Safety by the numbers: Ergo hazards and results
Health system defines maximum force
Patient handling isn’t like carrying boxes, which can be defined by weight and size. But you can still take a methodical, or even numerical, approach to the hazards.
And with ergonomic interventions, the outcome can be measured in dollars saved, both in workers’ compensation costs and lost workdays.
At Winona (MN) Health, the efforts begin with a functional assessment that is part of the preplacement exam for newly hired nursing assistants. They must be able to lift 30 pounds and perform patient transfer activities.
That is the force nursing assistants may exert when helping a patient move from a lying to a sitting position in a "moderate assist," says Sally Mergendahl, OTR-L, an occupational therapist and employee health specialist, who will present her program at the annual conference of the American Association of Occupational Health Nurses (AAOHN), to be held in Minneapolis.
Nursing assistants who work either in the acute care hospital or the adjacent long-term care center receive annual ergonomics training. They learn how to limit the use of force in repositioning patients, a frequent cause of musculoskeletal injuries.
"In our training, we have them practice what it is to pull up 30 pounds. We attach a force gauge to a person and have them pull and have them guess how much weight they’re handling at that period of time," Mergendahl adds. "Most people work harder than they need to be working.
"Most people pull and handle around the 75 pound range. They really only need to pull at the 35 pound range," she points out.
If the patient or long-term care resident is unable to assist in the repositioning or transfer, and the force would be greater than 30 pounds, then the nursing assistant is expected to use a mechanical lift, Mergendahl says.
Winona Health also uses checklists and report cards to assess workplace hazards and injury rates.
Checklists developed by the Washington state Department of Labor and Industries (L&I) help quantify the hazards. For example, the checklist indicates how much time per shift should be spent in a squatting position or reaching above the arms. (The checklist is available at www.lni.wa.gov/Safety/Topics/Ergonomics/ServicesResources/Tools/default.asp.)
Mergendahl picks an hour during an employee’s busiest or most stressful time to observe and actually tally the hazardous activity.
"Most employees know what is the hardest part of their job," she notes. "You want to have a general checklist and identify the key areas and then more specifically take some observations, then you can generate some solutions to the problem. By doing a good analysis where you can get some numerical value — how much ergonomic risk there is in performing the job — it can help you set up programs so you can tackle the ones that are the most risky."
Sometimes, employees just need an awareness of their body posture and suggestions on how to change the activity to reduce the need to reach, bend, or squat, Mergendahl explains.
"Most of the time, in my experience, employees don’t really know how they’re using their body," she says. "They do it in the easiest way they’ve figured out how to do it. Having someone come in and observe with a different perspective sometimes helps them realize they can do it in an easier way."
In some cases, the analysis may indicate the need to purchase equipment to minimize the hazard, Mergendahl says.
Mergendahl also monitors departments by creating a report card on ergonomic risk.
She uses Bureau of Labor Statistics data as a benchmark and calculates an incident rate for musculoskeletal disorder injuries over a three- to five-year period. (Number of injuries and illnesses X 200,000/employee hours worked = incidence rate. More information on calculating incidence rates is available at www.bls.gov/iif/osheval.htm.)
When a problem is identified, Mergendahl seeks job activity changes and new equipment that can reduce the hazard. For example, in radiology, the transfer to the X-ray table can be made safer by transferring the patient from a gurney rather than a wheelchair, she notes.
Involving employees in a team approach can create a greater chance of success, Mergendahl says. "People spend time thinking about their jobs a lot more than somebody from employee health. They’ve already had years and years to think about it and already have some ideas about what would be the key area to focus on."
In a pilot project in the long-term care center, Winona Health purchased additional mechanical lift and repositioning equipment. Three years later, the health system was able to demonstrate a $250,000 savings in workers’ compensation costs and a one-third reduction in lost work time from injuries.
"It does make a big difference," Mergendahl notes.
The Minnesota L&I is trying to quantify the success of ergonomic interventions on a larger scale.
In 2004, the department launched a three-year study involving 77 nursing homes. Half will work in consultation with the department to lower resident handling injuries, while the control group will continue with their own individual efforts.
The study will look at improvements and their effectiveness, such as ceiling lifts, electric beds, and other mechanical lifts.
"If everybody [in both groups] gets better, we’ll consider that a success," says Philip Jacobs, MS, CSP, CPE, ARM, ergonomics program coordinator for the Minnesota L&I Workplace Safety Consultation program in St. Paul. "We want to see if we can make an extra difference by working on this."
Patient handling isnt like carrying boxes, which can be defined by weight and size. But you can still take a methodical, or even numerical, approach to the hazards.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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