Vol. 9 Issue 10
Successful patient handling programs rely on common factors
By Karin Lillis
The safe patient handling movement has gained steady ground in recent years, as healthcare organizations realize the financial impact of work-related injuries and their effects on patient care and staff retention.
"We're now coming into the second wave of healthcare institutions that are adopting safe patient handling practices. There are large studies and strong research that show the benefits of such programs," said Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Center of Inquiry at the James A. Haley Veterans' Hospital, Tampa, FL. "It's nice to focus on best practices, instead of how to build a program from scratch."
Safe patient handling programs are unique to each facility, but successful programs have a core of common factors.
Involve Staff Early
Launching a comprehensive safe patient handling program takes dedication, drive and a lot of legwork something Beth McCawley, MSN, RN, CCRN, knows firsthand.
Director of services for UNC Hospitals, Chapel Hill, NC, McCawley is leading a comprehensive pilot project among nine specialty and critical care units she oversees. Before the project's inception in January, two of McCawley's units burn and ortho trauma had the highest handling-related injury rates in two of the top four areas.
"You don't just buy the equipment, put it in place and expect your staff to use it," McCawley said. "Launching a safe patient handling program is a huge practice and culture change."
The working policy covers nursing surgery service divisions, physical and occupational therapists working in those divisions, linen services and medical equipment. Every staff member, from administrators to support staff, helped shape the program and carries equal responsibility for its success, McCawley said.
Before go-live in January, McCawley held numerous meetings across all shifts and disciplines on the units involved in the pilot study.
"I had to tailor every talk to individual audiences," she said. "We [went] from 60-80 people at a daylong conference to talking with three nurses on the surgical ICU at 11 p.m."
Currently, UNC's ortho trauma, vascular, urology and solid organ, GI surgery, neuroscience, surgery ICU, neurosurgery ICU, burn center and intermediate surgery care units are testing the safe patient handling policy. The hospital plans to incorporate its psychiatric and radiology departments in July, with the rest of the hospital joining in the second half of 2008.
Train Peer Educators
UNC trained 45 staff members as transfer and mobility coaches (TMCs) who offer support and refresher training for bedside clinicians.
"The coaches are leaders on the unit, usually peer-level, who can encourage practice change," McCawley said.
Assigned to each shift and unit, TMCs test current employees on the use of assistive equipment and train new hires. The coaches on the surgical services unit are RNs and a handful of experienced nursing assistants. Physical and occupational therapy departments select their own coaches within their departments. Each TMC must complete a comprehensive 8-hour course on equipment use and staff training.
After a general training session, nurses on the pilot units complete an assistive equipment checklist, signed by the employee and validated by a TMC.
The James A. Haley VA Hospital relies on its back injury resource nurses to offer bedside education and support. These peer safety specialists are experts in patient handling techniques and equipment, provide initial training and continuing competency assessments, and help sustain a safe patient handling program's success.
"Peer leaders offer more credibility than outside trainers and allow training to occur over time, enhancing competency," Nelson said.
Offer Ongoing Training
"Training nurses can be challenging with [multiple] shifts over 7 days a week," Nelson said. "One-shot training is rarely effective in assuring competency. You need to follow up as the staff discovers new questions."
At UNC, McCawley arranged general 2-hour training sessions for 400 employees, with follow-up competency testing by the TMCs. The unit-based educators provide ongoing support as staff adjust to the new safe patient handling policy.
Training also needs to be part of the unit orientation program, McCawley said. As nurses are brought to the pilot units, TMCs educate new hires and transfers and provide follow-up skills validation.
McCawley encouraged nurses to help write the policy that would guide their safe patient handling processes. Ultimately, the staff chose a corrective matrix designed to first educate and support employees without supporting repeat offenses.
"Our first approach is education and evaluation with progressive corrective action for repeat or blatant violations," McCawley said. "[The disciplinary part] won't be implemented until we're several months into the program."
At James A. Haley, nursing leaders emphasized continual education when the hospital introduced its safe patient handling program.
"We approached our staff from a realistic point of view. We encouraged them to look out for themselves. If they were injured on the job, it could impact their nursing careers as well as their lives outside of work," said Gladeen Jackson, RN, clinical manager and back injury resource on a 28-bed spinal cord injury unit. Jackson's unit was among the participants in a research study of 23 high-risk units at six VA facilities.
Karin Lillis is regional editor at ADVANCE.
Common Barriers to a Successful Program
Failure to launch. Competing organizational demands, insufficient data, resistance, lack of a champion and past failures can hamstring efforts to introduce a safe patient handling program. Possible solutions include building a business case for the project and conducting an on-site pilot to gather credible data.
Insufficient resources. "If resources are limited, concentrate on a small area, rather than trying to implement facilitywide," noted Audrey Nelson, PhD, RN, FAAN, director, of the Patient Safety Center of Inquiry at the James A. Haley Veterans' Hospital, Tampa, FL. "Pick an area likely to succeed to help you 'sell' the program later."
Lack of staff buy-in. Savvy organizations include front-line workers in the selection of equipment. Targeting specific interests of each group, from C-suite to bedside nurses, also can help "sell" the project.
Failure to maintain momentum. "Initial attempts at implementations do not necessarily result in continued use of the program over time," Nelson said. "Often, they fizzle out around 6 months." Obtaining a strong champion, unit-level peer leaders, communication and a written policy can help ensure a program's long-term success.
Training staff on multiple shifts and units. "Training staff is like hitting a moving target," Nelson said. She recommended incorporating training into orientation programs, using peer leaders to provide unit-level support, developing annual competency evaluations, providing refresher training, and beginning with low-tech equipment and phasing in higher-tech equipment.
Source: Nelson, A. (2007). Top 10 reasons why programs fail É and what to do about it. Patient Safety Center of Inquiry, Tampa VA Medical Center.
Two-thirds of the way through its patient handling pilot program, UNC Hospitals surgical services division is reporting promising results, said director Beth McCawley, MSN, RN, CCRN.
A young woman, quadriplegic after a spinal cord injury, presented with a stage IV pressure ulcer in the coccyx area. Attempts to graft a skin flap over the wound had failed twice, so UNC surgeons completed a third procedure. As part of her postsurgical care, staff had to turn the woman once an hour.
Days before the project's official launch, nurses on the unit asked McCawley for approval to use new patient transfer equipment – a vinyl sheet designed to help staff turn or reposition dependent patients. Knowing the procedures would help the healing process, the nurses worked hard to pass the required skills test.
"A week later, the woman's grafts were healing beautifully. Her physicians never thought the third procedure would work, but it did. We credit our staff's vigilance and the implementation of the new policy," McCawley said.