National Emphasis Program in National Emphasis Program in Nursing & Residential Care Nursing & Residential Care

Facilities: Facilities: Impact for Safe Lifting & Moving Impact for Safe Lifting & Moving

in Health Carein Health CareDana Root, PT, CPE, CSPHPRegional Ergonomics Coordinator, OSHA Region 5414.297.3315root.dana@dol.gov

National Emphasis Program for Nursing and Residential Care Facilities

• Provide guidance to agency compliance staff– Policies and procedures for targeting and conducting

nursing home inspections – Focus on the hazards associated with nursing and

residential care.• BBP, STF, VWP, TB, Ergonomic resident handling stressors

• Why are we here again?– In 2010 nursing and residential care facilities experienced

one of the highest rates of lost workdays due to injuries and illnesses of all major American industries.

– No improvement in injury rates over past 10 years2

National Emphasis Program for Nursing and Residential Care Facilities

OSHA recommends: Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible.

•October 2012 –OSHA cited three Wisconsin nursing homes from a large nursing home chain –One serious violation of OSHA’s “general duty clause”–Violation cites each facility for:

• Allowing employees to perform lifting, transferring, repositioning and assisted ambulation tasks that may cause musculoskeletal disorders.

3

Illinois Regulations

• Public Act 096-0389 HB2285– Effective date January 1, 2010

• Restrict, to the extent feasible, manual lifting or movement

• Assess handling needs of resident• Educate nurses in the identification, assessment,

and control of risk to injury • Evaluate alternative ways and strategies

Ergonomic Assessment: Fresh Eyes

• We conduct our investigation the same way that we think you conduct yours

• Goal: To look at your facility with fresh eyes– Focus your efforts to minimize/eliminate manual physical

assistance by healthcare provider– Examine your policy and procedures

• Self Assessment:– Calculate rates for past 3 years– Observe what you have and what you are doing– Interview staff and management– Review processes to make improvements

5

Fresh Eyes: Policy & Procedures• Purpose and Scope of the Policy• Staff responsibilities

– NHA – Unit Managers– Therapy– Resident Handlers

• Resident assessment• Workplace assessment• Training requirements• Equipment requirements• Medical management

6

Fresh Eyes: Rates

• Information – OSHA Logs– Safe Lifting Policy and Procedures

• Calculate the Rates– Facility DART and Severity Rates– MSD DART and Severity Rates– RHIR and RHSR Rates

• Compare 2010 to BLS average DART rates– Nursing and Residential Care Facilities: 5.6– Resident Handling Incident Rate: 9.6 – Private Industry: 1.8

RHIR & RHSR for Past Three Years

• Resident Handling Incident Rate

= # OF RH CASES With days away from work job transfer DAYS or Restricted days x 200,000 Resident Handling Hours worked

• Resident Handling Severity Rate

= (days away from work + On job transfer DAYS or Restricted days) x 200,000 Resident Handling Hours worked

8

OSHA 300 Log

9

RHIR & RHSR for Past Three Years• Look at the 300 Log entries:

– Who– Where occurring– When occurring– How occurring

• It is not about body mechanics– Easier to figure out why injuries are occurring

• Pattern:– Trend over 3 years

• BLS comparison– MSD days away rate: 9.6 for 20109.6 for 2010

10

Fresh Eyes: Interviews

Resident Handlers– Employee Issues:

• Training• Staffing• Resident assessment• Communication• Equipment

– Availability & storage– Slings– Battery

• Workplace constraints• Injury management

11

– Operational Issues:• SPH policy and procedures• Resident assessment process• Staffing levels• Equipment & slings• Storage• Space constraints• Training and competency• Medical management

supervision

Nurse and Therapy Managers

Fresh Eyes: Resident Assessment

OSHA recommends: Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible.• Resident assessment: –Algorithms (see page 12)–MDS: Resident Assessment Instrument

• ADL Support Provided versus ADL Self-Performance–FIM: Functional Independence Measure–Develop own facility assessment tool

12

• Tool to guide decision making• Based on

– Patient’s ability– Equipment availability

• Standardizes practice• Guides for planning handling tasks

– “Tools not rules”• Clinical judgment still needed• Manual lifting of residents be

minimized in all cases and eliminated when feasible

Fresh Eyes: Resident Assessment

Fresh Eyes: Resident Assessment

• Functional Independence Measure (FIM)– 7 level functional assessment scale of resident's actual performance

• Evaluates the amount of assistance required to perform basic life activities• Need for assistance from another person or a device• Measures what the resident actually does

Independent7 Complete Independence8 Modified independence – requires assistive device, …..

Modified Dependence – resident expends 50% or more of the effort5 Supervision (setup) – without physical contact by helper, or applies assistive device6 Minimal Contact Assistance – resident expends 75% of effort3 Moderate Assistance – resident expends between 50% to 75% effort2 Maximal Assistance – resident expends between 25% to 50% of effort1 Total Assistance – resident expends less that 25% of effort

15

Fresh Eyes: Resident Assessment

• Egress Test– Purpose: To facilitate the safe progression of a resident’s

debut transfer through repetitions1. Three repetition of sit to stand2. Three steps of marching in place3. Advance step and return each foot

– If, during any part of the Egress Test, the resident demonstrates difficulty or need for physical assistance beyond cues and/or guarding techniques, the resident is indicated for mechanical conveyance.

16

Fresh Eyes: Resident Assessment

• What is on the care plan is what the resident handler must perform– Depending on the facility policy

• May take the more supportive method• Manual lifting of residents be minimized or eliminated when

feasible, and that mechanical support devices be used for lifting whenever possible.

• Restrict, to the extent feasible, manual lifting or movement

17

Fresh Eyes: The Care Plan

Fresh Eyes: Equipment:

• Equipment– Full Body Lifts

• Floor based or ceiling– Repositioning Aids– Stand-Assist or Sit/Stand

Devices• Active versus passive

– Ambulation Devices– Bariatric devices

• Scheduled maintenance

• Slings– Sizes– Task types– Backup sling availability – By vendor

• Battery– Charging location– Charging schedule

18

Fresh Eyes: Resident Handler Focus

Protect the Resident HandlerProtect the Resident HandlerEstablish a written program•Admission policy

– Prevent MSD injury to resident handlers

•How residents are assessed•Competent in procedures for lifting and moving residents•Appropriate equipment for the task

Monitor resident handling injuries•Track and Trend

– By year, by shift, by wing, by xxx•Compare

– BLS, between shifts, departments, sites

19

Investigation Findings

• Integrate System-wide Findings– Rates– Observations– Perspectives

• Are MSD injuries occurring from manual resident handling?– RHI rates above 9.6

• Why?– What needs to be improved?– How to improve it?– Who will improve it?

20

Resource Guides

http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp

http://www.cdc.gov/niosh/topics/ergonomics/

http://www.aohp.org/About/documents/GSBeyond.pdf

www.osha.gov/SLTCergonomics/index.html