'TLC' program helps cut lifting injuries
Everyone can use a little TLC, and at Baptist Health, a multifacility health system based in Jacksonville, FL, staff get it from a program called "Transferring and Lifting with Care" or TLC.
The program is aimed at reducing the injuries that result from lifting, repositioning and transferring patients, daily events that put both health care workers and patients at risk. According to the United States Department of Labor, Bureau of Labor Statistics, nursing and personal care facilities rank highest in the incidence of non- fatal occupational injuries and illness, with 12.6 injuries per 100 full-time employees reported in 2002. The agency also reported that one-third of these injuries resulted in absence from work, and that nursing aides and orderlies were reported to have the highest number of absentee days (44,000) due to musculoskeletal disorders.
To prevent these types of injuries, Baptist Health developed a comprehensive program that uses assistive equipment and devices on nursing units and in clinical departments at every one of its five hospitals to help caregivers safely lift and move patients.
Injury prevention consultants are helping Baptist Health create a cultural change in how staff lift and move patients, says Beth Mehaffey, vice president of human resources for Baptist Health.
"This is being accomplished through the establishment of customized policies and procedures, ongoing clinical support, and formal training on assistive equipment for lifting, repositioning, and transferring patients," she says.
Chris Olinski, RN, MSN, COHN-S/CM, manager of employee health for Baptist Health, says programs addressing lifting injuries are increasingly needed as health care workers are aging.
"The average age of a nurse in the United States is 48 years old, and the average patient's weight is 250 lbs.," Olinski says. "That's 20-25 years of lifting, causing wear and tear on a caregiver's back. When you combine that with the average patient's weight, hospitals are losing caregivers from the bedside, and these are experienced employees."
Not only do the injuries result in significant liabilities from injuries to patients and staff, but they also produce costs related to bringing in additional staff to replace those taken off line by injuries, Olinski says. One of the first steps toward addressing lifting injuries at Baptist Health was hiring an employee injury specialist, Holly Lemmons, LPN, in the employee health department. She points out that the health care industry has long tolerated lifting injuries that would be cause for alarm in any other industry.
"Health care workers are the only laborers in this country who consider 100 lbs. light," Lemmons says. "In any other industry, such as UPS or the U.S. Postal Service, staff would enlist the use of a mechanical device to assist them with a load heavier than 50 lbs. As a result, bedside caregivers endure microtears to their muscles. These microtears accumulate over years and years of undue stress on back muscles from lifting and moving patients, which could turn into a career-ending injury."
Nurses involved in choosing devices
The hospital system formed a team to start looking at vendors to supply lifting devices and transfer aids, but then Olinski, Lemmons and the others involved realized from the start that equipment would be only part of the solution.
"The biggest challenge is the cultural change and changing the mindset of the staff on how to move and lift patients," Olinski says. "One of the things we knew would be important was having the nurses who would be using the equipment actually involved in selecting it."
To do that, Baptist Health organized vendor fairs at two of its facilities to allow nurses and other caregivers to see and try out some of the equipment offered by different suppliers. With their input, Baptist Health partnered with Arjo Inc., a company based in Roselle, IL, which manufactures lifts and other patient-transferring equipment. Arjo also is the parent company of Diligent, the consultative team that provides staff education and assists with implementation and ongoing support.
Baptist Health rolled out its TLC program first at Baptist Medical Center Downtown in October 2007. The other facilities have adopted the program gradually, with the last beginning the TLC effort in March 2008. In addition to widespread implementation of lifting devices, Baptist Health provided extensive training in using the new equipment and other methods for avoiding lift injuries. Those receiving training include nurses, physical therapists, occupational therapists, radiologic technologists, nurses' aides, patient transport staff, and any other employee who is responsible for lifting, moving or transferring patients.
More than 4,100 Baptist Health employees have been trained. In addition, a total of 225 "super users" have been trained systemwide to act as coaches for all other staff about two per shift, per unit. They go through more intensive eight-hour training and they are responsible for confirming that other staff have completed two hours of staff training and are proficient in the proper techniques.
In addition to providing the assistive devices, the TLC program includes policies on how to lift and transfer patients, providing specific requirements rather than leaving it up to the individual staff member's judgment. The methods of lifting and transferring are based on best practices, but the TLC program creates a uniform, systemwide expectation of how to safely move patients, Olinski says.
The program also includes a signage system that allows staff to mark the patient's room with an indication of what type of assistive devices are needed for that individual.
Cory Meyers, RN, MN, LHRM, director of risk management and corporate compliance, and patient safety officer, points out that the TLC program was positioned as a benefit to staff, a way to help them avoid injuries and deal with the growing number of large patients, rather than just another set of rules they had to follow. She says that approach is proving key to how the staff are embracing the program.
The program is too new to yield much in measurable results, but Olinski says the initial indication is that lifting injuries are decreasing. The goal of the TLC program is to achieve a 70% reduction systemwide in employee injuries related to lifting and transferring patients, after one full year of using the new policies and equipment.
Baptist Health has long monitored falls and studied how they occur, and now that analysis will include an assessment of whether staff followed the new TLC policies and whether the lifting and transfer devices were used properly, Meyers says.
"Any time there is a fall, we have to see if the equipment was involved, and in the time since this program was begun, we have seen no incidents that were caused in any way by the equipment," she says. "So, a focus for us now is determining whether employees used the equipment and used it properly, and so far we are seeing satisfying results from that aspect also. We expect it to keep improving."
Sources
For more information about the Baptist Health TLC program, contact:
- Holly Lemmons, LPN, Injury Prevention Specialist, Baptist Health, Jacksonville, FL. Telephone: (904) 202-2000. E-mail: [email protected].
- Beth Mehaffey, Vice President, Human Resources, Baptist Health, Jacksonville, FL. Telephone: (904) 202-2000. E-mail: [email protected].
- Cory Meyers, RN, MN, LHRM, Director of Risk Management and Corporate Compliance, and Patient Safety Officer, Baptist Health, Jackson-ville, FL. Telephone: (904) 202-2000. E-mail: [email protected].
- Chris Olinski, RN, MSN, COHN-S/CM, Manager, Employee Health, Baptist Health, Jacksonville, FL. Telephone: (904) 202-2000. E-mail: [email protected].
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