Zero Lift Programs in Small Rural Hospitals in Washington State

Proof of Concept Testing of Safe Patient Handling Intervention Using Wearable Sensor Technology

BACKGROUND

Healthcare workers make up one of the occupations in the United States that experience the most musculoskeletal injuries. These injuries are often related to the movement and repositioning of patients. Despite previous injury prevention attempts, injury rates remain at an unsustainable level. The purpose of this proof-of-concept study is to provide preliminary testing of the impact of a lifting intervention on common biomechanical risk factors for injury during high-risk patient movements.; Methods: A before-and-after (quasi-experimental) design was utilized to compare biomechanical risk factors before and after a lifting intervention. Kinematic data were collected using the Xsens motion capture system, while muscle activations were collected with the Delsys Trigno EMG system.

RESULTS

Improvements were noted in the lever arm distance, trunk velocity, and muscle activations during the movements following the intervention; Conclusions: The contextual lifting intervention shows a positive impact on the biomechanical risk factors for musculoskeletal injury among healthcare workers without increasing the biomechanical risk. A larger, prospective study is needed to determine the intervention's ability to reduce injuries among healthcare workers.

Healthcare worker choice and low back force between self-chosen and highest bed height when boosting a patient up in bed

Healthcare workers have a high rate of low back injury due to patient handling tasks. These workers receive training in patient handling methods such as adjusting bed height, but often ignore them. In this study, 35 healthcare workers completed patient boosts at a self-chosen bed height and again with the bed in a higher standardised position. Motion capture and force data were collected for analysis. Given the choice, less than half of participants adjusted the bed at all and none of them moved the bed to the highest position (99.1 cm). The self-chosen bed position yielded significantly higher low back force than the higher position at L4-L5 and L5-S1 (p = 0.02, p = 0.01 respectively). Low back forces can be reduced by raising the bed prior to engaging in patient handling tasks, which is a simple step that can reduce forces placed on healthcare workers' low backs. Practitioner summary: Healthcare workers experience high rates of low back pain secondary to patient handling tasks. In this cross-sectional crossover study, healthcare workers consistently chose a low bed height when boosting a patient, which resulted in higher low back loads compared to the highest bed height.

Interventions to prevent and reduce work-related musculoskeletal injuries and pain among healthcare professionals. A comprehensive systematic review of the literature

INTRODUCTION

Work-related musculoskeletal disorders (WMSDs) are among the main causes of injury and pain in healthcare professionals. Previous reviews provided a fragmented view of the interventions available for WMSDs. This review aims to provide a comprehensive description of interventions for preventing and reducing work-related musculoskeletal injuries and/or pain among healthcare professionals, and to assess the methodological quality of studies.

METHODS

A systematic literature review was performed, based on the Effective Public Health Practice Project process. A comprehensive search was conducted on six peer-reviewed databases and manually. The methodological quality of the studies included was rated as weak, moderate, or strong. The studies were organized based on the 2019 classification of the interventions by Oakman and colleagues.

RESULTS

Twenty-seven articles were included reporting individual (n = 4), task-specific (n = 4), work organization and job design (n = 2), work environment (n = 1), and multifactorial (n = 16) interventions. Overall quality rating was strong for 6 studies, moderate for 16, and weak for 5. Individual interventions such as neuromuscular and physical exercise were effective in reducing pain. Task-specific and work organization interventions could prevent certain injuries. Significant reduction of both injuries and pain resulted from multifactorial interventions, which were reported by the majority of strong (n = 5) and moderate (n = 10) quality articles.

CONCLUSIONS

This review provides healthcare professionals with evidence-based information to plan interventions targeted towards reducing WMSDs. In particular, more efforts are needed to implement and extend effective multifactorial interventions. Moreover, studies about each professional healthcare target group are needed.

PRACTICAL APPLICATION

Our results can guide policy-makers, healthcare managers and professionals to choose the best strategies to prevent and reduce WMSDs and to shape continuous education programs. This study prompts clinicians to develop inter-professional collaborations and to practice physical activities in order to reduce WMSDs.

The effects of patient transfer devices on the risk of work-related musculoskeletal disorders (WMSDs): a systematic review

Objectives. This study aimed to evaluate the efficacy of patient transfer assistive devices in reducing the risk of work-related musculoskeletal disorders (WMSDs) among nurses. Methods. PubMed, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews were searched to identify studies with a quantitative assessment of the efficacy of patient transfer assistive devices on the incidence and injury claims of WMSDs as compared to the manual lifting of patients. A health impact analysis of the pre-post intervention of assistive device implementation was performed. The percentage of the reduction of forces, incidence of WMSDs, number of missed workdays and injury compensation claims were calculated, pooled and presented as boxplots. Results. A total of 25 studies met the inclusion criteria. The best post-intervention outcomes of assistive devices deployment in the healthcare setting included a reduction in WMSD incidence by 59.8%, missed workdays by 90.0% and workers' compensation claims by 95.0%. Additionally, hand force declined by 71% (p < 0.05) and 70% (p < 0.05) with the use of air-assisted devices and ceiling lifts respectively. Conclusions. Overall, the evidence suggests that patient transfer assistive devices, notably ceiling lifts and air-assisted devices, are effective in reducing the risk of WMSDs among nurses.

Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury

Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.

Priority approaches of occupational safety and health activities for preventing low back pain among caregivers

Objectives

The incidence of occupational low back pain (LBP) is high among caregivers. The use of care equipment and training about care methods could prevent LBP among caregivers. However, in care facilities in Japan, these measures are not adequately employed. Moreover, the care facilities have faced issues regarding poor staffing in recent years. The present study investigated the relationship between LBP and occupational safety and health activities (OSHAs) for preventing LBP among caregivers and aimed to validate the priority approaches of OSHA.

Methods

This cross‐sectional study was conducted in care facilities for the elderly in Japan. Questionnaires for administrators and caregivers were distributed to 1,000 facilities and 5,000 caregivers, respectively. Questionnaires completed by 612 facilities and 2,712 caregivers were analyzed.

Results

No direct association was observed between severe LBP and OSHA, but indirect association was done. A significant relationship was noted between severe LBP and the care methods. Direct factors causing severe LBP were lifting a resident using human power and taking an unsuitable posture. These care methods were associated with the following OSHAs: promoting the use of care equipment, training about care methods, and consultation regarding the use of care equipment and employing an appropriate care method with the person in charge.

Conclusions

These OSHAs decreased lifting a resident using human power and taking an unsuitable posture, which are the primary risk factors of LBP. Therefore, these OSHAs should be implemented as priority approaches to prevent LBP among caregivers in care facilities for the elderly.

Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review

OBJECTIVE

The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides.

BACKGROUND

Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry.

METHOD

A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review.

RESULTS

Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies).

CONCLUSION

MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities.

On SHiPs and safety: a journey of safe patient handling in pediatrics

Nursing personnel have consistently been ranked among the top ten professions impacted by musculoskeletal injuries. Inpatient pediatric nurses witnessed an increase in injuries and upon discovering limited evidence applicable to pediatrics, conducted a research study to evaluate the effectiveness of a safe patient handling program. Surveys were distributed to assess risk and workplace safety perceptions. Post-implementation, surveys revealed a statistically significant (p>0.0001) increase in staff perception of workplace safety, reduction in risk perception for several nursing tasks, and reduction in injury related costs. As a result of this program, workplace safety was improved through education and equipment provision.

Differences among nursing homes in outcomes of a safe resident handling program

A large nursing home corporation implemented a safe resident handling program (SRHP) in 2004-2007. We evaluated its efficacy over a 2-year period by examining differences among 5 centers in program outcomes and potential predictors of those differences. We observed nursing assistants (NAs), recording activities and body postures at 60-second intervals on personal digital assistants at baseline and at 3-month, 12-month, and 24-month follow-ups. The two outcomes computed were change in equipment use during resident handling and change in a physical workload index that estimated spinal loading due to body postures and handled loads. Potential explanatory factors were extracted from post-observation interviews, investigator surveys of the workforce, from administrative data, and employee satisfaction surveys. The facility with the most positive outcome measures was associated with many positive changes in explanatory factors and the facility with the fewest positive outcome measures experienced negative changes in the same factors. These findings suggest greater SRHP benefits where there was lower NA turnover and agency staffing; less time pressure; and better teamwork, staff communication, and supervisory support.

Improving transfer task practices used with air travelers with mobility impairments: a systematic literature review

Manual lifting in healthcare and air transportation is a high-risk activity and a primary cause of musculoskeletal injuries for workers who are required to provide transfer assistance to people with mobility impairments. In the healthcare industry, safe patient-handling programs and policies are accepted as effective ways to prevent worker injury and to improve patient safety. We reviewed evidence-based studies and several websites for disability groups and the airline industry. Seven studies found significant improvements in musculoskeletal comfort levels and declines in musculoskeletal injuries. One study found significant improvements in every musculoskeletal group surveyed. Our review of websites revealed that there were no published research studies or policies about safe handling practices for air travelers. It is evident that passengers with mobility impairments have different expectations for assistance, not congruent with existing services offered by the airline industry.

The influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare

AIMS

This study evaluates the influence of individual and organisational factors on nurses' behaviour to use lifting devices in healthcare.

METHODS

Interviews among nurses were conducted to collect individual characteristics and to establish their behaviour regarding lifting devices use. Organisational factors were collected by questionnaires and walk-through-surveys, comprising technical facilities, organisation of care, and management-efforts. Generalised-Estimating-Equations for repeated measurements were used to estimate determinants of nurses' behaviour.

RESULTS

Important determinants of nurses' behaviour to use lifting devices were knowledge of workplace procedures (OR = 5.85), strict guidance on required lifting devices use (OR = 2.91), and sufficient lifting devices (OR = 1.92). Management-support and supportive-management-climate were associated with these determinants.

CONCLUSION

Since nurses' behaviour to use lifting devices is influenced by factors at different levels, studies in ergonomics should consider how multi-level factors impact each other. An integral approach, addressing individual and organisational levels, is necessary to facilitate appropriate implementation of ergonomic interventions, like lifting devices.

It’s not about the hoist: A narrative literature review of manual handling in healthcare

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field.

The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.

Work-related activities associated with injury in occupational and physical therapists

OBJECTIVE

The purpose of this study was to examine work activities associated with work-related injury (WRI) in occupational and physical therapy.

PARTICIPANTS

1,158 occupational and physical therapists in Wisconsin responded to a mailed survey, from a total of 3,297 OTs and PTs randomly selected from the State licensure list.

METHODS

The study used a cross-sectional, survey design. Participants reported information about WRI they sustained between 2004 and 2006, including the activities they were performing when injured. Investigators analyzed 248 injury incidents using qualitative and quantitative analysis.

RESULTS

Data were examined across OT and PT practice in general, and also by practice area. Manual therapy and transfers/lifts were associated with 54% of all injuries. Other activities associated with injury were distinct to practice area, for example: floor work in pediatrics; functional activities in acute care; patient falls in skilled nursing facilities; and motor vehicle activities in home care.

CONCLUSIONS

Injury prevention activities must address transfers and manual therapy, but also must examine setting-specific activities influenced by environment and patient population.

Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel

OBJECTIVE

The aim of this study was to evaluate long-term efficacy of an ergonomics program that included patient-handling devices in six long-term care facilities (LTC) and one chronic care hospital (CCH).

BACKGROUND

Patient handling is recognized as a major source of musculoskeletal disorders (MSDs) among nursing personnel, and several studies have demonstrated effectiveness of patient-handling devices in reducing those MSDs. However, most studies have been conducted in a single facility, for a short period, and/or without a comprehensive ergonomics program.

METHOD

Patient-handling devices along with a comprehensive ergonomics program was implemented in six LTC facilities and one CCH. Pre- and postintervention injury data were collected for 38.9 months (range = 29 to 54 months) and 51.2 months (range = 36 to 60 months), respectively.

RESULTS

Postintervention patient-handling injuries decreased by 59.8% (rate ratio [RR] = 0.36, 95% confidence interval [CI] [0.28, 0.49], p < .001), lost workdays by 86.7% (RR = 0.16, 95% CI [0.13, 0.18], p < .001), modified-duty days by 78.8% (RR = 0.25, 95% CI [0.22, 0.28], p < .001), and workers' compensation costs by 90.6% (RR = 0.12, 95% CI [0.09, 0.15], p < .001). Perceived stresses to low back and shoulders among nursing staff were fairly low. A vast majority of patients found the devices comfortable and safe. Longer transfer times with the use of devices was not an issue.

CONCLUSION

Implementation of patient-handling devices along with a comprehensive program can be effective in reducing MSDs among nursing personnel. Strategies to expand usage of patient-handling devices in most health care settings should be explored.

Patient handling and musculoskeletal disorders among hospital workers: analysis of 7 years of institutional workers' compensation claims data

OBJECTIVES

Musculoskeletal disorders (MSDs) are the most common occupational injuries and illnesses among hospital workers in the United States. To date, there is little in the literature examining the principal effect of patient handling on MSDs. The primary objective of this study was to investigate and confirm the principal effect of patient handling on hospital worker MSDs.

METHODS

Workers' Compensation (WC) claims related to MSDs filed during 2003-2009 by employees in a large US healthcare system were classified using ICD-9. Patient handling, demographic, work, and injury characteristics were obtained. Two multivariable Poisson regression models were compared to evaluate association between risk factors and MSDs. One model contained all risk factors, excluding patient handling; the other model included patient handling.

RESULTS

Among 3,452 claims from 24,824 FTEs, 76% were MSDs. About half of the MSDs involved patient handling. In the regression model without patient handling, EMS workers, women, 50-59 years of age, union members, evening shift workers, and fulltime workers showed associations with MSDs. However, all the observed associations disappeared when patient handling was included in the second regression model; patient handling was the only factor showing an association with MSDs, although the effect was not strong (RR = 1.2, 95% CI = 1.2-1.3).

CONCLUSIONS

All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers.

Patient Handling Methods Taught in Occupational Therapy Curricula

Sixteen of 100 full-time occupational therapists are injured while performing manual patient handling techniques. We developed a Theory of Planned Behavior self-report questionnaire to determine what educators teach and the behavioral constructs that best predict intention to change curriculum content. Traditional manual patient handling and safe patient handling methods were investigated. The results showed that both methods are taught in most programs; however, only 22% stated that they teach safe patient handling as the standard of practice. Stepwise regression analysis demonstrated that attitude and perceived behavioral control are the best predictors of intention to continue teaching manual transfers as the standard; however, normative belief and attitude best predict intention to teach safe patient handling as the standard. Knowing these predictors will assist in developing strategies to promote a paradigm shift in the way patient transfers are taught.

Individual and organisational determinants of use of ergonomic devices in healthcare

OBJECTIVE

This study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities.

METHODS

This cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use.

RESULTS

247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices.

CONCLUSIONS

The use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare.

Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector

INTRODUCTION

Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards.

METHODS

A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions.

RESULTS

The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health.

CONCLUSIONS

The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.