Posts Tagged ‘lifting’

One of the most dangerous jobs in America

Wednesday, February 11th, 2015

NPR featured the first in a series of reports on one of the most dangerous jobs in America, one that they say has more debilitating back injuries than the construction industry or law enforcement. In Hospitals Fail To Protect Nursing Staff From Becoming Patients, Daniel Zwerdling investigates the high rate of back injuries that plague the nursing profession, largely the result of poor patient lifting practices, which are greatly exacerbated by the obesity epidemic.

The impact of obesity cannot be overstated – nurses are required to lift or support morbidly obese patients as many as 15 to 20 times a day. NPR puts this in context, citing NIOSH manager James Collins: “… before studying back injuries among nursing employees, he focused on auto factory workers. His subjects were “93 percent men, heavily tattooed, macho workforce, Harley-Davidson rider type guys,” he says. “And they were prohibited from lifting over 35 pounds through the course of their work.”

Yet nursing employees in a typical hospital lift far heavier patients a dozen or more times every day. Tom Lynch discusses safe lifting limits in a prior post:

“… according to NIOSH the most a nurse or aide in the 90th percentile of strength should lift at any one time is 46 pounds. But a typical 8-hour workday in this field involves lifting about 1.8 tons. Twelve percent of registered nurses who quit the field report that they do so because of back pain due to patient handling.”

A Case in Point

Zwerdling talks to a number of nurses who discuss their injuries and how they happened. He focuses on the experiences of nurses at Kaiser Permanante in Walnut Creek, which he notes is no worse and perhaps better than many healthcare facilities. Although the hospital had dedicated lifting equipment and teams, there were not enough machines and not enough teams to staff them when needed. When patients need help, the need is often urgent and immediate.

Nurses who worked at Kaiser Permanante asked for a state investigation into lifting practices shortly after California’s 2012 Hospital Patient and Health Care Worker Injury Protection Act went into effect. In January 2014, a state Administrative Law Judge issued an order that declared that Kaiser had failed to have “specific procedures in place to ensure that sufficient staff was available to perform patient handling tasks safely.”

While this report is one that frames the issue in terms of nursing injuries, it’s also a safety issue for patients.

The American Nurses Association tracks legislation related to safe patient handling and mobility (SPHM). They note that:

“…eleven states have enacted “safe patient handling” laws or promulgated rules / regulations: California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii.

Of those, ten states require a comprehensive program in health care facilities (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas and Washington), in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation.”

Exacerbating Factors

In our prior post cited above, Tom talks about some additional factors contributing to the problem – the aging work force and nursing shortages.

“The average age of a registered nurse is now nearly 47. For Home Health Aides (HHA), it’s 46; for Certified Nursing Assistants (CNA), 39. Wages for the aides and assistants average between $11 and $12. Forty percent have been on food stamps and many get their own healthcare through Medicaid. (See: HHS Direct Care Workforce) The BLS (Bureau of Labor Statistics) estimates that the demand for HHAs between 2010 and 2020 will grow by 69%; CNAs, 40%. Collectively, we are confronted with a critical shortage of healthcare talent. According to the U.S. Department of Health & Human Services, “Direct care work is difficult, the wages are low and fringe benefits are often limited.”

It’s the same with registered nurses where, oftentimes, the shortage is self-inflicted. A study of 21 hospitals in the Twin Cities found that when registered nursing positions were decreased by 9%, work-related illnesses and injuries among nurses increased by 65% (Trinkoff, et al., 2005).”

Related Resources:

Prior Workers Comp Insider posts highlight other dangers involved in nursing:

OSHA Announces National Emphasis Program for Nursing and Residential Care Facilities

Monday, April 30th, 2012

According to the U.S. Bureau of Labor Statistics, nursing and residential care facilities experienced some of the highest rates of lost workdays due to injuries and illnesses. In response to this, OSHA has announced a new National Emphasis Program for Nursing and Residential Care Facilities to protect workers from serious safety and health hazards that are common in medical industries. These hazards include exposure to blood and other potentially infectious material; exposure to other communicable diseases such as tuberculosis; ergonomic stressors related to lifting patients; workplace violence; slips, trips and falls, and exposure to hazardous chemicals and drugs. See OSHA’s complete directive PDF).
Safe Lifting
Injuries resulting from patient transfer and patient lifting are a particular area of concern. According to OSHA:

“The incidence rate for cases involving days away from work in the nursing and residential care sector was 2.3 times higher than that of all private industry as a whole, despite the availability of feasible controls to address hazards. The data further indicate that an overwhelming proportion of the injuries within this sector were attributed to overexertion as well as to slips, trips and falls. Taken together, these two categories accounted for 62.5 percent of cases involving days away from work within this industry in 2010. For this NEP, OSHA will target facilities with a days-away-from-work rate of 10 or higher per 100 full-time workers.”

According to the American Nurses Association, 12% of nurses leave the profession due to back pain. Nursing is one of the top 10 most hazardous jobs for injuries to muscles and joints. Many heavy labor industrial jobs have weight lifting limits of 50 pounds, yet nurses routinely bear many times that weight when transferring, repositioning or lifting patients. Nursing home workers in particular are at higher risk of injury than underground coal miners, construction workers, and tire manufacturers. Of the 16 million US workers employed in health care and social assistance, more than 3 million are employed in US nursing and residential care facilities.
NCCI study on safe lifting programs for long-term care facilities
A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers’ compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. Study authors found that the initial investment in equipment was recovered in less than three years based on post-intervention savings in workers’ compensation costs
More recently, further evidence was released via a study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.
NCCI summarizes the study results:

“After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution’s commitment to effectively implementing a safe lift program appears to be the key to success.”

According to the earlier NIOSH study, training alone is ineffective as a prevention strategy because “lifting the weight of adult patients is intrinsically unsafe.” It’s also important to note that the equipment alone won’t do it – workers also need to be trained how to use the equipment and management must implement and enforce a “zero lifting” policy.
Many states have safe patient handling laws
In recent years, a number of states have enacted legislation mandating safe patient lifting – and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 10 states have implemented safe patient handling laws. These include California, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking 6 states with pending legislation currently: California, Illinois, Maine, Massachusetts, Missouri and Vermont.
Tools & Resources

Rehabilitative robot roundup: Coming to a hospital near you?

Monday, December 19th, 2011

From time to time, we like to take a look at the wizardry that is under development in rehabilitative and assistive technologies. What used to be on the order of Flash Gordon type fantasy is now reality within reach. In out first clip, Toyota Unveils Quartet of Healthcare Robots. MedGadget says these four robots are expected to be production ready in 2013. Three are walking assist and balance training robots that would help in patient rehab. The fourth is a patient transfer assist – something we see as very valuable in helping to prevent health care worker injuries.

And while on the topic of lifting aids, we’d be remiss if we didn’t include RIBA, a versatile if somewhat surreal patient care robot.

Finally, we have a Robotic Man’s Best Friend to Guide the Blind. Yes, it may cost a bit more, but think of the savings in dog food. All joking aside, it’s exciting to see these technological advances moving closer to the practical reality of helping people to overcome injuries and disabilities.

NCCI study on safe lifting programs for long-term care facilities

Wednesday, March 30th, 2011

A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers’ compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. That’s pretty impressive.
Now we have further evidence based on the recently-released study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.
NCCI summarizes the study results:

“After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution’s commitment to effectively implementing a safe lift program appears to be the key to success.”

One of the interesting aspects of the study is the safe lift index, referenced above, which was developed by researchers to aggregate answers from the survey questions into a single number. Researchers looked at several variables pertaining to policies and procedures. These included the training of certified nursing assistants in proper use of mechanized lifts, preferences of the Director of Nursing for powered mechanical lift use, potential barriers to the use of powered mechanical lifts, and enforcement of the lift policies. The report discusses these factors in greater detail, and demonstrate that there are many variables beyond just the equipment that affect overall program efficacy.
Many states have safe patient handling laws
In recent years, a number of states have enacted legislation mandating safe patient lifting – and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 9 states have implemented safe patient handling laws. These include Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking states with pending legislation in 2001, currently 6 states: California, Illinois, Maine, Massachusetts, Missouri and Vermont. You can also track this legislation via a map and you can access additional resources and information at ANA’s excellent Safe Patient Handling website.
Prior posts on safe lifting
Texas enacts safe lifting guidelines for a hazardous industry
Washington passes “Safe Patient Handling” legislation
NIOSH study on nursing home lifting equipment: benefits outweigh costs
Safe Lifting and Movement of Nursing Home Residents

Readers reply: Premium comparison and safe patient handling

Friday, April 21st, 2006

State Premium Ranking – Thanks to Mike Manley for pointing us to the 2004 Oregon Workers’ Compensation Premium Rate Ranking Summary, which offers a comparison of premium by state. Mike is the Research Coordinator at the Information Management Division of Oregon’s Department of Consumer and Business Services. He also points us to some other workers comp studies that look very valuable – thanks, Mike.
Safe patient handling – Ann Hudson, RN, BSN commented on our recent post about Washington passes “Safe Patient Handling” legislation, noting that: “Substantial savings could be realized by insurance carriers and employers, and the nurse shortage could be eased, if workers’ comp carriers assisted employers to retain back-injured nurses in other non-lifting nursing positions.”
Her comment led us to the Working Injured Nurses Group or WING USA, a site that provides information, advice, and support to injured nurses. Anne is a founder of this group as well as co-author of Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts. She has been active in championing the cause of back-injured nurses – both in terms of prevention and also in advocating for reemployment of injured nurses in positions that don’t require lifting.
We appreciate informed comments from our readers. If you have resources, information, or just opinions, we encourage you to jump in!

Washington passes “Safe Patient Handling” legislation

Thursday, March 23rd, 2006

Few think of health care as one of the nation’s most hazardous professions, but there you have it: nurses, nursing home attendants, and other health care workers are among the nation’s most frequently injured work population, suffering from a high incidence of musculoskeletal injuries. Patient care calls for frequent lifting and moving, and this wreaks havoc with the back and shoulders. It’s estimated that as many as 12 to 18% of all nurses stop practicing due to chronic back pain. The nursing shortage means that many health care workers have to do more with less, increasing the likelihood of injury; ironically, these injuries may be a primary culprit in exacerbating the nursing shortage.
Not to mention the hazards to the patient. When you are at your most vulnerable, do you really want a single nurse to be heaving you about? Bill Cosby used to have a stand-up routine about how you never wanted to hear a doctor say “oops.” Similarly, When you are taking your first steps after major surgery, you don’t really want the nurse who is helping you to say “ouch” – a helper who is writhing in pain may not be in your best interests.
Legislators in Washington – prompted by the Washington State Nurses Association, United Food and Commercial Workers Local 141 and Service Employees International Union 1199NW – just passed a Safe Patient Handling law that requires hospitals to provide mechanical lift equipment for the safe lifting and movement of patients. According to Occupational Hazards:

“On a timeline between Feb. 1, 2007, and Jan. 30, 2010, Washington hospitals must take measures including implementation of a safe patient handling policy and acquisition of their choice of either one readily available lift per acute-care unit on the same floor, one lift for every 10 acute-care inpatient beds or lift equipment for use by specially trained lift teams.”

In August, we reported on Texas legislation that required nursing homes and hospitals to implement safe patient handling and movement programs. Most importantly, both laws have provisions that protect health care workers from reprisals should they refuse to perform patient handling that they deem potentially harmful to themselves or their patients.

Texas enacts safe lifting guidelines for a hazardous industry

Tuesday, June 28th, 2005

Quick – name the three leading industries with the overall greatest numbers of injuries and illnesses.
I’ve run this little pop quiz on people who work in the industry and those who don’t, and it’s rare that people get the right answers. According to Bureau of Labor Statistics, the dubious *winners* in the win, place, and show categories are laborers and material movers; heavy and tractor-trailer truck drivers; and nursing aides, orderlies, and attendants. (source)
For many people, this information is something like a game my nieces used to play called “one of these things is not like the other.” Many are startled to learn that our nation’s healthcare workers are right up there in the ranks of the nation’s most hazardous professions. The reason is largely due to patient handling that takes a heavy toll in back and neck injuries. An article in ErgoWeb describes some of the hazards for nursing home staff.
“In “Ergonomics: Guidelines for Nursing Homes,” OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn’t difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer’s disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.
Some good news from Texas
From Jordan Barab’s Confined Space, we learn that Texas has taken legislative steps to protect healthcare worker safety. The state is the first to enact legislation (TX SB 1525) requiring hospitals and nursing homes to implement a safe patient handling and movement program. The legislation takes effect on January 1, 2006. In his post, Jordan notes:
Most significantly, the law requires the plan to include “procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury.”
This is good news for healthcare workers and hopefully other states will follow suit since OSHA has issued only ergonomic guidelines which, although good for what they are, many feel are meaningless in terms of affording workers any protection.

Morbid Obesity: One Man’s Tale

Monday, June 27th, 2005

David Montgomery, a staff writer for the Washington Post, has written a moving and intimate article (registration required) about John Keitz, who weighs 625 pounds (down from his maximum weight of 781 pounds). The article is accompanied by a remarkable set of photographs, which you should be able to link to at the article. Keitz is so heavy his legs will not support his weight. The last time he stood on his feet was Aug. 1, 1998. That night he was making macaroni and cheese for his wife, Gina. He boiled and drained the noodles. Right after he cut in the Velveeta (nutritionists take note), he went down — and he has been bedridden ever since. Keitz is 39 years old. This article presents Keitz as a man of Falstaffian dimensions, who regales the reporter with his exploits as a youth and dreams of the day when he can sit up and even stand up on his own.
Morbid Obesity Personified
Keitz has to lie on his front, because if he were to lie on his back, rolls of flesh would press on his windpipe and suffocate him. His head never touches sheet or pillow. At night, his left cheek nestles upon a soft white pile of shoulder and breast meat.
Every time Keitz must be moved — usually to the hospital to treat his asthma — a major public drama ensues. One time, firefighters removed two windows from his second-story apartment and extracted him with a lift truck. More recently, firefighters used a whale sling from the National Aquarium in Baltimore to haul him out of his house in Dundalk. They put him on a flatbed truck. His ordeal was rehashed on late-night television and morning radio.
Obesity as Illness
At 26, Keitz got the first dramatic warning that his weight was barreling out of control. On the job at a bowling alley, his knees gave out. Doctors diagnosed severe arthritis. He stopped working regularly and began receiving disability checks. I think we can assume that the disability payments were under SSDI and not workers comp.
Montgomery writes that many scientists, doctors and health insurance executives are coming around to the conviction that obesity is a disease. But it is a disease with personal responsibility attached. Advocates for obese people say health care is full of conditions that involve personal choice: smoking; alcoholism; gum disease brought on by poor dental hygiene; skin cancer following too much tanning. Yet obesity is unique in how much blame is placed on the victims themselves. “Once you take off this moral interpretation, it is a dysfunction of the body and an abnormal physiological state,” says Morgan Downey, executive director of the American Obesity Association in Washington.
Workers Comp Risks
I would direct you to the 6th image in the gallery of photos that accompanies the article. (It is sometimes difficult to access Washington Post articles, so I will describe the scene in detail.) Six men from East Coast Ambulance surround Keitz. They have placed a yellow rubber tarp under him. On the count of three, they all lift. You can see the strain on the face of one of the men near to the camera — the faces of the others are obscured in the dim light of the dingy apartment. The men have only the yellow tarp to hold — there are no handles, so the lift places tremendous pressure on their forearms, fingers and wrists. Four of the men are clustered around Keitz’s formidable upper body, so only two are available to lift his lower body. Theoretically, it’s a 105 pound lift for each man. However, Keitz’s great bulk is prone to shifting, so the weight itself may change as they head for the ambulance. Indeed, you can tell from the photo that some of the men bear more weight than others (at least one appears to be “dogging” it). Ergonomically, the lift is far from ideal. Beyond that, there is clutter on the floor — tripping hazards for the men as they begin to move Keitz toward the door. There is no stretcher or gurney in the photo — it appears that they are going to carry him out of the house to the waiting ambulance.
The doorway is of average width. How will the men get through it, when Keitz’s bulk alone will barely fit through? The men at his head will have to squeeze ahead, while trying to keep Keitz from slipping out of the sling. We are left with no answers, as this is the only photo of this particular move. Given the absence of additional details in what is a very comprehensive article, perhaps we can assume that the lift was performed without any problems. No workers comp claims this time. (One hospital client of ours had two serious back injuries in the single lift from an ambulance of a similarly sized person.)
Heavy Issues
Obesity is surely a personal crisis for those who suffer from it, as well as for those who love them. It presents challenges to employers. It is also a crisis for the insurance industry — to pay or not to pay for stomach stapling, that is the question — see this Los Angeles Times article. On the front lines, it’s a huge challenge for health care workers who are called upon to move morbidly obese individuals under very difficult conditions. In the working world, it’s not always possible to perform the work as outlined in the ergonomic textbooks. All too often the workers — and their employers — are left to bear the consequences.

Airport baggage screening: a high hazard job

Thursday, March 10th, 2005

USA Today recently ran a feature on airport baggage screeners and the extraordinarily high rate of injuries that they suffer in the course of their work. Approximately one out of every four workers reports an injury and one out of 8 workers has an injury that requires lost time. Yikes – this makes bag screening one of the nation’s most hazardous jobs.
Injured workers at the Transportation Security Administration (TSA), more than two-thirds of whom are screeners, missed nearly a quarter-million days of work last year. The lost job time has contributed to a staffing shortage that has strained checkpoint security and lengthened lines at airports.
TSA employees injured on the job missed work in 2004 at five times the rate of the rest of the federal workforce. They were injured four times as often as construction-industry workers and seven times as often as miners.

Most of the injuries are soft tissue strains and sprains resulting from lifting and carrying heavy bags. Since most of the screening machines and checkpoints were added after 9/11 and squeezed in wherever they would fit, few screening stations were designed with an eye to ergonomics. OSHA has issued numerous hazard citations to airports across the country.
Adding to these problems, the TSA staffed up quickly and in most instances, strength tests were not part of the application process, and training – at least from a safety standpoint – was minimal. In a snowballing problem, the more staff injuries and absences there are, the more overworked remaining employees are. According to the article, the staff attrition rate last year was 22%.
This is distressing both for the workers involved and also for airline travelers. Although authorities say that security is not being compromised, it is hard to see how injured, overworked, and poorly trained workers can deliver the best results.
Related:
OSHA Ergonomics eTool on Baggage Handling
Safe Lifting
Safe lifting tecchniques
Lifting Safety: Tips to Help Prevent Back Injuries

Lifting guidelines and RTW

Monday, December 15th, 2003

The Ohio Bureau of Workers Comp and Ohio State University have teamed up on a research project that studies back injuries and reinjuries that can occur when people return to work. As an offshoot of the research, they developed an interactive lifting resource with guidelines intended to help employers and physicians in developing realistic transitional work programs. Considering that back injuries cause more time away from work than anything besides the common cold, it’s a resource worth checking out.