SAFE PATIENT MOVEMENT AND HANDLING: VHA NATIONAL PERSPECTIVE STEPS

1. SAFE PATIENT MOVEMENT AND HANDLING:VHA NATIONAL PERSPECTIVE STEPS Office of Public Health and Environmental Hazards Office of Nursing Services Office of Patient Care Services Tampa PSCI

2. GOALS OF THIS TALK Champion reporting to satisfy VHA CO • Executive Committee • Deputy Under Secretary for Operations and management • Health Systems Committee • Deputy Under Secretary of Health • Under Secretary of Health

3. REPORTING NEEDS: EX COM 10/1/08 F/u on $61,000,000 funding NRM needs for June 08 $s 12/30/08 Estimate of equipment funding Associated FY09 NRM funds Identification of facilities with structural assessment needs 3/331/09 Equipment and NRM funding status Overall progress (Tampa data)

4. REPORTING NEEDS: DUSHOM FY09/Q1 Facility-wide equipment inventory Identification of prior expenditures Unit-based hazard assessment FY09/Q2 Policies, Procedures, protocols Review of injuries Initial peer leader training FY09/Q3 Minimal lift policy FY09/Q4 Facility strategic plan

5. Injury Rates by SIC Codes

6. Injury Type by Fiscal Year

7. # and Rate of Incidents by Skill Mix(from VANOD ASISTS proclarity cube on VSSC) Yellow = Total Emp Count Orange= # of Incidents Blue line= Calc. Rate

8. Incident Rate by Type of Incident(from VANOD ASISTS proclarity cube on VSSC)

9. Type of Incident by Skill Mix(from VANOD ASISTS proclarity cube on VSSC) Lifting & moving patients – most freq. reported injury

10. TOTAL AND PATIENT TRANSFER INJURIES BY GENDER

11. PATIENT TRANSFER INJURY RATES BY GENDER AND NURSING LEVEL

12. TOTAL INJURY RATES BY GENDER AND NURSING LEVEL

13. Patient Transfer Injury Rates and Age

14. WEAKNESSES INHERENT IN ANY BUSINESS CASE JUSTIFICATION APPROACH • Under-reporting of injury and disease • Attention and focus predict long-term consequences • Horse-racing effect

15. SYSTEM NEEDS ASSESSMENT • Data review and call to determine need • VSSC Review • DUSHOM ITEM • Estimation of cost per dependent • Ceiling lifts • Movable equipment • Supplies • Estimates by patient category • BIRN Costs

17. BUSINESS CASE DEFINITIONS

18. BUSINESS CASE CONSIDERATIONS: CALCULATIONS

19. HISTORY OF SPMH in VHA 1998-1999 Tampa program development 1999 HSR&D Tampa SPMH grant (expert panel) IOM Report: Safe Work in the 21st Century 2001-2003 VISN 8 Demonstration project 2001 1st Conference on SPMH 2004 VISN 1 EDM and program roll-out Publications on economics VHA CO staff support for roll-out 2005-2007 VISN 3, 9, 11 initiatives 2006 10N data call on implementation initiatives 2007 SPMH initiative for FY2009-11 budget series 2008 VA * OMB negotiations on 6 vs. 3 year roll-out Concurrence $61,500,000 distributed in June 2008

20. LESSONS RFOM PROGRAM IMPLEMENTATION IN 4 VISNs • 2 years of VISN-level support • .5 FTE facility staff support • Program equipment management • Peer safety leader leadership • Peer Safety Leader functionality (“back injury resource nurses”, “injury prevention nurses”) • Essential element • Issues of fiscal support (“certification” vs step increases)

21. COSTS AND BENEFITS $150,000,000 - equipment and construction $4,000,000 / year - facility champions $5,000,000 / year – injury prevention nurses on each unit $10,000,000 – data system redesign / support ASISTS inadequate WARIMS application to IDMC

22. CONSIDERATIONS:Decision-making criteria • Is program necessary: can VHA afford not to do it? • Does the program pay for itself (when does the program pay for itself) • What happens if we do not implement the program?

23. CONSIDERATIONS • Construction vs. medical programs (80% vs. 20%): need national assessment at facility / patient room level • VISN roll-out experience: 2 – 3 years of VISN support and planning • Facility-level program management: Staff support (program development, leading assessment, equipment maintenance, peer safety leader training and coordination) Likely ~$4,300,000 / year

24. CONSIDERATIONS • Facility level – front-line worker support – peer and coordination) (.1 peer safety leader/injury prevention nurse / shift): $~$5,000,000 / year • IT Support: ASISTS does not address unit level rates, instrumentation/ equipment / track intervention recommendations (Accident Review Board solutions) • Roll-out timing: VISN, facility staffing; facility-level assessment, equipment

25. CONSIDERATIONS • Prior expenditures and early adopters: reimbursement issues (10N solution: include information on actual equipment/construction expenditures) • Budget shifts • Initial estimates: no facility- or unit level coordination • $16,000,000 in initial draft for 3 years of unit-level peer safety leaders • Move to 6 years: inadequate funding

26. CONSIDERATIONS • First year funds expenditures: • Universally needed equipment (lateral sliding devices ~ $15,000,000) • $4,300,000 facility level staffing • Reimbursement (10N model) • Program oversight in CO • Future delays and reimbursement: consequences of 6-year implementation delay and impatience in the field

27. OPTIONS • Option 1: $30,000,000 / yr x 6 • VHA CO staff support, national assessment, facility level support, devolution of program to 10N in ~3 years • Option 2: assign moneys to VISNs without oversight • Option 3: do nothing

28. REPORTING NEEDS 10/1/08 F/u on $61,000,000 funding NRM needs for June 08 $s 12/30/08 Estimate of equipment funding Associated FY09 NRM funds Identification of facilities with structural assessment needs 3/331/09 Equipment and NRM funding status Overall progress (Tampa data)