SAFE PATIENT HANDLING IN
WASHINGTON HOSPITALS
Your guide to a safer healthcare environment
On the phone…
Chris
Barton
SEIU
1199NW
Dan
Donahue
Providence
St. Peter
Hospital
Lynn
LaSalle
MultiCare
Health
System
Barbara
Silverstein
Department
of Labor &
Industries
Brenda
Suiter
Washington
State
Hospital
Association
Credo
“Patients should not be
harmed by the care that is
intended to help them, nor
should harm come to those
who work in health care”
Crossing the Quality Chasm, 2001
Agenda

Safe Patient Handling Law Background

Safe Patient Handling Website

Law Timelines

Equipment requirements and funding

Questions
Safe Patient Handling Legislation


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Governor Gregoire signed Engrossed
Substitute House bill 1672 on March 22,
2006
Bill became law on June 21, 2006
Legislation makes safe patient handling
part of how hospitals provide care by
adding this requirement to DOH hospital
licensing requirements
Background
The law was supported by:


Service Employees International Union
Local 1199NW
United Food & Commercial Workers’
Union

Washington State Hospital Association

Washington State Nurses Association
Why was the law enacted?


To improve the safety of healthcare
employees and patients
Provide funding to hospitals implementing
safe patient handling programs

To improve nurse retention

To reduce costs to hospitals
We Know…
Nurses lift an estimated 2
tons per shift
Do the math:
Number of patients/day
Number of lifts/patient
Average weight/patient
4 X 6 X 170 = 4,080lbs/day
We know…


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38% of nurses suffer work-related back
injuries requiring time away from work
12% of nurses consider leaving nursing due
to low back pain at average age 39
Nurse aides have also experienced
significant injury
“Zero-Lift” Program

Lifting programs have been proven to be
effective. WHS’s Workers’ Compensation
“Zero Lift Program” has experienced
remarkable success:


Patient Handling injuries had decreased by 43%
Time loss frequency rates had decreased by 50%
Safe Patient Handling
Steering Committee

Collaboration developed to provide tools and
models that will help hospitals implement safe
patient handling programs.
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
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Healthcare Unions
Department of Labor & Industries
Physical and Occupational Therapists
Employee Health Managers
Urban and Rural Hospital Administrators
Washington State Hospital Association
Washington Hospital Services’ Workers’
Compensation Program
Law Timelines



February 1, 2007 – establish safe patient
handling committee
December 1, 2007 – implement safe patient
handling program
January 30, 2010 – acquire lifting
equipment
Enforced by the Department of Health
Poll Question
Flow Chart
February 1, 2007
Establish a safe patient handling
committee with at least half of the
committee being direct care staff
Establishing a Committee



Recruit Participants (50% direct care
staff)
Elect committee chair and co-chair
Develop meeting schedule and
protocols
The primary responsibility of the committee is to
establish, implement and monitor the Safe Patient
Handling Program.
Labor Management
The Steering Committee recommends
union involvement in committee
development and decision making
Poll Question
December 1, 2007
Establish a safe
patient handling program
Safe Patient Handling
Program
1.
2.
3.
4.
5.
Safe patient handling program shall include and
hospitals must:
Implement a safe patient handling policy
Conduct a safe patient handling hazard
assessment
Develop a process to identify the appropriate use
of the safe patient handling policy based on
patient needs and availability of equipment
Conduct an annual performance evaluation
Consider the feasibility of incorporating
equipment when constructing or remodeling a
hospital
Establishing a Safe
Patient Handling Program
1. Implement a safe patient handling policy for
all shifts and units of the hospital
It is recommended your safe patient handling
committee draft a policy together
2. Conduct patient handling hazard assessment.
Include variables such as patient handling
tasks, types of nursing units, patient
populations, and the physical environment
Establishing a Safe
Patient Handling Program
3. Facilitate the development of standards
for assessing each patient and their
activities
A. Get input for department staff
B. Include how to document and share
information across shifts and departments
C. Consider using algorithms
Establishing a Safe
Patient Handling Program
4. Conduct an annual performance
evaluation of the program to determine its
effectiveness-report results to your safe
patient handling committee
5. When developing architectural plans,
consider the feasibility of incorporating
patient handling equipment into the
design
What Makes a Successful Program?
Analyze what works already in your hospital:

Existing practices

Attitudes about change

Administration’s support

Organizational culture

Barriers to change

Current patient flow
Know Current Practices


Department practices and techniques
already used for handling their patient
population
Who is influential in each department
the leaders of co-workers
Educate Your Hospital

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Committee members to their role on the
team, empower them to do their work
Management - for staffing, so team
members can attend meetings and do their
work
Keep the committee informed of their
accomplishments so they feel successful
Campaign – Build Momentum

Use every modality possible to share what
is being planned and implemented:

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Recruit an Administration sponsor who will
speak directly to the care givers
Design in accountability of managers,
supervisors, charge nurses, house supervisors
and direct care givers; to know when the team
meetings occur, who the members are,
department’s need for equipment, what
systems and techniques will change, processes
for acquiring what they need, etc.
Inform Your Patients, Families, and Visitors

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Advertise in brochures, newsletters,
hospital bulletin boards
Create expectations
Make the work of the committee public,
positive and rewarding
Please visit website to view a sample marketing materials
Individual Patient Assessment
Risk & Needs Assessment

Measures to eliminate or reduce
patient handling risks must be
identified
Conduct an analysis of injuries
 Identify and prioritize patient handling
risks
 Assess patient mobility needs
 Conduct an inventory of patient handling
equipment
 Identify environmental and system barriers

Learn From Your Mistakes
Conduct annual performance evaluations
of the:

System’s policy

Committee’s work

Program effect on injuries & falls

Equipment Use
Annual Performance Evaluation
Change Can Be Hard
Have activities with rewards for individual
care givers and departments:

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Informal brown-bag lunches
Departments can compete against each
other

Rodeos
A Successful Program

Adheres to the requirements of the law
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Meets all deadlines

Uses the available tools

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Involves your safe patient handling team in
decision making
Shares experiences, ask questions
Washington Regulatory Requirements1

When developing architectural plans for
constructing or remodeling a hospital or
unit, the hospital must consider the
feasibility of incorporating patient handling
equipment or design needed to incorporate
equipment later.
1RCW
70.41.390
Before The Blue Prints
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Get all levels of staff
involved
Think about all possible
scenarios
Place real users in a mock
up of the design concept
and simulate simulation
Full scale simulation with
props or3-D computer
simulations
Working Space Transfer to Bed
(Add 12” all around the bed for bariatric patient)

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Transfer bed /wheel
chair or bed to
stretcher: 1500 mm 5’
Transfer with floor lift
or bed/geriatric chair
1800 mm 6’ (ceiling
lift saves 12”)
Space for care giver
and rest chair 100 mm
39”
Door room width
1220 mm (48”) for
bariatric patient
*Adapted from Jocelyn Villeneuve,
Design for Safe Patient Handling
Single Bed/Bath Room Layout

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Total Space ~180 sq ft
Side nearest the door 6’
for a transfer involving
floor device add 12” for
bariatric

Window side 47”

Foot of Bed 47”

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Bed faces the door
privacy maintained
with curtain, better
observation and transfer
(working) space
Door width 1220 mm
(48”) for bariatric patient
Bathroom Space
Make sure equipment,
staff and patient can fit in
space.
• 36” door
• 24” minimum clearance on
each side of toilet
• Retractable bars attached
to wall for client transfers
assisted by 1-2 care givers
• Wheel Chair rotation 5’
diameter
• Toilet weight tolerance
needs to be 600+ lbs
January 1, 2008


A hospital shall develop procedures for hospital
employees to refuse to perform or be involved in
patient handling or movement that the hospital
employee believes in good faith will expose a
patient or a hospital employee to an unacceptable
risk of injury.
A hospital employee who in good faith follows
the procedure developed by the hospital in
accordance with this subsection shall not be the
subject of disciplinary action by the hospital for
the refusal to perform or be involved in the
patient handling or movement.
Employee Rights

Hospitals MUST develop procedures for
employees to refuse to perform or be involved
in patient handling or movement task that the
employee believes “in good faith” will expose
a patient or employee to an unacceptable risk
of injury
Please visit website to view a model policy
http://www.washingtonsafepatienthandling.org/image
s/Refusal_final.pdf
January 30, 2010

Each hospital must complete, at a
minimum, acquisition of their choice of:

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One readily available lift per acute care unit on
the same floor unless the safe patient handling
committee determines a lift is unnecessary in
the unit;
One lift for every ten acute care available
inpatient beds; or
Equipment for use by lift teams
Hospitals must train staff on policies,
equipment, and devices at least annually
January 30, 2010

Acquire equipment using your hazard
assessment, injury data and with the input
of the hospital’s safe patient handling
committee
Acquire Equipment




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Step 1: Establish a safe patient handling
committee (50% direct care staff)
Step 2: Train the safe patient handling
committee
Step 3: Write your Safe Patient Handling
Policy
Step 4: Assess the risks and needs for each
unit in your hospital
Step 5: Plan for the purchase of equipment
Our “Challenge” Is:
Getting the Equipment & Changing Practice…
Getting from manual
handling…
To safe patient
handling…
Where is High Injury Risk Exposure?
Inpatient Rooms*
(+ OR, PACU, Rehab)

Repositioning

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Move up, roll, clean
Transferring

Bathroom/Commode

Walking

Bed to Gurney
 Bed to Chair
*Biomechanical Evidence… William Marras,
PhD, CPE
Example of continuous track
from patient room to bathroom
Where to put track…

Committee Decision – Need/Data Driven

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Remodel Driven

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CCU-Tele-Neuro-Med/Renal-Rehab
Or combo data/remodel, needs to be cleared
w/committee
“Track” As Many Rooms As Possible*

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Fixed Lifts – view rooms, plus as follows…
 Isolation Rooms
 CCU
 Known heavy low mobile patient care areas
Portables (475 lb capacity) 1 per 5 rooms
 Use until you have budget for fixed lifts
*Tampa General Model
Patient Transfer Devices

Floor lifts/Bariatric Room Set-up
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Slider Transfer Sheets
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Repositioning, floor to bed, bed to chair
Beds
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Lateral and horizontal transfer
Ceiling Lifts
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From floor, chair, bed, also sit to stand
& walking
Chair posit., flexi-foot, Trendelenburg
Transport devices

Zoom stretcher, bariatric stretcher,
“Ergo-tug”
This is a cut out of our transfer device locator
Ceiling Lifts
Portable lift on gantry
(xy) configuration
Pam working
with training
dummy and
ceiling lift.
Seated universal
sling
Repositioning is easy
Full body
repositioning sling
December 30, 2010
A hospital may take a credit for the cost
of purchasing mechanical lifting
devices and other equipment that are
primarily used to minimize patient
handling by health care providers,
consistent with a safe patient handling
program developed and implemented
by the hospital
B&O Tax Credit

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All hospitals qualify for the B&O Tax
Credit
Hospitals can receive up to $1000 per acute
care available inpatient bed
The number of acute care available
inpatient beds in each hospital is based on
the year-end financial reports submitted to
the Department of Health
Form can be downloaded at:
http://www.washingtonsafepatienthandling.org/images/B_O_tax_
form.pdf
Poll Question
The Patient Handling Bible
In Summary

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Use hazard assessment, injury data and
committee to make equipment
acquisitions
Equipment: key points
Engage your facilities staff & give
ergonomic input for construction remodel
design
Think BIG and spend lots!
Thank you
Service Employees
International Union Local
1199NW
Washington State Nurses
Association
Regional Hospital
Regional Hospital for
Respiratory and Complex
Care
Valley Medical Center
Multicare
St. Mary Medical Center
Valley General Hospital
United Food & Commercial
Workers Union Local 21
Harrison Medical Center
Kittitas Valley Hospital
United Food & Commercial
Workers Union Local 141
Providence St. Peter
Hospital
Empire Health Services
Department of Labor &
Industries
Washington State Hospital
Association
Swedish Medical Center
WHS Workers’
Compensation Program
Thank you
Chris
Barton
SEIU
1199NW
Dan
Donahue
Providence
St. Peter
Hospital
Lynn
LaSalle
MultiCare
Health
System
Barbara
Silverstein
Department
of Labor &
Industries
Brenda
Suiter
Washington
State
Hospital
Association
Questions
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