The NSC Health Care Section Presents Current Issues in Health Care Safety

1
The NSC Health Care Section PresentsCurrent
Issues in Health Care Safety

• Session 18
• Speakers Barbara Ondrisek, Dean Klatt, Frank
  Denny, Jim Ramsay and Kara Szirotnyak
• NSC Congress - New Orleans
• September, 2004

2
Barbara Ondrisek

• Exposure based training matrix for all employees.
• Exposure based training matrix for
  managers/supervisors.
• Exposure based training matrix for affected
  employee groups.

3
Barbara Ondrisek

• Exposure based training matrix for maintenance
  and facilities personnel.
• Exposure based training matrix for emergency
  preparedness and response personnel.

4
Dean Klatt

• Healthcare and OSHAs Voluntary Protection
  Program (VPP).
• This year, OSHA has announced four alliances with
  organizations to improve safety and prevent
  accidents and illnesses.
• The alliance with the New Your State On-Site
  Consultation Program and GNYHCGA.

5
Current Issues in Health Care SafetySession
18Limited Lifting/Zero Lifting Programs

• Kara Szirotnyak, MSN, RN, COHN-S/CCM
• Department of Veterans Affairs

6
Facts to Consider

• 7 out of 10 injuries in healthcare facilities are
  in Nursing.
• Nursing 2nd nationally for injuries.
• Average age of nurses is 47.5 y/o
• 1 out of 3 injuries results in a LTC.
• 1 out of 2 employee injuries results in an injury
  to the patient.

7
Nurses are a creative, resourceful bunch who are
use to working under less than ideal conditions.
We also understand the importance of patient
safety, however, when left up to us to prioritize
safety issues we may come up with something like
this..
8
(No Transcript)
9
More Facts

• The average cost of one back surgery is 125,000
  (non-complicated).
• The average cost of one room with overhead lift
  is 4,000.
• The average cost of knee surgery is 8,000
  (non-complicated).
• The average cost of lateral lifting equipment is
  3,000.

10
Nurses are a creative, resourceful bunch who
adapt to doing much with very little, however,
when it comes to prioritizing equipment needs we
may come up with something like this
11
(No Transcript)
12
Limited Lifting / Zero Lifting Programs
13
Why Do This???

• Nursing shortage- 55 VA nursing staff eligible
  to retire.
• Patient safety.
• Employee safety.
• Retention of staff.
• Recruiting tool.
• Cost management/containment.

14
Effects of Forward Bending Lifting in a Forward
bent Position

• Bending forward to brush your teeth or working at
  a bench that is 6 inches to low puts 50 more
  compressive force on your back.
• Bending forward at the waist to lift 50
• puts 1300 pounds of force into the lower back.

15
Nursing Survey Stats

• Do you anticipate getting injured at some point
  in time of your career? 90
• Have you ever been injured? 75
• Have you ever worked injured? 89
• Did you report your injury to your
  supervisor/reporting official? 92
• Have you ever missed work d/t an injury? 78

16
What Steps To Take

• Top management support
• Nursing support/buy-in
• Site specific needs for equipment
• Leader for each area to monitor
• Training
• Injury data
• Process for handling pieces parts
• Policy to enforce use of equipment

17
What Can You Anticipate?

• Positive marketing tool (new employees).
• Improved job satisfaction.
• Increased patient safety.
• Increased patient satisfaction.
• Decrease in lost time injuries.
• Decrease in overall cost for injuries.

18
Thanks Folks!
19
The Origins of Nursing Safetya new look at JHAs
for nurses

• By
• Frank Denny, US VA
• Jim Ramsay, Ph.D., UW Stevens Point
• NSC Congress
• New Orleans, LA
• September, 2004

20
Overview

• The many OSH exposures nurses face present a
  difficult challenge from a safety management
  perspective.
• Our thoughts as to whats been done whats not
  been done about this.
• Future directions ? our study.

21
Nurses role in health care

• It is widely acknowledged that nurses are an
  essential component of the US health care system,
  holding about 2.3 million jobs (BLS web site,
  accessed 6/22/04).
• Nurses are the central components across a wide
  continuum of care ranging from acute care
  settings to prevention and wellness programming
  to restorative care.
• The nurse is central to successful patient
  outcomes and is always on the front lines.

22
Nursing exposures

• Given the nature of their working environment and
  responsibilities nurses are at the frontline for
  many occupational hazards.
• Communicable diseases including BBP, TB, SARS,
  Methicillin Resistant Staph Infections, and
  Norovirus.
• Musculoskeletal injuries including those from
  patient movement and handling.
• Chemical exposures.

23
Nursing exposures

• Workplace violence exposures.
• Unmanaged stress.
• Terrorism/chemical spill victims.
• Slips/Falls.
• Radiation.
• Other physical hazards gt such as electrical and
  flying objects.

24
Exs of nursing morbidity

• Blood borne pathogenic exposures (HIV, HCV, HBV,
  etc) - due to percutaneous needlestick injuries.
• Between 600,000 and 800,000 NSIs occur/year in
  all healthcare settings, with injections (21),
  suturing (17) and drawing blood (16) the top
  three exposures (Perry, et al., 2003).

25
Exs of nursing morbidity

• Airborne exposure from various diseases such as
  SARS, Tuberculosis (TB), Methicillin Resistant
  Staph, etc..
• During 2003, CDC received 34 reports of TB
  outbreak activity, (CDC web site, accessed on
  7/6/04).

26
Exs of nursing morbidity

• Patient movement and handling - 38 of all nurses
  are affected by back injuries, which are due to
  the fact that 98 of the time nurses are lifting
  and moving patients manually (Meier, 2001).
• Obviously, we could go on.

27
Exs of nursing morbidity

• Workplace violence exposures compared to all
  other workers, nurses face a higher level of risk
  of violence.
• 9.5 of general nurses working in general
  hospitals are assaulted annually (Wells Bowers,
  2002).
• Gerberich et al. (2004) report that rates for
  both physical (13.2) and non-physical (38.8)
  violence are rising in EDs, home/long term care,
  intensive care psychiatric/behavioral settings.

28
OSHAs list of ED nurse exposures

• Bloodborne pathogens.
• Hazardous chemicals - e.g., EtO, spilled
  medications, carcinogenic materials, noxious
  fumes and flammable liquids.
• Slips/falls - high traffic and compact treatment
  spaces are a combination for risk.
• Latex allergy e.g., reaction to gloves made
  from natural latex and/or materials used to make
  the gloves.
• Tuberculosis.

29
OSHAs list of ED nurse exposures

• Equipment hazards - e.g., electrical shock (e.g.,
  defibrillators).
• Workplace stress Studies suggest work stress
  may increase a person's risk for cardiovascular
  disease, psychological disorders, workplace
  injury, and other health problems. Early warning
  signs may include headaches, sleep disturbances,
  difficulty concentrating, job dissatisfaction,
  and low morale. factors such as shift work,
  long hours, fatigue, and intense emotional
  situations, (e.g., the suffering and death of
  patients).

30
OSHAs list of ED nurse exposures

• Methicillin resistant staph infections.
• Workplace violence - beyond physical attacks -
  cursing, threats, etc.
• Terrorism e.g., receiving victims form an
  unknown terrorist incident.
• Physical agents - such as flying objects - eye
  injury risk.

31
So what?

• Given the wide range of OSH exposures, are we
  surprised that nurses suffer such high rates of
  illness or injury?
• Whats being done to either prepare nurses or to
  train nurses once theyve been hired to help them
  better avoid these exposures?

32
Nursing education and training

• Does nursing education offer enough safety
  self-protection practices?
• Are nurses being socialized tobelieve the
  responsibility for personal injuries is a result
  of something that is inherent to the nursing
  profession?
• Do nurses believe there is a dichotomy between
  self protective measures and the patient needs?

33
Nursing education and training

• What are the core accreditation requirements for
  nursing schools how do they match up with what
  OSHA has identified as the typical exposures
  faced by ED nurses?
• The National League of Nursings core
  accreditation requirements.

34
Nursing position descriptions (PDs)

• OPM has standardized PDs for nurses.
• Facilities abide by these core standards, but
  have levity to add additional requirements as
  they see fit according to their patient
  population service needs.
• PD competencies vary from facility to facility
  depending on the patient population and the level
  of care administered at each facility.

35
ED nursing hazard experience

• Employees are unlikely to know the standards or
  regulations to the degree needed in order to
  comply on their own - plus management may feel
  unprepared to measure an individuals performance
  in this area given their own lack of knowledge
  and an overriding mission.

36
ED nursing hazard experience

• Odds are that ED nurses will
• Sustain some type of a work-related injury during
  their employment
• Believe it is a normal expectation of their job
  as a nurse to become injured at some point in
  time during their careers
• Likely become injured at one time or another and
  then will never reported it.

37
Nursing position descriptions (PDs)

• What do ED nursing job descriptions tell us about
  the on the job accountability for OSH
  exposures?
• Once on the job how is job safety evaluated?
• Our review of 29 VA PDs from around the country.

38
The future

• The question is what to do now
• There are a clear set of engineering controls and
  PPE available to most nurses today.
• Ex the needlestick prevention act of 2001 which
  modified the BBP standard re percutaneous
  needlestick injuries.
• However, how well have administrative controls
  been utilized?

39
Classic administrative controls

• Job rotation job enlargement are not
  well-suited to nursing.
• What about job safety analyses (JSAs)?
• Anecdotal evidence and a general lack of mention
  in the literature indicate that JSAs are
  underutilized among ED nurses.

40
4 steps to JSAs

• Select the job to be evaluated based on some
  clear criteria like potential for exposure, or
  severity of exposure, etc.
• Define the steps required to complete the job
  task.
• Identify the possible hazards associated with the
  performance of each step.
• Develop appropriate control strategies in order
  to eliminate the exposure to the extent possible.
  

41
The future

• What we plan to do
• Our manuscript will be reviewed by the J of
  Safety Research this fall.
• Survey nurses re their training, ed and exposure
  concerns.
• Develop pilot an Ed nurse JSA.
• Conduct longer term (2-3 yrs.) study with a
  treatment control group and compare relative
  morbidity rates.
• Revise the ED nursing JSA as advised.

42
Thats it folks!
Thanks for your time!