Saving Healthcare Workers From Back Injuries Healthcare Ergonomics Part I – A Case for Implementation Massachusetts Care Self-Insurance Group, Inc. S afety A wareness F or E veryone from Cove Risk Services

Healthcare A growing industry in need of effective injury prevention programs.

The Practice of Nursing...Difficult and Demanding How can we make improvements?

Agenda Making Improvements Where we have been Where we are Where we are going Sharing my thoughts Sharing your thoughts

What is your opinion on back injuries? What are the major causes? What are the major impacts?

Impact of Back Injuries Pain Lost time Disability Expense Inconvenience

The Financial Impact to the Healthcare Industry and to Individual Facilities

Who is at risk for back injuries? What has been tried to prevent back injuries? What should be done to prevent back injuries?

Occupations at Risk for Strains and Sprains Number (in 1,000s) of work related musculoskeletal disorders involving time away from work by occupation. BLS Total Musculoskeletal Disorders592.5 Nursing aids, orderlies and attendants49.1 Truck drivers43.9 Laborers, non-construction36.6 Assemblers19.7 Janitors and cleaners14.0 Registered nurses12.4 Stock handlers and baggers11.3 Construction laborers10.8

BLS Statistics (U.S. injury data) How many musculoskeletal disorder (MSD) cases involved health care patient handling? Almost all (97%) of the MSD cases involving patient handling occurred within the health care and social assistance industry, composing 58 percent of the 67,700 total MSD cases in that industry. For MSD cases involving patient handling, almost all (99%) were the result of overexertion. Sprain, strain, or tear was the type of injury incurred in 83% of the MSD cases involving patient handling. Nursing aides, orderlies and attendants incurred occupational injuries or illnesses in 49% of the MSD cases involving health care patients. Registered nurses accounted for 17% and home health aides for another 6%. Other occupations with MSD cases involving health care patients included licensed practical and licensed vocational nurses; emergency medical technicians and paramedics; personal and home care aides; health care support workers; radiologic technologists and technicians; and medical and health services managers.

Today Nurses are Very Concerned Believe quality of care has deteriorated Time for patients has declined Place patient safety ahead of their own Feel discouraged and powerless One third under thirty are thinking of leaving Strikes and walk-outs increasing

The Aging Nursing Work Force The average age of nurses is close to 46 years old. The largest portion of nurses are in their 50’s. What are the impacts?

Impact of Nursing Crisis As Baby Boomer’s age = increased need for nurses Nurses are burning out Severe shortages Increased risk of injury - Insufficient staff - Higher stress levels - Risk increases with age

Work Conditions = Caregiver Shortage Root cause of nursing and nursing aide shortage – poor working conditions Improving methods for lifting, transferring, and repositioning can contribute much to improving working conditions

The Problem of Back Injuries in Healthcare is Well Recognized What Have Been Traditional Approaches for Prevention?

The Comprehensive Approach Anatomy and function of the back Knowledge of physical fitness General nutrition Functional evaluations Stress reduction Pre-placement screening Body mechanic and lifting technique Ergonomics and job design …The Back School Concept

Can you train staff how to eat?

Can you make them exercise?

Does a bad x-ray predict future injury?

Does Traditional Training Reduce Back Injuries Several studies have been unable to demonstrate the effectiveness of training in lifting techniques in preventing back injuries.

Why Have Traditional Training Programs Failed? Difficult to modify behavior and habits Lack of follow-up competency checks Difficult to apply optimum principles in real work environment (everyone has different natural abilities) Does use of proper technique remove the risk to the healthcare worker?

Notice the handles?

No handles here

Understanding Causation and Investigating Limits for Manual Lifting

NIOSH Lifting Equation RWL = LC x HM x VM x DM x AM x FM x CM LC = Load Constant HM = Horizontal Multiplier VM = Vertical Multiplier DM = Distance Multiplier AM = Asymmetric Multiplier FM = Frequency Multiplier CM = Coupling Multiplier

Ergonomics or Human Factors Engineering Design job tasks to fit the person Do not expect the person to adapt to poor design

What is the engineering control in this picture?

Ergonomics Move beyond the office environment and into the patient care environment

Single Most Important Factor to Reduce Exposure to Back Injury ELIMINATE THE LIFT!

Problems with Patient Handing Equipment in Years Past Poor design Not available Not maintained Improper use Time

OUCH! Review Current Practices Has this ever happened in your organization? Play Catch Lately?

Proactive vs. Reactive

What is your next step? Direction for the Future Massachusetts Care Self-Insurance Group, Inc. S afety A wareness F or E veryone from Cove Risk Services