Safe Patient Handling Program Research Articles

Differential Effectiveness of the Minnesota Safe Patient Handling Act by Health Care Setting

Introduction Taiwan is the fastest aging countries in the world. In 2016, Taiwan implemented Long-Term Care Plan 2.0 (LTC Plan 2.0), aims to provide coordinated and integrated LTC services. However, how to assess the level of integration and which integration mechanisms are better applied are still unclear in the literature. This study intended to address a research question regarding “How can agencies measure their level of service integration?” and, therefore, aimed to develop an integration assessment tool—the Taiwanese Self-Assessment for LTC Systems Integration (TwSASI)- for LTC agencies to use to self-evaluate their current “level” of providing integrating LTC services. Methods TwSASI was first developed base on Connie J. Evashwick’s (2005) framework and literature review, including four domains: inter-entity planning and management, care coordination, integrated information system, and integrated financing, and 11 dimensions with 51 items. Through the Delphi method, with two rounds of investigation and feedback from 26 experts, RAND/UCLA Appropriateness Method (RAM) was used to assess the consensus regarding the dimensions and items developed and refined the tool content accordingly. Results After two rounds of investigation, four domains remained with 10, 11, 4, and 5 items in each domain respectively. All items reached good experts' consensus with medians of the 30 items’ importance, feasibility, and appropriateness all over 8. The Scale Content Validity Index (SCVI) of the 4 dimensions all over than 0.9. Conclusion The TwSASI can be feasible for evaluating the level of LTC service integration in Taiwan. LTC agencies can improve their level of service integration accordingly.

Impact of California Safe Patient Handling Legislation: Health Care Workers' Perspectives.

Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers' experiences and perceptions about the law, their hospital's SPH policies and programs, patient handling practices, and work environment. Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis. Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers. This study identified improvements in hospitals' SPH programs and practices since the passage of California's SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.

A Study Protocol for a Randomized Trial on Effect of Safe Patient Handling (SPH) program on Rehabilitation Outcomes and on Safety of Physical Therapists in Rural Hospital

Introduction: Patient management and intervention practices are a crucial component of patient treatmentin the hospitals. In recent times the focus is put on early and regular mobilization of patients to boost recoveryduring and after hospitalization. Increase in inpatient mobilization to improve patient treatment raises aphysiotherapist’s physical demands and therefore risk of injury. With the context of a patient mobilizationprogram, better work procedures and decrease in physiotherapist’s injuries while working, SPH programwill be incorporated.Purpose : The goal of this research is to evaluate the effect of SPH program and mobilization in context ofefforts to improve quality of health care and safety of patients as well as the physical therapist.Method : There will be 2 groups, intervention (SPH) and comparison (no-SPH) each group will consist of20 patients. The intervention group will be consisting the patients admitted in rehabilitation unit for the firstthree months of the research and the comparison group will consist the patients admitted in rehabilitationunit in the last 3 months of the research. Intervention group will undergo rehabilitation with SPH programwhich will include equipments like lifts based on ceiling and floors, sit to stand supports, motorized hospitalbeds and ambulation aids.Result : Statistical analysis will be conducted. Comparison will be made on a variety of characters such asage, duration of stay and diagnosis to determine equivalence between the groups. Evaluation of the impactof SPH program on recovery outcome will be done by linear regression model. FIM scores of interventiongroup at admission and discharge will be compared to the comparison group FIM scores at the time ofadmission and discharge. The linear regression model will represent the graphical overview of the meanmobility scores at the time of admission and at the time of discharge for each group.Conclusion: The publication of conclusion will be done after conducting the study and obtaining the resultsthrough statistical analysis.

Investigating emergency nurses’ beliefs and experiences with patient handling in the emergency department

BackgroundPatient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses’ adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses’ beliefs and experiences with patient handling in the emergency department. MethodsA phenomenological approach was used to explore the participants’ experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. ResultsFive interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: ‘Putting the patient first’ describes participants prioritisation of patient safety over their own; ‘Patient -related challenges’ describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; ‘Staff knowledge’ of policy and procedure; and ‘Inadequate resources’ which describes the physical and human resource limitations that made patient handling more difficult. ConclusionsIssues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.

Simulation to Teach Safe Patient Handling and Mobility for Home Caregivers

Safe patient handling and mobility (SPHM) programs are needed in the home care environment. As patient-lifting technology and devices become more widely available for use in the home setting, caregivers need opportunities to learn how to properly use these devices. Nonmedical caregivers employed by personal support services agencies (PSSAs) and home caregivers have very limited access to opportunities for SPHM training in rural areas of Tennessee. Safe patient handling and mobility training utilizing simulation with an interprofessional approach was developed and provided to 17 nonmedical and family home caregivers. The training was evaluated utilizing Kirkpatrick’s Four-Level Training Evaluation Model. Participants completed anonymous surveys immediately following the training and 4 to 6 weeks after the training. Survey I (n = 17): Respondents indicated increased knowledge of safe patient handling (94%) and applied knowledge of safe patient handling in training (90%). Survey II (n = 6): Most respondents (67%) indicated that they had applied the knowledge and skills that they had learned in the training. Two respondents (33%) indicated that they had not yet had the opportunity to apply the knowledge and skills they learned. The survey also showed that all respondents believed that the knowledge and skills they had learned helped to decrease the risk of personal injury and injury to patients. Safe patient handling and mobility training utilizing simulation with an interprofessional approach was effective in promoting safety of nonmedical and family caregivers in the home setting. Based on the success of this program, more training opportunities should be implemented to improve patient and caregiver safety.

Impact of California's safe patient handling legislation on musculoskeletal injury prevention among nurses.

This study evaluated the impact of California's safe patient handling (SPH) legislation on musculoskeletal injury prevention among hospital nurses. Two serial cross-sectional surveys were conducted using postal and online questionnaires in statewide random samples of California registered nurses in 2013 and 2016. Analysis included hospital nurses who performed patient handling (n = 254 and n = 281, respectively). In 2016, there were significant improvements in nurses' knowledge of a SPH policy in their hospital (87%), receipt of annual SPH training (73%), and availability of lift equipment (80%); 33% perceived their hospital's SPH programs as excellent or very good. Significant prevalence reduction was observed for work-related musculoskeletal symptoms (61% vs 52%; Adjusted Prevalence Ratio = 0.78, 95% CI 0.66-0.91). Our findings indicate the significant role of SPH legislation with positive impacts on SPH policies and programs at the hospital level and on musculoskeletal health outcomes at the worker level.

Implementation of a Safe Patient Handling Program in a Multihospital Health System From Inception to Sustainability: Successes Over 8 Years and Ongoing Challenges

Implementation of a Safe Patient Handling Program in a Multihospital Health System From Inception to Sustainability: Successes Over 8 Years and Ongoing Challenges

Expediting Return to Work Full Duty with Successful Onsite Medical Management

Abstract 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 48 hours. 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.

Health Care Ergonomics: Contributions of Thomas Waters.

The aim of this study was to assess the contributions of Thomas Waters's work in the field of health care ergonomics and beyond. Waters's research of safe patient handling with a focus on reducing musculoskeletal disorders (MSDs) in health care workers contributed to current studies and prevention strategies. He worked with several groups to share his research and assist in developing safe patient handling guidelines and curriculum for nursing students and health care workers. The citations of articles that were published by Waters in health care ergonomics were evaluated for quality and themes of conclusions. Quality was assessed using the Mixed Methods Appraisal Tool and centrality to original research rating. Themes were documented by the type of population the citing articles were investigating. In total, 266 articles that referenced the top seven cited articles were evaluated. More than 95% of them were rated either medium or high quality. The important themes of these citing articles were as follows: (a) Safe patient handling is effective in reducing MSDs in health care workers. (b) Shift work has negative impact on nurses. (c) There is no safe way to manually lift a patient. (d) Nurse curriculums should contain safe patient handling. The research of Waters has contributed significantly to the health care ergonomics and beyond. His work, in combination with other pioneers in the field, has generated multiple initiatives, such as a standard safe patient-handling curriculum and safe patient-handling programs.

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.

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.

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.

Improving transfer task practices used with air travelers with mobility impairments: A systematic literature review

Manual lifting in healthcare and air transportation is a high-risk activity and a primary cause of musculoskeletal injuries for workers who are required to provide transfer assistance to people with mobility impairments. In the healthcare industry, safe patient-handling programs and policies are accepted as effective ways to prevent worker injury and to improve patient safety. We reviewed evidence-based studies and several websites for disability groups and the airline industry. Seven studies found significant improvements in musculoskeletal comfort levels and declines in musculoskeletal injuries. One study found significant improvements in every musculoskeletal group surveyed. Our review of websites revealed that there were no published research studies or policies about safe handling practices for air travelers. It is evident that passengers with mobility impairments have different expectations for assistance, not congruent with existing services offered by the airline industry.

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.

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.

Effect of a Safe Patient Handling Program on Rehabilitation Outcomes

ObjectiveTo evaluate the effect of a safe patient handling (SPH) program on rehabilitation mobility outcomes. DesignRetrospective cohort study. SettingA rehabilitation unit in a hospital system. ParticipantsConsecutive patients (N=1291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). InterventionsThe SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. Main Outcome MeasuresThe mobility subscale of the FIM. ResultsPatients rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH. ConclusionsSPH programs do not appear to inhibit recovery. Fears among therapists that the use of equipment may lead to dependence may be unfounded.

Letters

Letters

Safe patient handling

Safe patient handling

To Lift or Not to Lift

Musculoskeletal injury is common among nurses as a result of lifting and handling patients. In response to musculoskeletal injuries, safe patient-handling programs are being instituted to decrease the risk of injuries and resulting impaired function. This study was designed to identify patient-handling practices in clinical practice. This qualitative study used 128 hours of observations of patient-handling practices and interviews of 32 nursing staff who discussed these practices. Findings demonstrated five factors impact nurses' judgment regarding the best way to move patients: complexity of everyday care, patient treatment goals, time, knowledge, and equipment issues.