Transcript Safe Patient Handling: A Worthy Investment

Safe Patient Handling:
A Worthy Investment
Oregon OSHA
Injuries in Oregon Health Care
“Between 2001 and 2005, the Oregon Department
of Consumer and Business Services received
notification of 9,835 accepted disabling claims in
the health care and residential care industries, an
average of 1,967 claims per year. Although the
numbers have remained steady from year to year,
health care disabling claims are growing as a
percentage of total disabling claims in Oregon.”
“Accepted Disabling Claims in Health Care, Oregon, 2001-2005,” Oregon DCBS, IMD, July 2007
Dark Clouds on the Horizon for
Health Care
A serious shortage of nurses is expected in the future as demographic
pressures influence both supply and demand. The future demand for
nurses is expected to increase dramatically as the baby boomers reach
their 60s and beyond.
Looking forward, almost all surveyed nurses see the shortage in the
future as a catalyst for increasing stress on nurses (98%), lowering
patient care quality (93%) and causing nurses to leave the profession
(93%).
the ratio of potential caregivers to the people most likely to need care,
the elderly population, will decrease by 40% between 2010 and 2030.
Demographic changes may limit access to health care unless the
number of nurses and other caregivers grows in proportion to the rising
elderly population.
Though AACN reported a 7.6% enrollment increase in entry-level
baccalaureate programs in nursing in 2006 over the previous year, this
increase is not sufficient to meet the projected demand for nurses.
American Association of Colleges of Nursing
Some Unfortunate Math
In the January/February 2007 issue of Health
Affairs, Dr. David I. Auerbach and
colleagues estimated that the U.S. shortage
of registered nurses will increase to 340,000
by the year 2020. This is especially
problematic for rural facilities who face
greater obstacles in recruiting nurses.
The ratio of potential caregivers to the
people most likely to need care, the elderly
population, will decrease by 40% between
2010 and 2030. Demographic changes may
limit access to health care unless the number
of nurses and other caregivers grows in
proportion to the rising elderly population.
American Association of Colleges of Nursing
Shortage of
Nurses
Aging Population
Demanding More
and More Health
Care
Overworked
Nurses &
Undertreated
Patients
How Serious Will It Get?
Expected Changes
from 2002 to 2020
6%
Supply of
Nurses
Department of Health and Human Services
40%
Demand for
Nurses
What happens
when demand
exceeds supply?
Self-perpetuating Injuries have
Resulted in Health Care
Prospective
Nurses shy away
from the dangers
of the health care
industry
Over-worked
employees face
higher injury
incident rates
Labor pool
quality suffers
Nursing
Shortage
Wages must be
raised to
compensate for
shortages
Quality of Care
for Residents
Declines
How Can Facilities Fight the
Growing Shortage?
Preserve nurses currently employed.
Replacement is expensive and is detrimental to the
team atmosphere and fluidity of operations.
Also, skilled health care workers, now more than
ever, are not easily replaced.
An excellent way to keep nurses employed is to
create a safe, manageable environment that
minimizes physical and mental stress. Reducing
injury risk will allow nurses to work longer and be
more productive.
The Prevalence of Musculoskeletal
Disorders in Oregon Health Care
MSDs accounted for half of all accepted disabling claims (ADCs) in
Oregon health care between 2001 and 2005.
Patient handling MSDs made up 27.4% of total ADCs
Nurse aids comprised 32.6% of total ADCs, registered nurses 14.2% and
other health aides 5.9% from 2001 through 2005
Musculoskeletal disorders are
defined as injuries and disorders to
muscles, nerve, tendons, ligaments,
joints, cartilage, and spinal discs, such
as sprains, strains, and tears, carpal
tunnel syndrome, hermias, and pain
caused by overexertion, repetitive
motion, or bodily reactions due to
bending, climbing, crawling, reaching
or twisting
Accepted Disabling Claims in Oregon Health Care
2695
Patient Handling MSDs
Other MSDs
4917
All Other ADCs
2223
“health care” includes SIC 80 (health services) and SIC 8361 (residential care)
Oregon DCBS, IMD, July 2007
Injuries are a Cancer in the
Workplace
From 2001 to 2005 nursing aides experienced a total of 3,205 injuries,
registered nurses 1,397, and other health aides 583.
Many of those were patient handling MSDs. 167 of the injuries to health aids
were patient handling MSDs, as were 2,371 for nursing aids and 881 for RNs.
The most frequent cause of injury was “bodily reaction and exertion” (63.2%)
which includes bodily reactions, overexertion and repetitive motions.
Drastic reduction in patient handling MSDs is an essential step to combat the
unfulfilled demand for nurses.
3500
3000
Injuries
2500
2000
All ADCs
1500
Patient
Handling
MSDs
1000
500
0
Health aid
Nursing aid
Oregon DCBS, Information Management Division, July 2007.
Registered nurse
Patient Handling Injury Claims
1997 - 2006 in Oregon
300
Gen Med and
Surg Hospitals
250
200
Nursing Care
Facilities
150
100
50
0
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
patient handling MSD claims
Patient Handling MSDs in Oregon
Oregon DCBS, Information Management Division, July 2007.
Community Care
Facilities for the
Elderly
Other
Residential Care
Facilities
Holistic Estimates of the Costs of
Workplace Injuries
The most expensive medical conditions per 1000 full
time employees for all companies based on medical,
drug, absenteeism and presenteeism costs:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Back/neck pain
Depression
Fatigue
Other chronic pain
Sleeping problem
High cholesterol
Arthritis
Hypertension
Obesity
Anxiety
Loeppke et al. 2007
$530,000/1000 FTEs*
$425,000
$410,000
$385,000
$350,000
$280,000
$275,000
$265,000
$225,000
*Full Time Equivalents
$220,000
MSDs are Extremely Costly!
Although insurance covers some costs up front,
they are recouped by insurers in changing rates
over time.
Meanwhile…
Indirect costs associated with injuries are
generally MORE expensive than the injuries
themselves and are never covered.
What Does Insurance Cover in
Oregon?
Direct Costs Only
Medical coverage includes:
Medical treatment of injuries
Drug costs
Indemnity coverage includes:
Time loss costs
Temporary and permanent disability payments
Fatality costs/awards
Vocational assistance costs
Settlement costs
Claim expense costs
Oregon State Workers’ Compensation Division, SAIF Corporation
The Covered Costs of Patient
Handling MSDs in Oregon
The average patient handling injury costs $11,055 in medical and
indemnity costs over the lifetime of the claim.
Injuries to health aids cost on average $10,049
Nursing aid injuries cost $9,062
Registered nurse injuries cost $16,090
All other health care employees cost $11,950
Average Claim Cost for Health Care Employees
$18,000.00
$16,000.00
$14,000.00
$12,000.00
$10,000.00
$8,000.00
$6,000.00
$4,000.00
$2,000.00
$0.00
health aid
licensed
practical
nurse
Oregon DCBS, Information Management Division, July 2007.
nursing aid
other
occupation
registered
nurse
Total Injury Occurrence and
Direct Costs by Occupation
Claims for 1997 – 2006
Nursing aids account for 59% of patient
handling MSD claims
Registered nurses make up 22%
Employees of other occupations 12%
Health aids 4%
And licensed practical nurses 3%
Claims Costs for 1997 - 2006
Nursing aid injuries cost $21,486,110
Registered nurse injuries cost $14,175,307
Employees of other occupation injuries cost
$5,747,965
Health aid injuries cost $1,678,137
Licensed practical nurse injuries cost $1,263,739
patient handling injury claim dispersion 1997-2006
patient handling injury cost dispersion 1997-2007
167 112
health aid
881
licensed practical
nurse
nursing aid
$1,678,137
$1,263,739
$14,175,307
other occupation
licensed practical
nurse
nursing aid
other occupation
481
$21,486,110
registered nurse
$5,747,965
2371
health aid
registered nurse
Patient Handling MSD Claim
Cost Components
Statistics cover
1997-2006, with
4012 total claims
Indemnity @
closure
Indemnity
after
closure
Medical @
closure
Medical
after
closure
Total
$22,200,187
$2,368,534
$17,393,400
$2,389,137
Average
$5,533
$590
$4,335
$596
Percent
50%
5%
39%
6%
Covered Cost Components
Medical after
closure
Medical @
closure
Indemnity @
closure
Indemnity
after closure
Oregon DCBS, Information Management Division, 2007
Why do these figures matter?
Implicit within “indemnity” costs,
which comprised 55% of total claims
cost in the time period, are time loss
and disability costs. Insurance
compensations go to the employee,
not the facility. They do not pay for
the costs associated with absenteeism,
presenteeism and other indirect costs
incurred in the workplace during and
following an injury.
Total Injury Cost Estimates
Presenteeism represents the
costs incurred by injured
workers who return to work
before completely recovering
and are therefore less
productive than in a healthy
state.
Back/neck injury cost breakdown
Medical
32%
Presenteeism can result in
more long-term health issues.
Employees arriving at work
despite injury may only
operate at a fraction of their
normal capacity while still
requiring the same wages.
Although significant,
presenteeism is only one of
many indirect and uncovered
costs associated with an
injury.
Loeppke et al. 2007
Presenteeism
49%
Drug
1%
Covered Costs
Uncovered Costs
Absenteeism
18%
Another Look at Indirect Costs
https://www4.cbs.state.or.us/exs
/osha/safety/
$afety Pays, OSHA, 1998
12
10
indirect costs
The Stanford Department of Civil
Engineering determined that the
indirect costs of injuries are
generally inversely related to the
severity of the injury. Note the
initially high, then decreasing
ratio of indirect to direct costs as
total costs increase. Consider a
very expensive and crippling
injury versus a mild injury.
For cost calculations based on these
general dynamics see OROSHA’s Safe Patient Handling
Pays program on the web at
8
6
4
2
0
0
1
2
3
4
5
6
direct costs
7
8
9
10
MSD Indirect Cost Estimates
Referring back to the Oregon data, the average patient
handling MSD in health care as a whole between 1997 and
2006 costs $11,055 in medical and indemnity costs alone.
By Federal OSHA’s “Safety Pays” model, this direct cost
correlates with an indirect cost of $12,500 yielding an
estimated total cost of $23,555.
Indirect costs vary considerably depending on many
situation-specific conditions. Despite their
unpredictability, its important to remember that they do
exist and inhibit facilities from operating as efficiently as
otherwise possible.
$afety Pays, OSHA, 1998
Some Possible Indirect Costs
fear of
injury
disrupted
schedules
lose faith in
management
productivity
decreases
lowers employee
morale
cleanup,
damaged
material
replacement
Work stoppage time loss
material
depletion,
expense
attorney
fees
Indirect Costs
legal costs
orientation costs
advertising &
Interviewing costs
time in
court
hiring/retraining
costs
use of traveling
nurses
investigation costs
terminal
payouts
lost
productivity
overtime
temporary
replacement
documentation
time loss
possible
lawsuit
Training & Hiring Costs
Following Injuries are Pricey!
Orientation Costs
Advertising/Interviewing
Use of traveling nurses
Overtime
Temporary replacement
Lost productivity
Terminal payouts
= $92,442 in 2000 dollars, and $145,000 for specialty nurses
OUCH!
Robert Wood Johnson Foundation, 2006
And the Good News…
These Injuries are Preventable!
…And it’s profitable to do so!
95% percent of business
executives report that
workplace safety has a
positive impact on a
company's financial
performance.
Liberty Mutual
Prevent an Injury, Save a Dollar,
Earn a Dollar
Suppose a facility experiences only 1 ergonomically-related
disabling MSDs per year.
Each incurs $12,500 in indirect, uncovered costs.
Eliminating one claim = $12,500 dollars saved at the end of that
year.
Reductions in yearly turnover from 5 to 4 employees results in
$92,442 saved.
Total savings in the first year of
implementation are $104,942 through
indirect and rehiring/ retraining costs avoided
by eliminating just one injury.
Safe Patient Handling Programs
are Proven to Reduce…
Associated costs by 35-65% (MSDs are generally more
expensive than other injury types).
Lifting related claims by 30-95%
Lost workday injury rates by up to 66%
Restricted workdays up to 38%
Workers’s compensation costs by 30-75%
The number of workers suffering from repeat injuries
*According to NIOSH, mechanical lift equipment is the
only effective way to prevent overexertion injuries that
occur due to patient handling.
Enos, 2007
If All Patient Handling Injuries
were Eliminated…
Total injuries to health care employees
could be reduced by about two-thirds!
Oregon health care facilities would save
$4,435,126 yearly in claims alone.
3500
3000
Injuries
2500
2000
All Injuries
1500
Patient
Handling
MSDs
1000
500
0
Health aid
Oregon IMD 2007
Nursing aid
Registered nurse
What is required for a Successful
Safe Patient Handling Program?
Program Plan
Multidisciplinary SPH program
Identified program champion and facilitator
Hazard Identification & Control
Evaluation of system to ensure compatibility between equipment, patients and facility design
Implementation of SPH equipment
Identification of Best Work Practices
Development of Administrative Controls (policy/procedure)
Education & Training
Equipment competency training for expert or super users, employees, support staff and
patients & their families
Safety Culture
Facility-wide internalizatin of the importance of safety
Employees actively involved in development, implementation and evaluation of the SPH
program
No manual lifting policies
Enos, 2007
Components of Project Success
Inputs
Results
Management Commitment
Steadfast enforcement of “No lift”
policy
Employee Involvement
Employee-friendly policy
Program Management
Program executed as planned
Hazard Identification & Control
Injuries are preemptively eliminated
Education and Training
Employees understand the program
Disability management
Injuries and costs are minimized
Follow the link to see a “No lift” policy draft:
http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp
Safe Patient Handling Expenses
 Safety Culture Development
-ergonomic consultations
-published safety policy
-internal enforcement
 Equipment
-lift equipment
-installation
-associated supplies
-maintenance due to depreciation
-possible loss or theft
 Training
-backfill for those being trained
-trainer expenses
-training materials
Investment requirements are facility
specific. Professional consultation may
be necessary to ensure that the right
equipment and training is purchased,
otherwise the program will not enjoy the
full potential benefits.
For an idea of how to cater to the needs
of a specific facility see:
http://www.visn8.med.va.gov/patientsafe
tycenter/safePtHandling/default.asp for
“Assessment Form and Algorithms” to
decide what your unique patient,
employee, structural, and budget
conditions require.
Equipment Types
Lateral Transfer: Supine
Repositioning: Bed and Chair
Lift and Transfers: Seated
Sit to Stand position
Ambulation
Lifting Patients from the floor
Bathtub, Shower and Toilet transfers
Weighing
Moving beds & wheelchairs
Department of Veterans Affairs, Enos 2007
 Lower MSD incidence rate
=> fewer workers’
compensation claims =>
Lower
lower insurance premiums Insurance
Premiums
=> higher profits
 Longer employee retention
=> lower hiring and
Fewer
Accepted
retraining costs => higher Disabling
Claims
profits
 More productive employees
=> lower staffing costs =>
higher profits
A More Efficient and
Profitable Facility
Lower
Hiring and
Retraining
Costs
Longer
Employee
Retention
Patient
Handling
MSDs
SPH Savings
Lower
Total
Staffing
Costs
Healthier,
More
Productive
Workers
Two Empirical Accounts
JW Collins L Wolf, J Bell and B Evanoff,
“An Evaluation of a ‘Best Practices’
Musculoskeletal Injury Prevention Program
in Nursing Homes,” 2004
Kris Siddharthan, Audrey Nelson, Hope
Tiesman, FangFei Chen, “Cost
Effectiveness of a Multifaceted Program for
Safe Patient Handling,” 2005
JW Collins “An evaluation of a ‘best practices’
musculoskeletal injury prevention program in
nursing homes”
Investment
Invested $143,556 in equipment and $27,600 in training ($498 an $77 per
employee respectively)
Trained 288 employees for 1 ¼ hours each on equipment use
Recorded data 3 years before and 3 years after program implementation
Results
MSD claims were reduced by 57% from 129 to 56
Direct injury costs dropped from $441,670 to $277,061 yielding a savings of
$164,609 during the post-implemenation period and an annualized saving of
$54,870.
The 10 year net present value of the project at the time of implementation was
$594,605.
Accounting for estimated capital maintenance, anticipated retraining, and
training backfill, the adjusted recovery time on investment was 3 ¾ years
Kris Siddharthan, “Cost Effectiveness of a
Multifaceted Program for Safe Patient Handling”
Investment
Invested $774,000 in equipment and $392,423 in training ($1,441 and $121
per employee respectively)
Trained 537 employees for 6 hours each on equipment use
Recorded data for ¾ years before and ¾ years after program implementation
Results
MSD claims were reduced by 30% from 129 to 91
Direct injury costs dropped from $344,793 to $126,420 yielding a savings of
$218,373 during the post-intervention period and an annualized savings of
$291,164
The 10 year net present value of the project at the time of implementation was
$847,501.
Accounting for estimated capital maintenance, anticipated retraining, and
training backfill, the adjusted recovery time on investment was 4.6 years
Investment Recovery Time Periods
Investment Recovery Time Frames
1600000
In Siddharthan et al.
investment recovery
occurred in 4.3 years
1400000
cost/savings
1200000
1000000
collins savings
800000
collins costs
600000
Siddharthan
savings
Siddharthan
costs
400000
200000
0
0
1
2
3
years
Siddharthan et al., 2005, Collins et al., 2004
4
5
In Collins et al.
recovery occurred in
slightly less than 3
years
Discussion of Cost Recovery
Studies assumed facilities were self-insured so savings
were realized immediately
The Siddharthan cost curve is positively sloped to reflect
4% annual capital and retraining costs subject to turnover
rates. Collins did not estimate these factors so costs over
time were not calculated.
Most Oregon facilities are insured so recovery based solely
on dropping premium rates may take longer.
Neither study accounted for savings through indirect costs
avoided. Had these been considered, the recovery time
period would have been much shorter.
Monitoring Investment Recovery
Follow the progress of your safe patient handling program
by tracking incident rates over time and comparing to
previous rates will give you an idea of the program’s
efficacy.
Incident Rates are calculated as follows:
IR = (Number of incidents per year) x (200,000 hours of work)
(Number of hours worked by target population)
Ex:
3 MSDs x 200,000 hours
=3
100 employees x (50 weeks x 40 hours)
Incident rates control for employee population change and
employee hours worked so figures can be compared
between facilities and over time.
Lynda Enos, “Cost Justification of Ergonomics Programs,” Central Oregon Occupational Safety & Health Conference 2005
Another Measurement Technique
Records of changes in injury Severity Rates can provide
information about whether or not the program is reducing
the severity of injuries that do still occur.
Severity rates are calculated as follows:
SR = (Number of lost or resting workdays) x (200,000 hours of work)
Number of hours worked by the target population
Ex: If the MSDs kept employees home for 20, 30 and 50 days,
SR =
(20 + 30 + 50) x 200,000 =
100
100 employees x (50 weeks x 40 hours)
Enos 2005
And Then?…
Compare yearly claims list from before and after program
implementation.
If facility has correctly used the lift equipment, significant
decreases in the number and severity of patient-handling
injuries should be evident.
Remember savings extend beyond the reductions in claims
costs! Tracking changes to yearly turnover, rehiring and
retraining will reveal additional savings.
References
“Economic evaluation in occupational health – its goals, challenges, and opportunities” The Scandinavian Journal of
Work, Environment and Health
American Association of Colleges of Nursing, Fact Sheet, March 2007.
http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm
Chuck Easterly, Claims Manager, SAIF Corporation, June 2007
Lynda Enos RN, MS, COHN-S, CPE, Oregon Nurse’s Association, 2007
“Accepted Disabling Claims in Health Care,” Oregon DCBS, Information Management Division, July 2007
Loeppke, Ronald, Michael Taitel, Dennis Richling, et al., “Health and productivity as a Business Strategy,” Journal of
Occupational and Environmental Medicine, Volume 49, Number 7, July 2007, 712-721
JW Collins L Wolf, J Bell and B Evanoff, “An Evaluation of a ‘Best Practices’ Musculoskeletal Injury Prevention
Program in Nursing Homes,” IP Online, 2004
Kris Siddharthan, Audrey Nelson, Hope Tiesman, FangFei Chen, “Cost Effectiveness of a Multifaceted Program for
Safe Patient Handling,” 2005
“Safe Patient Handling and Movement,” Department of Veteran’s Affairs, 8/7/2007,
http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp
Oregon Information Management Division, Bulletin 220 data regarding patient handling accepted disabling claims.
“Wisdom at Work: The Importance of the Older and Experience Nurse in the Workplace”, Robert Wood Johnson
Foundation, 2006.