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: – – – – 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 9 RHIR & RHSR for Past Three Years • Look at the 300 Log entries: – – – – 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. 16 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 – – – – 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 19 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? 20 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