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


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

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

Barbara Ondrisek
  • Exposure based training matrix for all employees.
  • Exposure based training matrix for
  • Exposure based training matrix for affected
    employee groups.

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

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.

Current Issues in Health Care SafetySession
18Limited Lifting/Zero Lifting Programs
  • Kara Szirotnyak, MSN, RN, COHN-S/CCM
  • Department of Veterans Affairs

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.

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
(No Transcript)
More Facts
  • The average cost of one back surgery is 125,000
  • The average cost of one room with overhead lift
    is 4,000.
  • The average cost of knee surgery is 8,000
  • The average cost of lateral lifting equipment is

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
(No Transcript)
Limited Lifting / Zero Lifting Programs
Why Do This???
  • Nursing shortage- 55 VA nursing staff eligible
    to retire.
  • Patient safety.
  • Employee safety.
  • Retention of staff.
  • Recruiting tool.
  • Cost management/containment.

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.

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

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

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.

Thanks Folks!
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

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

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.

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
  • Musculoskeletal injuries including those from
    patient movement and handling.
  • Chemical exposures.

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

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).

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

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.

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,
  • 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.

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.

OSHAs list of ED nurse exposures
  • Equipment hazards - e.g., electrical shock (e.g.,
  • 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

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.

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?

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
  • Do nurses believe there is a dichotomy between
    self protective measures and the patient needs?

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.

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.

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.

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.

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

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?

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.

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
  • 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.

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
  • 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.

Thats it folks!
Thanks for your time!