National Emphasis Program in
Nursing & Residential Care
Facilities:
Impact for Safe Lifting & Moving
in Health Care
Dana Root, PT, CPE, CSPHP
Regional Ergonomics
Coordinator, OSHA Region 5
414.297.3315
root.dana@dol.gov
National Emphasis Program for
Nursing and Residential Care Facilities
• Provide guidance to agency compliance staff
– Policies and procedures for targeting and conducting
nursing home inspections
– Focus on the hazards associated with nursing and
residential care.
• BBP, STF, VWP, TB, Ergonomic resident handling stressors
• Why are we here again?
– In 2010 nursing and residential care facilities experienced
one of the highest rates of lost workdays due to injuries
and illnesses of all major American industries.
– No improvement in injury rates over past 10 years
2
National Emphasis Program for
Nursing and Residential Care Facilities
OSHA recommends:
Manual lifting of residents be minimized or eliminated
when feasible, and that mechanical support devices be
used for lifting whenever possible.
•October 2012
–OSHA cited three Wisconsin nursing homes from a large
nursing home chain
–One serious violation of OSHA’s “general duty clause”
–Violation cites each facility for:
• Allowing employees to perform lifting, transferring, repositioning
and assisted ambulation tasks that may cause musculoskeletal
disorders.
3
Illinois Regulations
• Public Act 096-0389 HB2285
– Effective date January 1, 2010
• Restrict, to the extent feasible, manual lifting or
movement
• Assess handling needs of resident
• Educate nurses in the identification, assessment,
and control of risk to injury
• Evaluate alternative ways and strategies
Ergonomic Assessment: Fresh Eyes
• We conduct our investigation the same way that
we think you conduct yours
• Goal: To look at your facility with fresh eyes
– Focus your efforts to minimize/eliminate manual physical
assistance by healthcare provider
– Examine your policy and procedures
• Self Assessment:
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–
–
–
Calculate rates for past 3 years
Observe what you have and what you are doing
Interview staff and management
Review processes to make improvements
5
Fresh Eyes: Policy & Procedures
• Purpose and Scope of the Policy
• Staff responsibilities
–
–
–
–
•
•
•
•
•
NHA
Unit Managers
Therapy
Resident Handlers
Resident assessment
Workplace assessment
Training requirements
Equipment requirements
Medical management
6
Fresh Eyes: Rates
• Information
– OSHA Logs
– Safe Lifting Policy and Procedures
• Calculate the Rates
– Facility DART and Severity Rates
– MSD DART and Severity Rates
– RHIR and RHSR Rates
• Compare 2010 to BLS average DART rates
– Nursing and Residential Care Facilities:
– Resident Handling Incident Rate:
– Private Industry:
5.6
9.6
1.8
RHIR & RHSR for Past Three Years
• Resident Handling Incident Rate
= # OF RH CASES With days away from work job transfer DAYS or Restricted days x 200,000
Resident Handling Hours worked
• Resident Handling Severity Rate
= (days away from work + On job transfer DAYS or Restricted days) x 200,000
Resident Handling Hours worked
8
OSHA 300 Log
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RHIR & RHSR for Past Three Years
• Look at the 300 Log entries:
–
–
–
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Who
Where occurring
When occurring
How occurring
• It is not about body mechanics
– Easier to figure out why injuries are occurring
• Pattern:
– Trend over 3 years
• BLS comparison
– MSD days away rate: 9.6 for 2010
10
Fresh Eyes: Interviews
Resident Handlers
– Employee Issues:
• Training
• Staffing
• Resident assessment
• Communication
• Equipment
– Availability &
storage
– Slings
– Battery
• Workplace constraints
• Injury management
Nurse and Therapy Managers
– Operational Issues:
• SPH policy and procedures
• Resident assessment process
• Staffing levels
• Equipment & slings
• Storage
• Space constraints
• Training and competency
• Medical management supervision
11
Fresh Eyes: Resident Assessment
OSHA recommends:
Manual lifting of residents be minimized or eliminated when
feasible, and that mechanical support devices be used for lifting
whenever possible.
• Resident assessment:
–Algorithms (see page 12)
–MDS: Resident Assessment Instrument
• ADL Support Provided versus ADL Self-Performance
–FIM: Functional Independence Measure
–Develop own facility assessment tool
12
Fresh Eyes: Resident Assessment
• Tool to guide decision making
• Based on
– Patient’s ability
– Equipment availability
• Standardizes practice
• Guides for planning handling tasks
– “Tools not rules”
• Clinical judgment still needed
• Manual lifting of residents be
minimized in all cases and eliminated
when feasible
Fresh Eyes: Resident Assessment
Fresh Eyes: Resident Assessment
•
Functional Independence Measure (FIM)
– 7 level functional assessment scale of resident's actual performance
• Evaluates the amount of assistance required to perform basic life activities
• Need for assistance from another person or a device
• Measures what the resident actually does
Independent
7 Complete Independence
8 Modified independence – requires assistive device, …..
Modified Dependence – resident expends 50% or more of the effort
5 Supervision (setup) – without physical contact by helper, or applies assistive
device
4 Minimal Contact Assistance – resident expends 75% of effort
3
Moderate Assistance – resident expends between 50% to 75% effort
2
Maximal Assistance – resident expends between 25% to 50% of effort
1 Total Assistance – resident expends less that 25% of effort
15
Fresh Eyes: Resident Assessment
• Egress Test
– Purpose: To facilitate the safe progression of a resident’s
debut transfer through repetitions
1.
2.
3.
Three repetition of sit to stand
Three steps of marching in place
Advance step and return each foot
– If, during any part of the Egress Test, the resident
demonstrates difficulty or need for physical assistance
beyond cues and/or guarding techniques, the resident is
indicated for mechanical conveyance.
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Fresh Eyes: The Care Plan
• What is on the care plan is what the resident handler must
perform
– Depending on the facility policy
• May take the more supportive method
• Manual lifting of residents be minimized or eliminated when
feasible, and that mechanical support devices be used for
lifting whenever possible.
• Restrict, to the extent feasible, manual lifting or movement
17
Fresh Eyes: Equipment:
• Equipment
– Full Body Lifts
• Floor based or ceiling
– Repositioning Aids
– Stand-Assist or Sit/Stand
Devices
• Active versus passive
– Ambulation Devices
– Bariatric devices
• Slings
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–
–
–
Sizes
Task types
Backup sling availability
By vendor
• Battery
– Charging location
– Charging schedule
• Scheduled maintenance
18
Fresh Eyes: Resident Handler Focus
Protect the Resident Handler
Establish a written program
• Admission policy
– Prevent MSD injury to
resident handlers
• How residents are assessed
• Competent in procedures
for lifting and moving
residents
• Appropriate equipment for
the task
Monitor resident handling injuries
• Track and Trend
– By year, by shift, by wing, by xxx
• Compare
– BLS, between shifts, departments,
sites
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Investigation Findings
• Integrate System-wide Findings
– Rates
– Observations
– Perspectives
• Are MSD injuries occurring from manual resident
handling?
– RHI rates above 9.6
• Why?
– What needs to be improved?
– How to improve it?
– Who will improve it?
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Resource Guides
http://www.cdc.gov/niosh/topics/ergonomics/
http://www.visn8.med.va.gov/patientsafe
tycenter/safePtHandling/default.asp
http://www.aohp.org/A
bout/documents/GSB
eyond.pdf
www.osha.gov/SLTCergon
omics/index.html