1. PREVENTING MUSCULOSKELETAL INJURIES IN THE WORKPLACE Corinne Showalter Kellen Wright Angelene Tania Sidney Resmondo

2. PROPOSED CHANGE  After evaluating different facilities in the Bay Area and their resources for safe patient handling, a deficit in nursing education on proper ergonomics when lifting, transferring, repositioning and ambulating patients is evident.  When comparing facilities, it was found that a lift team structure appeared to facilitate safe patient handling, increase staff satisfaction, and improve patient outcomes and facilitate trust.  As a result, it is proposed that a lift team structure is beneficial in preventing musculoskeletal injuries amongst nursing staff in conjunction with proper education on proper body mechanics when lifting, transferring, or ambulating a patient.

3. SUPPORTING RESEARCH  According to the Occupational Safety and Health Administration (OSHA), the most common types of musculoskeletal injuries are muscle strains, low back injuries, rotator cuff injuries, and tendonitis (Safety, n.d.).  The Bureau of Labor Statistics lists Registered Nurses 6 th in a list of at risk occupations for strains and sprains.

4. SUPPORTING EVIDENCE  Lifting equipment has the potential to reduce the number of work related musculoskeletal injuries. According to a study conducted by OSHA, 95% of manual lifting injuries were prevented by the use of lifting equipment (Safety, n.d.).  Some other benefits include:  Positive work environment  Retention of experienced nurses  Increased patient satisfaction  Reduction of pressure ulcers  Decreased risk of falls  Decreased costs associated with worker’s compensation

5. PLAN FOR IMPLEMENTATION  Educate  Require an in-service where physical therapy can teach nursing staff on proper body mechanics when lifting, transferring, repositioning, and ambulating patients.  Facilitate buy in from the nursing staff through utilization of the nurse educators, nurse managers, physical therapists, and charge nurses. The members of this team will promote and reinforce the importance of this change.  Provide evidenced based handouts to the staff outlining the proper form for safe patient handling.  Pilot a Lift Team on a Medical Surgical floor and an Intensive Care Unit.

6. PLAN FOR COLLECTING DATA  Proper Body Mechanics  Create a competency evaluation form.  Each member of the nursing staff will be audited using the tool by the Nurse Manager, Charge Nurse, and a Physical Therapist on the designated floor.  Lift Team Effectiveness  Utilize an Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in order to assess patient satisfaction.  6 months prior to pilot study  6 months of pilot study  Evaluate how many musculoskeletal injuries were reported during the 6 month time period of the pilot study in comparison to the 6 months prior.  Assess nursing satisfaction through the use of a survey that evaluates the positive or negative feelings associated with the availability of a Lift Team compared to the absence of a Lift Team.

7. DO: IMPLEMENTING A LIFT TEAM STRUCTURE  An Article in the Journal of Nursing Administration, highlights the Lift Team Program at Tampa General Hospital and it’s effectiveness in decreasing the rate of injury due to improper lifting technique and inadequate resources (Kutash, et al., 170).  Recommended equipment:  Portable lifts  Transfer devices, such as hover mats  Sit to Stand lifts  Ceiling lifts  A system for paging the Lift Team and instituting Lift Team rounds on high risk patients is also recommended.  In addition, members of the Lift Team should be given a designated zone to cover STAT requests in a timely manner.

8. Safety and health topics: Safe patient handling. (n.d.). Occupational Safety and Health Administration. Retrieved October 26, 2015, from https://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html

9. DO: PROPER BODY MECHANICS: LIFTING, TRANSFERING, AND AMBULATING  Provide nursing staff with an in-service by members of the physical therapy team to review proper body mechanics  Some basic body mechanics include:  Using your legs when lifting instead of your back  It is important to use your strongest muscles (your legs) and engage your core in order to protect your back  Keep the back straight and lift from the thighs  Lift objects close to the body so you are not tempted to lean forward and use your back muscles when lifting or transfering.  Push rather than pull the patient toward you  Widen your stance in order to provide more support  In the event of a patient fall, use your legs to squat down to the floor with the patient. Do not attempt to lower the patient to the ground by bending over.

11. STUDY  According to the International Journal of Nursing Studies (IJNS) (2013), “greater availability and use of lifts were associated with less musculoskeletal pain and injuries among critical care nurses”.  When comparing nurses with lift availability to nurses without, it was found that nurses with lift availability were 50% less likely to injure their lower back (Kutash, M., et al, 1648).  In a study piloted by the IJNS, 46% of nurses did not have access to lift equipment. Of those that did have access, 59.5% reported that it was easy to get to access to lifts (Kutash, M., et al, 1648).  Availability of lifts has been shown to improve overall job satisfaction, with an emphasis on psychosocial job strain (Kutash, M., et al, 1648).

12. STATISTICS Gomaa, A. E., Tapp, L. C., Luckhaupt, S. E., Vanoli, K., Sarmiento, R. F., Raudabaugh, W. M., & … Sprigg, S. M. (2015). Occupational traumatic injuries among workers in healthcare facilities: United States, 2012-2014. MMWR: Morbidity and Mortality Weekly Report, 64(15), 405-410.

13. ACT  Based on the post-data analysis, Lift Teams and proper body mechanics have proven to reduce the number of musculoskeletal injuries among nursing staff, improve nursing job satisfaction, and improve patient satisfaction and comfort  Therefore, implementation of a Lift Team Structure and proper body mechanics will be initiated hospital wide  Recommended equipment will be provided to all units to assist with lifting, transfers, and ambulation of patients  Ceiling lifts, sit to stand lifts, portable lifts, and transfer devices such as hover mats  Provide in-services to all hospital nursing staff by members of the physical therapy team to review safe body mechanics  Instruct all nursing staff to complete the competency form by the Nurse Manager, Charge Nurse, and a Physical Therapist on each floor to ensure proper body mechanics

14. REFERENCES Gomaa, A. E., Tapp, L. C., Luckhaupt, S. E., Vanoli, K., Sarmiento, R. F., Raudabaugh, W. M., &... Sprigg, S. M. (2015). Occupational traumatic injuries among workers in healthcare facilities: United States, 2012-2014. MMWR: Morbidity and Mortality Weekly Report, 64(15), 405-410. Kutash, M., Short, M., Shea, J., & Martinez, M. (2009). The lift team’s importance to a successful safe patient handling program. Journal of Nursing Administration, 39(4), 170-175. doi: 10.1097/NNA.0b013e31819c9cfd. Lee, S., Faucet, J., Gillen, M., & Krause, N. (2013). Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: An analysis of cross-sectional survey data. International Journal of Nursing Studies, 5, 1648-1657. doi: 10.1016/j.ijnurstu.2013.03.010 Safety and health topics: Safe patient handling. (n.d.). Occupational Safety and Health Administration. Retrieved October 26, 2015, from https://www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html