Safe Patient Handling Research Articles

Expediting Return to Work Full Duty with Successful Onsite Medical Management

Emory Healthcare with Emory University in Atlanta, Georgia is the largest employer in DeKalb County. Contract onsite physical therapy and ergonomic services were added in 2001. Emory employees with work related injures were discharged after five onsite physical therapy visits on average versus the national average of fourteen outpatient visits. The estimated cost savings was $887,574 in 2006. In 2008, Emory's Occupational Injury Management Department separated from the Employee Health Department to handle injured employees. Two orthopedic physical therapists specializing in ergonomics were hired full time. The injured employee fills out an online incident report and is seen by the medical staff within 1 to 48hours. The employee is evaluated in physical therapy, treated and instructed in proper body mechanics. An ergonomic evaluation is performed if an employee has symptoms due to the work postures or the physical demands of the job. Physical therapy statistics of discharged patients were recorded for three years to evaluate the work status on discharge, the departments where injuries occurred, and types of injuries. The information was utilized to target the common injuries and develop a plan to reduce and prevent further injuries. Over 300 Emory employees were discharged annually from onsite physical therapy. The statistics consistently revealed 90% to 93% of the employees returned to work full duty. Only 35% of the employees required referral to an outside physician. The primary departments where injuries occurred were in Nursing, Facilities Management, and the Food and Nutrition Departments. Injury prevention programs were designed based on the ergonomic evaluations. The Safe Patient Handling Program was initiated in 2006. Overhead and mobile lifts were utilized. With continual nursing education and administrative support, there has been a 12.5% cumulative reduction in lifting injuries in 2014. In 2005, WC cases cost $3500 but currently are $1400. Emory's comprehensive approach expedites successful return to full duty work and reduces the cost of work related injuries.

Interprofessional teaching project with nursing and physical therapy students to promote caregiver and patient safety.

Nurse educators must adjust curricula to meet the dynamic and critical changes in the health care environment, and to recognize the risk of injury our educational approach has on safety, team effectiveness, and culture change. Interprofessional collaboration and simulation are key components in the preparation of our students. Utilizing the interprofessional alliance model, an experience to promote collaborative relationships among nursing and physical therapy (PT) students to improve patient and caregiver safety was developed. Through this model, PT students taught safe patient-handling skills in a simulated setting to undergraduate nursing students. The majority of nursing students (N=351) from 2009–2014 strongly agreed or agreed that they were confident in the skills taught by the PT students and provided an overall course rating of outstanding or above average. This educational model, which includes simulation and safe patient handling, was a valuable addition to the curriculum, reinforcing the significance of developing collaborative relationships.

Effects of a safe patient handling and mobility program on patient self-care outcomes.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

National Research Council Board on Human Systems Integration Panel

The National Research Council’s Board on Human-Systems Integration has organized this session. An initial presentation by the NRC BOHSI will provide information on recent projects and updates. Then a panel will discuss the application of human-systems integration (HSI) to the issue of safety patient handling, an issue of growing concern given the high rate of injuries during patient handling activities. The focus of the panel will be on issues related to the scope of the problem, an HSI perspective of patient handling, and the design and implementation of safe patient handling and mobility programs. We will engage the audience in a discussion of these issues to help refine our project in this area.

Saving our backs: safe patient handling and mobility for home care.

Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.

On SHiPs and Safety: A Journey of Safe Patient Handling in Pediatrics

Nursing personnel have consistently been ranked among the top ten professions impacted by musculoskeletal injuries. Inpatient pediatric nurses witnessed an increase in injuries and upon discovering limited evidence applicable to pediatrics, conducted a research study to evaluate the effectiveness of a safe patient handling program. Surveys were distributed to assess risk and workplace safety perceptions. Post-implementation, surveys revealed a statistically significant (p>0.0001) increase in staff perception of workplace safety, reduction in risk perception for several nursing tasks, and reduction in injury related costs. As a result of this program, workplace safety was improved through education and equipment provision.

Safe Patient Handling Perceptions and Practices: A Survey of Acute Care Physical Therapists

Acute care physical therapists are at risk for developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling. The purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined whether an SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists. Subscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire. The majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%), and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with an SPH program were more likely to use SPH equipment and practices, have received training in the use of SPH equipment and practices, agree that the use of SPH equipment and practices is feasible, and feel confident using SPH equipment and practices. The study might not reflect the perceptions and practices of the population of acute care physical therapists. Acute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with an SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.

Safe Patient Handling and Movement: A Literature Review

Musculoskeletal disorders (MSD) as a result of patient handling tasks occur at high rates for nursing staff and other patient care providers. Patient care providers perform high-risk patient handling tasks including lifting, transferring, ambulating, and repositioning patients. Continuous performance of these tasks places a patient care provider at risk for development of a MSD. MSDs affect a healthcare organization financially and impact the core of a hospital-the health of the workforce. The purpose of this research was to study the impact of a safe patient handling and movement program on healthcare worker injury, costs and job satisfaction. A critical review of the safe patient handling literature was conducted. A safe patient handling and movement (SPHM) program decreases overall work injury costs and improves healthcare worker job satisfaction. Reduced work injuries, decreased injury costs, improved patient outcomes validated in research and employees feeling the support of their employer all contribute to a program that moves an organization toward a culture of safety.

Processes and Outcomes of the Veterans Health Administration Safe Patient Handling Program: Study Protocol

BackgroundHealth care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries.ObjectiveThe goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associated with patient handling, to explore the potential mediating and moderating mechanisms, and to identify unintended consequences of implementing the program.MethodsThis 3-year longitudinal study used mixed methods of data collection at 6- to 9-month intervals. The analyses will include data from surveys, administrative databases, individual and focus group interviews, and nonparticipant observations. For this study, a 3-tiered measurement plan was used. For Tier 1, the unit of analysis was the facility, the data source was the facility coordinator or administrative data, and all 153 VAMCs participated. For Tier 2, frontline caregivers and program peer leaders at 17 facilities each completed different surveys. For Tier 3, six facilities completed qualitative site visits, which included individual interviews, focus groups, and nonparticipant observations. Multiple regression models were proposed to test the effects of SPH components on nursing outcomes related to patient handling. Content analysis and constant comparative analysis were proposed for qualitative data analysis to understand the context of implementation and to triangulate quantitative data.ResultsAll three tiers of data for this study have been collected. We are now in the analyses and writing phase of the project, with the possibility for extraction of additional administrative data. The focus of this paper is to describe the SPH program, its evaluation study design, and its data collection procedures. This study evaluates the effects associated with the national implementation of a comprehensive SPH program that was implemented in all 153 VAMCs throughout the United States to reduce patient handling injuries.ConclusionsTo our knowledge, this is the largest evaluation of an SPH program in the United States. A major strength of this observational study design is that all VAMCs implemented the program and were included in Tier 1 of the study; therefore, population sampling bias is not a concern. Although the design lacks a comparison group for testing program effects, this longitudinal field study design allows for capturing program dose-response effects within a naturalistic context. Implementation of the VA-wide SPH program afforded the opportunity for rigorous evaluation in a naturalistic context. Findings will guide VA operations for policy and decision making about resources, and will be useful for health care, in general, outside of the VA, in implementation and impact of an SPH program.

New Standards for Safe Patient Handling and Mobility

New Standards for Safe Patient Handling and Mobility

Patient Handling in the Veterans Health Administration

To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership. Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data. Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors. Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

Long-Term Effects of Safe Patient Handling Program on Staff Injuries

This study evaluated the effectiveness of a safe patient handling program (STEPS) at an inpatient rehabilitation unit in reducing injury due to patient transfers. Our objectives were to compare number of staff injuries during the 1.5-year period post training to pre training (baseline) and to determine whether reduction in injuries was sustained long term during a 2.5-year post training period. All nursing and therapy staff as well as new hires received STEPS training. Periodic retraining was not provided. The number of injuries was significantly reduced at post training compared to baseline (p = 0.01). However, the reductions in injuries were not sustained long term. We estimated a cost benefit of $3.71 for every dollar invested in retraining based on injury reduction realized during the post training period. Retraining is likely to have a positive cost benefit when it results in maintaining reduction in staff injuries.

Creating a Culture of Safety for Safe Patient Handling

Healthcare workers who handle patients have little guidance to help them identify when to use the existing equipment for moving patients. Manual lifting of patients and healthcare worker injuries continue despite equipment installation and training. The purpose of this project was to decrease the number and severity of healthcare worker injuries by implementing a culture of safety for safe patient handling. A multicomponent safe patient handling program was deployed on one inpatient unit at a Midwest academic acute care hospital. There was a 36% decrease in the number of patient handling injuries, a 71% reduction in the number of lost work days, and a 60% reduction in costs in 1 year related to patient handling injuries. The RN Satisfaction Survey question regarding having enough help to lift/move on last shift improved from 41% presurvey to 69% postsurvey.

Creating a Culture of Safety for Safe Patient Handling

Creating a Culture of Safety for Safe Patient Handling

Frontline Hospital Workers and the Worker Safety/Patient Safety Nexus

Previous work on the relationship between worker safety and patient safety has focused on nurses and physicians.1 Safety climate and nurses’ working conditions predict both patient injuries and nurse injuries, supporting the premise that these outcomes may be linked.2 Less attention has been paid to other members of the health care team, including nursing assistants, orderlies, aides, food service workers, janitors and other environmental service workers, ward clerks, and others. (We use the term health care workers [HCWs] to include frontline hospital workers rather than “support personnel” or other terms that may unintentionally exclude them.) Engaging frontline HCWs in developing, implementing, and evaluating interventions to improve safety may improve patient as well as worker outcomes. A recent monograph issued by The Joint Commission has recommended that health care organizations consider making patient and worker safety a core organizational value and develop a business case for integrating patient and worker safety activities across departments and programs.3 The potential benefits of expanding research to explore the relationship between underlying safety culture and patient and frontline worker outcomes include savings in workers’ compensation costs, lower staff turnover, improved staff morale, increased patient satisfaction, and fewer patient adverse events. A day-long workshop was held in Washington, D.C., on October 25, 2012, to explore whether and how hospital-based frontline HCWs affect patient safety and how they experience safety in their work settings.* The four panels and small-group discussions addressed the following questions: ■ What recommendations do frontline HCWs have to improve patient safety as well as worker safety? ■ What is the current state of the evidence for a relationship between worker safety and patient safety? ■ Are effective, data-driven interventions available that improve both worker and patient safety? ■ What are the data gaps? ■ How could they be filled? ■ What are institutional and policy barriers to implementing interventions that improve safety? Representatives from academe, the federal government, hospitals, unions, and patient organizations participated in the event, which was sponsored by Georgetown University and cosponsored by the Johns Hopkins Bloomberg School of Public Health, the University of Illinois at Chicago School of Public Health, the Service Employees International Union (SEIU), the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), the Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Veterans Health Administration (VHA) Office of Public Health and The Joint Commission. Workshop sessions focused on the intersection of worker safety and patient safety and on specific steps that health care institutions have used to implement a culture of safety in the workplace. The 85 workshop attendees broke out into small groups to identify barriers and opportunities for specific topics. The Honorable David Michaels (OSHA†) welcomed the attendees and charged them to integrate the occupational safety and health needs of hospital workers when addressing safety culture in health care. HCWs sustain higher rates of nonfatal occupational injuries and illnesses than workers in other sectors, including construction and mining. OSHA is targeting this problem through outreach efforts, with special sections on safe patient handling, infectious diseases transmission, and workplace violence4—and through the OSHA and The Joint Commission and Joint Commission Resources Alliance,5 which includes approaches to recognizing and reducing work-related illness and injury by reviewing and acting on the OSHA-required record-keeping.6 Frontline workers are central to these efforts.

Safe Patient Handling Education in Nepal: A Canadian Perspective in Creating and Conducting Training in a Developing Country

Safe patient handling (SPH) and positioning is a worldwide health care issue in both developed and developing countries. It is important for all caregivers and patients but especially for palliative care and oncology patients. While there is a wide breadth of curriculum available in developed countries, little information is available about how to teach SPH and positioning in a developing country where resources are very limited. This article describes the process and recommendations used by a Canadian multidisciplinary health professional team in developing SPH curriculums for palliative care communities in Nepal. Educational materials were developed to teach SPH to a group of health care professionals at a palliative care conference in Bhaktapur, Nepal, in addition to a number of other settings within the Kathmandu Valley area. Current barriers toward future development of SPH in Nepal are defined and discussed. The SPH curriculums that have been created are provided and specific recommendations are outlined. There is a dearth of research to guide SPH education in developing countries. SPH change requires long-term support and curriculums that are culturally sensitive and contextually appropriate.

Results of a pilot intervention to improve health and safety for health care workers.

To test the feasibility of a multicomponent pilot intervention to improve worker safety and wellness in two Boston hospitals. A 3-month intervention was conducted on seven hospital units. Pre- (374 workers) and postsurveys (303 workers) assessed changes in safety/ergonomic behaviors and practices, and social support. Wellness outcomes included self-reported pain/aching in specific body areas (musculoskeletal disorders or MSDs) and physical activity (PA). Pain was reported frequently (81%), and PA averaged 4 hours per week. There was a postintervention increase in safe patient handling (P < 0.0001), safety practices (P = 0.0004), ergonomics (P = 0.009), and supervisor support (P = 0.01), but no changes in MSDs or PA. Safe patient handling, ergonomics, and safety practices are good targets for worker safety and wellness interventions; longer intervention periods may reduce the risk of MSDs.

Safe-Patient-Handling Equipment in Therapy Practice: Implications for Rehabilitation

To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.

Transdisciplinary Collaboration in Developing and Designing Patient Handling/Transfer Assistive Devices: Current &amp; Future Designs

Many health care facilities deal with challenges associated with safe patient handling and movement. Back injuries are a serious problem for nursing personnel who perform frequent patient handling activities. The main objectives of this study are to demonstrate the necessity of patient handling/transfer assistive devices, explore the economic benefits of them, review current assistive patient transfer devices, and investigate design parameters of an ideal patient handling/transfer assistive device. This paper also focuses on the importance of transdisciplinary collaboration in developing and designing patient handling/transfer assistive devices.

Establishing a physical therapist-driven model of safe patient handling and movement programs in a general hospital

Healthcare workers are at great risk for musculoskeletal injuries related to ergonomic risk work factors. Patient handling tasks such as transfers and bed positioning pose the highest risk. This report describes the implementation of a physical therapist-driven model of ergonomic intervention in a general hospital in Israel. A group of senior physical therapists undertook the lead role in implementing an ergonomics program on four hospital wards. After participating in an extensive ergonomics training program, the therapists were guided through the process of risk analysis and program formation tailored to four pilot wards. Four interdisciplinary ergonomic teams were established. The teams will define their ongoing role in coordinating and implementing ergonomics activities in the future. Short-term outcomes include the advancement of ergonomics knowledge and awareness among therapy and nursing staffs, and recognition of therapists' role in healthcare ergonomics, as well as the establishment of four interdisciplinary ergonomics teams. The long-term outcome will be the maintenance of team activities over time, including repeated surveys of staff attitudes and practices, which have been positively correlated with reductions in musculoskeletal injury rates. This model of intensive involvement of therapists within multidisciplinary ergonomics programs may serve as a protocol for further projects in healthcare settings.