with Karen Stenger RN, MA, CCRN

Fortunately, there are plenty of examples of facilities who have drastically slashed costs related to worker injury by implementing appropriate patient handling equipment such as lifts, air mattresses, stretchers, wheelchairs and transfer devices.

One such facility is the University of Iowa Hospitals and Clinics where a successful culture change led to increased patient and staff safety and resulted in drastic initial savings in worker’s compensation costs. According to Karen Stenger RN, MA, CCRN, Advanced Practice Nurse with the University of Iowa Hospitals and Clinics, in 2000, the facility initiated a multidisciplinary ergonomics committee to look at how to deal with both patient handling-exertion injuries and non-patient care injuries.

Stenger notes the initial focus was on the general patient population. "At the time, there wasn’t so much of an awareness of bariatrics," she said.

The increasing number of obese and severely obese patients presenting to healthcare facilities only amplifies the need for safe patient lifting procedures and equipment. NIOSH has ruled that the maximum recommended weight to be lifted or lowered under ideal condition is 51 pounds. Certainly the average size patient is well over 50 pounds.

With the help of outside consultation to lay the foundation for the culture change, the facility had, by January 2003, invested nearly $700,000 in a variety of patient handling equipment including mobile patient lifts, repositioning aids, air mattress lateral transfer devices and ceiling lifts. As part of that plan, leadership at UIHC and within nursing, as well as direct caregivers, were educated about the need to safely move and lift patients.

Stenger notes that some of the first ceiling lifts were installed in otherwise hard to reach clinical areas where they weren’t able to maneuver in a portable lift, or for example, where portable equipment wouldn’t fit under an exam table.

"Then in 2005," said Stenger, "the focus began to shift much more towards bariatrics than it was in the beginning; and we started installing more ceiling lifts with a 600-lb. capacity, and we now have two ceiling lifts that have a 1,000-lb. capacity in our inpatient areas. We of course do have ceiling lifts on our inpatient bariatric unit, but we also definitely realize that the bariatric patients go to all different units depending on what their diagnosis is. We don’t send all bariatric patients to one unit."

She notes that not only do different patients have different mobility needs, those needs may fluctuate on a daily or even hourly basis. For example, patients may be stronger in the morning then in the afternoon, which could affect their mobility and the type of equipment they will need, whether it be a dependant or total-assist lift for patients with very limited mobility, stand-assist lift or limited assistance device.

"It’s really good to have a continuum of devices from total-assist to limited assistance. Because as the patient’s progressing you don’t want to keep them in a dependent lift if they don’t need that. It’s important for recovery and rehab goals, not to limit the rehab but enhance the rehab," said Stenger.

She also notes that portable lifts are critical if ever a patient should fall or trip.

Stenger said that research conducted by Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Research Center at the Veterans Administration Medical Center in Tampa, FL, was integral in guiding their initial efforts. (See "Safe Patient Handling & Movement in High Risk Units" available at http:www.visn8.med.va.gov/patientsafetycenter/).

"It’s interesting, because [initially] people didn’t know what ergonomics was, or when you said ergonomics, they thought of carpal tunnel and trying to protect yourself when you’re using a computer." It was something that applied to other industries, she explained. "It wasn’t related to lifting patients."

"One of our first educational posters we sent out to staff said, ‘Only nurses think 100 pounds are light.’ We tried to educate direct care givers that in no other industry would somebody go and lift up a 100-lb. box and not think anything of it." Initial and ongoing education for nursing staff has been under the direction of Lou Ann Montgomery PhD, RN, BC, Associate Director, Nursing Education. Stenger and Dr. Montgomery also provide education assistance and consultation to other departments within the hospital.

An integral part of the ergonomics program was staff training. Stenger credits the success of the training program with the appointment of several "key coaches" – specially trained employees who helped to lead the culture of safety change and champion the use of patient handling equipment and safe lifting policies throughout the facility. New nursing staff receives two hours of ergonomics orientation, where they not only lift one of their peers using the devices, they also are lifted themselves. Other disciplines such as physical therapy and radiation therapy are also involved in safe patient handling.

"Now the culture has changed. People are questioning how can we do this safely? For example, assisting a patient from a bed to a chair – that would be something that we were doing manually before. When we looked at incident reports we learned that would be a high-risk task where people would get hurt. We just don’t do that now. Now people don’t even question going to get that equipment," said Stenger.

"One important piece to mention is that a person can get injured just by one lift, or they can have an accumulation of injuries just by doing things over and over again in their career. So it’s really important to look at the career of the nurse and trying to protect them. With those kinds of accumulative injuries, they may not realize that they are setting themselves up for injury, and then they might end up getting injured at home or elsewhere."

UIHC employs what they call a "minimal-lift policy" explained Stenger. "We try very diligently to respond to any patient handling need that arises, and ask ‘do we have the right equipment in the hospital to perform that lift?’ If we don’t have the equipment, we question what we can do about that task in the short term and long term to make it as safe as possible."

She notes that most of the facilities’ current construction projects, including an ambulatory surgery clinic and neurosurgery clinic, will all have ceiling lifts installed.

"Also, if a unit closes down for renovation and moves to a different unit, you have to think again — what in the environment needs to be looked at to be sure that it’s safe when the unit relocates?"

As a result of their efforts, UIHC saw a decrease in worker’s compensation costs from $559,610 in 2002 to $245,677 in 2003, and $84,088 in 2004. Lost work days decreased from 2,881 in 2002 to 529 in 2004.

"What we’ve learned from Dr. Audrey Nelson is that the number of injuries may not decrease drastically, but the severity of injuries will go down. I was surprised by that at first, but that’s exactly what we’re seeing," said Stenger. "Nurses are also so aware of it they are reporting more if they are injured."

"I think that we’ve taken care of some of the easier things to take care of like transferring patients from bed to chair, and look at how much the worker’s comp. costs dropped. What we spend the majority of our time with now is trying to have a plan for the harder tasks and one of those being a bariatric patient."

Stenger says that the multidisciplinary ergonomics committees continue to meet regularly and they are continually looking at purchasing new bariatric equipment as technology advances.