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Developing a Safe Patient Handling Program

Safe patient handling programs increase knowledge among both workers and employers about the prevention of MSDs and improved patient safety. Providing safe patient handling requires more than a “quick fix” or a singular solution, such as more training or simply purchasing patient lifting equipment.

The Association of Occupational Health Professionals in Healthcare (AHOP), in alliance with the Occupational Safety and Health Administration (OSHA) developed “Beyond Getting Started: A Resource Guide for Implementing a Safe Patient Handling Program in the Acute Care Setting“. This guide provides sample policies, product evaluation tools and a strategic plan for initiating a program.

Components of a successful safe patient handling program

Gain Management Support

All programs begin with management support as a key element for success. Most organizations have a basic “back injury prevention” program; however, continuing incidents of back injuries should prompt the development of a more comprehensive program. Providing senior management with information on the huge opportunity to reduce costs that will result from effective worker and patient safety improvements is a key factor in gaining support and the necessary resources for a successful program.

Effective programs may prompt increase in reporting of injuries An effective program may initially result in increased reporting of symptoms. Though sometimes alarming, this increase in early reporting helps to ensure that measures can be taken to reduce the severity and cost of injuries. This strategy requires commitment and education of senior management and supervisory personnel as well as care givers.

Tips for enlisting leadership support:

  • Change the focus: Many decision-makers grapple with the fact that money has been spent on back injury prevention programs before, yet injuries continue to occur. To help overcome this hurdle, rather than focusing on preventing back injuries in patient care personnel, the focus could be changed to improving patient care. One organization changed their program title to reflect this approach: “Preventing Back Injuries in Nursing Care” became “Patient Handling and Movement.” Regardless of the term chosen, if the focus includes patient care, decision-makers may be more receptive to providing the resources required for a successful program.
  • Demonstrate success: Data are critical to demonstrating proven injury-prevention systems. Organizations implementing safe patient handling programs with effective engineering and work practice controls have achieved considerable success in reducing worker-related injuries and workers’ compensation costs. (See “Success Stories” for examples.) Some institutions have experienced additional benefits, including reduced staff turnover and associated costs, reduced absenteeism, increased productivity, improved morale, reduced patient injury and increased patient comfort.
  • Focus on the advantages of safe patient handling The Veterans Health Administration has a highly successful safe patient handling and movement program and shares their resources in a specialized toolkit. They suggest it is possible to accomplish the following goals with a well implemented program:
    • Reduce injuries
    • Become the employer of choice
    • Reduce costs
    • Improve quality of care
    • Increase patient safety

Assess the environment and patients

An essential first step in developing your program is to perform a worksite assessment to identify the types of patients, types of movement and transfers needed, and the nature of worker injuries. With the increasing use of computers in healthcare settings, attention should also be paid to hand, wrist, neck and upper extremity stressors among workers. Obese patients will need specific attention for safe handling. You can determine the obesity prevalence in your state using CDC’s Adult Obesity Facts.

Gather input and data

  • Data on injuries. Gather data on injuries and cost to the organization. Data from national statistics and studies, the organization’s own OSHA Injury and Illness Records, internal incident reports, employee health records, and workman’s compensation claims are useful.
  • Gather input from frontline workers. Employees who will be using the safe patient handling program on a daily basis have an understanding of clinical needs and can provide insights that will enrich the program. Including these workers in the planning process will help ensure that they have a vested interest in the program’s success.

Determine a reasonable goal for the program

A comprehensive safe patient handling program combines management support, equipment use, work practices and training to reduce the risk of each patient/resident handling event. In OSHA’s guideline, the goal is to “minimize manual lifting [of patients] in all cases and eliminate it when possible”.

 Specific goal-setting is a critical step in creating successful, long-lasing improvements. The organization must develop incremental, measurable goals based on its size, patient mix and the results of injury data analyses, surveys, and interviews. Management approval is essential to implementing a safe patient handling program that, by its nature is complex and requires a great deal of organizational commitment and resources to be successful. As the program moves into setting specific goals and designing implementation strategies (such as beginning to purchase equipment and initiating training); it is a good time to reaffirm commitment to the goals of the program and gain concurrence on a timeline for implementation.

Identify patient handling equipment needs

Decisions about lifting and transfer equipment should reflect the worksite assessment, including equipment currently available and the environment in which it is used. Additional equipment can be chosen for specific situations so that purchasing is targeted and effective.

Preventing MSDs, such as serious back injuries, through safe patient handling must include the use of patient lifting and transfer equipment, especially for obese (bariatric), confused or physically dependent patients. Devices to consider include: lateral slides, full body slings and lifts, stand assist and repositioning lifts, ergonomically designed beds and gait belts.

Establish policies and procedures

Safe patient handling policies and protocols ensure consistency with the organization’s patient care policies, patient and employee injury reporting process, and return-to-work programs. Lifting assistance is a critical part of patient care and caregivers need clear direction on making decisions on which equipment to use. Patients and families need to know the organization’s policy on use of equipment (for example, is equipment use mandatory). OSHA has developed a poster titled, “Need a Lift” to encourage families and patients to cooperate with lifting policies.

Develop a timeline for action and begin implementation
There is no single solution to safe patient handling. Each organization will need to develop a plan and timeline that matches their specific patient population needs and organizational goals. Getting both managers and employees “on board” is critical for success and each of these groups will need to be involved in the planning and implementation strategies. Additional lifting equipment may be required, policies and procedures need to be updated, and subsequent training and education need to be delivered. Timelines should be ambitious, but feasible; plan for success!

Provide training

Training needs should be identified and provided for all levels of personnel. Caregivers will need “hands-on” experience with the equipment. Many manufacturers provide this training with the purchase of equipment. Planning should include training for the following groups.

  • Managers: so they will support the use of safe lifting practices and equipment and early reporting of injuries
  • Caregivers: so they understand the benefits and are able to effectively use the equipment
  • Support personnel: so they can complete preventative maintenance tasks such as cleaning and repairs

Evaluate progress

Success of the program will need to be measured against the goals each organization has set. This requires ongoing monitoring and evaluation, incorporating findings into new prevention strategies. If measures are not producing the results identified in the goals, the program should be re-evaluated to determine appropriate corrective measures.