Safe Patient Handling and Movement (SPHM)
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 greater than 52% of the nursing workforce suffers from chronic back pain. Injuries and pain 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 handling (SPH) 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.
In addition to safety, a business case can be made for implementing a safe patient handling program.
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Initial investment in both lifting equipment and employee training can be recovered in 2 to 3 years through reductions in workers’ compensation costs. Source: Collins et al., 2004; Tiesman et al., 2003; Nelson et al., 2003; Garg, 1999.
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Research has shown that resident lifting programs reduce workers’ compensation injury rates by 61%, lost workday injury rates by 66%, restricted workdays by 38%, and the number of workers suffering from repeated injuries. Source: Collins J.W., et al. 2004. An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes. injury prevention. Injury Prevention (10) 206–211.
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SPH programs are cost-effective due to reductions in workers’ compensation claims, costs associated with absenteeism, and turnover. Source: Bureau of Labor Statistics (BLS). (2007). Nonfatal occupational illness and injuries causing days away from work, 2006. United States Department of Labor NEWS. USDL 07-1741. Accessed 09/04/09 at www.bls.gov/iif/oshwc/osh/case/osnr0029.pdf
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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. Source: Siddharthan, Kris, Nelson, Audrey, & Weisenborn, Gregory. (2005) "A Business Case for Patient Care Ergonomic Interventions" Nursing Administration Quarterly. Vol 29:1, pg 63-71
For more information, visit ANA's Handle with Care Program; OSHA at: www.osha.gov
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