1. OSHA Long Term Care Worker Protection Program

2.  Describe the OSHA Ergonomic guidelines as they apply to long term care settings.  Identify potential ergonomic hazards in long term care work settings.  Discuss practical solutions to eliminate and/or minimize ergonomic problems in the workplace.

3.  The practice of designing equipment and work tasks to conform to the physical capability of the employee;  A means for adjusting the work environment and work practices to prevent injuries before they occur.

4.  Strives to assure safe and healthful working conditions;  Mandates that each employer shall provide each employee a place of employment which is free from recognized hazards that are causing or likely to cause death or serious physical harm….

5.  Musculosketal Disorders are the Leading Cause of Disability u affects ½ of the nation's work force  30% to 40% of lost work time injuries/illnesses are related to MSD This is second only to common cold at 40%

6.  Pain in the fingers, wrists, shoulders, back, or other parts of the body: may include a dull aching pain, a sharp stabbing pain, or even a burning sensation.  Tingling or numbness, particularly in the hands or fingers.  Swelling, inflammation, or joint stiffness.  Loss of muscle function or weakness.

7.  Discomfort or pain in the shoulders, neck, or upper or lower back.  Extremities turning white or feeling unusually cold.  General feeling of muscle tightness, cramping, or discomfort.  Clumsiness or loss of coordination.  Range of motion loss.  Discomfort when making certain movements.

8. OSHA recommends minimizing manual lifting of patients/residents in all cases and eliminating lifting when possible.

9.  Provide Management Support  Involve Employees  Identify hazards and problems  Implement solutions  Response to injuries  Provide training  Evaluate Ergonomics Efforts

10. Demonstrate a commitment to reduce or eliminate patient lifting/moving hazards: * establish a plan * consistent, continuous training of employees in injury prevention * identify appropriate methods and equipment for transfer and lifting of residents, equipment, and supplies by all staff * assure compliance with these methods * help every department to identify potential ergonomic hazards * support reporting and follow-up evaluation of signs/symptoms of back pain or other musculoskeletal injuries

11. Empowering/involving all employees * to report unsafe working conditions * engage employees in identifying hazards and potential solutions * evaluate equipment * participate in developing/updating the organization’s Ergonomics plan/processes. * encourage prompt reporting of any injury

12. Identify existing and potential hazards through careful and on-going assessment of work tasks and routines. * look for duration, frequency, and magnitude of exposure to ergonomic stressors: - force - repetition - awkward postures - vibration - contact stress * do this through observation, workplace walkthroughs, talking with employees, and periodic screening surveys

13.  Repetitive: repeatedly making manual adjustments to equipment.  Awkward positions: reaching across objects/beds to lift patients or materials; uncomfortable positions when using computers/chairs/desks in any areas.  Force: pushing wheelchairs/stretchers/supply carts/cleaning equipment across elevation changes, on/off elevators, up ramps.  Heavy lifting: manually lifting heavy patients or equipment alone.  Overexertion: trying to stop a patient or object from falling or picking up a patient or heavy equipment who has fallen.

14.  Multiple lifts per shift : more than 20.  Lifting alone: limited available staff to help.  Moving/lifting uncooperative/combative patients.  Moving large objects: cleaning equipment, kitchen equipment, etc.  Moving/lifting patients that cannot support their weight.  Caring for overweight (bariatric) patients.  Ineffective training of employees.

15. Includes implementing and monitoring administrative and engineering controls. * Administrative controls: provide adequate staffing, assessment of ergonomic hazards and needs in all work areas, provide training and monitoring. * Engineering controls: provide appropriate moving and lifting equipment, provide training in safe lifting/moving and use of equipment, keep work areas uncluttered, good lighting of work areas, eliminate uneven floor surfaces, and immediate clean up of spills.

16.  Analyze jobs in each area and work environment.  Modify how tasks are done, change the environment, monitor use of appropriate equipment.  Training in lifting, moving for employees; training related to computer workstations/desk areas as appropriate.  Involve physical therapists in training program. * www.osha.gov/desp/success_stories/ergonomics

17.  Assess each resident in terms of: * level of assistance they need. * their size and weight. * ability/willingness to understand and cooperate * any medical conditions that could influence the choice of methods for lifting or repositioning. Standardize the process for assessment of each resident.

19.  Use lifting equipment when appropriate: * Requires training of all staff that will use it. * Availability of technical services? * Is “charging” of the equipment necessary – must be assigned and checked. * Have two staff involved in using the equipment * Provide careful and complete explanation to the resident before using the equipment.

20.  Employee feet solidly planted on ground, shoulder width.  Place resident or object close to you – avoid reaching across bed/distance.  Use lift sheet, slide board, moving equipment as appropriate.  Two people for a lift or repositioning.  If moving to a wheelchair or other movable device, be certain it is locked and in a good position.

21.  Use of gait belt.  Be certain the resident transfers to their strong side.  Should not be used to lift.  Secure the belt on the resident, on top of a layer of clothing.  Keep the resident as close to the caregiver as possible.

22.  Use bath boards and transfer benches, for residents who have partial weight-bearing.  Be aware of any potential friction between skin and the boards/benches.  Have grab bars and stand bar assists.  Long handled shower heads.  Toilet seat risers with hand rails.  Always important to assess the patient’s ability and comprehension of the moving technique.

23.  Bending to make a bed or feed a resident.  Lifting food trays or other items above shoulder or below knee level.  Collecting waste.  Pushing heavy carts.  Bending to remove items (laundry, etc) from large deep carts or reaching into a deep sink.  Removing laundry from washing machines/dryers. These may not present problems in all circumstances.

24.  Involve employees in finding the solutions that will work for your setting.  Encourage employees to think carefully before lifting/moving an object or a patient: what is the safest way to do this?  Provide appropriate lifting equipment.  Good work practices based on education and role- modeling is the best!  Other simple solutions?

25. That could present an ergonomic challenge?

26.  Do not over-estimate your ability to lift/move!  Do not over-estimate the resident’s ability – need to assess carefully.  If a box looks light and easy to move, be cautious!  Avoid reaching to move a resident or object.  Look for ergonomic hazards in every area, with every work task.

27.  Many people work with computers every day.  May sit or stand at computers.  Evaluation checklist (OSHA Ergonomic Solutions) can be helpful.

28.  Top of monitor at or just below eye level.  Head and neck balanced and in-line with torso.  Shoulders relaxed.  Elbows close to body.  Lower back supported.  Wrists and hands in-line with forearms.  Adequate room for keyboard and mouse.  Feet flat on floor.  If using a computer on wheels: can height be adjusted, room for mouse, lighting?

29.  A great, easy to use checklist developed by OSHA.  It is in your handouts!  Check the website (www.osha.gov) for more information!

30. Careful, comprehensive management of employees with injuries: * Accurate and prompt reporting of injuries. * Early treatment of injured employees. * “light duty” or “no lifting” work restrictions during recovery periods. * Monitoring of injured employees to identify when they are ready to return to full duty.

31. Critically important to an ergonomic safety program: * For all employees who may encounter a hazard. * Consistent and current. * Provide opportunity for employees to practice and demonstrate safe techniques. * Review reporting of injuries.

32.  Occur before the employee lifts or moves or faces any recognized ergonomic hazard.  Review of policies and procedures.  Include demonstrations and return demonstrations.  How to recognize a MSD and early recognition.  Advantages of reporting an injury as soon as possible.  Critical importance of reporting any injury to a supervisor.

33. OSHA requires that employers record each fatality, injury, or illness that: * is work related and * is a new case, and * meets one or more of the criteria as cited in sections 29 CFR 1904.7 through 1904.12 of the regulations.

34.  Thorough review of all MSD injuries.  How was the injury managed medically?  Return to work process – was it easy or difficult for the employee?  Identification of ergonomic hazards that were not previously recognized.  Assess outcomes of the injuries.  Solutions – ways to prevent a reoccurrence.  Look for industry-wide data.