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Safety and Health Management System for Preventing Musculoskeletal Disorders in Nursing Homes . Sukhvir Kaur and John Newquist. Cost of Workplace Injuries/Illnesses. Large amount of physical, financial, emotional hardship. WHAT DO ACCIDENTS COST YOU?. Direct - Insured Costs.

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safety and health management system for preventing musculoskeletal disorders in nursing homes

Safety and Health Management System for Preventing Musculoskeletal Disorders in Nursing Homes

Sukhvir Kaur and John Newquist

cost of workplace injuries illnesses
Cost of Workplace Injuries/Illnesses

Large amount of physical, financial, emotional hardship



Direct -

Insured Costs

Unseen costs can sink the ship!

“Just the tip of the iceberg”

Indirect - Uninsured, hidden Costs - Out of pocket

1. Time lost from work by injured employee.

2. Lost time by fellow employees.

3. Loss of efficiency due to break-up of crew.

4. Lost time by supervisor.

5. Training costs for new/replacement workers.

6. Damage to tools and equipment.

7. Time damaged equipment is out of service.

8. Loss of production for remainder of the day.

9. Damage from accident: fire, water, chemical, explosives, etc.

10. Failure to fill orders/meet deadline

Unknown Costs -

1. Human Tragedy

2. Morale

3. Reputation

creating a strong s h culture
Creating a strong S&H Culture
  • Positive workplace attitudes – from the president to the newest hire.
  • Involvement and buy-in of all members of the workforce.
  • Mutual, meaningful, and measurable safety and health improvement goals.
  • Policies and procedures that serve as reference tools, rather than obscure rules.
  • Personnel training at all levels within the organization.
  • Responsibility and accountability throughout the organization.
osha safety and health program management guidelines 1 26 89
OSHA Safety and Health Program Management Guidelines(1/26/89)
  • Management Commitment
  • Employee Involvement
  • Worksite Analysis
  • Hazard Prevention / Control
  • Training
  • (Evaluation / Improvement)
pre rule i2p2
Pre Rule: I2P2
  • Proactive program to find and fix hazards
  • Effective in reducing injuries, illnesses, fatalities
  • 34 states and many nations around the world have such requirements
  • Injury and illness incidences lowered by 9 percent to more than 60 percent in eight states where either program required or incentives through workers’ comp
  • Fatality rates in California, Hawaii and Washington, with their mandatory injury and illness prevention program requirements, were as much as 31 percent below the national average in 2009.
cal osha 8ccr 3203 injury and illness prevention program
Cal OSHA 8CCR 3203 Injury and Illness Prevention Program

Model Program Elements

  • Responsibility
  • Compliance
  • Communication
  • Hazard Assessment
  • Accident / Exposure Investigation
  • Hazard Correction
  • Training (Instruction)
  • Recordkeeping
    • Implement and Maintain Program
vpp s compelling evidence
VPP’s Compelling Evidence
  • Successful because its replicable!
  • On average for CY’2010, VPP participants are:
    • 47% below the Total Recordable Cases of Injuries and Illnesses (TCIR) rate
    • 56% below the Days Away from Work, Restricted Work Activity, or Job Transfer (DART) rate
  • Avoided an estimated 9,023 TCIR injuries and 6,310 DART injuries when compared to expected results within their respective industries

Research demonstrates that such programs are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities; lowering workers compensation

  • Reduced employee turnover, improved morale
  • Fewer injuries among workers
  • Reduced workers’ compensation costs
  • Resident injury reduction
  • Increased admissions from improved PR
  • Overall better resident care
  • Reduced risk of OSHA inspection & penalties
    • VPP sites are exempt from programmed inspections
a process for protecting workers
A Process for Protecting Workers

OSHA Guidelines: Ergonomics for preventing MSDs in Nursing Homes

  • Provide management support
  • Involve employees
  • Identify problems
  • Implement solutions
  • Address reports of injuries
  • Provide training
  • Evaluate ergonomic efforts
provide management support
Provide Management Support
  • Develop clear goals
  • Assign responsibilities to staff
  • Quality assurance
    • Competent in equipment usage
    • Enforcement/discipline of facility policy and procedures
  • Provide necessary resources
  • Ensure that responsibilities are fulfilled
employee involvement
Employee Involvement
  • Employees: The Real Champions for the Process
  • Results in:
    • Increased problem-solving capabilities
    • Enhanced worker motivation and job satisfaction
    • Greater acceptance of changes
employee involvement1
Employee Involvement
  • Establish a Lift Committee
  • Participate in selection, training, evaluation of equipment
  • Involved in developing the ergonomic process
hazard analysis identify problems
Hazard Analysis: Identify Problems
  • Review
    • Injury and illness logs
    • Workers’ compensation records
    • Reports of problems
    • Accident reports
    • Insurance company reports
  • Talk with employees
  • Observe jobs/workplace
facility injury illness rate
Facility Injury/Illness Rate
  • DART Rate for all site injuries/illnesses:
    • Total # of cases with lost workdays or restricted days
    • Multiply by 200,000
    • Divide by total employee hours
  • Comparing it to the national average:
    • BLS DART Rate for 2010: 5.6
    • BLS Resident Handling Incident Rate (RHIR): 9.6
facility musculoskeletal disorder msd rate
Facility Musculoskeletal Disorder (MSD) Rate
  • DART Rate for MSDs:
    • Total # of MSD cases with lost workdays or restricted days
    • Multiply by 200,000
    • Divide by employee hours (only department hours if calculating MSD rate for the department)
  • Severity Rate:
    • Total # of lost + restricted days
    • Multiply by 200,000
    • Divide by employee hours
trend analysis
Trend Analysis


  • How many MSD injuries are occurring
  • Where, when, how they are occurring
  • Easier to figure out why they are occurring
  • Trend over the years
  • Look for patterns
rhir rhsr for past three years
RHIR & RHSR for Past Three Years

Resident Handling Incident Rate

2011: 14.7

2010: 4.3

2009: 20.3

Resident Handling Severity Rate

2011: 1860.3

2010: 769.9

2009: 203.0

Site DART Rate:

2011: 8.8

2010: 8.9

2009: 7.9

BLS National Avg.:

2011: 5.3

2010: 5.6

2009: 5.6

accurate recordkeeping
Accurate Recordkeeping
  • Mechanism for reporting MSDs and their signs and symptoms
  • Accurate documentation of injury reports
  • Intervention and access to health care professionals
accident incident investigations
Accident / Incident Investigations
  • Seek out root causes of the accident or event – not fault finding
  • Address "near miss" incidents.
  • A system to analyze trends
    • review of injury/illness experience
    • hazards identified through inspections
    • employee reports
    • accident investigations, and/or other means
hazard prevention and control
Hazard Prevention and Control

Hierarchy of Controls

  • Engineering controls
  • Administrative controls
  • Work Practice controls
  • Personal protective equipment.
resident assessment
Resident Assessment

Decision Logic

  • Size and weight
    • Level of assistance required
    • Resident’s rehabilitation needs
    • Need to restore resident’s functional abilities
  • Ability and willingness to cooperate
  • Medical conditions impacting choice of methods
implement solutions
Implement solutions
  • Mechanical assist devices help reduce injury by avoiding unnecessary manual transfers
  • Eliminate the need to manually lift or move residents
    • Sufficient quantities
    • Readily available for use
    • Sufficient accessories
    • Maintained in good working condition
implement solutions1
Implement Solutions
  • Reassessing need
  • Thorough training on equipment and proper work practices
  • Lift teams
  • Space constraints- movement and operation of equipment
  • Preventative maintenance
  • Early reporting and treatment of injuries
alternative to manual lifting
Alternative to Manual Lifting
  • Providing an alternative to manual resident lifting in nursing homes is the primary goal of the ergonomics process and of the OSHA guidelines
  • OSHA recommends that manual lifting of residents be minimized, and eliminated when feasible

To be able to recognize potential ergonomic issues

Understand measures available to minimize risk of injury

To recognize MSDs and early indications of MSDs

Site’s ergonomic policy -work practices and use of equipment

Injury/illness reporting process

evaluate ergonomics efforts
Evaluate Ergonomics Efforts
  • Open lines of communication
  • Interview employees, ask suggestions
  • Observe workplace conditions
  • Track improvements- performance markers:
    • Decrease in incidence and severity of injuries
    • Decrease in OSHA recordables
    • Increase in employee satisfaction
    • Decrease in employee turnover
  • Safety and Health Management system e-tool:
  • Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders
  • Small Business Handbook: