1. National Emphasis Program in Nursing & Residential Care Facilities: Impact for Safe Lifting & Moving in Health Care Dana Root, PT, CPE, CSPHP Regional Ergonomics Coordinator, OSHA Region 5 414.297.3315 root.dana@dol.gov

2. National Emphasis Program for Nursing and Residential Care Facilities Provide guidance to agency compliance staff –Policies and procedures for targeting and conducting nursing home inspections –Focus on the hazards associated with nursing and residential care. BBP, STF, VWP, TB, Ergonomic resident handling stressors Why are we here again? –In 2010 nursing and residential care facilities experienced one of the highest rates of lost workdays due to injuries and illnesses of all major American industries. –No improvement in injury rates over past 10 years 2

3. National Emphasis Program for Nursing and Residential Care Facilities OSHA recommends: Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible. October 2012 –OSHA cited three Wisconsin nursing homes from a large nursing home chain –One serious violation of OSHA’s “general duty clause” –Violation cites each facility for: Allowing employees to perform lifting, transferring, repositioning and assisted ambulation tasks that may cause musculoskeletal disorders. 3

4. Illinois Regulations Public Act 096-0389 HB2285 –Effective date January 1, 2010 Restrict, to the extent feasible, manual lifting or movement Assess handling needs of resident Educate nurses in the identification, assessment, and control of risk to injury Evaluate alternative ways and strategies

5. Ergonomic Assessment: Fresh Eyes We conduct our investigation the same way that we think you conduct yours Goal: To look at your facility with fresh eyes –Focus your efforts to minimize/eliminate manual physical assistance by healthcare provider –Examine your policy and procedures Self Assessment: –Calculate rates for past 3 years –Observe what you have and what you are doing –Interview staff and management –Review processes to make improvements 5

6. Fresh Eyes: Policy & Procedures Purpose and Scope of the Policy Staff responsibilities –NHA –Unit Managers –Therapy –Resident Handlers Resident assessment Workplace assessment Training requirements Equipment requirements Medical management 6

7. Fresh Eyes: Rates Information –OSHA Logs –Safe Lifting Policy and Procedures Calculate the Rates –Facility DART and Severity Rates –MSD DART and Severity Rates –RHIR and RHSR Rates Compare 2010 to BLS average DART rates –Nursing and Residential Care Facilities: 5.6 –Resident Handling Incident Rate: 9.6 –Private Industry: 1.8

8. RHIR & RHSR for Past Three Years Resident Handling Incident Rate = # OF RH CASES With days away from work job transfer DAYS or Restricted days x 200,000 Resident Handling Hours worked Resident Handling Severity Rate = ( days away from work + On job transfer DAYS or Restricted days) x 200,000 Resident Handling Hours worked 8

9. OSHA 300 Log 9

10. RHIR & RHSR for Past Three Years Look at the 300 Log entries: –Who –Where occurring –When occurring –How occurring It is not about body mechanics –Easier to figure out why injuries are occurring Pattern: –Trend over 3 years BLS comparison 9.6 for 2010 –MSD days away rate: 9.6 for 2010 10

11. Fresh Eyes: Interviews Resident Handlers –Employee Issues: Training Staffing Resident assessment Communication Equipment –Availability & storage –Slings –Battery Workplace constraints Injury management 11 –Operational Issues: SPH policy and procedures Resident assessment process Staffing levels Equipment & slings Storage Space constraints Training and competency Medical management supervision Nurse and Therapy Managers

12. Fresh Eyes: Resident Assessment OSHA recommends: Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible. Resident assessment: –Algorithms (see page 12) –MDS: Resident Assessment Instrument ADL Support Provided versus ADL Self-Performance –FIM: Functional Independence Measure –Develop own facility assessment tool 12

13. Tool to guide decision making Based on –Patient’s ability –Equipment availability Standardizes practice Guides for planning handling tasks –“Tools not rules” Clinical judgment still needed Manual lifting of residents be minimized in all cases and eliminated when feasible Fresh Eyes: Resident Assessment

15. Functional Independence Measure (FIM) –7 level functional assessment scale of resident's actual performance Evaluates the amount of assistance required to perform basic life activities Need for assistance from another person or a device Measures what the resident actually does Independent 7Complete Independence 8Modified independence – requires assistive device, ….. Modified Dependence – resident expends 50% or more of the effort 5Supervision (setup) – without physical contact by helper, or applies assistive device 4Minimal Contact Assistance – resident expends 75% of effort 3 Moderate Assistance – resident expends between 50% to 75% effort 2 Maximal Assistance – resident expends between 25% to 50% of effort 1 Total Assistance – resident expends less that 25% of effort 15 Fresh Eyes: Resident Assessment

16. Egress Test –Purpose: To facilitate the safe progression of a resident’s debut transfer through repetitions 1.Three repetition of sit to stand 2.Three steps of marching in place 3.Advance step and return each foot –If, during any part of the Egress Test, the resident demonstrates difficulty or need for physical assistance beyond cues and/or guarding techniques, the resident is indicated for mechanical conveyance. 16 Fresh Eyes: Resident Assessment

17. What is on the care plan is what the resident handler must perform –Depending on the facility policy May take the more supportive method Manual lifting of residents be minimized or eliminated when feasible, and that mechanical support devices be used for lifting whenever possible. Restrict, to the extent feasible, manual lifting or movement 17 Fresh Eyes: The Care Plan

18. Fresh Eyes: Equipment: Equipment –Full Body Lifts Floor based or ceiling –Repositioning Aids –Stand-Assist or Sit/Stand Devices Active versus passive –Ambulation Devices –Bariatric devices Scheduled maintenance Slings –Sizes –Task types –Backup sling availability –By vendor Battery –Charging location –Charging schedule 18

19. Fresh Eyes: Resident Handler Focus Protect the Resident Handler Establish a written program Admission policy –Prevent MSD injury to resident handlers How residents are assessed Competent in procedures for lifting and moving residents Appropriate equipment for the task Monitor resident handling injuries Track and Trend –By year, by shift, by wing, by xxx Compare –BLS, between shifts, departments, sites 19

20. Investigation Findings Integrate System-wide Findings –Rates –Observations –Perspectives Are MSD injuries occurring from manual resident handling? –RHI rates above 9.6 Why? –What needs to be improved? –How to improve it? –Who will improve it? 20

21. Resource Guides http://www.visn8.med.va.gov/patientsafe tycenter/safePtHandling/default.asp http://www.visn8.med.va.gov/patientsafe tycenter/safePtHandling/default.asp http://www.cdc.gov/niosh/topics/ergonomics/ http://www.aohp.org/A bout/documents/GSB eyond.pdf http://www.aohp.org/A bout/documents/GSB eyond.pdf www.osha.gov/SLTCergon omics/index.html www.osha.gov/SLTCergon omics/index.html