Lifts/Bathing Feature — Raising the bar

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Along with expectations, the no-lift movement has raised questions for providers intent on doing the right thing.

Since resident handling accounts for more than half of all work-related injuries in long-term care, it's little wonder that safer resident handling programs have moved higher on the list of providers' priorities. More than half of nurses complain of chronic back pain.
Unfortunately, bridging the gap between the problem and an effective, sustainable solution remains an elusive goal for many facilities.
While providers may see a need for safer lifting practices – and are feeling the pressure in the aftermath of the Occupational Health & Safety Administration's ergonomic standard and legislation imposed at the state level — a lack of training, staff buy-in, and in some cases proper equipment, continues to hinder their efforts.
"Are facilities more interested in lifting and transferring equipment and processes to help reduce injuries? The short answer is, 'Yes.' Unfortunately, their efforts often fall short because they don't have a clear understanding of what's involved. Many don't even have baseline data to show where they are in terms of injuries and where they need to be going," notes Jeremy Bespalko, director of sales for Waverley-Glen Systems, a Concord, Ontario-based manufacturer of lifting, positioning and transferring systems.
Such limitations could prove particularly problematic given residents' higher acuity levels, an aging caregiver population that is more susceptible to workplace injuries and an escalating nursing shortage.
"With these trends, I anticipate that [safer] resident handling will become even more of an issue," says Melissa Greenfield, director of regulatory services, American Health Care Association, Washington.

Overcoming obstacles
Some blame the industry's slow acceptance on a lack of consensus as to what actually constitutes safe handling. While some contend that the only truly safe resident handling program is one that involves a strict no-manual-lifting policy, others question whether such a practice is even possible in long-term care.
"Implementing a 100 percent no-lift policy is difficult because there will be times where mechanical lifts are medically contraindicated for certain residents," explains Stefanie Mair, administrator of extended care for Renaissance Gardens at Cedar Crest, an Erickson Retirement Community in Pompton Plains, NJ.
Patient rights also must be considered, adds Janice Zalen, AHCA's senior director of special programs.
"It's important to realize that a resident has the right to refuse a lift," she explained.
The paradox, however, is that some laws, such as Texas SC 1525, give caregivers the right to refuse any resident lifting or movement activity that they believe would expose the healthcare worker or resident to an unacceptable risk of injury.
"It's a clash between resident rights and healthcare worker rights," explained Bespalko, the product sales manager. "The question becomes, 'Who's going to win in the standoff?'"
One staunch supporter of the no-manual-lift policy believes both resident and caregiver can win if the problem is addressed systematically and thoroughly. Not getting hung up on semantics also may help.
"While, in my opinion, successfully implementing a true no-lift policy is possible, I think some people are getting too caught up in the terminology," said Betty Bogue, RN, BSN, founder and president of Prevent Inc. and the Get a Lift Program, Hickory, NC. "We hear 'no lift,' 'minimal lift' and 'safe patient handling,' and those are often used interchangeably. My argument is no matter what the terminology used, the program is effective if it's able to reduce patient handling injuries by at least 80 percent." The Get a Lift Program, founded in 1996, has been implemented in more than 450 long-term care facilities and has cut the number of employee resident handling injuries by more than 90%.

Changing culture
Interest in safe patient handling programs is spreading. Besides Texas, several other states have adopted or are considering legislation.
Last month, Rhode Island became the latest state to pass such a law. It requires healthcare facilities, including nursing homes, to replace manual lifting, transferring and respositioning of patients with proper equipment.
Earlier this year Washington Gov. Christine Gregoire (D) passed a law requiring hospitals to provide lift equipment as part of their safe patient handling policy.
Meanwhile, New Jersey, California and Massachusetts have introduced measures. Two safe patient handling bills in Florida died earlier this year in committee.
Considering that a lifting activity involves bearing weight greater than 30 pounds, it becomes clear that having the right equipment is vital to the success of any safe lifting program. Today's lift models are far more user-friendly, safe, aesthetically pleasing and versatile. Slings no longer have chains, lifts have shifted from hydraulic to electrical mechanisms, and many devices are better designed to fit in tight spaces.
Some other good news is that lifting and transferring equipment doesn't have to be at the high end of the complication or cost spectrum to be effective.
"Safe lifting isn't just limited to sophisticated equipment," explains Dan Gilmore, marketing director for Liko Inc., Franklin, MA. "Something as simple as slide sheets can be very effective for reducing injuries."
Kathy Dunning, a private practice occupational therapist, said slide sheets can reduce the amount of force required to move a resident by 85%. When used in conjunction with certain lifting systems, such as a new inflatable lift offered by Mangar International, risky push-pull movements can be virtually eliminated.
"The most dangerous lift is from the ground," she said. "Technology that can eliminate the physical force is essential for reducing injuries."
Bogue pointed out that Prevent Inc. has used 10 different equipment vendors in its Get a Lift Program, all of which have provided similar results.
"If the equipment is used properly and consistently, it shouldn't matter which name brand you use," she said.
But that's exactly the point: Equipment alone isn't enough. Many organizations have created a no- or minimal-lift program, but are "dismayed because staff continue to not use the [equipment]," according to Laurette Wright, RN, MPH, clinical director of Diligent Services, ARJO Inc., Roselle, IL.
In great part, barriers in operating and practice culture are to blame. Overcoming core caregiver beliefs — such as the notion that 100 pounds is light and two-person manual transfers are adequate — is a must.
Some healthcare professionals resist using lifting equipment because they believe it could hinder a resident's progress. Stacy Lemmer, director of marketing for Medcare Products, Burnsville, MN, said resistance is a particularly pervasive problem in the physical therapy discipline.
"Many PTs claim they do not need equipment because they know how to lift properly and because they do not want their patients to become dependent on the equipment," Lemmer said.
Overcoming outdated nursing school training is another challenge. Although more colleges are beginning to incorporate mechanical lifting and transferring devices into their training, some are still focusing solely on ergonomics and body mechanics for manual lifting.
In light of those obstacles, sources agree that the first step toward success is getting providers to recognize the swift return on investment that appropriately implemented programs can provide. That begins with an understanding on the importance of acquiring necessary lifting equipment.
Although studies have shown that the price of a piece of lifting equipment can pay for itself by preventing just one or two injuries, some providers still face sticker shock.
"The initial investment may be a problem, particularly for providers who are primarily paid by Medicaid," AHCA's Zalen said. "States may be requiring these lifts, but there isn't really any funding to help facilities acquire them."
Ohio law HB 67, however, will create a workers' compensation long-term care fund to make interest-free loans available to help providers purchase, improve, install or erect sit-to-stand floor lifts, ceiling lifts and other lifting systems. The fund also will pay for the education and training of personnel to help facilities implement safe lifting.
Once a safe lifting program is in place, it's up to management to ensure that it's being consistently and successfully implemented. When management observes staff not using equipment and then fails to provide feedback, they have implicitly said to the workers and residents that the program is unimportant, stressed Wright.
Assigning a caregiver safe-lifting champion is an effective way to promote widespread acceptance, according to Fran Spidare, product manager for patient transport, Invacare Continuing Care Group, a division of Invacare Corp., which is based in Elyria, OH.
"This can make a big difference in the level of compliance among caregivers," he noted.
An added benefit? A well-implemented safe lifting policy also may be used as a recruiting tool for new caregivers, he said.

Success stories
Healthcare organizations that have mastered the art of safe resident handling share some common characteristics. Aside from achieving organization-wide buy-in from administrators and staff on the benefits and safe use of mechanical lifts, caregivers are aggressively trained to determine which type of device is most appropriate, based on individual resident assessments.
Erickson, for example, requires that any individual who comes in direct patient contact be thoroughly trained in safe lifting. Training, which provides a detailed explanation of lifting and transferring equipment and processes, begins in orientation, but compliance monitoring and training continues on an ongoing basis.
The approach is certainly working. Since Renaissance Gardens at Cedar Crest opened a year and a half ago, only one lift-related injury has been reported, Mair said.
Genesis HealthCare is also setting a standard for safety. The organization launched its Safe Resident Handling initiative in 2004 as part of its previously implemented musculoskeletal disorder program. Since then, the frequency and cost of work-related injuries have dropped by more than 60%.
"Centers have also reported that through increased toileting with the sit-to-stand lift, they've experienced a reduction in resident [rashes] and urinary tract infections," said Mark Santoleri, Genesis HealthCare's corporate director of safety and loss control.
Santoleri credits much of Genesis' success to its participation in the Prevent Get a Lift Program. The joint venture involves a comprehensive implementation and oversight plan, a resident assessment process that creates a "hierarchy of equipment alternatives as a primary intervention to manual lift and assist procedures," as well as a component that addresses bed repositioning and ambulation. Monthly follow-up visits by Prevent's nurses reinforce ongoing compliance. Currently, 126 centers have been transitioned into Safe Lift facilities, and more are on the way.
"I expect that all GHC owned and managed centers will [make the transition] by the end of fiscal year 2006," said Santoleri. "It's an incredibly important initiative with a very big payoff."

Workplace injury statistics

- Musculoskeletal disorders account for more than a third of all workplace injuries that require time off from work.

- Nursing home workers suffer most injuries (51.2%) when handling residents.

- Back and shoulder injuries are responsible for 54% of all injuries among nursing assistants.

- Nationally, approximately 67,000 back injuries occur among healthcare workers and could total $1.7 billion in worker's compensation.
Source: Bureau of Labor Statistics, U.S. Department of Labor

- MSD incident rate (2003-2004): 12.77 per 1,000 workers.
Source: OSHA

- Healthcare workers sustain 4.5 times more overextension injuries than any other type of worker.
Source: Premier Safety Institute analysis of Bureau of Labor Statistics

- Claims involving back strain can cost about $4,000, with average back injury cases costing about $25,000. More serious cases can cost $85,000.
Source: State Compensation Insurance Fund