Lift team prevents staff/patient injuries, saves money
At OSF Saint Francis Medical Center in Peoria, Illinois, lift injuries have decreased substantially and staff satisfaction has soared after the creation of a new lift team department that provides patient transfer and mobility assistance. This program can be easily adapted to the long-term care environment after a careful review of its needs.
Our new department was proposed as an effort to curtail increasing lift injuries and growing workers’ compensation costs. With the high turnover rate of nurses, (12% of nurses leave the profession every year because they cannot physically do the job any longer), a facility has to show it cares in order to retain quality staff members, and this department is a step in the right direction. In the past two years, our hospital has seen a 30% reduction in staff injuries associated with patient handling activities, recording 67 fewer injuries, 134 fewer lost work days, and has slashed more than 1,217 restricted work days.
The National Center for Health Statistics reports low back pain is the most common work-related medical problem in the United States and the second most common reason for doctor visits. Low back pain affects 20 million Americans and is the leading cause of disability among people ages 19 to 45.
Our program is so successful that we are reinvesting our $400,000 in savings back into our safe patient handling program and lift team department.
How it all started
To begin planning for the new department, Linda Helle, RN, manager of the Coronary Care Unit, and a group of nurses concerned about the growing number of injuries among their staff, launched a six-month pilot program. During the pilot program, they tested equipment from various vendors (finally settling on a ceiling-mounted lift), tracked injuries, and measured patient and staff satisfaction. The nurses, patients, and administration were so pleased with the results that approval was granted for the creation of a new lift team department and the purchase of additional portable lift equipment.
I'm an occupational therapist with a background in ergonomics and injury prevention services and was hired to manage the department. We also hired a 21-member staff, recruited both internally and externally.
Our only special requirement for lift team members is a willingness to learn and work with the patient population and patient care staff. The selected members then go through an extensive two-week (or longer) orientation to become lift team technicians. Their orientation consists mostly of hands-on training with another lift team employee. There are equipment videos we have them watch, as well as a video on obesity and sensitivity issues. There is a lift equipment competency checklist that is reviewed and completed with each new employee, along with a mini-refresher session each year for all employees.
For new employees who have no healthcare experience, we have them spend extra time with the nursing staff. For example, the lift team has a heavy volume of calls in the ICU, so we often have them spend an entire day with a bedside nurse who can explain the critical nature of the patients, the various lines, tubes, and other equipment. This helps to improve the new employee's comfort level in working with that patient population. With the department, there are no patient weight requirements, so anytime a staff member needs assistance moving, turning, lifting, or transferring a patient, they are eligible for the lift team. The staff member who needs help calls a dedicated line that goes directly to a dispatcher who gathers information on what's needed, when, and where. From there, a lift team is provided a brief description of the situation so they know what equipment to bring and dispatched to the location.
Our dispatching system has evolved greatly over the past three years. Initially, the dispatch process was through an alpha paging system. The lift team wore pagers that all had the same number. Nursing could access the pager through the computer via a SmartWeb program that allowed them to send a text page to the lift team for what they needed. It was a new system for the hospital, and the nurses weren't comfortable with it and resisted using it. We recently switched to a computerized dispatch system, TeleTracking, which has been in use for patient transport and bed placement. It will provide better tracking data. Although most of the calls/pages for the lift team were “on demand,” there were also many scheduled appointments. For example, the lift team would round through the ICU every two hours to provide lift and turn assistance; they had four scheduled daily visits to our Med/Surg unit to get vented patients up to a chair and back to bed. The nursing staff did not have to page the lift team for those services. They were prescheduled and the team would show up at the designated times.
Once the lift team arrives, they will take over “the lift,” but the nurses stay on hand for help with different aspects of the lift and patient care, such as watching for the movement of patient tubes and IVs and to inform the lift team staff of any special considerations the patient might have. Our policy is that the nurse or tech must be present in the patient's room at the time of service. This was mostly done for patient safety—verifying that the correct patient was being lifted to the chair, to watch lines, manage feeding tubes, and oversee all medical concerns. This procedure could be modified in the nursing home setting depending on the acuity level of the patient and the qualifications of your lift staff. For example, if you required the lift staff to have a patient care technician(PCT)/certified nursing assistant (CNA)certification, there would be less need for the RN to be in the room. We still get varying levels of cooperation from the nursing staff. The team approach is critical no matter what the setting. The nursing staff response to the lift teams has been very positive overall, and hospital surveys show improved job satisfaction.
In the nursing home setting
If you're considering a lift team approach in your skilled nursing facility, first take a look at your injury rates and what you are spending on staff injuries associated with patient handling. If you do not have high injury rates, it may be difficult to justify a lift team program, especially for a small facility. You could consider training a core group of staff who are engaged in employee/patient safety and have an interest in using lift equipment. They would be the experts and be paged to help with difficult patient transfers. PCTs/CNAs would be good to train since they typically bear the brunt of the physical workload. There needs to be enough equipment in place, and the equipment needs to be readily accessible for staff to use. Many times facilities buy one piece of lift equipment to say they provide a safe lifting facility, but then it's tucked back in a remote storage room which makes it difficult for staff to access.
To make a program successful, you really need to understand your facility's culture and have data to back up the need for a program to those responsible for funding it. Maybe there's a wing that has more injuries than any other area in the nursing home—start there. Implement a program on a small scale and monitor the progress. The key is to involve the staff in designing what the program should look like. If they are not engaged, it won't matter how good of an idea it is or how important it is—it will fail. The Safe Patient Handling Web site, (https://www.visn8.med.va.gov/patientsafetycenter/), through the VA Patient Safety Center, is an excellent resource for programs in nursing homes.
The nurses see the lift team department as a resource and many are even requesting equipment for their own units. We never expected such an overwhelmingly positive response from the nursing staff. They really understand that this department is an investment in the safety and well-being of the staff and patients.
It is important for facility administration and staff alike to understand that to facilitate a change in culture there must be a comprehensive plan in place. One of the key factors to our program's success was the approach. If use of the lift equipment had been mandatory for staff, it could have completely backfired. We are in the process of developing our safe patient handling policies and procedures. When the policies are in place, then we will expect staff to use the equipment with the appropriate patients. It will be hard to justify the additional purchase of equipment if the staff continues to get injured and isn't using the equipment.
Administration buy-in is important to facilitate purchasing capital equipment. Patient testimonials were very helpful to us. Many of them will tell you it's more comfortable to be glided up to the head of the bed, rather than being dragged. It's also more dignified for the patient not to have so many hands around them. We have seen our pressure ulcer scores greatly decrease as well because there's less friction to the skin and the equipment allows patients to get up to a chair and to be turned more frequently.
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