Nursing ranks among the top 10 of at-risk occupations for back injury, not to mention musculoskeletal disorders, according to the Bureau of Labor Statistics. More than half the RNs responding to a survey commissioned by Health Professionals and Allied Employees/AFT/AFL-CIO, New Jerseys largest union of nurses and healthcare professionals, said they had been injured on the job, and 12% of nurses left the workforce because of back pain. These dire statistics make it urgent for hospitals to fill a prescription for injury prevention.
Englewood Hospital Medical Center (EHMC) has taken up the challenge with a comprehensive safe patient handling program. Rather than just purchase new equipment, we decided to make a culture change with a program called, Patient Assistance to Lift and Move Safely (PALMS), says Edna Cadmus, PhD, RN, CNAA, EHMC senior vice president of Patient Care Services.
Solution to the problem
In January, New Jersey Governor Jon Corzine signed the Safe Patient Handling Act, requiring all licensed healthcare facilities, state developmental centers, and county psychiatric hospitals to put a program in place that reduces risk of injury to patients and healthcare workers during patient movement and transport.
According to the N.J. bill, within 18 months of its enactment, facilities are required to establish a program, maintain a detailed written description, and provide a copy to the Department of Health and Senior Services or the Department of Human Services. The plan must also be available to healthcare workers in the facility and to any collective bargaining agent representing the facility staff.
The safe patient handling program must include the following
A safe patient handling policy on all units and for all shifts
An assessment of the safe patient handling assistive devices needed to carry out the facilitys safe patient handling policy
The purchase of safe patient handling equipment and patient handling aids essential to carry out the policy
Protocols and procedures for assessing and updating the appropriate patient handling requirements for each patient
Even before the bill was introduced, EHMC was considering how to create an environment for safe patient handling for patients and employees, says Cadmus.
Through our Joint Nursing Practice Council, we talked about the work of ergonomics expert Audrey Nelson, RN, PhD, director of the Patient Safety Center of Inquiry, and that of James A. Haley, Veterans Hospital, Tampa, Florida, she adds. Based on these discussions, a committee led by Pat Brigley, RN, BSN, EHMC Occupational Health coordinator, which included an interdisciplinary team of nurses, physical and occupational therapists, patient care associates, technicians and managers, met to understand the process for creating a safe patient handling environment.
Were proud to be the first hospital in New Jersey to implement a comprehensive, clinically safe patient handling program, says Cadmus.
Reframe a culture
With support from the EHMC Board of Trustees and the administrative team, $600,000 was earmarked for PALMS, which was no small investment, but we were convinced it would be well worth it in terms of an investment return, says Cadmus. That return focuses around recruitment and retention; for example, nurses staying in the workforce longer, reduced workers compensation and lost days, and increased patient satisfaction, she explains.
Brigley coordinated working with many departments such as laundry, infection control, transport, purchasing, nursing, and rehab medicine to create policies and to provide the education and training on equipment for more than 800 employees. The transfer mobility coaches trained patient care associates (PCAs) as trainers so the PCAs could serve as resources for unit staff. Nursing staff super users on each unit also assist staff in terms of competency and the assessment of types of equipment needed for patient care. My observations on rounding have been that staff is not afraid to lift patients and that patients and staff feel comfortable, says Cadmus.Another example of equipment support that helps to lift a patient safely and more easily.
Right equipment, right patient
The National Institute of Occupational Safety and Healths lifting limit is 35 pounds per lift, says Brigley. Consider that the average hospital patient weighs approximately 200 to 250 pounds. The average RN who cares for six or more patients moves each patient about six times per day. In the course of the day, the nurse lifts 7,200 pounds.
Staff uses equipment for every type of lift, says Cadmus. The policy is called minimal lift because some component will involve lifting, but equipment supports lifting and can be easily manipulated so staff can maneuver the patient safely.
Units at EHMC were assessed for the type of equipment needed, based on patient population. In ICUs, for example, ceiling lifts in each room would assist with moving patients from bed to chair and for turning patients in bed. Given the amount of other equipment typically found in an ICU room, floor equipment was considered too difficult to use when maneuvering patients.
On surgical units for bariatric patients, ceiling lifts were ordered to provide the safer and more comfortable way to mobilize obese patients. The ease of their transfer from bed to chair makes the experience safer and more positive for patients and staff.
By late November, 75 pieces of new equipment were delivered to the units. The Radiology Department also benefited from equipment that enables safe movement of patients from wheelchairs to radiology tables.
Because the equipment is user-friendly and safer for patients and caregivers, we believe that we will have patients out of bed more often, sooner, and more comfortably, says Brigley. The long-term benefits will be shorter lengths of stay and a quicker recovery, she says.
Time will tell. Culture doesnt change overnight, says Cadmus. It takes constant reinforcement, so we are working with the equipment supplier, ARJO, and with Diligent, which is providing ongoing monitoring of the program, she says.
A three-year follow-up of outcomes will tell whether PALMS will meet with patient satisfaction, reduce work-related injuries, and enable staff members to continue their careers in a safe work environment.