Minimizing back injuries in nursing home staff.

In the event of a "Hurricane Andrew" type emergency, could your facility's staff quickly and safely transfer non-ambulatory residents without causing injury to them and placing the residents' safety at risk? The safe transfer of residents in emergency situations, as well as day-to-day activities,

Within the health care profession, nearly 50% of all "lost time" employee accidents involve back injuries related to resident transfer by clinical personnel (nursing services, technicians, therapists) or manual material handling by ancillary support personnel (dietary, environmental services, engineering departments) -- a rate double that of the industry in general. As a result, workers' compensation premiums continue to increase drastically.

Health care workers in the course of their daily direct care, or in support of it, may actually lift more than construction or warehouse workers. The health care worker's loads are far more precious, come in all sizes and shapes, and may not always be cooperative. Reducing the most severe employee exposure and the potential liability exposure of residents falling during transfer is essential to the fiscal as well as the physical well-being of health care organizations.

Back Injury Prevention

In the nursing home environment, there are many causes for back injuries, which includes injuries to the upper extremities such as the shoulder or arm, as well as neck strains. Common causes are decrements in the fitness level, overall physical strength, and proper posture of the worker. An employer who encourages, supports and promotes healthy lifestyles, such as weight management and exercise programs, may positively impact the staff's back injury exposure.

Beyond fitness and posture, senior management who wishes to reduce their staff's exposure to back injury needs to focus on some basics of how to manually move residents and materials in nursing home facilities, and take administrative steps to implement them.

Back injuries often result from activities other than lifting, such as pushing, pulling or carrying. Clinical personnel may be involved with transferring residents from beds to chairs or restrooms or repositioning residents in bed. Ancillary support personnel may be involved with pushing or pulling dietary or laundry carts, or manually carrying materials such as food supplies, laundry or equipment.

Most facilities have ongoing educational programs that periodically address proper resident transfer and manual material handling. Unfortunately, the fact that these topics are only periodically addressed makes these programs less than successful. The key to success is a consistent approach that constantly involves everyone in the process: senior management, supervisors and staff.

For any back injury prevention program to succeed, senior management must be committed to reducing back injuries. Often only lip service is given by management, which leads to confusion on the part of supervisors and staff. With constantly increasing workers' compensation costs, management should be more open to providing additional staff, additional lifting/residential transfer equipment, and continual incentives to reduce back injuries. The process must be one in which all levels of the health care team can and will participate.

Ideally, such a program emphasizes the following areas:

* Commitment and continual support

from senior management, including

adequate staffing assistance and

proper resident and material handling

equipment;

* Consistent involvement and direction

from supervisory personnel;

* Continual awareness efforts and training

sessions for staff personnel;

* Incentive awards to support awareness

efforts and reward improved resident

and material handling injury experience

within the organization;

* Lifting techniques described in nursing

home policies and procedures,

and staff formally oriented in the following

techniques:

* Keep the resident/load as close as

possible to your body. Ten pounds

at waist height close to the body is

equal to 100 pounds in force on

the back when arms are extended

away from the body.

* Bend at the knees, not at the waist,

when lifting loads from floor

level. Ten pounds at floor height

with bent knees is equal to 100

pounds of force on the back when

bending at the waist with legs

straight.

* Avoid any twisting motion. Pivot

the feet to turn.

* Push, don't pull, loads. It takes

only half the force to move something

by pushing than it does by

pulling.

* Store heavy bulky items at waist

level so that access will be at waist

height, close to the body.

* Get help. Team lifting with residents

and material is essential.

* Communicate with residents before

transferring or repositioning

so that they will work with you.

Also ask the resident if he or she is

able to help.

* Use lifting equipment, i.e., chair

lifts, hoyer lifts, transfer boards

and belts. Research indicates that

clinical personnel fail to use such

equipment to transfer residents

because they are unfamiliar with

using mechanical aids. Training

on proper use of mechanical lifting

aids is essential to ensure that personnel

are comfortable with equipment

use.

Conclusion

The injury to facility personnel, as well as potential injury to the resident being transferred, could have a negative impact on the facility's reputation, as well as on its workers' compensation and liability costs. Instructing staff in proper lifting techniques is basic to maintaining a safe environment in the nursing home.

David C. Paterson, CSP, is Loss Control Manager, National Accounts Services Division, Willis Corroon Corporation, Nashville, Tennessee. The company's Health Care Concepts division has developed health care industry specific video training and awareness programs addressing emergency response and back injury prevention.