Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks

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Abstract

Problem statement

Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful.

Specific aims

The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment.

Intervention

The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, “Back Injury Resource Nurses”, (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy.

Methods

A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001–January 2002) and post-intervention (March 2002–November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs.

Results

The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of ‘unsafe’ patient handling practices performed daily. Nurses ranked program elements they deemed to be “extremely effective”: equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers’ compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation.

Conclusions

This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Section snippets

Problem statement

Nurses have one of the highexst incidences of work related back injuries of any profession (Bureau of Labor statistics BLS, 2002), estimated at 12.6/100 full time workers (Bureau of Labor Statistics [BLS], 2003). This number is considered to be a low estimate, since underreporting of injuries in nursing is common (US Department of Health and Human Services (USDHHS), 1999). Data from over 80 studies across a number of countries indicated that back injury to nurses have a worldwide point

Background

Many patient handling tasks are considered to be high-risk, based on the magnitude of weight lifted, awkwardness and unpredictable nature of the load lifted (patient), and sustained awkward positions used to provide nursing care. Historically, patient handling injury-reduction strategies have been based on tradition and personal experience rather than scientific evidence. The most commonly approach is manual patient lifting, augmented with classes training in body mechanics, training in safe

Goals and objectives

The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and

Program description

A multifaceted program with six program elements was designed after examining international case studies within and outside the healthcare industry (Nelson, 2003; Nelson et al., 2003b). The program elements included: (1) ergonomic assessment protocol, (2) patient handling assessment criteria and decision algorithms, (3) peer safety leaders, known as a Back Injury Resource Nurses (BIRNS), (4) patient handling equipment based on needs identified in the ergonomic assessment, (5) after action

Methods

A pre/post design without a control group was used to evaluate the effectiveness of a patient care ergonomic program in 23 high risk units. Injury rates, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, and costs were compared for the nine month pre-intervention (May 2001–January 2002) and the nine month post-intervention (February 2002–October 2002) periods. Data were

Results

Injury rates: Post-intervention injury rate decreased in 15 of the 23 units, increased in 7 units and remained the same in 1 unit. Overall, the injury rate decreased from 24.0/100 caregivers at baseline and 16.9/100 caregivers post-intervention. Post-intervention injury rates were found to be significantly lower χ2(1, n=46)=4.42, p=0.036. Table 2 depicts the injury rates by unit.

Modified duty days: The number of modified duty days decreased significantly (p=.02) from 1,777 modified duty days

Discussion

Nurses have one of the highest incidences of musculoskeletal work related back injuries of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. This study tested a newly developed patient care ergonomics program designed to create safer working environments for nurses who provide direct patient care.

This study is consistent with other field studies supporting the use of patient handling equipment as part of a

Conclusions and recommendations for future research

This multi-faceted program resulted in positive outcomes associated with injury rates, modified duty days, job satisfaction, self-reported safety in performing patient handling tasks, and cost. The program was well accepted by patients, nursing staff, and administrators. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. We believe the program was successful in the short term. Further research is needed to evaluate long

Acknowledgement

The authors would like to thank James W. Collins, Ph.D., MSME, Associate Director of Science, Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH) and Bernice Owen, Ph.D., RN for their thoughtful critique of this manuscript.

Disclaimer

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA), Health Services Research & Development and New Program Initiatives. The views expressed in this article

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