Dana Root, PT, CPE, CSPHP Regional Ergonomics Coordinator, OSHA Region 5 414.297.3315

1. 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

2. 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

3. 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. 

4. 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

5. 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

6. 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

7. Fresh Eyes: Rates • Information • OSHA Logs • Safe Lifting Policy and Procedures • Calculate the Rates • FacilityDART and Severity Rates • MSD DART and Severity Rates • RHIR and RHSR Rates • Compare 2010 to BLS average DART rates • Nursing and Residential Care Facilities: 5.6 • Resident Handling Incident Rate: 9.6 • Private Industry: 1.8

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

9. OSHA 300 Log

10. 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

11. Fresh Eyes: Interviews Resident Handlers • Employee Issues: • Training • Staffing • Resident assessment • Communication • Equipment • Availability & storage • Slings • Battery • Workplace constraints • Injury management • Operational Issues: • SPH policy and procedures • Resident assessment process • Staffing levels • Equipment & slings • Storage • Space constraints • Training and competency • Medical management supervision Nurse and Therapy Managers

12. 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

13. 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

14. Fresh Eyes: Resident Assessment

15. 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 • Complete Independence • Modified independence – requires assistive device, ….. Modified Dependence – resident expends 50% or more of the effort • Supervision (setup) – without physical contact by helper, or applies assistive device • 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

16. Fresh Eyes: Resident Assessment • Egress Test • Purpose: To facilitate the safe progression of a resident’s debut transfer through repetitions • 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.

17. 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

18. 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 • Scheduled maintenance • Slings • Sizes • Task types • Backup sling availability • By vendor • Battery • Charging location • Charging schedule

19. Fresh Eyes: Resident Handler Focus Protect the Resident Handler Monitor resident handling injuries Track and Trend By year, by shift, by wing, by xxx Compare BLS, between shifts, departments, sites 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

20. 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?

21. Resource Guides http://www.cdc.gov/niosh/topics/ergonomics/ http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp http://www.aohp.org/About/documents/GSBeyond.pdf www.osha.gov/SLTCergonomics/index.html