Injuries in Nursing Homes

1. Injuries in Nursing Homes • Nursing Homes are ranked fifth among all industries for low back injuries • 17 Injuries For Every 100 Full Time Workers • Nursing Home Workers Have the Most Injuries Related to Overexertion of Any Industry (no. 1 for overexertion) • Injuries Rose 55% in the Last Decade

2. Why Injuries Are Increasing • Pressure in the Industry to Drive Down the Price of Health Care • Nursing Home Sector Seeing More Acutely Ill Patients - Hospitals Move Patients Out Faster • More Acutely Ill Patients Means More Dependant Patients who Requires More Handling

3. Other Injury Risks • Nursing (in general) has the highest rate of Falls to the Floor on the Same Level of any Group of Workers • 96 Cases per 10,000 workers • Lack of Adequate Housekeeping Staff Contributes to Slipping/Falling Problem

4. Risks for Injury: Patient Handling Tasks • Frequent Manual Lifting of Patients is the Primary Risk • Two-person Manual Lift is the most common patient transfer method • Average Nursing Home Worker Lifts More Than 10,000 Human Pounds Per Day

5. Other Stressful Tasks • Lifting Patient Up in Bed • Weighing Patient • Repositioning Patient • Making Bed With Patient In It • Making Bed Without Patient In It • Lifting Carrying Equipment or Supplies

6. Hoists Have Not Worked • One study found that mechanical hoists were used for only 2% of patient transfers • The reasons for not using hoists: • hoist not available • takes too much time • lack of staffing • the physical effort required to use hoist

7. For Dependant Weight Bearing Patients • For patient transfers, the two-person walking belt was found to be least physically stressful among several methods • Using a pulling technique (not lifting) was important to minimize stress to the worker • Training of workers to use the pulling technique with walking belts was required

8. Lifting Devices Differ Widely • Several Mechanical Lifting Devices were compared • Arjo-Century’s Ambulift Device was found to be least physically stressful to workers • Hoyer Lifts were found to be as physically stressful as manual lifting of patients

9. Comparing Three Lifting Devices • Using Hoyer lifts is more physically stressful than most manual methods • Trans-Aid lifts reduced physical stress compared to manual methods • Arjo-Century lift was least stressful mechanical device, and patients preferred this device (felt more secure)

10. Staff to Patient Ratio • Inadequate staffing is a major obstacle to injury prevention efforts • Many transfers require two workers, but are performed by one worker • Lifting Teams have been used successfully in hospital settings to dramatically reduce workers compensation losses

11. Adequate Equipment • Adequate equipment includes: • Walking Belts • Shower Chairs • Shower Chairs fit over toilet • Shower Chair fits easily into shower • Adaptive Clothing as needed

12. Ergonomics Efforts Do Work • In one study losses were reduced by 50% by making ergonomic improvements • Classifying patients and applying consistent transfer methods per category was important • Compliance Required Adequate Staff to Patient Ratio

13. Classifying Patients • dependent/non-weight bearing • dependent/weight bearing • independent

14. Patient Handling Per Classification • non-weight bearing: Use Mechanical Device • weight bearing dependant: Use Two-Person Walking Belt with Pulling Technique • independant: Patient Moves on Their Own

15. Lifting Team Approach • Also relies on classifying patients into categories • Lifting Team specially trained in each method or patient category • Lifting Team adheres strictly to prescribed methods per category • Adequate staffing ensured by Lifting Team approach

16. Lifting Team Approach • Team members selected for strength, ability • Nurses and Nurses Aids free to perform other tasks • May increase number of Full Time Equivalents (FTE) required • Has been cost-effective in hospital settings due to reductions in injuries and costs

17. Administrative Issue • Handling of Patients By Prescribed Method Per Patient Classification Required • Compliance Must Be Monitored and Enforced/Reinforced • Adequate Staffing is Required for Compliance

18. Other Equipment • Adjustable height beds • Slings attached to beds • Adequate number of mechanical lifts • Adequate type of mechanical lift

19. Most Stressful Tasks • Ratings of Perceived Exertion has been useful in job/task evaluations of nursing home tasks • Transfers from wheelchair to toilet was most stressful task • Transfers from chair to bed also stressful • Two-person manual lifting method most stressful of several methods examined

20. Walking Belts and Gait Belts • Walking belts differ from gait belts in that they have handles and better secure the patient • For best results with walking belt method, nurses were instructed “Pull with your hand, not your back. Do not lift” • Many nurses have old habit of lifting when transferring - which must be “unlearned”

21. Improving Ergonomic Conditions • Consistent Use of Lifting Devices for Non-Weight Bearing Patients • Easily Adjustable Chair and Bed Heights • Adequate Staff to Patient Ratio - Increase Staff if Necessary • Training in Proper Techniques • Walking-Belts With Pulling Method

22. Standards and Regulatory • OSHA Launced an Initiative To Improve Conditions for Nursing Home Workers in 1996 • Unions Pushing for Enforceable Staffing Standards • OSHA’s Proposed Regulation on Ergonomics Could Stimulate Dramatic Improvement - If Made Into Law