Posts Tagged ‘nursing homes’

Health Wonk Review; Paduda recognized by IAIABC; Oregon Premium Rankings & More

Thursday, October 11th, 2012

Health Wonkery – David Williams hosts the October Surprise Edition of Health Wonk Review at Health Business Blog – and as might be expected in a pre-election climate, it’s a good one – with many submitters weighing in on the debates or other campaign related issues.
State premium rankings – The Oregon Department of Consumer & Business Services announces the availability of the 2012 Oregon Workers’ Compensation Premium Rate Ranking Summary (PDF). National premium rate indices range from a low of $1.01 in North Dakota to a high of $3.01 in Alaska. The 2012 median value is $1.88, which is a drop of 8 percent from the $2.04 median in the 2010 study. The authors of the study – Jay Dotter and Mike Manley – say: “One notable trend nationally is that the distribution of state index rates in our study continues to compress–there is less variation between the highest and lowest states, and there are 20 states within plus or minus 10 percent of the study median. This makes the rank values more volatile from one study to the next. I would recommend that states look also to their “Percent of study median” figure for comparisons over time.”
See Background information and historical state rankings since 1995. See also: Dave DePaolo on the Oregon study.
Paduda Earns IAIABC Award – At their recent 98th Annual Convention, the International Association of Industrial Accident Boards and Commissions (IAIABC) recognized Joe Paduda, Principal of Health Strategy Associates with the IAIABC Presidents Award for his efforts in raising awareness about opioid abuse in workers’ compensation. IAIABC noted that, “Through his weblog, during speeches, and in the course of his ongoing work with workers’ compensation stakeholders, Mr. Paduda has urged discussion and action on the growing use of opioids in the treatment of work injury. ” Kudos to Joe, who has clearly been a leader on this issue – as well as a driving force in raising awareness about the pricing abuses associated with physician dispensing and drug repackaging. See: IAIABC Award Recipients Uphold a Tradition of Excellence and Dedication.
Kudos also to seven other individuals who were recognized for their contributions and leadership. These include: Glenn Shor, California Division of Workers’ Compensation; Dr. Kathryn Mueller, Colorado Division of Workers’ Compensation; Ken Eichler of Reed Group; Christine Siekierski of the Wisconsin Compensation Rating Bureau; Gregg Lutz of NCCI; Terry Bogyo of WorkSafeBC; and Mike Manley of the Oregon Department of Consumer and Business Services.
Related: Joe Paduda has good things to say about IAIABC: Mutual Admiration Society.
Breast Cancer Screenings – October is National Breast Cancer Awareness Month – a good time to remind employees about screenings. The CDC’s National Breast and Cervical Cancer Early Detection Program make breast and cervical cancer screenings and diagnostic services available to low-income, uninsured, and underinsured women across the United States. Search for free and low-cost screenings in your state. The American Cancer Society offers good resources on dealing with a coworker who has cancer, including helpful tips for supervisors.
Nursing Homes – The Washington State Department of Labor & Industries has introduced a page of resources addressing Nursing and Residential Care Facilities. 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, OSHA has introduced a National Emphasis Program, and Washington’s resources gather some helpful tools. See Washington’s A-Z list of Safety & Health Topics.
Risky BusinessRisk Scenarios are an interesting and noteworthy ongoing interactive feature by editors of Risk and Insurance. A Risk Scenario consists of two parts — The Scenario, a hypothetical situations that showcases an emerging risk, and The Analysis, which offers a summary of themes, as well as access to relevant articles and resources. They are interactive features that allow readers to decide how they would handle a situation and learn how peers and other industry experts would handle the situation. They cover a range of risks from data breaches and gas explosions to MRSA exposure and complex claims. Browse an archive of Risk Scenarios.
Other items of note from around the web

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Wednesday, August 15th, 2012

When it comes to on-the-job assaults, healthcare workers are on the front lines. Earlier this year, NCCI issued a report on Violence in the Workplace, which showed that homicides and assaults are trending down. Good news, overall, but let’s take a closer look at assaults:

“The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified.”

Now, a new research report from Maine offers a close-up snapshot of the issue of workplace violence as it relates to caregivers. The Research and Statistics Unit of the Maine Department of Labor compiled data from First Reports of Injury for 2011 and issued a report on 2011 Violence Against Caregivers in Maine.
The report encompassed about 100,000 workers in healthcare and affiliated professions. Of the nearly 10,000 thousand injuries reported by those workers, 13.4% were related to violent and aggressive acts by patients and care recipients.
Key report findings include:

  • Where incidents occurred – Mental health care settings and other residential care facilities accounted for 52% of all violent/aggressive incidents in 2011. These were followed by nursing care facilities for the elderly and people with disabilities, 18.9%, and general medical and surgical hospitals and services, 16.8%.
  • What types of jobs were involved – Nurses at all levels (including nursing assistants) were involved in 21.27% of the cases; education technicians were involved in 18.6% cases; direct support professionals (personal care, hygiene, life skills, etc) were involved in 9.4% cases; Other occupations with significant numbers of cases included psychiatric technicians, behavioral health technicians and analysts, mental health and social workers and child care and senior child care workers.
  • What types of assaults occurred – The most prevalent type of assault – being hit – accounted for 21.3% of all incidents. Bites were the second highest reports, at 16.6%, of the incidents. Other identifiable assault categories included kicks, 9.45%, and being grabbed, 9.4%.

Due to the high number of bite incidents, a specific section of the report focuses on bite injuries and references information from the Federal Bureau of Prisons’ 2009 Clinical Guidelines regarding viral and bacterial exposures and the potential for infections if the skin is broken. The report also cites NIOSH publications and reports, including common risk factors for violence and a list of potential prevention strategies.
The full report is available in PDF: Maine’s Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011.
(Hat tip to WorkersCompensation.com for pointing us to this news item.)

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

Highest injury rate POP quiz: construction, manufacturing, mining, or nursing homes?

Tuesday, November 1st, 2011

Pop quiz:
Match the Injury Incident Rate per 100 Full Time Equivalents (#1 through #4) with the industry (A, B, C, D)
1. 8.6
2. 5.6
3. 4.8
4. 3.5
A. building construction
B. coal mines, underground workers
C. nursing home workers
D. tire manufacturing workers
Answers: 1-C, 2-B, 3-D, 4-A
Yes, you read that right. Nursing home workers are at higher risk of injury than underground coal miners, construction workers, and tire manufacturers. And the picture is pretty much the same when you talk about serious injuries that result in lost time. “The lost-time/ restricted duty injury case rate for nursing home workers is 5.6 per 100 FTEs, compared to 3.7, 3.3 and 1.7 for these same sub-industries, respectively.”
At The Pump Handle, Celeste Monforton posts about new data that reveals that nursing home workers face an extraordinarily high rate of on-the-job injuries.
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. In comparison, Monforton notes that about 17.1 million people were employed in manufacturing and construction. OSHA focused approximately 78% of its inspections on these two industries, and less than 2% on healthcare workers. She notes that there are different standards or triggers to prompt inspections in these industries. “Manufacturing plants on the targeting list, for example, aren’t selected for a possible inspection unless their DART rate* is 7.0 per 100 FTEs or greater. Nursing homes in contrast, have to have a DART rate of 16 per 100 FTEs or greater to “make the cut” for a possible inspection.
*DART: days away from work, restricted-duty or transfer to a different job
Related
NCCI study on safe lifting programs for long-term care facilities

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

Health & Safety resource roundup

Wednesday, October 29th, 2008

Cleaning out our bookmark files, we came upon an assortment of health and safety resources that we thought we’d pass along.

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.