Styles keynote
address can be viewed at www.nursingworld.
org/news.
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