Prompted by ANA's Handle with Care Campaign which began in 2003, eleven states have enacted "safe patient handling" laws or promulgated rules / regulations: California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii.
Of those, nine states require a comprehensive program in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, Rhode Island, Texas and Washington), in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation. For additional information about this issue, visit the Safe Patient Handling and Mobility page.
California added section 6403.5 to the Labor Code of the existing law, the California Occupational Safety and Health Act of 1973 ( effective 2012) a requirement that employers provide safety devices and safeguards reasonably necessary to render employment safe, including a safe patient handling policy, replacing manual lifting with lifting devices and use of lift teams.
Missouri's safe patient handling and movement for hospitals is defined in rules 19 CSR 30-20.097. (1) shall be an active multidisciplinary committee responsible for implementing and monitoring the safe patient handling and movement program. At least one-half (1/2) of the members of the committee shall be frontline non-managerial employees who are involved in patient care handling activities. (2) This program shall include: (A) A safe patient handling policy for all shifts that will achieve elimination of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances; (B) A patient-handling hazard assessment that considers such variables as patient-handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas; (C) A process which assesses patient's needs for safe patient handling and movement; (D) Educational materials for patients and their families to help orient them to the hospital's safe patient handling program; (E) An annual evaluation of the program utilizing measurable outcome measures including but not limited to employee and patient injuries, lost work days, and workers' compensation claims; and (F) Evidence of changes based on the program evaluation. (3) All employees involved in patient care handling activities are to be trained and demonstrate competence on safe patient handling policies, equipment, and devices before implementation, annually, and as changes are made to the program.
New York, once again, authorized (AB7772/ SB5569) a 2 year extension of a statewide safe patient handling demonstration project, first enacted in 2005. The program is intended 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. Funding for this project has been lacking.
Illinois' Public Law 97-0122 amends the Hospital Licensing Act to address safe patient handling policies, setting forth common definitions and minimum requirements with regards to strategies intended to control the risk of injury to patients and staff. Previously, a 2010 law required 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.
Minnesota requires all settings that move patients to develop a comprehensive safe patient handling plan. (HB1760) In 2007, Minnesota passed a law, providing 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. Missouri's Department of Health and Senior Services published rules calling for hospitals to have multidisciplinary committees responsible for a comprehensive safe patient handling program and policy. (CSR 30-20.20.97)
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 was to establish a safe patient handling workgroup with equal membership between management and employees resulting in policy for which the goals 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.
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.
Rhode Island law requires each licensed healthcare facility to have a committee with responsibility for development of a written safe patient handling program. By July 1, 2008, facilities must have been 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's law 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.
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.