Safe Patient Handling -- Preventing Musculoskeletal Disorders in Nursing Homes

record serious injuries and illnesses that are work-related Common Beliefs vs. Facts Under the OSHA law, employers have the responsibility and meet other general criteria on the OSHA 300 Log. About Safe Patient Handling Programs for providing a safe and healthful workplace for their Information from the 300 Log and the 301 form can be workers. Workers have the right to working conditions used to identify tasks and jobs with higher risks of injury, “Mechanical lifting is not as safe and comfortable for that do not pose a risk of serious harm. For questions, or to monitor trends and to gauge the effectiveness of patients as manual lifting.” to get information or advice, to order publications, or to intervention efforts. FACT: Once patients realize the ease and comfort of file a confidential complaint, contact OSHA at 1-800-321- modern mechanical lifts, they will be more likely to OSHA (6742), or go to www.osha.gov. Whistleblower Protections accept them. Mechanical lifts are safer for both patients Under the Occupational Safety and Health Act employees and healthcare workers. may not be retaliated against for reporting a work-related injury or illness (29 U.S.C. 660(c)). Employers must ensure “Training and use of proper body mechanics (including use that no employee is discriminated against for exercising of back belts) is effective in preventing job-related injuries.” his or her rights, including reporting potential hazards, FACT: Research shows that relying on “proper” body symptoms or work-related injuries. mechanics (including use of back belts) is not, by itself, an effective way to reduce injuries. There is no such thing as The Free OSHA On-site Consultation Program: safe manual lifting of a patient. A Valuable Resource for Implementing a Safe Patient Handling Program “You don’t need to worry about patient-handling Through the OSHA On-site Consultation Program, OSHA injuries if your workers are healthy and never had For more information on safe patient handling provides free and confidential safety and health advice a problem.” legislation in states and other resources, visit to small and medium-sized businesses committed FACT: Manual lifting can cause micro-injuries to the spine. to improving workplace safety and health. On-site www.osha.gov/SLTC/nursinghome. Although workers may not feel the effects immediately, consultation services are separate from enforcement and cumulative micro-injuries can result in a debilitating injury. DO NOT result in penalties or citations. Experts recommend that lifts be limited to 35 pounds or less. Good health and strength may actually put workers at Additional Resources: increased risk because their peers are much more likely to yy Occupational Safety and Health Administration www.osha.gov seek their assistance when manually lifting patients. Safe Patient yy National Institute for Occupational Safety and Health www.cdc.gov/niosh/topics/safepatient “It is much faster to manually move patients.” FACT: If equipment is located conveniently, accessing it will Handling yy The Veterans Health Administration not take a long time. It is often more time-consuming to Preventing www.va.gov/health round up a team of workers to manually lift a patient than to get safe patient handling equipment. Musculoskeletal yy The Joint Commission www.jointcommission.org Disorders in yy Service Employees International Union (SEIU) “Manual lifting is less expensive than mechanical lifting.” Nursing Homes http://tinyurl.com/seiuOSH FACT: Costs associated with back injuries in the yy American Nurses Association healthcare industry are estimated to be $20 billion www.nursingworld.org; annually. Research shows the use of assistive technology www.anahealthyworkenvironment.org such as mechanical lifts reduces injuries to workers and lowers costs associated with workers’ compensation, lost productivity, and turnover.

OSHA 3708 - 02/2014 www.osha.gov

Disabling Injuries Work-related MSDs can be prevented. Safe patient Program Evaluation: Regular program evaluation within Nurses and other healthcare workers face many safety handling programs employ the use of mechanical the environment of care is critical to the success of the and health hazards in their work environments. In fact, equipment and other elements to reduce the number program. Establish evaluation procedures necessary healthcare workers experience some of the highest and severity of work-related MSDs. to assess the effectiveness of the safe patient handling rates of non-fatal occupational injuries and illnesses program and to ensure its continuous improvement and of any industry sector. Benefits of Safe Patient Handling long-term success. Credible data sources, including the Safe patient handling programs reduce the risk of injury OSHA Recordkeeping Log 300, and forms 301 and 300A, for both healthcare workers and patients while improving can be used to track and analyze injuries and trends Injuries & Illnesses Resulting in Days Away from Work, 2012 the quality of patient care. Use of lifting equipment is related to the ongoing implementation of the program. Cases per 10,000 Full-time Workers essential to a successful safe patient handling program and has been shown to reduce exposure to manual lifting OSHA Emphasizes the Importance of Safe Nursing & Residential 237 injuries by up to 95%. Hazard Assessment: Address high-risk units, areas, Patient Handling Programs Care Facilities and patient-handling tasks. Hazard evaluation should Reducing the number of musculoskeletal disorders in In addition to reducing healthcare worker injuries and healthcare workers is a priority for OSHA. The agency Construction 143 consider factors such as types of nursing units, the related lost work time, safe patient handling programs revised its Guidelines for Nursing Homes, Ergonomics physical environment of patient care areas, and existing have other benefits, including: for the Prevention of Musculoskeletal Disorders and Retail 114 equipment and its utilization. It is important to consider yy More satisfying work environment and professional status; characteristics of the patient population such as level of launched an educational outreach and enforcement patient mobility and cognition. program to address hazards specific to nursing homes. Manufacturing 106 yy Improved nursing recruitment and retention; OSHA promotes a safety culture of prevention of harm yy Increased patient satisfaction and comfort; Technology & Prevention Through Design: Implement for both patients and workers through Injury and Illness Professional & 52 yy Decreased patient falls and pressure ulcers; and methods to control hazards such as lifting, transferring, and Business Services Prevention Programs. 0 50 100 150 200 250 yy Reduced costs associated with injuries. repositioning patients. Manual lifting should be minimized in all cases and eliminated when feasible. For example, a Use the OSHA 300 Log for Recordkeeping Data Source: Bureau of Labor Statistics Elements of a Successful Safe Patient “zero-lift“ program or policy minimizes direct patient lifting In addition to a thorough worksite hazard analysis, Handling Program by using specialized lifting equipment and transfer tools. the OSHA 300 Log can be a useful tool to assess the In 2012, injuries and illnesses reported for nursing and The elements of a successful safe patient handling health and safety needs of facilities and to evaluate the Establish safe patient handling policies that are based residential care workers were significantly higher than program include: effectiveness of specific interventions and overall safe on patients’ physical and medical conditions and the those in construction, and 2-3 times higher than in patient handling programs. The OSHA Recordkeeping availability of lifting equipment and lift teams. retail or manufacturing. Almost half of the injuries and Commitment from Management at All Levels: Gaining Rule (29 CFR 1904) requires healthcare facilities to illnesses reported for nurses and nursing support staff management support, as well as assembling a team for Select appropriate lifting equipment in accord with were musculoskeletal disorders (MSDs). Rates of MSDs for a safe patient handling program, are critical to program the hazard assessment, and install and maintain lifting nursing assistants (225.8) were almost four times as high success. Management can provide visible support by devices according to manufacturer recommendations. as the average for all workers (37.8). consistently communicating the importance of safe The best proactive approach is through proper design patient handling; assigning roles for various aspects of a of the work environment, including incorporating MSDs affect the muscles, nerves and tendons. Work- safe patient handling program to appropriate managers, health hazard controls into the design of facilities during related MSDs (including those of the neck, upper supervisors, and other employees; and providing construction and remodeling. extremities and low back) are a leading cause of lost appropriate resources for implementing and sustaining workday injuries and illnesses for healthcare and social the program over time. Education & Training: Provide sufficient education and assistance workers, particularly in nursing homes and training so that each worker understands the elements residential care facilities. Examples of MSDs include A Safe Patient Handling Committee that Involves of the safe patient handling program and how to muscle strains and low back injuries, rotator cuff injuries Frontline Workers: To design and implement a safe participate. The education and training of healthcare (shoulder problems), and tendinitis. patient handling program, as well as to evaluate and workers should be geared toward the assessment of sustain the program into the future, the frontline (non- hazards, selection and use of the appropriate patient Research has identified that the risk factors for MSDs include managerial) employees who provide direct care to lifting equipment and devices, and review of evidence- the repeated and forceful movements associated with patients should be well-represented on the safe patient based practices for safe patient handling. Training should patient care such as lifting, transferring, and repositioning. handling committee. include when and how to report injuries.