Curbing injuries from moving patients
The VA Loma Linda (Calif.) Healthcare System was averaging dozens of staff injuries and $1 million in worker replacement costs a year when Tony Hilton came to the organization in 2009 as the 162-bed hospital’s first coordinator for safe patient handling.
She was charged with identifying risky tasks—such as manually lifting patients out of bed or moving them from a gurney to a bed—and finding high-tech solutions to prevent injuries. She also supervised the training and education designed to persuade skeptical healthcare workers to change their habits.
Loma Linda’s program was part of a large-scale effort by the Veterans Health Administration, announced in 2008, to implement safe patient-handling practices and technology in all its hospitals to reduce staff and patient injuries. To date, the VA has spent more than $200 million on the initiative.
U.S. healthcare workers suffer some of the highest rates of musculoskeletal injuries of any occupation, and most of those are attributed to the manual lifting and moving of patients, according to data from the U.S. Centers for Disease Control and Prevention.
Despite ample research showing the benefits of using mechanical patient-handling equipment such as overhead lifts, workers at many hospitals and nursing homes still are hoisting and moving patients the old-fashioned way. That’s both because of the cost and logistics of installing the equipment, and the challenge of changing organizational culture to get healthcare workers to actually use it, said Anthony Donaldson, president of the Association of Safe Patient Handling Professionals, a not-for-profit advocacy group. “No organization is ignoring this issue,” he said. “But it’s difficult.”
For instance, installing ceilingmounted lifts—the gold standard of safe patient-handling equipment, Donaldson said—can mean adhering to various building-code rules or having to move wiring and water lines or even remediating asbestos. Plus, patient rooms have to be taken out of service while the installa- tion work is done. Per-bed costs can range from $18,000 to as high as $60,000, Donaldson said. “You don’t just buy these things and put them up.”
The VA facility in Loma Linda encountered plenty of stumbling blocks, especially in retrofitting old spaces to accommodate lifts. “Older buildings, smaller rooms, smaller doors—we had to work around all of that,” Hilton said. The Loma Linda VA is now constructing several new buildings, including an expansion of its skilled-nursing facility, all of which will be designed with the safety equipment already in place.
Despite the installation challenges, the hospital now has ceiling lifts in all of its patient rooms, as well as in its clinics and diagnostic imaging rooms. The hospital’s transport workers also have lifting devices. “We want to follow patients wherever they go throughout the continuum of care,” Hilton said.
In addition to overhead lifts, the hospital uses other safe patient-handling equipment, including a power-lift seat that helps patients stand up from the toilet, power-drive stretchers and inflatable devices that make it easy to transfer patients from one surface to another.
“I used to have back pain all the time,” said Drew Crissman, a transport nurse who used to regularly lift patients from beds to gurneys. “Now, I just attach the patient and press a button.”
Changing worker attitudes took time, said Brian Breeden, the hospital’s lead inpatient transport nurse, who works with staff on safe patient-handling education. The hospital conducts three-hour training sessions with new hires and holds regular meetings to discuss progress and challenges. Old habits are hard to break, he said, but the hospital has reached a point where workers rarely try to manually lift or move patients.
The Loma Linda VA spent about $2 million initially and roughly another $2 million in upgrades, Hilton estimated. Since 2009, the hospital’s injury rate has dropped 35%, slightly less than the 40% reduction seen across all VA hospitals. And in 2013, the amount the hospital spent on staff replacement because of injuries dropped to zero. Additional return on investment has come from improvements in nurse and patient satisfaction and greater employee retention.
Hilton said Loma Linda’s program has resulted in improved clinical outcomes, including fewer falls and wounds, better mobility and shorter lengths of stay.
Donaldson, of the Association of Safe Patient Handling Professionals, says small changes can go a long way, even if organizations don’t have the resources that the VA had. “Look at the risks you are experiencing on a daily basis and find opportunities,” he said.