Big moves with little effort
Ten years ago, it was generally believed that simple tools like gait belts and drawsheets combined with correct biomechanics were sufficient to minimize the potential of back injuries when moving patients. Little thought was given to the long-term effects of lifting, transferring, and repositioning.
What a difference a decade makes! Study after study has proven that back injuries caused by lifting are the most prevalent issue facing nursing home operators and are the single largest contributor to the nursing shortage in the United States, with approximately 12% of nurses leaving the profession because of the problem.
The costs of back injuries caused by lifting are staggering. The National Institute for Occupational Safety and Health (NIOSH) identifies back injury as the second leading occupational injury in the United States, with back pain as the most common reason for filing workers compensation claims. In 1990, estimates of the annual cost of back injuries ranged from $50 billion to $100 billion in the United States. Studies of back-related workers’ compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry and compared with other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders.
More than one third of back injuries among nurses have been associated with patient handling and the frequency with which nurses are required to manually move patients. Clearly, we have a problem.
But despite the overwhelming evidence that mechanical lifts and other devices dramatically cut injuries to employees and residents, most long-term care facilities currently aren't using them. According to a Wall Street Journal article titled, “Lifts help workers handle patients safely; cut injury rate,” only 10% to 20% of nursing homes and fewer than 5 of hospitals have no-lift programs.
Why? The article says that most nursing schools and hospitals have traditionally taught reliance on manual lifting and transfers, many nurses are used to using drawsheets and their own strength and may be resistant to change, and caregivers in a hurry may not want to be bothered getting the facility's lift out of the closet.
Then there's the cost of the equipment itself. According to the NIOSH report, “Safe lifting and movement of nursing home residents,” https://www.cdc.gov/niosh/docs/2006-117, a 100-bed facility can expect to spend $25,000 to $30,000 on portable (not ceiling-mounted) mechanical lifts depending on how many residents require the use of a lift. The report says that as a general rule, one full-body lift should be provided for approximately every eight to 10 non-weight–bearing residents, and one sit-to-stand lift should be provided for approximately every eight to 10 partially weight-bearing residents.
Since the average cost of a mechanical lift can vary from $3,000 to $6,000 per lift and the average cost for a ceiling-mounted lift is approximately $4,000 per room, an effective combination of both floor and ceiling lifts is generally accomplished with a $50,000 to $60,000 investment per 100-bed facility, the report says.
For nursing home companies willing to make the investment in safety, the payoff can be huge. The Wall Street Journal article reported that Kennett Square, Pennsylvania–based Genesis Health Care Corp. launched a lift program in part because of pressure to cut workers’ compensation insurance costs.
In 2004, the company's Lafayette Center nursing home in Franconia, New Hampshire, spent $30,558 on mechanical lifts, and in just one year, the number of back injuries related to moving patients dropped from six to zero and the workers’ compensation injury claims went from $97,466 to zero.
In my own discussions with nursing home directors of nursing, the prevailing feeling has been that while such equipment would be welcomed, the challenge is convincing administrators and corporate bean counters that the short-term investment in capital equipment would have significant long-term benefits. But the NIOSH report on resident lifting shows cost-benefit analyses demonstrate that the initial investment in lifting equipment and employee training can be recovered in just two to three years through reductions in workers’ compensation expenses.
Benefits of a No-Lift Program
Rehab Management magazine cites nine benefits to having a complete no-lift program with full compliance by all staff members:
1. Staff Retention. The addition of technical aids helps keep experienced professionals on the job. Higher retention means lower turnover, which means lower recruitment costs, especially RNs, PTs, and OTs.
2. Recruitment. Newly trained healthcare professionals are technologically savvy and will work only where there is administrative commitment, policies, and equipment for maximum success. Facilities that do not provide equipment necessary to protect the health and welfare of their employees will not be able to compete effectively for talent.
3. Efficiency. With the right equipment, one person can safely move the heaviest resident, while manually lifting the same resident may take several staff members and put them and the resident at risk for injury.
4. Patient satisfaction. The use of transfer equipment enables residents to be safely transferred without being grabbed, tugged, or bruised.
5. Employee satisfaction. Having transfer equipment proves to staff members that they are appreciated and respected in the workplace by the company.
6. Higher attendance. Fewer employees out with injuries mean fewer sick days and light-duty days.
7. Reduced costs. The use of proper transfer aids can reduce workers compensation costs by 35% to 65%.
8. Reduced patient falls. The use of mechanical lifts significantly reduces the number of potentially injurious patient falls.
9. The Joint Commission and other professional reviewing entities look favorably on a well-defined, system-wide program of lifting devices and training.
Making It Mandatory
The United States does not yet have national safe patient legislation, but that may just be a matter of time. HR 378: Nurse and Patient Safety & Protection Act of 2007, was introduced in Congress this past January and is now in committee. In the meantime, the movement is spreading on a state-by-state basis. So far, such legislation has been enacted in New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In the past year, some type of legislation designed to address lifting in healthcare facilities has been introduced in California, Connecticut, Florida, Illinois, Massachusetts, Michigan, New Jersey, New York, Nevada, and Vermont.
What does such a law mean to facilities? The 2006 Rhode Island law, for example, requires each licensed healthcare facility to develop a written safe patient handling program.
By July 1, 2008, all Rhode Island healthcare facilities must be prepared to implement a safe patient handling policy for all shifts and units that will achieve the maximum reasonable reduction of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances.
Safe patient handling practices—whether adopted voluntarily or enforced by legislation—are going to determine which long-term care facilities not only survive but thrive in the coming years.
As staff and residents become more knowledgeable, they will become more insistent that the facilities they choose to work and live in provide the lifting and transfer equipment that ensures their health and well-being, and over the long term, that will mean a healthier bottom line to their facilities.
Janet White is a Sales Account Manager for DMSG, Inc., a distributor of bariatric and patient handling equipment selling to acute and long-term care facilities nationwide.