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Back Injury Prevention Guide for Health Care

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NO ONE IS REQUIRED TO USE THE Draft Document Preparation: INFORMATION IN THIS GUIDE Bernadine Osburn, Cal/OSHA Consultation Service, The guide is based on currently available information, Education and Training Unit, Sacramento, CA but the study of how to prevent back injuries is a dynamic process and new information is constantly Photography being developed. Ask your staff for their ideas Emi Manning, UC Davis and input. Try some of the suggestions in this book to see if they Institutional Cooperators for Onsite work for your organization. Cal/OSHA will Evaluation and Research: periodically update the information to include the U.C. Davis Medical Center latest developments. Home Health Care Services Department Catholic Health Care West Mercy General Hospital Mercy American River Hospital Mercy Care Writers and Editors: Sutter Health Care Mario Feletto, Cal/OSHA Consultation Service, Sutter General Hospital Education and Training Unit, Sacramento, CA Eskaton Walter Graze, Cal/OSHA Consultation Service, Greenhaven Country Place Headquarters, San Francisco, CA Eskaton Village The authors wish to thank the following persons and Peer Reviewers (alphabetical order by institutions for support and assistance in the research last name): and development of this document. Editorial Review: Vicky Andreotti, U.C. Davis Medical Center, Sacramento, CA Zin Cheung, Cal/OSHA Consultation Service, Michael L. Bradley, Sutter Community Hospital, Education and Training Unit, Sacramento, CA Sacramento, CA Dr. John Howard, Chief, Division of Occupational William Charney, San Francisco General Hospital, Safety and Health, California Department of San Francisco, CA Industrial Relations, San Francisco, CA Debbie Coughlin, Mercy Health Care, Sacramento, CA Layout and Design: Dianne Factor, UCLA-LOSH, Los Angeles, CA Sue Glumac, OSHA Training Institute, San Diego, CA Ghedeon Bere, Office of State Printing, Dan Leiner, Cal/OSHA Consultation, Santa Fe State of California Springs, CA Ed Mills, Cal/OSHA Consultation Service, Fresno, CA Bob Reeves, California Chamber of Commerce, Sacramento, CA ABOUT THIS GUIDE This booklet is designed to provide general guidance for employers and employees about how to prevent back injury as a result of lifting and moving patients and residents. It may be useful in settings such as hospitals, nursing homes, assisted- living facilities, board and care homes, and during the provision of home health care. Some of the benefits of back injury prevention include decreased injuries and costs, as well as increased efficiency and employee morale. The practical suggestions in this guide are focused on orderlies, attendants, nurses, nursing assistants and others who actually lift and move patients and residents. The information was developed with the help of individuals and institutions in the health care field who have found effective ways to prevent back injuries. The guide discusses how to: • Understand the scope of the back injury problem • Analyze the workplace to find work activities, equipment and related factors which may contribute to the development of back injuries • Identify and implement improvement options • Evaluate the results A. Do Lifting and Moving Patients or Residents Lead to Injury? 3 B. Lifting and Moving Patients and Residents 4 Physical Demands of Work 5 Equipment and Facilities 6 Work Practice and Administrative Issues 7 Personal Factors 7 C. Evaluating Work Activities 8 Performing Work Task Evaluations 8 Work Evaluation Tools 8 D. A Closer Look at Improvement Options 17 The Good News: Back Injury Prevention Success Stories 17 Identifying Solutions 18 1. Patient or Resident Assessment 19 2. Assist Equipment and Devices 20 3. Work Practices 22 4. Lift Team 25 5. Other Measures 26 Institutional Equipment and Facilities 26 Maintenance 27 Administrative Measures 27 Exercise 27 Safety Gear 28 E. Resource Information 29 Assist Equipment and Devices 29 Design of Institutional Equipment and Facilities 33 Proper Work Practices 35 Body Talk 39 F. References 41 The Health Care Industry is facing a big chal- Res., Vol. 11, pp. 234-242 (April 1989) lenge. Nationally, total lost workday injury and Health care workers are hurting their backs A illness incidence rates for Hospitals (4.1) are while lifting, transferring and otherwise moving greater than those for Private Industry (3.6). patients or residents. The costs are enormous. The rates for Home Health Care (5.0) and The direct costs in workers’ compensation, med- Nursing and Personal Care Facilities (8.8) are ical treatment and vocational rehabilitation are very high. In California, back injuries account 10 for the largest proportion of incurred losses in 8 the workers’ compensation system. Claims in­ Nursing Care volving back strain can cost about $4,000. The 6 Home Health average back injury case costs $25,000. More 4 Construction Hospitals serious cases requiring surgery can cost $85,000 2 Private Industry (State Compensation Insurance Fund). Based 0 Bureau of Labor Statistics (BLS) (1995) on the average cost stated above, nationally, the LOST WORKDAY INCIDENCE RATES approximately 67,000 back injuries among health care workers could total $1.7 billion in similar to or greater than more typically haz­ workers’ compensation. ardous industries, such as Construction (4.9). (Note: Incident rates represent the number of Additionally, indirect costs such as lost produc­ injuries and illnesses per one hundred full-time tion, retraining and sick or administrative time employees.) Nursing aides, orderlies and atten­ can be at least four times the direct costs. An dants have a risk of lost workday injuries and indirect cost of particular concern is the disrup­ illnesses about 3.5 times that of the average pri­ tion of the professional integrity of services pro­ vate industry worker. Their rate is similar to vided. Injured health care workers cannot work that for construction laborers (Reuser, Report on up to their full potential or may even leave the the American Workforce, Bureau of Labor Sta­ profession due to back injuries. Lastly, there is tistics, 1994). Other health care providers are al­ the toll on their personal lives. so getting hurt often. Why are their rates high? Two words—back injuries. These increasing injury costs are occurring si­ multaneously with a national push to reduce ALL PRIVATE NURSING AIDES, INDUSTRY ORDERLIES, health care spending. This pressure to function OCCUPATIONS ATTENDANTS in a more cost-conscious manner is leading to (BLS, 1993) an emphasis on home health, reorganizations 26% 46% and downsizing. These trends, along with the traditional aspects of the health care workplace (e.g., emergency situations, long or rotating Other Other shifts, night work, a high census, or caring for Back Injury Back Injury large numbers of acutely ill individuals), make BACK INJURIES - AS A PERCENT OF TOTAL LOST WORKDAY CASES back injury prevention more difficult. In spite of all of these challenges, many health Nurses and other health care providers have care institutions have successfully prevented similar percentages. These numbers may not back injuries by using a combination of innova­ even tell the whole story. One study found that tive approaches. There are solutions that work! only one-third of nurses reported work-related A first step is to take a closer look at the types back injuries. (The Magnitude of Low-Back of work activities which can contribute to back Problems in Nursing, Owen, B., West. J. Nurs. injuries. 3 Caring for people often necessitates lifting or WHAT CONTRIBUTES TO BACK helping them move. Since these work tasks in­ INJURIES ? B volve sick or fragile human beings, they are more complicated and risky than handling ma­ Lifting or moving patients or residents requires terials in industrial settings. Compared to ob­ the interaction of the health care worker, the in­ jects manually lifted or moved in industrial set­ dividual being moved, the equipment used and tings, the body is heavier, more delicate and the work environment. There are a great variety awkward to handle. Also, the center of gravity of activities involved, including: and the distance to the patient or resident can • Manual lifting change during the handling activity. This can suddenly put the provider in an awkward pos­ • Laterally transferring between two ture or position and require them to make more horizontal surfaces forceful exertions (e.g., when stopping a fall). • Ambulating • Repositioning in bed or chairs In addition, patients and residents can have • Manipulating extremities medical, psychological or other conditions that • Transporting patients, residents and equipment can complicate lifting or moving them. • Performing activities of daily living • Stopping falls or transfers from the floor • Assisting in surgery • Have IV’s, monitoring devices, When lifting or moving pa­ dressings or other complicating tients or residents, there are a factors number of factors which can • Not be able to communicate well lead to the development or ag­ (e.g., disorientation or deafness) gravation of back injuries, in­ • Be uncooperative or actively resist cluding: • Have widely varied ranges of mobility 1. Physical demands of work • Be subject to changes in condition 2. Equipment and facilities due to fatigue or medication 3. Work practices or Complicating factors administrative issues Lastly, health care workers must 4. Personal factors often engage in prescribed mobi­ lizations where the goal of strengthening muscles and in­ creasing skills means that the patients or residents
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