National Emphasis Program in Nursing & Residential Care Facilities:
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National Emphasis Program in Nursing & Residential Care Facilities: Impact for Safe Lifting & Moving in Health Care. Dana Root, PT, CPE, CSPHP Regional Ergonomics Coordinator, OSHA Region 5 414.297.3315 r [email protected]

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National Emphasis Program in Nursing & Residential Care Facilities: Impact for Safe Lifting & Moving in Health Care

Dana Root, PT, CPE, CSPHP

Regional Ergonomics Coordinator, OSHA Region 5

414.297.3315

[email protected]


National emphasis program for nursing and residential care facilities
National Emphasis Program for Nursing and Residential Care Facilities

  • Provide guidance to agency compliance staff

    • Policies and procedures for targeting and conducting nursing home inspections

    • Focus on the hazards associated with nursing and residential care.

      • BBP, STF, VWP, TB, Ergonomic resident handling stressors

  • Why are we here again?

    • In 2010 nursing and residential care facilities experienced one of the highest rates of lost workdays due to injuries and illnesses of all major American industries.

    • No improvement in injury rates over past 10 years


National emphasis program for nursing and residential care facilities1
National Emphasis Program for Nursing and Residential Care Facilities

OSHA recommends:

Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible.

  • October 2012

    • OSHA cited three Wisconsin nursing homes from a large nursing home chain

    • One serious violation of OSHA’s “general duty clause”

    • Violation cites each facility for:

      • Allowing employees to perform lifting, transferring, repositioning and assisted ambulation tasks that may cause musculoskeletal disorders. 


Illinois regulations
Illinois Regulations Facilities

  • Public Act 096-0389 HB2285

    • Effective date January 1, 2010

  • Restrict, to the extent feasible, manual lifting or movement

  • Assess handling needs of resident

  • Educate nurses in the identification, assessment, and control of risk to injury

  • Evaluate alternative ways and strategies


Ergonomic assessment fresh eyes
Ergonomic Assessment: Fresh Eyes Facilities

  • We conduct our investigation the same way that we think you conduct yours

  • Goal: To look at your facility with fresh eyes

    • Focus your efforts to minimize/eliminate manual physical assistance by healthcare provider

    • Examine your policy and procedures

  • Self Assessment:

    • Calculate rates for past 3 years

    • Observe what you have and what you are doing

    • Interview staff and management

    • Review processes to make improvements


Fresh eyes policy procedures
Fresh Eyes: Policy & Procedures Facilities

  • Purpose and Scope of the Policy

  • Staff responsibilities

    • NHA

    • Unit Managers

    • Therapy

    • Resident Handlers

  • Resident assessment

  • Workplace assessment

  • Training requirements

  • Equipment requirements

  • Medical management


Fresh eyes rates
Fresh Eyes: Rates Facilities

  • Information

    • OSHA Logs

    • Safe Lifting Policy and Procedures

  • Calculate the Rates

    • FacilityDART and Severity Rates

    • MSD DART and Severity Rates

    • RHIR and RHSR Rates

  • Compare 2010 to BLS average DART rates

    • Nursing and Residential Care Facilities: 5.6

    • Resident Handling Incident Rate: 9.6

    • Private Industry: 1.8


Rhir rhsr for past three years
RHIR & RHSR for Past Three Years Facilities

  • Resident Handling Incident Rate

    = # OF RH CASES With days away from work job transfer DAYS or Restricted days x 200,000 Resident Handling Hours worked

  • Resident Handling Severity Rate

    = (days away from work + On job transfer DAYS or Restricted days) x 200,000                     Resident Handling Hours worked


OSHA 300 Log Facilities


Rhir rhsr for past three years1
RHIR & RHSR for Past Three Years Facilities

  • Look at the 300 Log entries:

    • Who

    • Where occurring

    • When occurring

    • How occurring

      • It is not about body mechanics

    • Easier to figure out why injuries are occurring

  • Pattern:

    • Trend over 3 years

  • BLS comparison

    • MSD days away rate: 9.6 for 2010


Fresh eyes interviews
Fresh Eyes: Interviews Facilities

Resident Handlers

  • Employee Issues:

    • Training

    • Staffing

    • Resident assessment

    • Communication

    • Equipment

      • Availability & storage

      • Slings

      • Battery

    • Workplace constraints

    • Injury management

  • Operational Issues:

    • SPH policy and procedures

    • Resident assessment process

    • Staffing levels

    • Equipment & slings

    • Storage

    • Space constraints

    • Training and competency

    • Medical management supervision

Nurse and Therapy Managers


Fresh eyes resident assessment
Fresh Eyes: Resident Assessment Facilities

OSHA recommends:

Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible.

  • Resident assessment:

    • Algorithms (see page 12)

    • MDS: Resident Assessment Instrument

      • ADL Support Provided versus ADL Self-Performance

    • FIM: Functional Independence Measure

    • Develop own facility assessment tool


Fresh eyes resident assessment1
Fresh Eyes: Resident Assessment Facilities

  • Tool to guide decision making

  • Based on

    • Patient’s ability

    • Equipment availability

  • Standardizes practice

  • Guides for planning handling tasks

    • “Tools not rules”

  • Clinical judgment still needed

  • Manual lifting of residents be minimized in all cases and eliminated when feasible



Fresh Eyes: Resident Assessment Facilities

  • Functional Independence Measure (FIM)

    • 7 level functional assessment scale of resident's actual performance

      • Evaluates the amount of assistance required to perform basic life activities

      • Need for assistance from another person or a device

      • Measures what the resident actually does

        Independent

      • Complete Independence

      • Modified independence – requires assistive device, …..

        Modified Dependence – resident expends 50% or more of the effort

      • Supervision (setup) – without physical contact by helper, or applies assistive device

      • Minimal Contact Assistance – resident expends 75% of effort

        3 Moderate Assistance – resident expends between 50% to 75% effort

        2 Maximal Assistance – resident expends between 25% to 50% of effort

        1 Total Assistance – resident expends less that 25% of effort


Fresh eyes resident assessment2
Fresh Eyes: Resident Assessment Facilities

  • Egress Test

    • Purpose: To facilitate the safe progression of a resident’s debut transfer through repetitions

      • Three repetition of sit to stand

      • Three steps of marching in place

      • Advance step and return each foot

    • If, during any part of the Egress Test, the resident demonstrates difficulty or need for physical assistance beyond cues and/or guarding techniques, the resident is indicated for mechanical conveyance.


Fresh eyes the care plan
Fresh Eyes: The Care Plan Facilities

  • What is on the care plan is what the resident handler must perform

    • Depending on the facility policy

      • May take the more supportive method

  • Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible.

  • Restrict, to the extent feasible, manual lifting or movement


Fresh eyes equipment
Fresh FacilitiesEyes: Equipment:

  • Equipment

    • Full Body Lifts

      • Floor based or ceiling

    • Repositioning Aids

    • Stand-Assist or Sit/Stand Devices

      • Active versus passive

    • Ambulation Devices

    • Bariatric devices

  • Scheduled maintenance

  • Slings

    • Sizes

    • Task types

    • Backup sling availability

    • By vendor

  • Battery

    • Charging location

    • Charging schedule


Fresh eyes resident handler focus
Fresh Eyes: Resident Handler Focus Facilities

Protect the Resident Handler

Monitor resident handling injuries

Track and Trend

By year, by shift, by wing, by xxx

Compare

BLS, between shifts, departments, sites

Establish a written program

  • Admission policy

    • Prevent MSD injury to resident handlers

  • How residents are assessed

  • Competent in procedures for lifting and moving residents

  • Appropriate equipment for the task


Investigation findings
Investigation Findings Facilities

  • Integrate System-wide Findings

    • Rates

    • Observations

    • Perspectives

  • Are MSD injuries occurring from manual resident handling?

    • RHI rates above 9.6

  • Why?

    • What needs to be improved?

    • How to improve it?

    • Who will improve it?


Resource guides
Resource Guides Facilities

http://www.cdc.gov/niosh/topics/ergonomics/

http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp

http://www.aohp.org/About/documents/GSBeyond.pdf

www.osha.gov/SLTCergonomics/index.html


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