Ergonomic Guidelines for the Nursing Home Industry

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Ergonomic Guidelines for the Nursing Home Industry
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THE PROBLEM

• Musculoskeletal injuries account for more than
  50 of all lost times injuries in the Healthcare
  Industry
• Greater than 750,000 work days are lost annually
  due to back injuries in Healthcare Sector

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OTHER FACTS

• In one 8-hr. shift the cumulative weight a
  Nurse/Aide, etc., lifts is.
• 1.8 Tons

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What Can You Do to Reduce Your Risk of MSDs?

• Conduct a hazard or risk assessment
• Assess the patient
• Assess prepare the environment
• Get necessary equipment help
• Perform the patient care task, lift or movement
  safely
• Plan and Prepare It only takes a minute but can
  save a career

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NIOSH Lifting Equation Applied toPatient
Handling Activities

• Even using the NIOSH Lifting Equation, the
  threshold limits for injury are exceeded when
  performing patient handling tasks.

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NIOSH

• Determined that ½ day of training was not
  effective in minimizing MSDs associated with
  patient lifting.
• 1 to 1.5 days of training better

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OTHER FACTS

• American Nurses Association is currently pushing
  for a national law governing safe lifting
  practices and standards at the National level.
• Gait belts have been banned from use several
  European countries

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LIFTS NOT ALLOWED

• UK, Austria, Ireland, Netherlands, Sweden,
  Denmark, S Africa, British Columbia do not allow
• Under the axilla lift hook and toss lift with
  patients arms around nurses neck, etc.

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Goal of Ergonomic Evaluation, Design, and
Intervention

• Increase Efficiency
• Increase Productivity
• Increase Quality
• Decrease Cost
• WHILE.....

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Goal of Ergonomic Evaluation, Design, and
Intervention

• Decrease Injury/Illness
• Lost work day rates
• Restricted work day rates
• OSHA reportable rates
• Workers compensation costs
• Decrease Fatigue
• Decrease Absenteeism
• Decrease Turnover

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Ergonomic Guidelines for the Nursing Home Industry

• Why are we doing this
• OSHAs Ergonomics for the Prevention of
  Musculoskeletal Disorders Recommendations to
  help reduce number and severity
• SB 1525 Safe Patient Handling and Movement
  Practices
• Promote and achieve as much as possible, a ZERO
  lift attitude in the work place dealing with
  PEOPLE

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Senate Bill - 1525

• Effective January 1, 2006
• Governing body/Assurance Committee shall adopt
  and ensure implementation of a policy to
  identify, assess, and develop strategies to
  control risk of injury to patients and nurses
  associated with lifting, transferring,
  repositioning, or movement of a patient.
• Analysis of risk of injury to both parties posed
  by patient handling
• Education of nurses in the identification,
  assessment and control of risks

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Senate Bill 1525 (cont.)

• Evaluation of alternative ways to reduce risks
  associated with patient handling
• Restriction, to the extent feasible with existing
  equipment and aids, of manual patient handling or
  movement of all or moist of a patients weight
• Collaboration with and annual report to the nurse
  staffing committee
• Procedures for nurses to refuse to perform or be
  involved in patient handling or movement that the
  nurse believes in good faith will expose a
  patient or nurse to an unacceptable risk of
  injury

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Senate Bill 1525 (cont.)

• Submission of an annual report related to the
  identification, assessment, and development of
  strategies to control risk of injury associated
  with lifting, transferring, repositioning, or
  movement of a patient
• In developing architectural plans for
  constructing or remodeling a hospital or nursing
  home in which patient handling and movement
  occurs, consideration of the feasibility of
  incorporating patient handling equipment, etc.

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BLS STATISTICS (2004)

• American Nurses Association survey found 83
  worked in spite of back pain
• 60 fear a disabling back injury
• 38 require time off during their career due to
  back pain

• In 2000 resulted in time away from work for
  10,983 RNs
• 44,854 in nursing aides, orderlies, etc.,
  experienced overexertion in lifting related
  incidents

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NO LIFT Technology

• We need to address a no lift process in Nursing
  Homes when it comes to lifting/moving/transferring
  of residents/clients, etc.

• This can be accomplished
• by use of any of the
• following
• Hoyer Lifts
• Sit/Stand Hoist
• Use of shower chairs
• Ceiling mounted lift devices
• Ambulation assist device
• Geri or Cardiac Chairs
• Stand Assist Devices
• Lift Chairs
• Transfer Boards

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The Process, Step By Step

• Evaluate Injuries and Costs
• Obtain Approval For Funding
• Establish A Lifting Committee
• Evaluate and Select Equipment
• Resident/Family Notification
• Receive and Prep Equipment
• Training
• Resident Assessment
• Coordination with Other Staff
• Enforcement
• Performance Measurement
• Evaluate Efforts Regularly

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Establish A Lifting Committee

• CNA based committee
• Select outgoing CNAs
• 45 minute meeting
• per week
• Food, fun, praise
• Leader has budget authority, is committed to
  project, and is a motivator

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Evaluate Equipment

• Hold open house for several different vendors
• Demo equipment never seen before
• Can's test equipment in the facility/provide
  feedback
• Four inch
• extenders
• added to
• bed legs
• so lift will
• fit under
• lowboy
• bed.

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Equipment Selection

• Equipment feedback list from CNAs
• Identify all different accessories needed for
  lifts such as scales and extra slings
• Decision meeting with lifting committee
• Final budget approval and purchase
• Set date for zero lifting policy

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Nursing Home Departments Primarily At Risk

• Nursing Care Services
• Housekeeping
• Laundry
• Maintenance
• Dietary/Food Service
• Office, Volunteer Services, etc.

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Nursing Care Services Risk Factors

• Risk Factors
• Pulling/Pushing Forces
• Heavy Lifting
• Awkward Postures
• Inappropriate Equipment
• Lack of or no Training

• Body Segment Affected
• Back
• Neck
• Shoulders
• Lower Limbs
• Arms
• Wrists
• Knees

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Lifting and Moving of Patients/Clients/Residents

• Possible Solutions
• Hoyer Lift
• Good Body Mechanics
• Team Lifting
• Powered sit-to-stand or standing assist devices
• Ceiling mounted lift devices