Giving a lift to safety
Nursing aides and orderlies have a high incidence of workplace injuries.
The phrase “safety first” typically conjures up visions of laborers plying machinery and tools at factories and construction sites, not healthcare workers in nursing homes.
But, in truth, long-term care employees suffer many injuries and consequently experience missed work time.
While the majority of laborers work with static materials, nurses and other caregivers interact with people, some of whom can behave in unpredictable ways. LTC workers have the second-highest number of incidents that cause missed work days, according to Occupational Safety and Health Administration figures.
Efforts are underway at the federal level to improve work conditions, however. In Congress, for example, Rep. John R. Conyers Jr. (D-MI) is sponsoring H.R. 2480, The Nurse and Health Care Worker Protection Act of 2013. The bill was referred to the subcommittee on health on June 28.
The legislation is a hybrid of previous bills. Among other things, it incorporates content from the American Nurses Association's newly published book, “Safe Patient Handling and Mobility: Interprofessional National Standards.”
One of the primary causes of injuries at long-term care facilities — manual lifting of residents — is addressed in the bill. One provision calls for machines to be used to aid in the movement of all residents.
Though not the law of the land yet, the benefits of such changes are already being demonstrated. Language in the act notes that a growing number of facilities with patient handling technology and practices have reported positive results.
Fewer workers' comp claims
Studies also show that assistive patient handling technology successfully reduces workers' compensation costs for musculoskeletal disorders (MSDs). Injuries among nursing staff and healthcare workers have dramatically declined at places that have implemented safe patient handling technology, equipment, devices and practices. As a result, the number of lost work days due to injury or related staff turnover has dropped.
Still, according to Conyers' bill, 52% of nurses complain of chronic back pain and 38% have pain severe enough that it causes them to leave work.
The goal of the proposed changes is to rewrite the book on workplace injuries for long-term care workers, something stakeholders agree is sorely needed.
According to OSHA, musculoskeletal disorders accounted for 33% of all injury and illness cases in 2011. Nursing assistants rated among the top six most-affected occupations and accounted for 26% of MSD cases. Nursing assistants had a median of 11 missed days.
Healthcare and social assistance had the highest proportion of days-away-from-work cases among female workers, with 81% of all incidents among all industries. These types of workers were involved in more than 40% of all private ownership cases in which the injured or ill employee was female.
In 2011, nursing aides, orderlies and attendants had the second-highest incidence of lost workdays, with 47,840 occurrences. The median number of days out was five.
The group's top cause of injury — overexertion and bodily reaction — led all other groups in the top five, at 56%. Injuries caused by falls, slips and trips ranked second for the group at 20%.
Long-term care operators likely would save money with the changes proposed in HR 2480. A Centers for Disease Control and Prevention study showed the cost of lifting equipment and training was recouped in less than three years due to a drop in workers' compensation claims.
Current practices vital
While long-term care professionals may hope for Conyers' bill to gain more support, they can't rely on it to pass. That means using best practices for safe lifting is as important as ever.
“Workers must be careful of slip and trip hazards while lifting or bathing patients in small spaces and reaching in awkward positions,” notes Ron Romano, RN, the vice president of professional relations for the American Association for Long Term Care Nursing. “The caregiver should not be wearing anything around the neck that a patient could grab. The caregiver must be alert and avoid distractions. (The care team should) always have two caregivers when transferring and bathing residents in the shower room.”
That information is especially important to new and younger employees.
Workers with one to five years of experience for the same employer accounted for 35% of injury cases, despite an 11% overall decrease. Numbers trended up for employees with less than three months of service (to 3%). Injuries for employees with three to 11 months of service rose also (to 7%), according to OSHA.
Bathing areas have additional dangers.
“Quite often there is limited space in bathing areas, making it difficult to maneuver and gain access to bathing equipment,” says Guy Fragala, a nationally known expert in ergonomics in healthcare settings. He currently serves as the Senior Advisor for Ergonomics at the Patient Safety Center of Inquiry in Florida, after retiring as the Director of Environmental Health and Safety at the University of Massachusetts Medical Center.
“Many times, patients must be lifted over obstacles to gain access to bathing equipment,” he notes. “Wet floors can present fall hazards to both the patient and caregiver.”
An important part of the planning process is the assessment, which determines the patient's dependency level and what type of lifting equipment or lifting aids might be required, Fragala notes.
“For highly dependent patients, consideration should be given to minimizing the number of lifts required,” he explains. “For example, can a patient be transferred into a transport device that can also be used to secure and hold the patient while the bathing process occurs?”
Devices such as shower chairs can be used for transport and then placed directly into a bathing or showering facility, Fragala says.
“Where short transports are involved, full sling lifts might be appropriate with proper bathing slings employed,” he says.
The type of bathing apparatus also can add to a safer equation.
“The best way to protect a resident and a caregiver during bathing is to use a side-entry tub with a lift,” says Kari Harbaugh, a product consultant for Direct Supply Equipment & Furnishings. “Whenever possible, it's better to use a chair lift made for the tub.”
The chair lift allows the resident to sit and slide into the door of the tub, not up and over the wall of the tub, Harbaugh explains. By allowing the resident to sit on the chair lift during the bath, the caregiver and resident stay safe.
“When the bath is over, the tub is drained and the resident exits the tub on the chair lift,” Harbaugh says.
Other types of apparatus are often needed in bathing.
“There are many types of bathing slings available today that can be used with a variety of full sling lifts,” Fragala says. “For a moderately dependent patient, thought must be given to how access to bathing equipment can be facilitated.
“Stand assist lifts might be appropriate to lift a patient out of a bed or chair and transport them to a bathing area. The size of the base of the lift is a consideration to ensure it can access the bathing area. Once in the bathing area it is important to remove any barriers or obstacles so the patient can easily gain access to the bathing equipment.”
Harbaugh suggests handrails and non-slip matting to increase safety in the bathing area. Residents with a tendency to become agitated might be calmed with the use of quieter whirlpool tubs, he adds.
Other dangers to avoid
Lifting and slipping hazards aren't the only dangers present in the bathing area for LTC workers.
“Proactive steps must be taken to control risks of infection transfer and self-infection,” says Mark Godfrey, vice president of business development at Apollo Corporation. “Continuous pathogen control is critical to cutting incidences of UTIs, respiratory infections and more dangerous bacterial infections such as MRSA, Legionella and others. The reduction of airborne bacteria during the bath can greatly benefit the staff, especially those facilitating a large number of baths per day.”
Special accommodations should be put in place for the bathing of dementia residents.
“These are easily frightened and confused residents,” Godfrey points out. “A high-quality care center avoids lifting them beyond a normal sitting height, provides minimal transfers and minimized sources of irritating or startling noises.”
The vendor community has products that address these situations. UV ray products, for example, reduce bacteria. Apollo cites studies showing that one of its systems, for example, can reduce urinary tract infections among an LTC resident population by 50% and respiratory infections by 35%. Quiet, quick-filling tub systems can further reduce stress in the bathing process.
Showers, of course, are another area of concern. Handrails are required for safety. In facilities where a more aesthetic feel is important, a less institutional approach can be implemented. Grab bars should meet the requirements of the Americans with Disabilities Act. Such supports should be designed around faucets, soap dishes and corner shelves to add safety along with the accents in the shower area.
Specialized equipment can be utilized in other areas of long-term care facilities to increase safety during resident bathing. Adjustable-height shampoo bowls, for example, could be helpful for both certain residents and caregivers, says Accessible Systems President Dave Shusterich.
While expecting entire staffs to be injury-free 100% of the time in healthcare facilities might not be realistic, experts agree it is a goal that many providers can come closer to achieving.