Integrating Safe Patient Handling Into Physical Therapist Education: Reducing the Incidence of Physical Therapist Injury and Improving Patient Outcomes

Abstract

BACKGROUND AND PURPOSESafe patient handling (SPH) programs were introduced in the United States in the late 1990s by the American Nurses Association (ANA) to combat work-related musculoskeletal disorders (WMSDs) by incorporating a combination of education, technology, and policies to help guide health care workers to safely and effectively move patients with impaired mobility.1 SPH programs and policies adopted by nursing relate primarily to patient transport. Physical therapists (PTs) should consider SPH programs both for safe patient transport and as a therapeutic tool. The focus of this position paper is on the incorporation of SPH programs in PT education. While this content applies to physical therapist assistant (PTA) education as well, it is not explicitly addressed in this position paper.The American Physical Therapy Association (APTA) supports the use of SPH programs in physical therapy practice and adopted a position in 2012 regarding the roles of PTs and PTAs in SPH.2 The position reinforces that PTs and PTAs should be the leaders in multidisciplinary health care teams in modeling the appropriate use of SPH. Both the ANA and APTA have advocated for implementing SPH programs to help tackle the vast number of debilitating and sometimes career-ending musculoskeletal injuries that occur among health care professionals when performing manual mobility activities.1,2 When manual patient handling techniques such as transfers, bed mobility, and gait are deemed risky, these programs advocate the ergonomic strategy of using equipment to assist with patient handling.The United States has been slow to implement policies regulating SPH. Since 2003, there have only been 11 states that have enacted SPH regulations to help enforce the use of technology to mobilize patients.3 The Occupational Safety and Health Administration (OSHA) has issued recommendations for SPH programs to establish policies which guide facilities in obtaining appropriate equipment, training staff, collecting data, and evaluating the effectiveness of the program.2,4 Some facilities develop formal policies in attempts to reduce worker injuries. These policies can include guidelines to ensure appropriate equipment is available to workers as well as train workers in the safe use of the equipment.5,6 In physical therapy practice, SPH equipment includes, but is not limited to, floor and ceiling mechanical lifts, sit to stand lifts, overhead track and harness systems, and body weight supported treadmill training.While there is little information regarding the efficacy of SPH programs in physical therapy practice, the implementation of SPH programs has been shown to be very effective in improving safety for patients and health care professionals in a variety of situations and settings. The ANA provides a summary of literature related to multiple health care disciplines and reports that SPH programs have increased job satisfaction, decreased worker compensation claims, decreased employee turnover, and reduced the incidence of health care worker injuries by up to 95%.* Li et al7 reported reductions in injury rates, lost workdays due to injuries, worker compensation, and musculoskeletal complaints after utilization of SPH devices. The health care workers also reported increased job satisfaction.5 Yassi et al8 reported that a healthier environment emerged as the equipment decreased fatigue of workers, improved comfort with patient handling tasks, and increased the perception of safety among staff. These findings are consistent with a systematic review conducted by Tuller et al,9 which concluded that there is moderate evidence that SPH programs improve musculoskeletal health of providers and decrease the incidence of staff WMSDs. Collins et al10 proposed a mechanism for injury reduction through use of SPH equipment. They demonstrated that mechanical lifts reduced compressive forces to the spine of skilled nursing facility personnel by 60%, removed two-thirds of lifting demand per transfer, and increased perceptions of comfort and security by patients when compared to being manually transferred. …