Bariatric Times - February 2009 - (Page 21) Bariatric Times • February 2009 Patient Management Perspective thought to be the leading cause of back, neck, and shoulder damage. Data calculated in the private sector of US healthcare workers indicate that back injuries result in more lost work days than other injuries or illness.3 For example, in 2005, healthcare workers sustained nearly 38,000 musculoskeletal (MSD) injuries, which totaled 10 percent of all MSD injuries in the US labor force.4 Yet, this estimation is probably low as researchers suggest many injuries are unreported. In fact, as many as 50 percent may go unreported.5 Data from more than 80 studies show that every year, 40 to 50 percent of nurses experience back injuries. At any point in time, 17 percent of nurses are injured.6 21 ELEMENTS OF A SAFE HANDLING AND MOVEMENT PROGRAM Audrey Nelson, a leader in the field of SPH, describes a comprehensive patient care ergonomics program comprising six elements: 1. 2. Ergonomic assessment protocol Patient assessment criteria and decision algorithms 3. Peer leader role, back injury resource nurse (BIRN) 4. 5. 6. State-of-the-art equipment After-action reviews No lift policy WHO IS AT RISK? Although it may be difficult to identify who is truly at risk for caregiver injury, researchers suggest that risk factors might include age, shift and hours worked, and gender. More specifically, older female nurses having worked longer evening or night shifts are thought to be at greater risk for injury. Tasks that create more risk are likely those associated with greater effort required to move the patient. Additionally, awkward positions of the patient or the position of the patient’s center of gravity in relation to the caregiver providing the transfer or lift can lead to greater risk, as well as the number of transfers, turns, and lifts on a daily basis or the ability of the patient to help with transfers. When both caregiver and patient are obese the threat to safe patient handling is considerably greater. And finally, the greatest concern is the mistaken assumption that exposure to occupational injury is simply an acceptable risk associated with patient care. This barrier to meaningful safe patient handling blocks efforts to improve working conditions in the patient care environment.7 Each of these risks further leads to cost consequences. COSTS OF INJURY The risks and threats of injury further contribute to an already serious nursing shortage as an estimated 47 percent of hospital nurses report that they have considered leaving patient care because of their jobs’ physical demands. Among those nurses already injured, 59 percent have considered quitting.8 From a cost perspective, nurses’ back injuries cost an estimated $16 billion annually in workers’ compensation benefits. Medical treatment, lost work days, “light-duty,” and employee turnover cost the industry an additional $10 billion.9 Nursing personnel have the highest workers’ on bariatric units. Regardless, the risk inherent with this repeated stress is the undetected wear and tear that occurs on caregivers’ bodies, which can go unnoticed for a long period of time because there are so few nerve endings within the spinal discs and other joints. Damage to the back, neck, and shoulders is then largely undetected until the injury is extensive, causing severe, lifelong, and disabling pain. This likely explains why patient lifting, transferring, and repositioning tasks over time are compensation claim rates of any occupation or industry. Efforts to connect work environment safety and caregiver injury with quality of patient care and patient care-related cost control have created interest from a different angle. For example, patient safety efforts have long been a driving force in cost outcome strategies; however, little emphasis has been given to improving care or controlling cost outcomes by improving the work environment for clinicians. This correlational research is just recently forthcoming. De Castro10 noted that using equipment during handling activities is a more secure process for patients, and, therefore, patients were subjected to awkward or forceful handling fewer times, they experienced less anxiety, patient autonomy was increased, and a higher level of dignity was maintained. Others have recognized use of lifting equipment with a decrease in combative behavior.11 Use of friction-reducing devices for lateral transfers are not only helpful in preventing neck and shoulder injuries among caregivers, but are known to reduce shearing injury in patients, which lead to skin damage and exacerbate pressure ulcers. Nelson et al12 recently reported a link between safe patient handling and patient outcomes in long-term care, citing a reduction in falls and other adverse events. to address the issues of caregiver safety, but are faced more and more often with the fact that a new way of thinking about safety is the only answer. For instance, caregivers, including nurses, continue to be trained on methods of manual lifts and transfers, despite the fact that body mechanics training in proper lifting techniques has been discredited by 35 years of research.13 More recently, the concept of mechanical handling devices has come under scrutiny, and never more seriously than with the larger, heavier patients. For example, consider dragging heavy or cumbersome bariatric equipment across carpeted inclines or placing a sling under a morbidly obese patient using a log roll technique. These tasks are thought to support a safe patient handling philosophy— but do they really? The challenge is recognizing practices that truly support a safe environment. The new paradigm is more than equipment; a safe environment comprises assessment, administrative support, an on-unit mentor, policies and procedures, and sustained enthusiasm for change. REALISTIC CHANGES The essence of a successful transformation is administrative support. This will likely occur on two fronts: individual states passing safe handling legislation and the federal government passing a national bill. In the interim, cost control will drive interest. The hospitals that have instituted successful safe patient handling ARE THERE SOLUTIONS? Hospitals and healthcare organizations are seeking strategies
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