1. 1 Ergonomics for Extended Care Facilities

2. 2 What is Ergonomics? l Designing jobs so people can do them safely and efficiently l Minimizing potential for overexertion and cumulative trauma (Musculoskeletal Disorders (MSDs)) l Developing a process for making on-going improvements

3. 3 Why is ergonomics important? l 89% of back injuries in health care facilities are related to patient handling activities l 10 to 20% of people have to leave nursing due to back pain/injury l Average turnover rate of STNAs in nursing homes is 50-60% l Cost to recruit, hire, and train a STNA = $2,000 - $ 3,000

4. 4 Composite Results of BWC Safety Grants in EC Facilities l The BWC Safety Grants program provided 4 to 1 matching of funds for ergonomic improvements (up to $40,000/policy) l Approximately 73 EC facilities received safety grants from BWC, amounting to a total of about $2.5 million l Most of the grants were for patient lifts, adjustable beds, and assistive devices

5. 5 Composite Results of Safety Grants in EC Facilities (cont’d) l Thus far, follow-up reports indicate: –38% reduction in the incidence of CTDs (sprains to back, shoulders, wrists, etc.) –41% reduction in lost work days –28% reduction in restricted work days –18% reduction in employee turnover –Significant reductions in skin tears, bruises and falls among residents

6. 6 What are the dollar savings of reduced turnover? l For a facility with 50 STNAs and a 50 % turnover rate –25 aides hired/year x $3000 avg. hiring cost = $75,000/year spent recruiting and hiring l If safety and ergonomics improvements reduce turnover by 15% (conservative estimate) -4 less aides hired/year x $3000 avg. hiring cost = $12,000 savings/year in reduced turnover alone

7. 7 What Factors Cause or Contribute to Overexertion? Contributing Factors l weight l

8. 8 What can be done to Prevent Overexertion? l Better Equipment l Better Facilities l Better Training l Better Policies l Better Staffing l Better Staff Fitness l Better Safety Management!

9. 9 Equipment Audit l What equipment do you have? l How do you currently use it? l Where is it stored? l Does the staff know how to use it?

10. 10 OSHA Ergonomics Guidelines for the Nursing Home Industry l Section I. Introduction –pp. 5-8 of OSHA 3182 l Section II. A Process for Protecting Workers –Provide Management Support –Involve Employees –Identify Problems –Implement Solutions –Address Reports of Injuries –Provide Training –Evaluate Ergonomics Efforts 5a1 General Duty Clause

11. 11 OSHA Ergonomics Guidelines for the Nursing Home Industry l Section III. Identifying Problems and Implementing Solutions for Resident Lifting and Repositioning –Resident Assessment and Algorithms –Suggestions for implementation –Types of equipment and considerations –

12. 12 Types of Control Measures l Engineering and Work Practice Controls l Administrative Controls l Personal Protective Equipment?

13. 13 Best Practices for Facilities Design and Arrangement l Automatic doors l Adequate space for transfers/equipment in bedrooms, bathrooms, and shower rooms l Minimal need to negotiate ramps/steps l Low, sloped thresholds l Non-slip flooring l Adequate storage space

14. 14 l Patient Lifters and Sit-to Stand Lifters l Drop/Removable Arm Wheelchairs l Low Profile Wheelchair Scales l Electric Low-Beds l Gait Belts with Handles l Pneumatic Seat Lift l Transfer Boards/Disks OSHA Guidelines for Nursing Homes booklet in resource section Nursing Department Engineering Controls

15. 15 General Considerations for Assistive Equipment Selection l Resident safety/comfort l Capacity/Durability l Size/Accessibility l Maneuverability l Ease/Speed of operation l Versatility l Maintainability l Training required l Cost l Compatibility with other equipment

16. 16 Patient Lifting Devices Important Features and Considerations l Mechanically powered l On-board scale l Minimal chains/sway l Quick recharging l Comfortable slings l Padded corners/edges l Remote control l Adequate lift range l Adequate capacity

17. 17 Sit-to-Stand Devices Important Features and Considerations l Mechanically powered l Remote control l Accessibility to toilets l Well-padded shin rest l Wide, padded strap l Easily adjustable l Non-skid foot plate l Easy lock/unlock casters

18. 18 Bathing Systems Important Features and Considerations l Low entry l Mobile chair/stretcher l Quick filling l Accessible with lift l Constant temp monitor l Self cleaning/sanitizing l Height adjustable

19. 19 Resident Beds Important Features and Considerations l Electrical operation l Low to high range l <20 sec low-high time l Minimal pinch points l Safe siderail design l Remote control l Locking casters

20. 20 Wheelchairs/Geri-Chairs Important Features and Considerations l Drop/removable arms l (Re)movable footplates l Multi-purpose design l Easily operable wheel locks l Easy fold up design l Adjustable l Customizable

21. 21 OSHA Ergonomics Guidelines for the Nursing Home Industry l Section IV. Identifying Problems and Implementing Solutions for Activities other than Resident Lifting and Repositioning –Refer to pp. 27-30 OSHA Guidelines for Nursing Homes booklet in resource section

22. 22 Dietary Department Engineering Controls l Anti-slip flooring and mats l Adequate storage space and shelving l Gravity flow racks for can foods l Well-designed serving line l Dispensers for trays, plates, racks l Well-designed food service carts l Well-designed dishwashing line OSHA Guidelines for Nursing Homes booklet in resource section

23. 23 Housekeeping Department Engineering Controls l Carts with side garbage removal feature and mop bucket attachment l Low-profile “slop” sink with hose l Dock level dumpster/compactor l Easy dump trash carts l Soaps and cleaners in small containers l Light weight aluminum handle mops OSHA Guidelines for Nursing Homes booklet in resource section

24. 24 Laundry Department Engineering Controls l Light-weight carts with side access for bag removal l Laundry chemical dispensing system l Appropriate-height folding tables l Anti-fatigue mats l Linen carts with elevated or spring-loaded bottom OSHA Guidelines for Nursing Homes booklet in resource section

25. 25 What types of Administrative Controls help to prevent injuries? l l l l l l l l l l l l l l

26. 26 Administrative Controls l Ordering, Purchasing, and Storage l Inspection/Maintenance Systems l Accountability Systems l Training, Observation, Coaching l Staffing, Teamwork, Familiarity l Methods, Policies and Procedures l Fitness, Wellness Programs l Work Hours/Work Distribution l Communication Systems

27. 27 Best Practices for Purchasing and Storage l Minimize weight and bulk of items handled l Optimize order quantities/unit loads l Provide adequate space and access to shelves l Use gravity flow racks for perishables l Optimize storage location

28. 28 Best Practices for Facility and Equipment Maintenance l Efficient work order system and scheduling l Frequent updates on repair status l Availability of spare parts and units l Maintenance of wheels, brakes, cranks, etc. l Proper floor cleaning products and schedule l Good drainage & mats

29. 29 Best Practices for Training and In-servicing Staff l Timeliness of training l Staff involvement in development/delivery l Relevance to job/tasks l Demonstration and return demonstration l Observation, coaching, positive reinforcement l Incorporate best practices into policy

30. 30 Best Practices for Staffing and Scheduling l Evenly distribute the workload and tasks l Schedule physical tasks to best utilize staff l Use a buddy system to encourage teamwork l Establish familiarity with buddy & residents l Reward attendance and longevity

31. 31 Best Practices for Developing Policies and Procedures l Get staff involved in development/updates l Educate on importance l Clearly communicate expectations/discipline l Consistently enforce l Update, Revise, and Reinforce as necessary l Use positive reinforcement

32. 32 Best Practices for Employee Communication l Provide frequent updates on safety progress/performance l Facilitate thorough shift change reports and discussion l Post safety reminders and committee minutes l Facilitate inter-departmental communication/cooperation l Clearly define responsibilities l Give recognition/rewards for achievement and participation

33. 33 Small Group Problem Solving Topics l Vertical transfers (e.g. sit to stand) l Horizontal transfers (e.g. repositioning) l Ambulating residents l Showering/Bathing l Support services (e.g. laundry, dietary)

34. 34 Small Group Problem Solving Assignment l Summarize the steps to be followed in the problem assessment, and in the solution development & implementation process l Brainstorm important features for the types of equipment you need to address the problem l Identify specific administrative controls that you will use to help ensure safety and effective use of equipment l Explain how you will monitor the effectiveness of the various control measures

35. 35 Implementation Of Ergonomic Improvements l Develop an implementation team l Put together an action plan with a timetable l Develop product evaluation criteria and forms l Get staff input in evaluation and selection l Develop and document policies for use l Document training and competency l Conduct periodic follow-up assessments

36. 36 Who should be involved in the improvement process? l ID of needs l ID of alternatives l Eval of alternatives l Selection l Purchase l Installation l Training l Evaluation ð ð ð ð ð ð ð ð ð ð ð ð ð ð ð ð

37. 37 Tools and Resources for Developing Safety/Ergo Teams l BWC OCOSH courses –GEN 360 – Effective Safety Teams –GEN 101 – Fundamentals of an Effective Safety and Health Program l University outreach programs l Chambers of Commerce l Private consulting/training firms

38. 38 OSHA Ergonomics Guidelines for the Nursing Home Industry l Section V. Training –Nursing Assistants and Other Workers at Risk of Injury –Training for Charge Nurses and Supervisors –Training for Designated Program Managers

39. 39 What topics should be addressed in Ergonomics Awareness Training l l l l l l l l l l l l l l

40. 40 Topics for Ergonomics Awareness Training l Overview of the goals of ergonomics l Importance of staff input/involvement l Impact of injuries on staff, residents, and the facility l Various factors that contribute to injuries l Examples of recent ergo improvements l Current concerns/ opportunities l Possible controls and improvements l Next steps in the improvement process

41. 41 Resources for Ergonomics and Safety Training and Materials l BWC OCOSH Courses l Corporate and other Internal Resources l BWC Library/Video Library l Ergonomics Training/Consulting Firms l Product Vendors l Web Sites

42. 42 OSHA Ergonomics Guidelines for the Nursing Home Industry l Section VI. Additional Sources of Information l References l Appendix: A Nursing Home Case Study –Wyandott County Nursing Home

43. 43 Safety and Ergonomics Web Sites for Healthcare Facilities l www.wa.gov/lni –comparison charts for lifts l www.dir.ca.gov/dosh_publications – Back injury prevention guide l www.osha-slc.gov/SLTC – Nursing Home eCAT l www.silver-cross.com –product comparison charts

44. 44 Safety and Ergonomics Web Sites for Healthcare Facilities l www.patientsafetycenter.com – Safe Patient Handling and Movement Resource Guide l www.healthcare.healthandsafetycentre. org –Home Healthcare safety info l www.saftek.com/safetyplans/nh/ www.saftek.com/safetyplans/nh/ –Back Injury Prevention Strategies

45. 45 Solution: Sit/Stand Lift

46. 46 Solution: Sit/Stand Lift

47. 47 Solution: Total Lift

48. 48 Solution: Total Lift

49. 49 Model for BWC Safety and Ergonomics Assessment l Meeting with Administrator/Facility Manager to establish common goals and objectives l Assessment of Safety Management Systems l Meetings with Management Team to prioritize and work through safety management improvements l Questionnaire and Walk-Through with Director of Nursing and/or Safety Team l Ergonomics/Safety Awareness Training Session to discuss issues and collect employee suggestions l Meetings to prioritize issues, develop action plans, and assist with implementation process.