Safe Patient Handling and Mobility: A systemwide standard of care

Healthcare providers who manually move patients are at high risk for musculoskeletal injuries. For the caregiver, these musculoskeletal injuries not only cause pain and discomfort but can also result in lifelong disability. For patients, their safety may be impacted when injured staff move and lift them. In addition, there may be patient outcomes such as patient skin shearing or patient falls which can be affected by manual transfers. Protecting our military and civilian healthcare providers from risk of musculoskeletal injury is of vital importance as they provide the highest standard of care to injured military members, retirees, and their families. Manually moving and handling patients is a risky activity undertaken many times each day by healthcare staff. Implementation of safe patient handling and mobility programs (SPHMP) can result in decreased injuries, discomfort, and lost work time and improved morale and staff retention. In addition to these staff benefits, SPHMPs may increase the frequency of getting patients out of bed and improve patient mobility and reduce the risk of patient falls and skin shears. Because these factors affect the overall quality of care, it is crucial that patient handling related injury risks be minimized or eliminated. Biomechanical studies have shown patient handling and movement exceeds the biomechanical capabilities of workers. Research has estimated that during the course of a shift a nurse typically lifts a cumulative weight of 1.8 tons. The National Institute for Occupational Safety and Health (NIOSH) has determined that the maximum allowable weight for manual movement of a patient is 35 pounds. (Waters, 2006) This limit is based on the biomechanical limitations of the body during manual movement. The Department of Labor recognizes nursing as having among the highest injury rates of any occupation in the United States. According to the 2007 Bureau of Labor Statistics (BLS), nursing is consistently near the top of the number of nonfatal injuries and illnesses involving musculoskeletal disorders with days away from work. Additionally, the workers compensation costs for injuries sustained as a result of manually transferring patients can be significant. Several trends in population health also influence the importance of this program. For example, the upward obesity trend over the past 25 years in the United States affects the caregivers who are manually moving heavier patients who may be sicker as a result of the comorbidities frequently associated with obesity. Additionally, an aging general population may result in higher patient census and increased dependency and acuity levels. While the impact of the aging of staff population may not be as severe in military health facilities due to the relative youth of military personnel, the aging population is also reflected in the civilian nursing workforce with an estimated average nursing age of 47. Several national and international organizations have addressed SPHMP. For example, in spring 2013 the ANA will be publishing SPHM National Standards; 10 states currently have enacted legislation or adopted regulation relating to SPHM; in 2012 the International Organization for Standardization (ISO) published a technical report (TR 12296) related to SPHM; and the 2010 Facility Guidelines Institute-Guidelines for Design and Construction of Health Care Facilities introduced a requirement for a patient handling and movement assessment and provided an associated white paper. Finally, the Veterans Health Administration has been a leader in implementing comprehensive SPHMPs across their facilities and based on their research and 4 year return on investment. In 2010 the VA established a directive that a SPHMP must be established and maintained in all VA facilities. The research that has been done regarding the implementation of comprehensive SPHMP by both the VA and civilian sector is significant and as demonstrated above these programs are becoming the standard of practice for workplace musculoskeletal injury prevention of nurses and other health care providers as well as addressing the effects of potentially positive patient outcomes. A comprehensive program includes several elements: (1) SPHM Assessment (2) SPHM Equipment (3) Training and Education (4) Personnel: Program Administrator and Unit Champions (5) SPHM Committee (or inclusion in existing committee) (6) Policy. These elements were first developed by the VA and have now successfully been implemented in Army facilities. Implementation of such a program requires buy in from leadership and staff. Too often equipment and technology is implemented in isolation without the support structure to create an environment where the change in culture and how care is provided can flourish. The Army has successfully implemented a comprehensive SPHMP at one MEDCEN and is currently implementing a second program in collaboration with the VA at a MEDCEN that is a joint facility. This program is scalable to facilities of all sizes and patient populations however, each care environment should be assessed for it’s own individual characteristics to ensure that the program is scaled to facility needs and funds are spent appropriately. Other facilities that are being renovated or built have included pieces of a comprehensive program however, standardized implementation across the MHS would provide a streamlined approach to implementation, invaluable lessons learned and MHS wide improvements in the ability of all medical staff to provide the greatest quality of care to patients while minimizing the possibility of patient handling related injuries to themselves or to those to whom they are providing care.

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