1. Lifting Hazards at Sunnyside Nursing Facility Keith Moore, Jyric Sims, Vikas Singh April 4, 2007

2. Introduction Agenda for today –Purpose –Sunnyside Nursing Facility –Background information of Ergonomic Hazards in Nursing Homes –Hazard Control Plan –Conclusion

3. Purpose Currently, there is a national problem with occupational lifting injuries –Our priority population is aging and with co morbidities Sunnyside Nursing Center has recently been experiencing increased incidence of injury-related issues Sunnyside Nursing Center has recently been experiencing increased incidence of injury-related issues Therefore, we must assess our current facility Outline a plan of action

4. Important terms Ergonomics is the study of work related modalities –“derived from the Greek word ergos meaning "work" and nomos meaning "natural laws of” or "study of." Musculoskeletal Disorders are disorders of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels, or spinal disc. –Common injuries include carpel tunnel syndrome, back sprain, low back pain, sciatica, rotator cuff injuries, tennis elbow, etc.

5. Welcome to Sunnyside Fort Smith, AR 88 beds 84% occupancy 1 to 3 staffing ratio Average pt age 69yo Average ADL (semi- dependant) Limited if any lifting equipment Increase trend in work related injuries

6. Lifting Injuries in Nursing Homes The health care industry is one of the most dangerous industries, ranking with construction, trucking, and meatpacking in nonfatal injury rates Nursing homes are in the top 10 industries for musculoskeletal problems, with incidence of approx. 17%.

7. Causes of Lifting Injuries ForceRepetition Awkward Posture According to NIOSH, the majority of lifting injuries in nursing center are from –Transferring residents on and off the toilet –Transferring residents in and out of beds and chairs –Bathing and weighing residents

8. Nursing Home Injuries “Source: 1994 BLS Survey of Occupational Injuries & Illnesses Total number of injuries/illnesses resulting in days away from work = 83,450”

9. Effects of Lifting Injuries High workers compensation cost Increased insurance costs High staff turnover Decreased productivity / increased absenteeism Decreased job satisfaction Decreased patient satisfaction

10. Warning Signs OSHA Logs Workers compensation claims Absenteeism Insurance premiums Productivity levels below benchmarks Employee feedback and surveys

11. Our Injury Related Issues Staff Ratio –1:3 ratio (industry standard 1:2) Lifting Equipment –Minimal (OSHA recommendations) Management Commitment –Funding Issues Reimbursement rates –Decrease rate & increase stress

12. Alternatives Out sourcing In-house program development

13. Outsourcing Strengths: Specialists Specialists Greater knowledge and experience of subject matter Greater knowledge and experience of subject matter Innovative solutions Innovative solutions No time constraints No time constraintsWeaknesses:  Less knowledge of organizational design and culture  Less employee buy-in  Problem with continuous monitoring, evaluation and changes

14. In-house Program Development Strengths: Greater buy-in Greater buy-in Familiarity with organization design, culture, needs and capabilities Familiarity with organization design, culture, needs and capabilities Greater awareness and communication of the issues Greater awareness and communication of the issues Continuous monitoring, evaluation and making changes in the plan made easy Continuous monitoring, evaluation and making changes in the plan made easyWeaknesses:  Requires time and effort from already busy employees  Less knowledge and experience with the ergonomic issues and solutions  Time consuming

15. Selected Alternative In-house –Size of facility –Rapport with colleagues –Financial constraints –Cultivate from within What’s Next?

16. The Hazard Control Plan

17. Implementation of a Task Force Task Force Chair Ergonomic/ Equipment Champion Compliance Champion Clinical Staff/ Implementation Champion Medical Director & Administrator

18. Hazard Control Plan - Sunnyside Hazard Control Task Force Analyze Problem/ Develop Hazard Control Plan Implement Plan Evaluate Results Feedback

19. Problem Assessment Injury surveillance - OSHA logs - OSHA logs - insurance claims - insurance claims -Benchmark (incidence and prevalence) -Benchmark (incidence and prevalence)Surveys Ergonomic assessment Job description analysis Patient profiling

20. Problem Assessment Continued Analyze the situation at Sunnyside Do industry analysis – situation and interventions

21. Hazard Control Plan - Sunnyside Provide Management Support Allocation of funds for equipment and training Strategic guidance Involve Employees Seek employee suggestions and concerns Discussion of current state of facility, work methods, equipment availability, etc… Incorporate employees in workgroup/taskforce, incorporate their views, concerns and suggestions in plans Ensure employee participation if plan formulation, implementation, equipment selection and testing, process modification and evaluation Provide ongoing training for knowledge and skills development

22. Hazard Control Plan - Sunnyside Implement Solutions Hardwiring policies Communication Education and training Sample group Modification and changes (Eliminate Hazards and Improve work environment) Phased implementation –Clinical Champion Align incentives Continuous monitoring and evaluation

23. Hazard Control Plan - Sunnyside Address Reports and Injuries Incident and injury reporting system Latent injury surveillance Prompt action and follow up

24. Hazard Control Plan - Sunnyside Provide training Knowledge and skills development Awareness modification Equipment training Training for procedural changes –Transferring residents on and off the toilet –Transferring residents in and out of beds and chairs –Bathing and weighing residents

25. Hazard Control Plan - Sunnyside Plan Monitoring and Evaluation Monthly compliance audits Injury log reviews Claims review Employee feedback and surveys

26. Implementation Hardwiring policies Communication Education and training Sample group Modification and changes Phased implementation –Clinical Champion Align incentives Continuous monitoring and evaluation

27. Evaluation Monthly compliance audits Injury log reviews Claims review Employee feedback and surveys

28. Expectations Before Implementation After Implementation High workers compensation cost Low Increased insurance costs Decreased High staff turnover Significant decrease Decreased productivity / Increased absenteeism Increased/decreased Decreased job satisfaction More satisfied employees Decreased patient satisfaction High patient satisfaction scores

29. Timeline Assessment (30 days) Plan Development (45 days) Resource Acquisition (On going) Training/development (18-21 days) Communication (On going) Project Launch (120 days) –Phase 1 (Test population) –Phase 2 (30 days) –Phase 3 (90 days) Evaluation (On going)

30. Summary What was discussed –Purpose –Sunnyside Nursing Facility –Background information of Ergonomic Hazards in Nursing Homes –Hazard Control Plan –Conclusion