OSHA Long Term Care Worker Protection Program

1. OSHA Long Term Care Worker Protection Program

2. Describe the OSHA Ergonomic guidelines as they apply to long term care settings. • Identify potential ergonomic hazards in long term care work settings. • Discuss practical solutions to eliminate and/or minimize ergonomic problems in the workplace.

3. The practice of designing equipment and work tasks to conform to the physical capability of the employee; • A means for adjusting the work environment and work practices to prevent injuries before they occur.

4. Strives to assure safe and healthful working conditions; • Mandates that each employer shall provide each employee a place of employment which is free from recognized hazards that are causing or likely to cause death or serious physical harm….

5. Musculosketal Disorders are the Leading Cause of Disability • affects ½ of the nation's work force • 30% to 40% of lost work time injuries/illnesses are related to MSD This is second only to common cold at 40%

6. Pain in the fingers, wrists, shoulders, back, or other parts of the body:  may include a dull aching pain,  a sharp stabbing pain, or even a burning sensation. • Tingling or numbness, particularly in the hands or fingers.  • Swelling, inflammation, or joint stiffness. • Loss of muscle function or weakness.

7. Discomfort or pain in the shoulders, neck, or upper or lower back.  • Extremities turning white or feeling unusually cold. • General feeling of muscle tightness, cramping, or discomfort. • Clumsiness or loss of coordination.  • Range of motion loss.  • Discomfort when making certain movements.

8. OSHA recommends minimizing manual lifting of patients/residents in all cases and eliminating lifting when possible.

9. Key Considerations • Provide Management Support • Involve Employees • Identify hazards and problems • Implement solutions • Response to injuries • Provide training • Evaluate Ergonomics Efforts

10. Demonstrate a commitment to reduce or eliminate patient lifting/moving hazards: * establish a plan * consistent, continuous training of employees in injury prevention * identify appropriate methods and equipment for transfer and lifting of residents, equipment, and supplies by all staff * assure compliance with these methods * help every department to identify potential ergonomic hazards * support reporting and follow-up evaluation of signs/symptoms of back pain or other musculoskeletal injuries

11. Empowering/involving all employees * to report unsafe working conditions * engage employees in identifying hazards and potential solutions * evaluate equipment * participate in developing/updating the organization’s Ergonomics plan/processes. * encourage prompt reporting of any injury

12. Identify existing and potential hazards through careful and on-going assessment of work tasks and routines. * look for duration, frequency, and magnitude of exposure to ergonomic stressors: - force - repetition - awkward postures - vibration - contact stress * do this through observation, workplace walkthroughs, talking with employees, and periodic screening surveys

13. Repetitive: repeatedly making manual adjustments to equipment. • Awkward positions: reaching across objects/beds to lift patients or materials; uncomfortable positions when using computers/chairs/desks in any areas. • Force: pushing wheelchairs/stretchers/supply carts/cleaning equipment across elevation changes, on/off elevators, up ramps. • Heavy lifting: manually lifting heavy patients or equipment alone. • Overexertion: trying to stop a patient or object from falling or picking up a patient or heavy equipment who has fallen.

14. Multiple lifts per shift : more than 20. • Lifting alone: limited available staff to help. • Moving/lifting uncooperative/combative patients. • Moving large objects: cleaning equipment, kitchen equipment, etc. • Moving/lifting patients that cannot support their weight. • Caring for overweight (bariatric) patients. • Ineffective training of employees.

15. Includes implementing and monitoring administrative and engineering controls. * Administrative controls: provide adequate staffing, assessment of ergonomic hazards and needs in all work areas, provide training and monitoring. * Engineering controls: provide appropriate moving and lifting equipment, provide training in safe lifting/moving and use of equipment, keep work areas uncluttered, good lighting of work areas, eliminate uneven floor surfaces, and immediate clean up of spills.

16. Analyze jobs in each area and work environment. • Modify how tasks are done, change the environment, monitor use of appropriate equipment. • Training in lifting, moving for employees; training related to computer workstations/desk areas as appropriate. • Involve physical therapists in training program. * www.osha.gov/desp/success_stories/ergonomics

17. Assess each resident in terms of: * level of assistance they need. * their size and weight. * ability/willingness to understand and cooperate * any medical conditions that could influence the choice of methods for lifting or repositioning. Standardize the process for assessment of each resident.

19. Use lifting equipment when appropriate: * Requires training of all staff that will use it. * Availability of technical services? * Is “charging” of the equipment necessary – must be assigned and checked. * Have two staff involved in using the equipment * Provide careful and complete explanation to the resident before using the equipment.

20. Employee feet solidly planted on ground, shoulder width. • Place resident or object close to you – avoid reaching across bed/distance. • Use lift sheet, slide board, moving equipment as appropriate. • Two people for a lift or repositioning. • If moving to a wheelchair or other movable device, be certain it is locked and in a good position.

21. Use of gait belt. • Be certain the resident transfers to their strong side. • Should not be used to lift. • Secure the belt on the resident, on top of a layer of clothing. • Keep the resident as close to the caregiver as possible.

22. Use bath boards and transfer benches, for residents who have partial weight-bearing. • Be aware of any potential friction between skin and the boards/benches. • Have grab bars and stand bar assists. • Long handled shower heads. • Toilet seat risers with hand rails. • Always important to assess the patient’s ability and comprehension of the moving technique.

23. Bending to make a bed or feed a resident. • Lifting food trays or other items above shoulder or below knee level. • Collecting waste. • Pushing heavy carts. • Bending to remove items (laundry, etc) from large deep carts or reaching into a deep sink. • Removing laundry from washing machines/dryers. These may not present problems in all circumstances.

24. Involve employees in finding the solutions that will work for your setting. • Encourage employees to think carefully before lifting/moving an object or a patient: what is the safest way to do this? • Provide appropriate lifting equipment. • Good work practices based on education and role-modeling is the best! • Other simple solutions?

25. That could present an ergonomic challenge?

26. Key Considerations • Do not over-estimate your ability to lift/move! • Do not over-estimate the resident’s ability – need to assess carefully. • If a box looks light and easy to move, be cautious! • Avoid reaching to move a resident or object. • Look for ergonomic hazards in every area, with every work task.

27. Many people work with computers every day. • May sit or stand at computers. • Evaluation checklist (OSHA Ergonomic Solutions) can be helpful.

28. Top of monitor at or just below eye level. • Head and neck balanced and in-line with torso. • Shoulders relaxed. • Elbows close to body. • Lower back supported. • Wrists and hands in-line with forearms. • Adequate room for keyboard and mouse. • Feet flat on floor. • If using a computer on wheels: can height be adjusted, room for mouse, lighting?

29. A great, easy to use checklist developed by OSHA. • It is in your handouts! • Check the website (www.osha.gov) for more information!

30. Careful, comprehensive management of employees with injuries: * Accurate and prompt reporting of injuries. * Early treatment of injured employees. * “light duty” or “no lifting” work restrictions during recovery periods. * Monitoring of injured employees to identify when they are ready to return to full duty.

31. Critically important to an ergonomic safety program: * For all employees who may encounter a hazard. * Consistent and current. * Provide opportunity for employees to practice and demonstrate safe techniques. * Review reporting of injuries.

32. Occur before the employee lifts or moves or faces any recognized ergonomic hazard. • Review of policies and procedures. • Include demonstrations and return demonstrations. • How to recognize a MSD and early recognition. • Advantages of reporting an injury as soon as possible. • Critical importance of reporting any injury to a supervisor.

33. OSHA requires that employers record each fatality, injury, or illness that: * is work related and * is a new case, and * meets one or more of the criteria as cited in sections 29 CFR 1904.7 through 1904.12 of the regulations.

34. Thorough review of all MSD injuries. • How was the injury managed medically? • Return to work process – was it easy or difficult for the employee? • Identification of ergonomic hazards that were not previously recognized. • Assess outcomes of the injuries. • Solutions – ways to prevent a reoccurrence. • Look for industry-wide data.