Saving Healthcare Workers
From Back Injuries
Healthcare Ergonomics
Part I – A Case for Implementation
Massachusetts Care Self-Insurance Group, Inc.
Safety Awareness For Everyone from Cove Risk Services
Healthcare
A growing industry in
need of effective injury
prevention programs.
The Practice of Nursing
...Difficult and
Demanding
How can we make
improvements?
Agenda
Making Improvements
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Where we have been
Where we are
Where we are going
Sharing my thoughts
Sharing your thoughts
What is your opinion on
back injuries?
What are the major
causes?
What are the major
impacts?
Impact of Back Injuries
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Pain
Lost time
Disability
Expense
Inconvenience
The Financial Impact
to the Healthcare Industry
and to Individual Facilities
Who is at risk for back injuries?
What has been tried to prevent
back injuries?
What should be done to prevent
back injuries?
Occupations at Risk for
Strains and Sprains
Total Musculoskeletal Disorders
592.5
Nursing aids, orderlies and attendants
49.1
Truck drivers
43.9
Laborers, non-construction
36.6
Assemblers
19.7
Janitors and cleaners
14.0
Registered nurses
12.4
Stock handlers and baggers
11.3
Construction laborers
10.8
Number (in 1,000s) of work related musculoskeletal disorders involving
time away from work by occupation. BLS
BLS Statistics (U.S. injury data)
How many musculoskeletal disorder (MSD) cases
involved health care patient handling?
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Almost all (97%) of the MSD cases involving patient handling occurred within the health
care and social assistance industry, composing 58 percent of the 67,700 total MSD
cases in that industry.
For MSD cases involving patient handling, almost all (99%) were the result of
overexertion. Sprain, strain, or tear was the type of injury incurred in 83% of the MSD
cases involving patient handling.
Nursing aides, orderlies and attendants incurred occupational injuries or illnesses in
49% of the MSD cases involving health care patients. Registered nurses accounted for
17% and home health aides for another 6%. Other occupations with MSD cases
involving health care patients included licensed practical and licensed vocational
nurses; emergency medical technicians and paramedics; personal and home care
aides; health care support workers; radiologic technologists and technicians; and
medical and health services managers.
Today Nurses are Very
Concerned
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Believe quality of care has deteriorated
Time for patients has declined
Place patient safety ahead of their own
Feel discouraged and powerless
One third under thirty are thinking of leaving
Strikes and walk-outs increasing
The Aging Nursing Work Force
The average age of nurses is
close to 46 years old.
The largest portion of nurses
are in their 50’s.
What are the impacts?
Impact of Nursing Crisis
• As Baby Boomer’s age = increased need
for nurses
• Nurses are burning out
• Severe shortages
• Increased risk of injury
- Insufficient staff
- Higher stress levels
- Risk increases with age
Work Conditions = Caregiver Shortage
• Root cause of nursing and nursing aide
shortage – poor working conditions
• Improving methods for lifting, transferring,
and repositioning can contribute much to
improving working conditions
The Problem of Back Injuries
in Healthcare is Well Recognized
What Have Been Traditional Approaches
for Prevention?
The Comprehensive Approach
…The Back School Concept
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Anatomy and function of the back
Knowledge of physical fitness
General nutrition
Functional evaluations
Stress reduction
Pre-placement screening
Body mechanic and lifting technique
Ergonomics and job design
Can you train staff how to eat?
Can you make them exercise?
Does a bad x-ray predict future injury?
Does Traditional Training
Reduce Back Injuries
Several studies have been unable
to demonstrate the effectiveness of
training in lifting techniques in
preventing back injuries.
Why Have Traditional
Training Programs Failed?
• Difficult to modify behavior and habits
• Lack of follow-up competency checks
• Difficult to apply optimum principles in real
work environment (everyone has different
natural abilities)
• Does use of proper technique remove the
risk to the healthcare worker?
Notice the handles?
No handles here
Understanding Causation
and Investigating Limits
for Manual Lifting
NIOSH Lifting Equation
RWL = LC x HM x VM x DM x AM x FM x CM
LC = Load Constant
HM = Horizontal Multiplier
VM = Vertical Multiplier
DM = Distance Multiplier
AM = Asymmetric Multiplier
FM = Frequency Multiplier
CM = Coupling Multiplier
Ergonomics or
Human Factors Engineering
• Design job tasks to fit the person
• Do not expect the person to adapt
to poor design
What is the engineering control in this picture?
Ergonomics
Move beyond the office
environment and into the patient
care environment
Single Most Important Factor to
Reduce Exposure to Back Injury
ELIMINATE
THE LIFT!
Problems with Patient Handing
Equipment in Years Past
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Poor design
Not available
Not maintained
Improper use
Time
Play Catch Lately?
OUCH!
• Review Current Practices
• Has this ever happened
in your organization?
Proactive vs. Reactive
What is your next step?
Direction for the Future
Massachusetts Care Self-Insurance Group, Inc.
Safety Awareness For Everyone from Cove Risk Services