Key to staff's healthy backs: Involve patients
Facility cuts injuries, downtime 97% in a year
As the residents of Good Shepherd Long Term Care Facility grew older, back injuries among their caregivers escalated. In just one year, back problems accounted for 725 days of lost time, at a cost of $157,663.
Part of the problem is that the caregivers, or associates, at this Allentown, PA, facility "age in place" right along with the residents. Because of low turnover, any solution had to be designed to keep the caregivers healthy through midlife and beyond. That's why one of the beauties of the turnaround is its sustainability - not to mention that it cut lost work days 97% within one year.
Good Shepherd is home to 135 residents with severe physical and cognitive disabilities, including brain and spinal cord injuries as well as cerebral palsy. Residents' ages are 12 through 60-plus. Some have lived there for 50 years, explains Ingrid Baruch, PT, director of Physical and Occupational Therapy. Among the 140 nursing associates, 30-year tenures are common. Among the 12 therapists, "there's zero turnover," Baruch explains.
The associates' aging backs - together with the patients' increasing weight and waning strength - made the sling- and manual two-person transfers less viable. However, the natural resistance to change dictated that any improvement process include a strong component of staff and patient participation.
QI process counts all views of problem
An 11-member improvement team orchestrated the turnaround. Members included people from nursing, administration, purchasing, and physical/occupational therapy. Sharon Kralick, director of Quality Process, coordinated the initiative.
The team surveyed patients and staff, and held discussion groups to get a read on the nature of the problem. Four trouble zones came to light:
1. Sketchy knowledge of, and inconsistent use of safe lifting techniques.
2. Inadequate staffing at peak patient care times.
3. Antiquated and poorly maintained patient transfer equipment.
4. Changed needs among residents.
(For more on the causes, see the graph, "Number of Associate Back Injuries," p. 136.)
Revamping inservice, easing anxiety
Although Good Shepherd had back safety training, it fell short. So the team replaced the videotape inservices with full-day sessions where staff learned by using state-of-the-art mechanical lifts and reviewing manual patient transfer skills.
Throughout the planning period, the improvement team paid close attention to the patients' concerns about changing the old ways. The unease was multifaceted, Baruch explains. "Everyone was used to the two-person lift in and out of bed. Going to the mechanical lift took a lot of trust building because change is always threatening and the fear of falling is great for severely disabled people. They learn to trust one way of moving, and they hate to change. And some residents just like the human touch of the manual transfers. So we explained all the changes, and made sure each resident was OK with them."
Staff, patients got to vote
To offer everybody a vote in selecting new equipment, Baruch arranged an on-site vendor fair where several companies displayed eight different products. "We needed everyone's buy-in to make a successful change, and I tried to make it fun," she notes. Staff and residents tried the devices in mock bedroom and bathroom situations. They looked for reliability, durability, ease of use, and overall user satisfaction.
At the end of the day, attendees completed product opinion questionnaires. The seven lifts that made the first cut were tested on the nursing units for two weeks. Then, based on a final staff and resident survey, the team purchased 12 lifts for a total of $71,472.
Instead of pressing the new equipment into immediate use, however, the improvement process team arranged another two weeks of training for staff and residents. At that point, associates developed a one-sheet transfer plan for each resident specifying which lift to use noting any special instructions for individual circumstances. Transfer plans are subject to revision whenever a resident's condition changes.
Within one year of the change, the payoffs began:
· Days lost due to back problems dropped from 725 a year to 17.
· Restricted work days dropped from 286 to six (97%).
· Cost of back injuries dropped from $157,663 to $322, a decrease of better than 99%. (For more details on the cost savings, see the graph, "Cost Savings Analysis," at left.)
Determined to sustain their gains, the team made permanent changes in training and scheduling:
· Continuous back safety reminders are printed as tips in staff communications. Baruch conducts an annual Back School to review body mechanics and lift maintenance skills for all nursing associates. Additionally, each nursing unit has a designated "key operator." This associate oversees the day-to-day lift operations, providing spot training, equipment maintenance, and revisions in residents' transfer guidelines.
· Peak load coverage relieves pressure during the wild morning hours of 5:30 to 8. It's hectic because the regular night shift leaves at 7 a.m., and the residents have to be ready for breakfast in the communal dining room at 8. Daily therapy and schooling routines start at 8:30. The mad rush to help residents with toileting, bathing, and dressing was a natural setup for back injuries until the improvement team fixed it.
The fix involved extra coverage from part-time staff from 5 a.m. through 1:30 p.m. Meal sittings are staggered. Some therapy sessions now start at 7 a.m., as soon as residents are dressed and before they go to the dining room.
Lessons learned set stage for future benefits
Momentum from the back injury prevention project greased the wheels of change at Good Shepherd. "Actually, I've learned to welcome change," Baruch offers. The project taught her these lessons for future quality improvements:
· Cultivate heavy frontline participation among caregivers and residents alike. Baruch advises, "It makes all the difference in the world when people can give their opinions on problems and have a chance to tell what they're afraid of."
· Educate people each step of the way. Baruch credits systematic staff and patient training for the smooth shift to new lift procedures. It dispelled any doubts that the change would enhance their comfort and safety.
· Trust the simplest solutions are the best solutions.
· Rely on empowered teams as a more powerful change force than empowered individuals. In fact, Good Shepherd's quality improvement motto is TEAM! (Together Everyone Achieves More!).
Besides paying dividends in-house, theback injury prevention project earned Good Shepherd a Highest Achievement team award in the 1997 regional Quality Valley USA competition, an all-industry competition based in Schnecksville, PA. (For information on another team award winner, see QI/TQM, September 1998, p. 120.)
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