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-Centurys 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
• OSHAs Proposed Regulation on Ergonomics Could
  Stimulate Dramatic Improvement - If Made Into Law