When patients need a lift, CNAs page colleagues
It’s a common paradox: Employees become injured during patient transfers, while lift equipment sits idle down the hall.
El Camino Hospital in Mountainview, CA, enlisted the health care workers to create a better ergonomic climate. They did it — not with lift teams, but with teamwork. The Sixth Floor medical unit once had the highest injury rate in the hospital. Since January 2002, there hasn’t been a single injury.
"There’s a certain amount of pride now on that floor relative to their performance," says John Deex, RN, MS, OHNP, COHN-S, director of employee health and safety. "It’s really cool to tell people, We don’t have any injuries.’"
Other units, such as the critical care unit, are now launching the same improvement process. Although the action plan may differ, the basic strategy is the same: involving frontline workers in the solution.
Deex also maintains the importance of regular feedback and recognition. The hospital CEO even singled out the Sixth Floor project as an example of excellence. "The whole idea of prevention is to keep it on the forefront of people’s minds," he says. "They can’t take care of other people until they take care of themselves."
The patient lift/transfer program began with an evaluation of the current ergonomic compliance. The results were bleak.
On admission, nurses were supposed to assess patients for their risk of falling, their level of dependency, and need for lift assistance on a computerized patient care plan. But most plans made no mention of lift needs. Patients on this medical floor suffer from chronic conditions, including Alzheimer’s Disease, and are among the weakest and sickest in the hospital.
Employee health nurse practitioner Beverly Nuchols, RN, OHNP, PhD, asked certified nurse assistants (CNAs), who were responsible for many lifts and transfers, about the ergonomic equipment. "Even though they had it there and they had been trained on it five years ago, they didn’t have the culture to support that. They didn’t have the time to use it," she says. "They didn’t feel comfortable using it because they hadn’t used it a lot. Some of them felt the patients would be afraid of it."
The registered nurses knew even less about the lift equipment than the CNAs and didn’t encourage its use, Nuchols discovered.
"What we have found is that it really requires an ongoing motivated program to educate and support people on the floors to use the equipment," Deex says.
Nuchols arranged meetings with workers and managers from each shift. "We would talk about the high-risk scenarios for patients," she says.
For example, the CNAs talked about a common scenario in which a family member wanted the patient moved up in bed or transferred to a chair. They didn’t want the CNA to wait for assistance. They wanted to move the patient right away, and they offered to help.
"They end up not doing their part. They pull at a different time," Nuchols says. "People got hurt that way by not having the other person they’re working with work as a team." How could the Sixth Floor staff get quick and safe transfers? They used the pagers carried by all employees on the floor to create a "transfer team page."
"When a CNA wants to move someone up in bed or get someone up in a chair or they’re going to transfer someone to a bed or a gurney, they would go to the front desk and say, Please get a transfer team to this room,’" Nuchols says. "The people responding to the page know they’re only going to be in that room for 30 seconds. The person sending the page has already gotten the room ready." Sometimes, five people might show up to respond to a page. The person leading the lift can pick the helpers, and the rest go back to their tasks, she explains.
The Sixth Floor has 10 transfer teams of about eight or nine members each, with an equal number of RNs and CNAs. A CNA is the transfer team leader, who trains the other on the use of the equipment.
At the launch of the new program, the teams entered a friendly competition to see who could be the most successful at reducing injuries. For six weeks leading up to the Oscar Awards, the teams vied to win Blockbuster gift cards. The team with no injuries would get the cards.
"Because the program was so successful, everybody was a winner. We had no injuries. Not one," Deex says.
Positive feedback and reinforcement from Nuchols helps keeps the teams on track. So does another imperative: Team lift support is now one of the employees’ job competencies. Being able to use the lift equipment and responding to the transfer team page will be addressed at annual performance reviews.
Call out the Bod Squad’
She continues to audit care plans and monitor use of the equipment and transfer team pages. But she also has moved on to other departments.
The Critical Care Unit calls their teamwork system the "Bod Squad." The unit is small, so employees just call out, "Code Bod Squad," and co-workers come to help them.
She’s also working with the transporters to track and prioritize calls, and with nurses to help them understand the importance of waiting a few minutes for a safe lift. Nuchols also is evaluating equipment needs and the purchase of new items.
El Camino expects to save money due to a lower rate of injuries. But that main message of the program involves a safety mindset — and the value of the workers to the hospital, Deex says. "It’s a culture you generate within your institution about how you feel about your employees and what it is you’re trying to do," he says. "If you start bringing in the issues of dollars and how much injuries cost, people perceive it’s all about money. It’s not all about money. It’s about preventing people from getting hurt."
El Camino Hospital in Mountainview, CA, enlisted the health care workers to create a better ergonomic climate.
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