Safe Patient Handling and Movement

Background

According to the Bureau of Labor Statistics, nursing aides, orderlies, and attendants reported the highest incidence rate of musculoskeletal disorders (MSD) requiring days away from work in 2006 (BLS, 2007). This group was ranked second in overall musculoskeletal disorders requiring days away from work, with Registered Nurses ranked fifth. Healthcare workers are over represented specifically for upper extremity MSD among worker's compensation claims. Injured nurses contribute to about one-fourth all claims and one-third of total compensation costs. More than one-third of back injuries among nurses have been associated with the handling of patients and the frequency with which nurses are required to move them.

The extent of musculoskeletal disorders among the U.S. nursing workforce is particularly distressing when considered in the context of the current nursing shortage. It is estimated that 12% of nurses leave the profession annually due to back injuries and greater than 52% complain of chronic back pain. Injuries secondary to patient handling tasks exacerbate the shortage and are of particular concern with the aging of the nursing workforce. Although the Occupational Safety and Health Act (OSHA, 1970) requires employers to maintain records of serious workplace injuries and illnesses (29 USC section 657c(2)), these statistics may not capture episodic and remitting musculoskeletal injuries. Because this type of injury is largely a result of repetitive movement over time, they often go under reported, so the reported data is likely just the tip of the iceberg.

Extended work schedules (mandatory overtime), an increased work pace as well as increased physical and psychological demands all contribute to MSD.

Two decades of research have demonstrated that use of a single approach (ie, engineering controls, administrative changes, or worker training) to reduce the incidence of MSD has not worked. Recently, the shift is toward evidenced based practices such as a program within a facility that creates no lift policies; secures appropriate patient handling equipment and lifts and trains staff on usage; with a comprehensive tracking system of MSD injuries that includes ongoing evaluation of the program. While specific measures may vary between settings, the Occupational Safety and Health Administration (OSHA) recommends that:

  • Manual lifting of residents / patients be minimized in all cases and eliminated when feasible.
  • Employers implement an effective ergonomics process that:
    • provides management; involves employees; identifies problems; implements solutions; addresses reports of injuries; provides training; and evaluates ergonomic efforts.

In spite of the statistics and OSHA recommendations, "no lift" policy initiatives in other nations such as the United Kingdom and Australia have been slow to be accepted in the US. In 2004, ANA developed a program, "Handle with Care" that supports safer practices with regards to patient handling. Approaches to addressing this issue include recommended changes in nursing school curriculums as well as legislation.

ANA's policy is supported by one of the Institute of Medicine reports describing nurses work environments as potential threats to their safety as well as that of patients, legislation in a number of states focusing on nurses working conditions have been advanced. One such area is that of requiring the creation of safe patient handling and movement programs with no manual lift policies.

Safe patient movement and handling benefits patients as well. The potential for patient injury (such as falls and skin tears) as a consequence of a manual handling mishap is reduced by using assistive equipment and devices. Equipment and devices provide a more secure process for lifting, transferring or repositioning patients. Patients are afforded a safer means to progress through their care, have less anxiety, are more comfortable and maintain their dignity and privacy. Assistive patient-handling equipment can be selected to match a patient's ability to assist in his or her own movement, thereby promoting patient autonomy and rehabilitation.

The payback period for a safe patient handling and movement program is calculated at 4.3 years without including indirect benefits associated with reduced injury, employee morale and patient satisfaction. Additionally there are savings in costs related to recruitment of nurses.(1)

For more information, visit ANA's Handle with Care Program; OSHA at: www.osha.gov

(1) Siddharthan, Kris, Nelson, Audrey, & Weisenborn, Gregory. (2005) "A Business Case for Patient Care Ergonomic Interventions" Nursing Administration Quarterly. Vol 29:1, pg 63-71

Enacted to Date

Prompted by ANA's Handle With Care Campaign which began in 2003, nine states have enacted "safe patient handling" legislation: Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. Illinois awaits the Governor's signature.

Summary of States Having Passed Legislation

(2009)
Illinois HB 2285 passed; awaiting the Governor's signature. It would require nursing homes and each of the inpatient facilities that are a part of the University of Illinois Hospital system to adopt and ensure implementation of policy that will identify, assess, and develop strategies to control the risk of injury to patients / residents, nurses and other healthcare workers associated with lifting, transferring, repositioning, or movement of a patient / resident. Restriction of lifting must be achieved to the extent feasible with existing equipment and aids while manual handling or movement of all or most of the patient’s body weight is to be done only during emergent, life-threatening, or otherwise exceptional circumstances. Some of the other provisions include staff education and training and a procedure for a nurse to refuse to perform or be involved in handling or movement that the nurse believes in good faith will expose the patient/ resident, nurse or other health care worker to an unacceptable risk of injury without fear of retaliation.

(2008)
Maryland extended safe patient handling practices to residents and employees in nursing homes. 2007 legislation applied to hospitals only. On or before December 1, 2008, each nursing home will establish a safe patient handling workgroup with equal membership between management and employees. On or before July 1, 2009, the workgroup shall have developed policy, the goals of which are to reduce employee injuries associated with lifting; develop or enhance the use of patient handling hazard assessment processes; enhance the use of lifting devices with the incorporation of lift teams (role not defined); and determine the process for evaluating the program.

(2007)
Both Maryland (April) and New Jersey (passed December, 2007 enacted January, 2008) chose a comprehensive programmatic approach, requiring healthcare facilities to establish a safe patient handling programs comprised of committees to establish policy and monitor the program.

Maryland's "Safe Patient Lifting" law, requires hospitals to establish a safe patient lifting committee with an equal number of managers and employees on or before December 1, 2007; requiring the committee to establish a safe patient lifting policy on or before July 1, 2008; and requiring the committee to consider specified factors while developing a safe patient lifting policy and program.

New Jersey requires licensed healthcare facilities, state developmental centers, and state and county psychiatric hospitals to establish a safe patient handling program to reduce the risk of injury to both patients and healthcare workers at the facility within 18 months of the bill's enactment. (July 2009) Each facility would be required to maintain a detailed written description of the program and its components and provide a copy to the Department of Health and Senior Services or Department of Human Services, as applicable, and make the description available to healthcare workers at the facility and to any collective bargaining agent representing healthcare workers at the facility. A facility would also be required to post its safe patient handling policy in a location easily visible to staff, patients, and visitors; and to designate a representative of management at the facility who will be responsible for overseeing all aspects of the program. Within 12 months following enactment, each facility must establish a safe patient handling committee, responsible for all aspects of the development, implementation, annual evaluation and revision of the facility's safe patient handling program, including the evaluation and selection of patient handling equipment and aids and other appropriate engineering controls. At least one-half of the members of the committee shall be healthcare workers who provide direct patient care to patients at the facility or are otherwise involved in patient handling at the facility. The remaining members of the committee shall have experience, expertise, or responsibility relevant to the operation of a safe patient handling program. The law provides that a healthcare facility shall not retaliate against any healthcare worker because that worker refuses to perform a patient handling task due to a reasonable concern about worker or patient safety, or the lack of appropriate and available patient handling equipment or aids.

With a voluntary approach, Minnesota law, signed at the end of May, provides for grants to support safe patient handling programs and activities in healthcare facilities by transferring money ($500,000 per year for two years) from the workers compensation special fund to an assigned risk safety account.

(2006)
Rhode Island legislation requires each licensed healthcare facility to have a committee developed, by July 1, 2007, to develop a written safe patient handling program. By July 1, 2008, facilities must be prepared to implement a safe patient handling policy for all shifts and units that will achieve the maximum reasonable reduction of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening or otherwise exceptional circumstances. The statute also addresses completion of patient handling hazard assessments, staff training and the provision for reporting to a safe patient handling committee within each facility annually.

Washington legislation promotes safe patient handling and reduction of injuries among healthcare workers by establishing a Safe Patient Handling Committee (with at least half of the committee comprised of direct care providers) and implementation of a safe patient handling policy to prevent musculoskeletal disorders among healthcare workers and injuries to patients. The law mandates hospitals to acquire the much needed lifting equipment and provide staff training. Hospitals will receive a tax credit when purchasing lifting equipment.

Hawaii passed a House Concurrent Resolution calling for the Legislature of the State of Hawaii to support the policies contained in the American Nurses Association's Handle with Care campaign.

(2005)
New York State (NYS) passed legislation that creates a two-year safe patient handling demonstration program and was extended by two additional years in 2007. The program will serve to collect evidence based data, reflecting the incidence of employee and patient injuries resulting from patient handling, comparing the use of manual and technology based techniques. Any type of licensed healthcare facility interested in participating in this program applies to the NYS Department of Health for funding. All participants must develop a risk identification and assessment plan, a comprehensive employee training program, be willing to commit to a culture which avoids manual patient handling to the greatest extent practicable, and provides ongoing reporting through the facility health and safety committee as well as the Department of Health. Appropriations were designated in the 2006 budget.

Ohio legislation resulted in the long term care loan fund program, to be operated by the bureau of workers' compensation. The administrator of the program shall use the program to make loans without interest to nursing homes for the purpose of purchasing, improving, installing lifts, as well as to support the cost of staff education and training in support of a policy of no manual lifting of residents.

Legislation enacted in Texas, effective 2006, requires the governing body of a hospital or the quality assurance committee of a nursing home to adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient. The code stipulates there be collaboration with and annual reporting to a nurse staffing committee, as well as reports to the governing body or quality assurance committee. There is also the provision that in developing architectural plans for constructing or remodeling a unit of a hospital or nursing home in which patient handling occurs, consideration of the feasibility of incorporating patient handling equipment must be considered.

2008-2009 Active Legislation

The following states have introduced similar bills that would require hospitals to establish a committee charged with developing a safe patient handling and movement program with associated policy and practices.

  • FL (HB 231/ SB626) Died in Committee
  • HI (HB440/SB519) applies to each private hospital in the state and each community hospital within the Hawaii health systems corporation.
  • IL (HB2285) Passed, awaiting Governor's signature
  • MA (SB803) while (SB1757) is an "Act to Improve Nurse Safety" that includes requirements for safe patient handling and movement programs in healthcare facilities along with a number of safety initiatives such as restriction of consecutive hours worked, provisions for hours of "rest" between shifts as wells as penalties for assault and battery of nurses.
  • MN (SB594/HB921)
  • VT (SB80/HB238)
  • TX ( HB2597)

Additionally, MI (SB193) Prevents promulgation of a rule or establishment of a standard for workplace ergonomics, would permit a department, board,or commission to provide guidance, best practices information or assistance for the voluntary implementation of a workplace program.

  • MS (HR13) Urges businesses to implement ergonomics practices to protect the health of the state workforce .
  • MO (HB401) Would provide for tax credits for facilities purchasing mechanical lifts and similar equipment for safe handling and movement.
  • NY (AB1723/SB317) Requires installation and use of ceiling lifts in hospitals and nursing homes; further requires appropriate staff training in the use of ceiling lifts and (AB2042) requires statewide adoption of safe patient handling and movement policy by all healthcare facilities, while creating a safe patient handling and movement task force within the Department of Health to provide guidance and monitor. (SB3839) creates the NYS Safe Patient Handling Task Force.

Last Updated: 6/9/09