Safe Patient Handling and Musculosketal Disorders

Introduction

The U.S. Department of Labor defines a musculoskeletal disorder as an injury or disorder of the muscles, nerves, tendons, joins, cartilage, or spinal disks.

Many MSDs in the healthcare field are due in large part to overexertion related to repeated manual patient handling activities, often involving heavy manual lifting associated with transferring, and repositioning patients and working in awkward postures.

Sprains and strains are the most often reported injuries, and the shoulders and lower back are the most affected body parts.

Here are some interesting statistics regarding back pain from the American Nurses Association:

• 52% of nurses complain of chronic back pain.
• 12% leave nursing because of back pain.
• 20% transfer to different units because of back pain.
• Back pain is the leading cause of disability in those less than 45 years old.

Consequences of Work-Related Injuries

The consequences of work-related muscular injuries among nurses is substantial. Along with the higher employer costs due to medical expenses, disability compensation, and litigation, nurse injuries also are costly in terms of chronic pain, missed work days, and employee turnover.

As many as 20% of nurses who leave direct patient care positions do so because of the risks associated with the work.

Direct and indirect costs associated with back injuries in the healthcare industry alone are estimated to be $20 billion annually.

Many healthcare employees who experience pain and fatigue, may also be less productive, less attentive, and more susceptible to further injury and may be more likely to affect the health and safety of others.

Most Susceptible Industries

The radiology department could be identified as high-risk.
(Click to enlarge)

Industries where patient handling tasks are performed include:

• long-term care (includes facilities that provide skilled or non-skilled nursing care)
• acute care (includes hospitals, out-patient surgical centers, and clinics)
• home healthcare workers
• others (includes physical therapists, radiologists, sonographers, etc.)

Some examples of areas of a facility that may be identified as high-risk include:

• bathing rooms
• extended care wings
• diagnostic units (for example, radiology, emergency department, spinal unit and orthopedics department)

MSD Assessment

The first step in addressing the issue of patient handling is to assess the size and nature of the problem. Comprehensive reporting of worker injuries helps ensure you have the data available to develop your hospital's safe patient handling program. Here are some steps you can take to assess your safe patient handling concerns and needs:

1. Review injury data for your facility. Injury data can be a useful diagnostic tool. This data includes the OSHA 300 Log; the OSHA Form 301 (Injury and Illness Incident Report); workers' compensation claims summaries; internal incident, investigation, and corrective action reports; and employee turnover and recruitment data. OSHA already requires many workplaces (including any hospital with more than 10 employees) to use the OSHA 300 Log to report serious job-related injuries. Employers must also complete the Form 301 for every recordable injury.
2. Examine your overall injury rates and see how you compare to others. Administrators and safety managers can use OSHA's self-assessment checklist to examine the hospital's injury rates and compare them with national averages and high-performing hospitals. You can also visit the Bureau of Labor Statistics to learn more about injury and illness rates in hospitals and other workplaces nationwide.
3. Examine your patient handling injury rates and start to pinpoint areas of concern. Use OSHA's patient handling self-assessment tool to review and reflect on the number, nature, and cost of patient handling injuries in your hospital.
4. Be proactive. A more forward-looking approach, to be used in combination with reviewing injury and illness records, is to be proactive in identifying potential problems that have gone unnoticed, before they result in injuries. Observations of workplace conditions and work processes, job analyses, workplace surveys, and worker interviews are common proactive methods for identifying problems before they result in injury.

Stages of MSDs

Early stage: pain may disappear after a rest away from work.

Intermediate stage: body part aches and feels weak soon after starting work and lasts until well after finishing work.

Advanced stage: body part aches and feels weak, even at rest. Sleep may be affected and light tasks are difficult on days off.

You should NOT ignore signs and symptoms of MSDs. Employees should report any pain to their manager or supervisor and seek treatment immediately to prevent further pain.

The video on this page demonstrates patient handling tasks that put the nurse at risk of developing MSDs. The video discusses anatomy and risks to the lower back, the shoulder, the wrist, and the knee.

Management Support

One of the most important aspects of any safe patient handling program is support from the top levels of hospital administration. Employees appreciate knowing managers care about their well-being. They are also much more likely to follow safe patient handling policies if management stands behind them.

In hospitals who have successfully reduced patient handling injuries, it is common to find administrators who support and promote a culture of safety. Administrators must weigh the benefits of investing in safe patient handling policies, procedures, training, and equipment. Hospital administrators should also fully understand how these investments impact their bottom line.

Several case studies show the initial capital investment in programs and equipment needed to safely handle patients can be recovered in two to five years, particularly when equipment purchases are coupled with training and policies to produce a lasting impact.

Although there can be considerable equipment, training, and infrastructure costs associated with implementing safe patient handling, hospitals with successful programs have found the long-term benefits far outweigh economic costs. Those benefits include:

• reduced injuries
• decreases in lost time and workers' compensation claims
• increased productivity
• higher quality of work life and worker satisfaction
• staff retention
• better patient care and satisfaction

Management support should encompass more than just the workers responsible for direct patient care. Departments such as laundry, maintenance, and engineering are vital to supporting safe patient handling as well. This includes maintaining equipment and supplying clean slings to troubleshooting facility design issues.

Safe Patient Handling Equipment

Given the increasingly hazardous biomechanical demands on caregivers today, it is clear the healthcare industry must rely on technology to make patient handling and movement safe.

• Involve your front-line staff in testing and selecting equipment. The people who actually move patients are a valuable resource when determining the equipment most appropriate to each unit.
• Choose equipment based on the specific lifting, transfer, and movement needs of each unit and patient population.
Make sure the equipment is conveniently located, readily available, and accessible so that staff can use it without keeping patients waiting or delaying other tasks.
• Put systems in place to ensure that mechanical equipment is maintained and supplies such as slings and transfer sheets are kept clean and stocked. Staff cannot use mechanical equipment if it is broken or not charged. Further, equipment that has not been maintained properly could result in injuries to both caregivers and patients.
• Consider partnering with an equipment vendor. Vendors can help you develop your safe handling program, host equipment fairs, troubleshoot issues, answer questions, and maintain and replace equipment.
• Design with safe patient handling in mind during construction and remodeling. It is easier and more cost-effective than retrofitting.

The use of assistive patient handling equipment and devices is beneficial not only for healthcare staff, but also for patients. Explaining planned lifting procedures before lifting and enlisting their cooperation and engagement can only increase patient safety and comfort, as well as enhance their sense of dignity.

Program Evaluation

By establishing evaluation procedures and a process for enhancing your safe patient handling program, you can periodically assess the effectiveness of your hospital's efforts and ensure continuous safe patient handling improvement and long-term success. A few evaluation steps to consider:

• Set goals that include worker safety. Most hospitals already have safety goals, but the safe patient handling leaders include worker safety in their goals and measure whether they are meeting them.
• Track the success of your program. Examine the number and type of patient handling injuries, the root causes that led to these injuries, the number of lost work or modified duty days, and more types of program measures. You can also assess the efficacy of your safe patient handling policies. These data can also help you identify opportunities for improvement.
• Share results with your employees. Sharing safety trend data creates motivation and instills pride (and competition) among units to achieve success.
• Gather feedback from staff who handle patients. Realize that every program will need adjustments after being put into practice. Even small changes can improve the use of equipment and worker engagement tremendously.

VIDEO

Instructions

Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

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