Handling Patients Safely

What’s the Issue?

Musculoskeletal disorders (MSDs) accounted for 34 percent of the injuries that resulted in lost workdays in 2002, according to the Bureau of Labor Statistics (BLS). Nursing aides, orderlies and attendants were the specific occupational category with the highest number of MSDs (Ergoweb, 2004). Healthcare workers suffer over 200,000 work-related injuries per year and according to the 2002 BLS report, work-related MSD incidence rates were 8.8 per 100 employees in hospital settings and 13.5 per 100 employees in nursing home settings and the rate appears to be increasing.

The cumulative weight that a nurse may have to lift within an 8-hour period is equivalent to 1.8 tons (Tuohy-Main, 1997). Since related injuries and exposures appear to be increasing, there has been a general shift away from many of the recommendations previously given to address the injuries experienced by this group of people. The older recommendations included manual patient lifting, body mechanics, safe lifting training and using back belts (Nelson, 2004). Employers should update methods and procedures to bring them in line with modern pro-active practices.

Commonwealth of Virginia agencies that may have this type of exposure include the Department of Mental Health, Mental Retardation & Substance Abuse Services, the Department of Health, medical units within the Department of Corrections and the Department of Juvenile Justice, the Virginia Veterans Care Center, the University of Virginia Health System, and agencies that provide emergency services, such as the State Police and the Virginia Department of Emergency Management.

Manual patient handling is defined as the transporting or supporting of a patient by hand or by pushing, pulling, carrying, holding, and supporting the patient or patient’s body part (Manual Handling Operations Regulations, 1992). When talking about safe handling practices, specific terms should be identified, including transfer, repositioning, and lifting.

• A transfer is the non-emergency transport of a patient from one location to another;
• Repositioning is defined as placing a patient in a new position;
• Lifting occurs when one directs or carries a patient from a lower to a higher position¹.

In some cases, repositioning or transferring a patient requires lifting. It is very important to remember that OSHA recommends that manual lifting of residents be minimized in all cases and eliminated when feasible (OSHA Guidelines for Nursing Homes, 2000). Before either of these tasks is completed, an assessment of the risks must be completed to determine the best and safest course of action.

Risk Assessments

Assess whether the patient is able to assist with the move prior to attempting to lift, reposition, or transport the individual. Several potential challenges should be considered.

• How much assistance does the patient require?
  • Patients who can assist with their own transfer, repositioning, and lifting should be encouraged to do so.
  • Specific tools will be needed for patients that cannot offer any assistance.
• What size, how tall, and how much does the patient weigh?
  • Heavier, taller patients may require additional attention/precaution, or different lifting devices.
• Does the patient understand what is happening?
  • Some injuries may occur if patients are disoriented and do not understand that the transfer, lifting, or repositioning process is not harming them.
• Is the patient cooperative?
  • Combative patients present additional concern. Special consideration should be given when interacting with this group of patients.
• What other factors might influence the decision to use a specific method to lift, transfer, or reposition?

As part of the risk assessment, potential injuries should also be identified.

Potential Injury Exposure

Some common exposures and problems for healthcare workers required to physically handle patients are:

• Repetitive motion
• Awkward positions
• Using extreme force to move patients
• Strains/sprains
• Lifting
  • Multiple lifts
  • Lifting alone
  • Lifting heavy patients

It is important to note that both employees and patients are at risk when patient handling tasks are performed.

After the risk assessment and potential exposures have been identified, administrative and engineering controls should be evaluated.

Administrative Controls

Administrative controls or work practice controls are changes in work procedures such as written safety policies, rules, supervision, and training with the goal of reducing the duration, frequency, and severity of exposure to situations². Ergonomic assessments and job safety analyses should be conducted as administrative controls to identify work practices/procedures that can be changed to prevent injury.

Policies such as a “No Lift Policy”, which emphasizes that workers should avoid any manual lifting of patients in every situation unless there is no other option, are another form of administrative control. This does not mean that employees will NEVER use the manual lift; however, the patient’s needs, physical characteristics, level of cooperation, and cognitive levels must be evaluated to determine if either manual lifting or using assistive devices is appropriate. Employers under this type of policy need to provide management support, employee training, and enough available and appropriately maintained equipment to ensure that employees will be able to comply with the policy.

Engineering Controls

Engineering controls are changes made to the work environment, layout, tools, or equipment used on the job, or changing the way a job is done to avoid work-related musculoskeletal hazards (Virginia Polytechnic Institute and State University, 2004). Engineering controls should protect all workers by reducing or eliminating the hazard.

Patient handling equipment and devices are the most common examples of engineering controls for healthcare workers. As technology improves, so do the devices that are available to assist with the many activities performed to care for patients.

Some of the devices and their uses are listed below (OSHA Guidelines for Nursing Homes, 2000):

Patient lifting

Designed to help patients who cannot support their own weight

• Portable lift device (sling type)
  • Lift from bed to chair, chair or floor to bed, bathing and toileting, or after a resident falls
• Lean-Stand Assist Lift
  • Lift from bed to chair, chair to bed, or bathing and toileting.
• Ceiling mounted lift device
  • Lift from bed to chair, chair or floor to bed, bathing and toileting, or after a resident falls

Patient transferring/repositioning

Designed to help patients who are cooperative and can provide some assistance.

• Powered sit-to-stand or standing assist devices
  • Transfer from bed to chair, chair to bed, or bathing and toileting. Can be used for repositioning in areas with limited space.
• Repositioning Devices
  Ex. Low friction mattress covers, transfer/slide boards, boards or mats with vinyl coverings, convertible wheelchair, Geri or cardiac chair to bed, or beds that convert to chairs
  • Transfer partial or non-weight bearing patient between two horizontal surfaces (bed to stretcher or gurney).
  • Lateral transfer of patients in and out of wheelchairs or from a sit-to-stand position.
• Gait belts/transfer belts with handles
  • Transfer from bed to chair, chair to chair, chair to car, and in some cases when guiding or controlling falls.

In addition to utilizing lifting devices, patient lift teams should be utilized. A patient lift team consists of at least two employees working together to perform transfers, repositioning, or lifting tasks on generally high-risk patients.

Exercise

It is important to remember that there may be occasions where manual lifting is necessary. Prior to performing a manual lifting task, the employee should properly stretch and warm up the muscles to prevent strain or injury.

Wall slides to strengthen muscles

• Back against wall
• Feet shoulder-width apart
• Slide down into a crouched position
• Knees bent to 90 degrees
• Count to 5
• Slide back up wall
• Repeat 5 times

Leg raises while seated

• Sit upright
• Legs straight and extended
• Lift one leg waist high
• Slowly return to floor
• Repeat with other leg
• Repeat 5 times with each leg
  

Back leg swing to strengthen hip and back muscles

• Stand behind chair
• Hands on chair
• Lift one leg back and up
• Return slowly
• Raise other leg and return
• Repeat 5 times with each leg
  

Decrease strain on back

• Stand with feet apart
• Hands in small of back
• Knees straight
• Bend backwards
• Hold for 2 seconds

By performing risk assessments, identifying potential exposures, and applying administrative and engineering controls, an agency can better protect healthcare workers from experiencing musculoskeletal disorders. If a manual lift is necessary, make sure the employee is physically prepared to perform and emphasize warming up since doing so reduces the likelihood of muscle injury. Workers can also participate in a wellness program and perform exercises to strengthen the body to reduce injury.

¹ The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2000 by Houghton Mifflin Company. ² The MSDS Hyperglossary, Copyright © 2005 by Interactive Learning Paradigms, Incorporated

References

Ergoweb. (March 29, 2004). Truck Drivers, Nursing Aids, Service Employees Have Highest Lost-Time Ergo-Related Injury Rates. Retrieved August 29, 2005, from http://www.ergoweb.com.

Manual Handling Operations Regulations. (1992). London: The Stationery Office.

Nelson, A., Baptiste, A. (September 30, 2004). “Evidence-Based Practices for Safe Patient Handling and Movement” Online Journal of Issues in Nursing. Vol. #9 No. #3, Manuscript 3. Available: http://www.nursingworld.org.

Occupational Health and Safety Agency for Healthcare in British Columbia (OHSAH). (2000). Safe Patient & Resident Handling. Retrieved September 1, 2005 from, http://www.ohsah.bc.ca

Occupational Safety and Health Administration. (n.d). Ergonomics: Guidelines for Nursing Homes. Retrieved August 9, 2005, from http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html.

Occupational Safety and Health Administration. (October, 2000). HealthCare Wide Hazards-Ergonomics Retrieved August 9, 2005, from http://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html.

Tuohy-Main, K. (1997). Why manual handling should be eliminated for resident and career safety. Geriaction, 15, 10-14.

Virginia Polytechnic Institute and State University, Environmental Health and Safety Services. (n.d.). Workplace Ergonomics: Engineering Controls. Retrieved August 29, 2005, from http://www.ehss.vt.edu.

OSHA hospital e-tool, (02,2002)