Injuries in Nursing Homes

Nursing Homes are ranked fifth among all Nursing Homes are ranked fifth among all industries for low back injuriesindustries for low back injuries

17 Injuries For Every 100 Full Time 17 Injuries For Every 100 Full Time WorkersWorkers

Nursing Home Workers Have the Most Nursing Home Workers Have the Most Injuries Related to Injuries Related to OverexertionOverexertion of Any of Any Industry (no. 1 for overexertion)Industry (no. 1 for overexertion)

Injuries Rose 55% in the Last DecadeInjuries Rose 55% in the Last Decade

Why Injuries Are Increasing

Pressure in the Industry to Drive Down the Pressure in the Industry to Drive Down the Price of Health CarePrice of Health Care

Nursing Home Sector Seeing More Acutely Nursing Home Sector Seeing More Acutely Ill Patients - Hospitals Move Patients Out Ill Patients - Hospitals Move Patients Out FasterFaster

More Acutely Ill Patients Means More More Acutely Ill Patients Means More Dependant Patients who Requires More Dependant Patients who Requires More Handling Handling

Other Injury Risks

Nursing (in general) has the highest rate of Nursing (in general) has the highest rate of Falls to the Floor on the Same Level Falls to the Floor on the Same Level of any of any Group of WorkersGroup of Workers

96 Cases per 10,000 workers96 Cases per 10,000 workers Lack of Adequate Housekeeping Staff Lack of Adequate Housekeeping Staff

Contributes to Slipping/Falling ProblemContributes to Slipping/Falling Problem

Risks for Injury: Patient Handling Tasks

Frequent Manual Lifting of Patients is the Frequent Manual Lifting of Patients is the Primary RiskPrimary Risk

Two-person Manual Lift is the most Two-person Manual Lift is the most common patient transfer methodcommon patient transfer method

Average Nursing Home Worker Lifts More Average Nursing Home Worker Lifts More Than 10,000 Human Pounds Per DayThan 10,000 Human Pounds Per Day

Other Stressful Tasks

Lifting Patient Up in BedLifting Patient Up in Bed Weighing PatientWeighing Patient Repositioning PatientRepositioning Patient Making Bed With Patient In ItMaking Bed With Patient In It Making Bed Without Patient In ItMaking Bed Without Patient In It Lifting Carrying Equipment or SuppliesLifting Carrying Equipment or Supplies

Hoists Have Not Worked

One study found that One study found that mechanical hoists mechanical hoists were used for only 2% were used for only 2% of patient transfersof patient transfers

The reasons for not using hoists:The reasons for not using hoists: hoist not availablehoist not available takes too much timetakes too much time lack of staffinglack of staffing the physical effort required to use hoistthe physical effort required to use hoist

For Dependant Weight Bearing Patients

For patient transfers, the two-person For patient transfers, the two-person walking belt was found to be least walking belt was found to be least physically stressful among several methodsphysically stressful among several methods

Using a pulling technique (not lifting) was Using a pulling technique (not lifting) was important to minimize stress to the workerimportant to minimize stress to the worker

Training of workers to use the pulling Training of workers to use the pulling technique with walking belts was requiredtechnique with walking belts was required

Lifting Devices Differ Widely

Several Mechanical Lifting Devices were Several Mechanical Lifting Devices were comparedcompared

Arjo-Century’s Ambulift Device was found Arjo-Century’s Ambulift Device was found to be least physically stressful to workersto be least physically stressful to workers

Hoyer Lifts were found to be as physically Hoyer Lifts were found to be as physically stressful as manual lifting of patientsstressful as manual lifting of patients

Comparing Three Lifting Devices

Using Hoyer lifts is more physically Using Hoyer lifts is more physically stressful than most manual methodsstressful than most manual methods

Trans-Aid lifts reduced physical stress Trans-Aid lifts reduced physical stress compared to manual methodscompared to manual methods

Arjo-Century lift was least stressful Arjo-Century lift was least stressful mechanical device, and patients preferred mechanical device, and patients preferred this device (felt more secure)this device (felt more secure)

Staff to Patient Ratio

Inadequate staffing is a major obstacle to Inadequate staffing is a major obstacle to injury prevention effortsinjury prevention efforts

Many transfers require Many transfers require twotwo workers, but are workers, but are performed by performed by one one workerworker

Lifting Teams Lifting Teams have been used successfully have been used successfully in hospital settings to dramatically reduce in hospital settings to dramatically reduce workers compensation lossesworkers compensation losses

Adequate Equipment

Adequate equipment includes:Adequate equipment includes: Walking BeltsWalking Belts Shower ChairsShower Chairs Shower Chairs fit over toiletShower Chairs fit over toilet Shower Chair fits easily into showerShower Chair fits easily into shower Adaptive Clothing as neededAdaptive Clothing as needed

Ergonomics Efforts Do Work

In one study losses were In one study losses were reduced by 50% reduced by 50% by making ergonomic improvementsby making ergonomic improvements

Classifying patients and applying consistent Classifying patients and applying consistent transfer methods per category was transfer methods per category was importantimportant

Compliance Required Adequate Staff to Compliance Required Adequate Staff to Patient RatioPatient Ratio

Classifying Patients

dependent/non-weight bearingdependent/non-weight bearing dependent/weight bearingdependent/weight bearing independentindependent

Patient Handling Per Classification

non-weight bearing: non-weight bearing: Use Mechanical Use Mechanical DeviceDevice

weight bearing dependant: weight bearing dependant: Use Two-Person Use Two-Person Walking Belt with Pulling TechniqueWalking Belt with Pulling Technique

independant: independant: Patient Moves on Their OwnPatient Moves on Their Own

Lifting Team Approach

Also relies on classifying patients into Also relies on classifying patients into categoriescategories

Lifting Team specially trained in each Lifting Team specially trained in each method or patient categorymethod or patient category

Lifting Team adheres strictly to prescribed Lifting Team adheres strictly to prescribed methods per categorymethods per category

Adequate staffing ensured by Lifting Team Adequate staffing ensured by Lifting Team approachapproach

Lifting Team Approach

Team members selected for strength, abilityTeam members selected for strength, ability Nurses and Nurses Aids free to perform Nurses and Nurses Aids free to perform

other tasksother tasks May increase number of Full Time May increase number of Full Time

Equivalents (FTE) requiredEquivalents (FTE) required Has been cost-effective in hospital settings Has been cost-effective in hospital settings

due to reductions in injuries and costsdue to reductions in injuries and costs

Administrative Issue

Handling of Patients By Prescribed Method Handling of Patients By Prescribed Method Per Patient Classification RequiredPer Patient Classification Required

Compliance Must Be Monitored and Compliance Must Be Monitored and Enforced/ReinforcedEnforced/Reinforced

Adequate Staffing is Required for Adequate Staffing is Required for ComplianceCompliance

Other Equipment

Adjustable height bedsAdjustable height beds Slings attached to bedsSlings attached to beds Adequate number of mechanical liftsAdequate number of mechanical lifts Adequate type of mechanical liftAdequate type of mechanical lift

Most Stressful Tasks

Ratings of Perceived Exertion has been Ratings of Perceived Exertion has been useful in job/task evaluations of nursing useful in job/task evaluations of nursing home taskshome tasks

Transfers from Transfers from wheelchair to toilet wheelchair to toilet was most was most stressful taskstressful task

Transfers from Transfers from chair to bed chair to bed also stressfulalso stressful Two-person Two-person manual lifting manual lifting method most method most

stressful of several methods examinedstressful of several methods examined

Walking Belts and Gait Belts

Walking belts differ from gait belts in that Walking belts differ from gait belts in that they have handles and better secure the they have handles and better secure the patientpatient

For best results with walking belt method, For best results with walking belt method, nurses were instructed nurses were instructed “Pull with your “Pull with your hand, not your back. Do not lift”hand, not your back. Do not lift”

Many nurses have old habit of lifting when Many nurses have old habit of lifting when transferring - which must be “unlearned”transferring - which must be “unlearned”

Improving Ergonomic Conditions

Consistent Use of Lifting Devices for Non-Consistent Use of Lifting Devices for Non-Weight Bearing PatientsWeight Bearing Patients

Easily Adjustable Chair and Bed HeightsEasily Adjustable Chair and Bed Heights Adequate Staff to Patient Ratio - Increase Adequate Staff to Patient Ratio - Increase

Staff if NecessaryStaff if Necessary Training in Proper TechniquesTraining in Proper Techniques Walking-Belts With Pulling MethodWalking-Belts With Pulling Method

Standards and Regulatory

OSHA Launced an Initiative To Improve OSHA Launced an Initiative To Improve Conditions for Nursing Home Workers in Conditions for Nursing Home Workers in 19961996

Unions Pushing for Enforceable Staffing Unions Pushing for Enforceable Staffing StandardsStandards

OSHA’s Proposed Regulation on OSHA’s Proposed Regulation on Ergonomics Could Stimulate Dramatic Ergonomics Could Stimulate Dramatic Improvement - If Made Into LawImprovement - If Made Into Law