ore than 10 years ago, a region of the VA Patient Safety Center of Inquiry undertook a research project on the redesign of high-risk patient handling tasks. An initial redesign featuring ergonomics and biomechanics ultimately resulted in a 30 percent decrease in staff injuries in a 9-month period and a 70 percent decrease in modified duty days.
A decade and $205 million later, the Veteran's Health Administration recommended safe patient handling programs throughout their facilities
Private hospitals are slowly but surely starting to follow suit. Some hospitals are classifying their policies as "no lift" and others simply as "safe patient handling," but experts say the difference is in semantics only.
"The general consensus is that you can't call these programs 'no-lift'," said Mary Matz, SPH, CPE, national VA program manager for safe patient handling. "It's impossible to have a truly no-lift environment because lifting and movement does occur during emergency situations."
Culture Change in Baltimore
Joan Warren, PhD, RN, NEA-BC, director of research and professional practice, Franklin Square Hospital Center, Baltimore, was sold on the concept after hearing about it from a physical therapy colleague who attended a safe patient handling conference. Warren became chair of Franklin Square's nursing implementation team in 2007.
When the friction-reducing slides, bariatric lift equipment and mechanisms to steady patients and facilitate walking arrived, Warren knew the hard part hadn't even begun.
"Think of the anxiety when needle systems arrived on the scene years ago. [Nurse adoption] was basically like pulling teeth," she said. "It was a huge culture change for those who've been lifting for 20-30 years. Your automatic instinct is to pull a sliding patient back up. Using the equipment does take more time."
Three years later, Warren can attest to improved safe patient handling at Franklin Square. During that time period, the number of injured nurses dropped by 82 percent.
It didn't happen overnight. The success of the program was contingent upon nursing leadership engagement and support, open staff dialogue, recognition and consistent enforcement, along with colleagues who serve as safe patient handling champions. This has contributed to nurse buy-in and ultimately, the success of the program. Continuous education has been the key to sustainability.
"I don't think people recognize they can't lift more than 35 lbs., the size of small child," said Warren. "Over time, you end up with back injuries. If you want to stay in nursing, you need to keep yourself strong for patients."
Designing for Safety
Jeanne Dzurenko, MPH, RN, is a firm believer in the 35 lb. lifting limit as well. As New York University Langone Medical Center was designing its new facility, the hospital's safe patient handling committee, consisting of nurses and physical therapists, ensured accommodations were made to reduce lifting as much as possible.
"We were constantly looking at data to mitigate lifting," said Dzurenko, senior director of nursing operations, patient care systems and business at NYU Langone. "As we planned the new hospital, we requested ceiling lifts in critical care, the new bone marrow transplant unit and anywhere with new construction."
Patient handling equipment isn't limited to new construction. When Dzurenko noticed female patients experiencing falls when they were moved for testing, she requested ceiling lifts that moved patients to ultrasound tables.
Like most hospitals, NYU Langone encounters the most problems storing mobile lifts. "Like they say in the literature, because storage is an issue with mobile lifts, they're sometimes far away from the patient. This means the nurse is more likely to move the patient with a colleague, rather than using the lift."
Still, she said, the hospital's approximate $8,000 investment in ceiling lifts would have been worthwhile even if only one injury was prevented. It's too early to estimate any final figures, as the bone marrow unit lifts were installed in July.
"We do know that there's been an $800,000 ROI [return on investment] in worker's comp claims alone," Dzurenko said. "These are life changing injuries so it's money well spent."
Lift Teams in California
Toby Marsh, MSN, RN, NEA-BC, assistant director of patient care services, University of California Davis Medical Center, attests to the benefits of an under-utilized component of safe patient handling programs - lift teams.
In 2004, a safe patient handling program started at UC Davis with two lift team members on each shift. Within just a few months, demand was so great that four-member lift teams were necessary.
The long-standing argument against lift teams was that it shifts the injury burden from the nurse to the lift team. However, UC Davis hasn't reported an increase in injury claims for lift team personnel. Back braces and training on body mechanics are responsible for the low injury rate as well, Marsh added.
Certain criteria dictates when nurses should call the lift teams. In cases of bariatric patients, lift teams are deemed necessary when the patient weights more than 200 lbs. In addition to the team members, UC Davis purchased gait belts, floor lifts, maxi slides, chairs that extend into the bathroom and ceiling lifts for patients weighing up to 650 lbs.
When the additional technology first appeared on med/surg units, nurses were less than thrilled, Marsh said. Slowly, early adopter nurses started voicing their preferences for certain products over others and gradually took ownership of the initiative.
For instance, non-disposable slings were voted out as the degree of cleanliness was deemed variable. Like blood pressure cuffs, these are used on a patient-by-patient basis.
"I'd advocate for a lift team and a program centered around assistive devices for mobilizing and moving patients," said Marsh. "Our nurses are satisfied and feel like they're being listened to, which improves our retention."
Facilitywide Improvement in Kansas
When Barb Hermann, BSN, RN, COHN-S, and her colleagues at Salina Regional Health Center in Salina, KS, noticed a spike in ICU staff injuries and nurses on work restrictions, they knew the time was right to start the safe patient handling journey.
The hospital's physical therapists had been advocating for some form of a safe patient handling policy for years. When vendors came in to present products side-by-side to the group purchasing organization, Hermann knew staff safety had to be a priority facilitywide, not just in the ICU.
Salina Regional purchased not only overhead lift systems, but also slip sheets, emergency lowering devices and lateral transfer devices that work together. One of the biggest initial concerns was the equipment breaking and forcing nurses to do the lift themselves. However, the product manufacturer's troubleshooting personnel has talked them through most potential problems.
When Salina Regional built a new patient tower, the company sent out a maintenance person to install new tracks for the ceiling lifts.
With an aging workforce and increasingly heavier patient population, Hermann doesn't see any way around creating a safe patient handling policy.
"We promote our policy in recruiting materials, stating the danger to wear and tear on the body and micro traumas," she said. "Hospitals need to just bite the bullet and go with it. You won't regret it."
Robin Hocevar is senior regional editor at ADVANCE.