One of the most injury-prone work environments is a place that seeks to rehabilitate the sick and the injured: long-term care.
The American Public Health Association ranked the long-term care sector in the same “danger” tier as construction and trucking due to its high non-fatal injury rate. Many of these injuries and illnesses can be prevented, researchers and specialists assert.
The Bureau of Labor Statistics found in 2012 that nearly half of reported injuries and illnesses among healthcare workers were musculoskeletal disorders. MSDs result from the wear and tear of joints, bones and muscles from repeated, forceful movements.
For long-term care workers, much of this pain and strain is associated with daily duties such as lifting, repositioning and transferring residents to and from baths, beds, chairs and lifts.
For years, researchers and specialists have established guidelines and policies aimed at reducing back injury rates in eldercare settings. The Occupational Safety and Health Administration released a new “Safe Patient Handling” publication in June.
6-step plan
According to OSHA’s “Safe Patient Handling,” successful programs have reduced exposure to lifting injuries by up to 95%. And it takes six steps to get there.
The first step is to build commitment from management at all levels, providing visible support through consistent communication, assignment of roles, and provision of appropriate resources.
OSHA also recommends the development of a safe patient-handling committee that includes frontline workers. This promotes communication and ensures that meaningful input on lifting techniques and policies is considered.
The third step calls for assessing high-risk areas, units and patient-handling tasks. This evaluation should reflect on factors that may increase risks, such as resident mobility, cognitive ability and physical environment.
In response to the assessment, methods to reduce exposure to back injury during lifting, repositioning or transferring residents should be implemented. OSHA recommends workers avoid manual lifting and to follow a “zero-lift” policy, using lifting equipment whenever possible.
After such elements have been developed, the next step is to ensure that caregivers and staff can access training and education to understand the program.
Lastly, an overall evaluation to assess the program’s effectiveness should be enacted to encourage continued improvement.
Unpredictable factors
However, although research and statistics have shown the success of proper resident handling, some experts agree that there are unpredictable factors that are not accounted for.
“The first thing we should all do is remember that there is no correct way to manually lift another person,” says Mike Odum, senior marketing manager at ArjoHuntleigh. “Bodies are dynamic and unpredictable and do not have handles on them.”
Caregivers need to assess the characteristics and needs of residents to correctly match them to proper care, he notes.
Equipment challenges may also hinder staff from adopting safe policies, agree Sandy Weiss, Alimed’s rehabilitation category business manager, and Kathryn Canny, OT/L, MBA, the company’s project manager.
“Providers have invested heavily into creating and implementing ‘no-lift’ policies within their facilities; however not nearly the same amount of time and dollars have been dedicated to understanding the realities and obstacles that prevent clinical staff from adopting these policies,” Canny says.
Indeed, transfers should not only be safe but should be as easy as possible both for the resident and caregiver, and impediments to this should be addressed, says Lee Penner, president of Penner Patient Care Inc.
Such challenges include “too few lifters or slings, batteries that aren’t charged, or lifters that fit poorly in the environment,” Alimed’s Weiss says. Therefore, it is “vitally important” for facilities to test lift practices to determine whether certain practices help workers perform with greater safety and ease.
Workers and long-term care providers also should implement a servicing program to avoid malfunctioning of equipment and potential danger to residents and staff, says Mike Larson, territory manager at SMT Health Systems. Such an incident occurred at an Ohio nursing home in late July, when a resident fell from a lift and experienced a fatal head injury. The part of the lift that malfunctioned allegedly belonged to a different lifting system.
“Servicing is very important because lifts are a mechanical piece of equipment,” Larson says. “Most manufacturers have a service program or a checklist along with their list. So it’s going to be important to always have a regular routine program.”
However, even proper equipment training, regular servicing, and resident assessment may not be enough to ensure the success of safe lifting in some cases, says Ray Miller, director of risk and safety solutions at Direct Supply.
“The answer goes far beyond training, getting help from another caregiver or having a lift and sling somewhere on the hallway,” Miller explains. “First, most employees, new-hire or experienced, bring some usually undefined degree of cumulative trauma (such as) a developing back injury. Second, most people lift based on habit and not conscious, planned thoughts or procedures.”
Fortunately, bath and lift manufacturers have recognized these blind spots and are in the process of appropriately addressing them through recent products.
Product developments
Ten years ago, lift technology was limited and ceiling lifts were rare, according to Alimed’s Canny. Now, providers have the option of choosing between ceiling lifts, transfer systems and baths with installed seating.
VANCARE Vice President Pat Vanderheiden calls ceiling lifts an “excellent option” for transferring residents with minimal effort.
“With most transfer equipment you are not only trying to move your weight but the resident’s weight, too,” he says. “With the simple push of a button, the lift can move the resident by itself with little or no effort from the caregiver.”
VANCARE provides various ceiling lifts that weigh as little as seven pounds and are strong enough to hold up to 1,000 pounds. Each lift is portable and can be operated by a single caregiver, with slings that accommodate to different resident needs.
SMT Health Systems also offers an array of ceiling lifts that are adaptable to different surfaces and environments, SMT’s Larson says.
SMT’s Volaro lifts can be mounted on ceilings, walls or even function free-standing. No matter the model, ceiling lifts are “always there and ready to go,” he adds.
That way, workers do not have to “hunt” for lifting equipment and avoid the potential risk of injury that comes with rushing and taking shortcuts, he says. However, for residents with dementia, Alzheimer’s or another cognitive disability, the Apollo Level Glide™ transfer system may be a better fit, believes Mark Godfrey, vice president of business development at Apollo Corporation.
“Residents with dementia or Alzheimer’s tend to be very apprehensive with things that are new, but the wheelchair is ubiquitous,” he says. “It’s something that looks familiar to a person with any cognitive problem and it’s also easier to operate.”
The transfer system is specifically designed to carry out “ergonomically safe movement” to “lessen the amount of maneuvering and to integrate the system into the bathtub,” adds David Anderson, Apollo’s national sales manager. The transfer system also features an integrated weight scale and an accommodated cutout in the center to allow continuous water flow over sensitive areas.
Another chair that offers flexibility for more dependent residents is ArjoHuntleigh’s Carendo Multi-Purpose Hygiene Chair. The caregiver can adjust the height to a comfortable working position and to remove residents’ clothing without having to lift them. The chair also can recline for better comfort and foot care.
“With the right lift and the right procedure consistently used and matched with the mobility level of the client, an investment in the safety of your clients and your staff will be a wise one, as injuries are drastically reduced or eliminated,” says Odum.
But if ceiling lifts or mobile transfer systems do not meet resident or caregiver needs, providers can opt for MasterCare’s new Entrée spa tub or Integrity tub, which are designed with the approach of reducing the need for lifting devices, says MasterCare owner Mary Novotne.
The Entrée spa tub has a barrier-free entry, while Integrity has a new transporter system that offers a tilt feature for greater comfort and immersion, she adds.
There are other methods for safely transferring residents into a bathing system, but for maximum safety, the most important consideration probably is “a transfer system that is an integral part of the bathing unit,” says Penner. For example, this might take the form of a swivel seat attached to the unit. Whatever form it takes, the integrated system should not come apart and should be able to go into the water with a resident, Penner advises.
Regardless of which technology is used, specialists agree that the key to providing quality care and preventing back injury is to thoroughly understand how to operate the lifting equipment and tools.
“Reinforce learning with follow-up training at specific intervals until proper use of equipment becomes second nature,” says Fran Spidare, business manager of safe patient handling at Invacare Corporation.
As for the future, manufacturers and others hold high hopes and expectations for “intelligence relative to preventative maintenance, longer lasting battery options and another attempt at a federal no-lift or low-lift mandate,” notes Direct Supply’s Miller.
From the September 01, 2014 Issue of McKnight's Long-Term Care News
