2. Safe patient handling is a broad topic. It includes how nurses deliver care to patients whether it be administering medications, preventing the spread of germs, protecting confidentiality, reporting abuse, or otherwise advocating for patients. This week we narrow the discussion, particularly, to how we provide safe patient care when we assist patients with transferring, lifting, turning, and repositioning.

3. Articles to read: Read over the DHHS (NIOSH) Publication How to Prevent Musculoskeletal Disorders at http://www.cdc.gov/niosh/docs/2012-120/http://www.cdc.gov/niosh/docs/2012-120/ Occupational Safety & Health Administration (OSHA) website. https://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html Review the topic and information under all five tabs including Hazards & Solutions, Training & Additional Resources, State Legislation, and Starting a Safe Patient Handling Program. Visit the ANA website http://www.nursingworld.org/handlewithcare and watchhttp://www.nursingworld.org/handlewithcare the video regarding SPHM Standards.

4. Discussion Board Questions: According to the Occupational Safety and Health Administration (OSHA) (2010), musculoskeletal injury to healthcare workers is seven times the average compared to other industries. Given the potential hazard of injury to healthcare workers related to lifting and transferring patients, it is important for health care facilities to implement safe handling practices. 1.) What types of safe handling practices are in place at your place of employment? Describe specific measures or policies that have been implemented to help reduce musculoskeletal injuries to health care workers. 2.) Identify some areas of improvement that are needed in safe patient handling practices at your place of employment. What are some things you could do to help implement change? Reference Occupational Safety and Health Administration (OSHA) (2010). Safe patient handling. Retrieved from: https://www.osha.gov/ SLTC/healthcarefacilities/safepatienthandling.htmlhttps://www.osha.gov/

5. SAFE PATIENT HANDLING BY DEBORAH LACKEY & ANGELA BRANDOW

6. A 2015 American Nurses Association (ANA) survey noted: 42% of nurses report a significant level of risk to their safety from lifting or repositioning patients. More than 50% say they regularly experience shoulder, neck, back and arm pain while working. Occupational Safety and Health Administration (OSHA), patient handling claims account for 25% of all workers’ compensation claims ($15,600avg./per claim)(Dimond, 2016). IS MANUAL LIFTING AND MOVING PATIENTS SAFE FOR HEALTHCARE WORKERS? IS MANUAL LIFTING AND MOVING SAFE FOR PATIENTS? Using mechanical lift equipment: reduces injury to patients including fewer falls, skin tears, and pressure ulcers Increases patient mobility, and therefore decreases length of stay Patients report feeling more comfortable and safe compared to manual techniques (OSHA, 2015).

7. Rates of musculoskeletal injuries from overexertion in healthcare occupations are among the highest of all U.S. industries (Bureau Of Labor Statistics, 2011). Average injuries across all industries: 38 per 10,000 of full time workers. Overexertion injury rate to hospital workers: 76 per 10,000. The rate for nursing home workers: 132 per 10,000. The rate for ambulance workers: 238 per 10,000. Biggest contributing factor? Manually lifting. Other contributing factors include : Rising obesity rates in the U.S. and an aging work force. In fact, the average age of a registered nurse in the U.S. is approximately 44 years; and, a projected nursing shortage is expected, of 260,000 unfulfilled nursing positions, by the year 2025.

8. Major factors that contribute to injury Lack of necessary tools to facilitate transfers and lifts. Lack of applying proper body mechanics or use of ergonomic best practice techniques. Lack of staff assistance when it is needed. Extended work shifts, and/or, limited break periods. Staff does not receive, periodic continuing education and training on, proper equipment use. (American Nurses Association, 2015) CONTRIBUTING FACTORS CONT’D.

9. #1 Cause: Manually lifting patients. Lack of proper body mechanics, +/or personnel. Lack of using mechanical life device. #2 Cause: Repositioning patients who are unable to use a trapeze bar. Lack of following EBP, proper body mechanics, getting help, or using mechanical assist. #3 Cause: Turning Patients. Lack of following EBP, proper body mechanics. getting assistance from other(s), or using mechanical bed assist. #4 (Least) Cause: Not allowing patients (with upper body strength) to assist in transfer/lift. (Mayeda-Letourneau, 2014) ROOT CAUSE ANALYSIS FISHBONE DIAGRAM (CAUSE & EFFECT)

10. CONSEQUENCES TO STAKEHOLDERS: Increased risk for patient falls and/or developing hospital-acquired pressure ulcers. Increased risk for nursing staff to become patients. Financial hardship, chronic pain, absenteeism, permanent job loss, and/or emotional stress impacts patients, their loved ones, (who may act as caregivers) healthcare employees and all who rely on these individuals for their support. Financial implications may extend to the immediate facility, community and beyond. Does your hospital or long term care facility have a Safe Patient Handling Program (SPHM)?

11. NUMBER ONE RECOMMENDATION FROM OSHA? USE A MECHANICAL LIFT DEVICE (Dimond, 2016) Ergonomics: An applied science that coordinates the design of devices, systems, and physical working conditions with the capacities and requirements of the worker. Also called human engineering (Webster’s Dictionary).

12. Implement or upgrade a safe patient handling program. Train staff in ergonomic best practice techniques. Provide staff with the tools and equipment they need to perform transfers, lifts, and repositioning of patients. Equipment can include the use of slide boards, overhead trapeze bars, Hoyer (sling) lifts, or, pneumatic hospital beds with programmable turning assist features. TO KEEP PATIENTS SAFE HEALTHCARE FACILITIES NEED TO KEEP THE CAREGIVERS THEY EMPLOY SAFE RECOMMENDATIONS (American Nurses Association, 2015)

13. Recommendations American Nurses Association’s (ANA) Handle with Care Campaign, which began in 2003, has prompted eleven states to enact “safe patient handling “ laws or promulgated rules/regulations. To date, Ten of those states require that a comprehensive program be in place in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas and Washington), in which there is established policy and guidelines for securing appropriate equipment and training, collection of data, and evaluation (2015). The ANA Safe Patient Handling and Mobility page at www.nursingworld.org has additional information about this issue.www.nursingworld.org On June 26, 2013, ANA released Safe Patient Handling and Mobility Interprofessional National Standards. These eight standards can be found at www.anasphm.orgwww.anasphm.org ANA is raising the bar: setting new standards and establishing policy and guidelines.

14. Prioritizing patient care through ergonomic best practices, use of mechanical lifts and implementation of quality improvement initiatives, will prevent injury and financial loss. Improving patient outcomes benefits everyone. Safe patient transfer, lift, and repositioning care should be done, as often as possible through mechanical means. The push for policy change at the national level will mandate that healthcare facilities implement a Safe Patient Handling Program. CONCLUSION

15. References American Nurses Association. (2015, June). Safe patient handling and mobility (SPHM). Retrieved from http://www.nursingworld.org/http://www.nursingworld.org/ MainMenuCategories/Policy-Advocacy/State/Legislative-Ag. Centers for Disease Control and Prevention. (2016, January 13). Safe patient handling. Retrieved from http://www.cdc.gov/niosh/http://www.cdc.gov/niosh/ topics/safepatient/default.html Dimond, V.J. (2016, January). Safe patient handling: Calls for support growing louder. Retrieved from http://0-search.proquest.com.http://0-search.proquest.com libcat.ferris.edu/docview/1754509177/fulltext?accountid=10825 Mayeda-Letourneau, J. (2014). Safe patient handling and movement: A literature review. Rehabilitation Nursing, 39(3). 123-129 7p. Doi:10. 1002/rnj. 133 Occupational Safety and Health Administration (OSHA) (2015). Safe patient handling programs: effectiveness and cost savings. Retrieved from: https://www.osha.gov/dsg/hospitals/documents/3.5_SPH_effectiveness_508.pdf