Transcript Injuries in Nursing Homes

Injuries in Nursing Homes
 Nursing
Homes are ranked fifth among all
industries for low back injuries
 17 Injuries For Every 100 Full Time
Workers
 Nursing Home Workers Have the Most
Injuries Related to Overexertion of Any
Industry (no. 1 for overexertion)
 Injuries Rose 55% in the Last Decade
Why Injuries Are Increasing
 Pressure
in the Industry to Drive Down the
Price of Health Care
 Nursing Home Sector Seeing More Acutely
Ill Patients - Hospitals Move Patients Out
Faster
 More Acutely Ill Patients Means More
Dependant Patients who Requires More
Handling
Other Injury Risks
 Nursing
(in general) has the highest rate of
Falls to the Floor on the Same Level of any
Group of Workers
 96 Cases per 10,000 workers
 Lack of Adequate Housekeeping Staff
Contributes to Slipping/Falling Problem
Risks for Injury: Patient
Handling Tasks
 Frequent
Manual Lifting of Patients is the
Primary Risk
 Two-person Manual Lift is the most
common patient transfer method
 Average Nursing Home Worker Lifts More
Than 10,000 Human Pounds Per Day
Other Stressful Tasks
 Lifting
Patient Up in Bed
 Weighing Patient
 Repositioning Patient
 Making Bed With Patient In It
 Making Bed Without Patient In It
 Lifting Carrying Equipment or Supplies
Hoists Have Not Worked
 One
study found that mechanical hoists
were used for only 2% of patient transfers
 The reasons for not using hoists:
 hoist not available
 takes too much time
 lack of staffing
 the physical effort required to use hoist
For Dependant Weight
Bearing Patients
 For
patient transfers, the two-person
walking belt was found to be least
physically stressful among several methods
 Using a pulling technique (not lifting) was
important to minimize stress to the worker
 Training of workers to use the pulling
technique with walking belts was required
Lifting Devices Differ Widely
 Several
Mechanical Lifting Devices were
compared
 Arjo-Century’s Ambulift Device was found
to be least physically stressful to workers
 Hoyer Lifts were found to be as physically
stressful as manual lifting of patients
Comparing Three Lifting
Devices
 Using
Hoyer lifts is more physically
stressful than most manual methods
 Trans-Aid lifts reduced physical stress
compared to manual methods
 Arjo-Century lift was least stressful
mechanical device, and patients preferred
this device (felt more secure)
Staff to Patient Ratio
 Inadequate
staffing is a major obstacle to
injury prevention efforts
 Many transfers require two workers, but are
performed by one worker
 Lifting Teams have been used successfully
in hospital settings to dramatically reduce
workers compensation losses
Adequate Equipment
 Adequate
equipment includes:
 Walking Belts
 Shower Chairs
 Shower Chairs fit over toilet
 Shower Chair fits easily into shower
 Adaptive Clothing as needed
Ergonomics Efforts Do Work
 In
one study losses were reduced by 50% by
making ergonomic improvements
 Classifying patients and applying consistent
transfer methods per category was
important
 Compliance Required Adequate Staff to
Patient Ratio
Classifying Patients
 dependent/non-weight
bearing
 dependent/weight bearing
 independent
Patient Handling Per
Classification
 non-weight
bearing: Use Mechanical
Device
 weight bearing dependant: Use Two-Person
Walking Belt with Pulling Technique
 independant: Patient Moves on Their Own
Lifting Team Approach
 Also
relies on classifying patients into
categories
 Lifting Team specially trained in each
method or patient category
 Lifting Team adheres strictly to prescribed
methods per category
 Adequate staffing ensured by Lifting Team
approach
Lifting Team Approach
 Team
members selected for strength, ability
 Nurses and Nurses Aids free to perform
other tasks
 May increase number of Full Time
Equivalents (FTE) required
 Has been cost-effective in hospital settings
due to reductions in injuries and costs
Administrative Issue
 Handling
of Patients By Prescribed Method
Per Patient Classification Required
 Compliance Must Be Monitored and
Enforced/Reinforced
 Adequate Staffing is Required for
Compliance
Other Equipment
 Adjustable
height beds
 Slings attached to beds
 Adequate number of mechanical lifts
 Adequate type of mechanical lift
Most Stressful Tasks
 Ratings
of Perceived Exertion has been
useful in job/task evaluations of nursing
home tasks
 Transfers from wheelchair to toilet was
most stressful task
 Transfers from chair to bed also stressful
 Two-person manual lifting method most
stressful of several methods examined
Walking Belts and Gait Belts
 Walking
belts differ from gait belts in that
they have handles and better secure the
patient
 For best results with walking belt method,
nurses were instructed “Pull with your hand,
not your back. Do not lift”
 Many nurses have old habit of lifting when
transferring - which must be “unlearned”
Improving Ergonomic
Conditions
 Consistent
Use of Lifting Devices for NonWeight Bearing Patients
 Easily Adjustable Chair and Bed Heights
 Adequate Staff to Patient Ratio - Increase
Staff if Necessary
 Training in Proper Techniques
 Walking-Belts With Pulling Method
Standards and Regulatory
 OSHA Launced
an Initiative To Improve
Conditions for Nursing Home Workers in
1996
 Unions Pushing for Enforceable Staffing
Standards
 OSHA’s Proposed Regulation on
Ergonomics Could Stimulate Dramatic
Improvement - If Made Into Law