Ergo guidelines called too weak to halt injuries
User-friendly,’ but not a mandate for change
With guidelines that are much weaker than the rule it once proposed, the Occupational Safety and Health Administration (OSHA) recommended that "manual lifting of [nursing home] residents be minimized in all cases and eliminated when feasible."
That advice represents just a small step toward the paradigm shift necessary to forestall back injuries among nurses and nursing assistants at nursing homes and hospitals around the country, says Joe Jolliff, administrator of the Wyandot County Nursing Home in Upper Sandusky, OH, which OSHA cites as an example of successful ergonomic interventions.
"Nurses have been taught in nursing school that two-man lifts, proper lifting techniques, and proper body mechanics are safe ways to handle patients and residents," says Jolliff. "That’s the biggest lie that we have taught for 200 years. It has never been safe.
"There has to be a paradigm shift all across the country in all health care," he says. "But it’s going to be a very, very tough issue."
With lift equipment and fast electric beds, Wyandot County Nursing Home actually eliminated back injuries due to patient handling. Total workers’ compensation costs dropped from about $140,000 a year to $4,000 a year. Employee turnover also dropped dramatically. In the past year, only two nursing assistants have resigned.
Such impressive statistics would be unimaginable for most nursing homes and hospitals.
Nationally, 18,000 hospital workers and 15,000 nursing home workers suffered lifting-related injuries that involved lost time from work in 2000, according to the Bureau of Labor Statistics.
OSHA administrator John Henshaw contends that a voluntary approach will help encourage employers to reduce their injuries and related costs. In select cases, OSHA will issue citations based on the "general duty clause" that requires employers to provide a workplace free of recognized hazards.
"We are sharing with you practical approaches. They are intended to be helpful, not prescriptive. What we are presenting is a wide range of potential problems and an equally broad array of potential solutions. We will not be enforcing these guidelines," he says. "They are advisory; they are not regulatory. Just because we will not enforce guidelines does not mean nursing homes can ignore musculoskeletal disorders if their workers are experiencing injuries."
Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester, encouraged hospitals to use the resources contained in the guideline.
"I think we need to see what impact this has on motivating the health care industry to move further in the direction of eliminating manual lifting," he says. "If workers continue to be injured at high rates, we need to reconsider the need for a standard."
Focusing on solutions, not on problem
In the final guideline, OSHA removed the introductory statement that outlined the problem of back injuries at nursing homes. The draft version noted that nursing home workers are twice as likely as other workers to be injured on the job, and that "employees in nursing and personal care facilities suffer over 200,000 work-related injuries and illnesses a year."
By removing the context for the guideline, OSHA also lessened its impact and employer motivation, contends Bill Borwegen, MPH, health and safety director for the Service Employees International Union (SEIU) in Washington, DC. "It doesn’t make a compelling case as to why people should take action."
He also took issue with a section that mentioned situations in which lift equipment might not be used. The guidelines state: "Administrators should also be cognizant of several factors that might restrict the application of certain measures, such as residents’ rehabilitation plans, the need for restoration of functional abilities, other medical contraindications, emergency conditions, and residents’ dignity and rights."
"They say the dignity and rights of the resident may be a factor, implying why you shouldn’t be using mechanical lifting and transfer devices," he says. "In fact, studies have shown it’s safer to use mechanical lifting and transfer devices. Residents will incur fewer drops on the floor, fewer skin tears.
"[The guideline] fails to mention that if a patient falls on the floor, that’s a pretty major degradation of someone’s dignity," he says.
Much of the guideline involves descriptions of types of equipment and how they can be used to reduce injuries. It makes use of the Patient Care Ergonomics Resource Guide developed by the Patient Safety Center of the James A. Haley Veterans Medical Center in Tampa, FL, (www.patientsafetycenter.com) and provides algorithms to determine what equipment is needed. The guideline also offers ergonomic information for nonpatient care tasks, such as housekeeping.
"Our intent was to make sure this document was as user-friendly as it could possibly be," says Henshaw.
According to the guideline, an effective ergonomics program:
- provides management support;
- involves employees;
- identifies problems;
- implements solutions;
- addresses reports of injuries;
- provides training;
- evaluates ergonomics efforts.
Involving employees in the evaluation of equipment and development of the program can improve their motivation and acceptance of changes, the guideline states.
The guideline can be a valuable resource for all health care facilities, according to MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, executive president of the Association of Occupational Health Professionals in Healthcare in Warrendale, PA.
Rather than just focusing on patient handling, the guideline also addresses other at-risk tasks among support staff that lead to a substantial number of injuries, she says.
"The case study of Wyandot County Nursing Home demonstrates the importance of active administrative involvement in an ergonomic effort," says Gruden, who is employee health nurse practitioner at Western Pennsylvania Hospital in Pittsburgh.
"It also demonstrates that even with the right’ equipment, changes to establish safe staff practice take time and continued commitment on the part of administration," she explains.
The American College of Occupational and Environmental Medicine in Chicago entered into an "alliance" with OSHA to help the agency develop training modules and educational programs on ergonomics and health care.
Meanwhile, Henshaw insists that ergonomic enforcement will be tough on employers that ignore the hazards. Inspectors have received training in how to use the general duty clause to make an ergonomics’ case, he says.
"The whole point is to make sure we use the general duty clause appropriately. We’re going to avoid frivolous 5a1 [general duty clause] cases without merit. We do want serious cases. OSHA means business," he says. "But we also mean to help business. That’s what these guidelines are all about."
With guidelines that are much weaker than the rule it once proposed, the Occupational Safety and Health Administration (OSHA) recommended that manual lifting of [nursing home] residents be minimized in all cases and eliminated when feasible.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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