According to an American Nurses Association (ANA) survey, the problem is pervasive, with 42 percent of nurses reporting a significant level of risk to their safety from lifting or repositioning patients. More than 50 percent say they regularly experience shoulder, neck, back and arm pain while working.

And it doesn’t stop there. When nurses suffer, everyone suffers — patients and facilities alike. According to the Occupational Safety and Health Administration (OSHA), patient handling claims account for about 25 percent of all workers’ compensation claims which average $15,600 per claim. Worker wage replacement accounts for the largest portion of that figure. Patients also risk falling and/or developing hospital-acquired pressure ulcers and other complications when nurses lack adequate support to lift and move them safely.

Assistant Secretary of Labor for Occupational Safety and Health at OSHA, Dr. David Michaels, says it’s time healthcare facilities get serious about implementing safe patient handling and mobility (SPHM) programs.

"There are feasible solutions for preventing these hazards and now is the time for employers to implement them," stated Michaels in a press release last summer.

So far, 11 states have enacted safe patient handling laws and congress is now looking at the 2015 Nurse and Health Care Worker Protection Act. OSHA will also start inspecting facilities more aggressively to determine if SPHM programs are in use and penalizing those that don’t have them.

Susan Gallagher

To assist healthcare facilities and encourage compliance, the ANA also introduced national SPHM standards in 2013. Susan Gallagher, PhD, RN, board member of the Association of Safe Patient Handling Professionals, says it’s those standards, rather than looming regulatory action, that will most likely influence reform.

"I think that is really driving a lot of interest in healthcare organizations because we finally have national standards of what it should look like. We didn’t have that before. We didn’t know how to quite interpret all of this," said Gallagher, author of "Safe Patient Handling and Mobility: Interprofessional National Standards Implementation Guide," a companion book to the ANA standards that facilities can use to incorporate them properly. "I know we’re looking at national legislation but I really think seeking to address safe patient handling compliance through OSHA is ambiguous at best. I’m not sure that will be the driving piece."

Yet, movement appears to be slow. According to a 2014 white paper by the Risk Authority - Stanford and Atlas Lift Tech, only a fraction of the nation’s healthcare facilities have moved forward to integrate a comprehensive SPHM program.¹

"Within the United States there are approximately 5,400 hospital facilities that would require an SPHM program of one form or another," the authors wrote. "In discussions with the American Nursing Association it has been estimated that of these 5,400 U.S. hospital facilities, 11 percent or approximately 600 facilities, have implemented their own ‘successful’ safe patient handling programs. Of these facilities that have SPHM programs, it is estimated that only 10 percent of those safe patient handling programs (roughly 60 hospitals) include in-house "lift teams" implying, some 1 percent of the total market has dedicated staff to lifting programs."

The white paper highlights the success of a one-year pilot study conducted at Stanford Hospital and Clinics and the Lucile Packard Children’s Hospital in which the facilities implemented the "lift coach" model. Professionally trained lift coaches provided repeated and comprehensive bedside instruction on how to lift/move patients safely until nursing staff could achieve a high level of competency on their own. The effort was a success and also gave the facilities a unique and encouraging return on their investment (ROI). They experienced fewer staff injuries, increased employee retention, better clinical outcomes, including lower incidence of pressure ulcers, increased patient safety, satisfaction, and more referrals.

The Veteran’s Health Administration Safety Patient Center is another successful example of how SPHM programs are worth the time and money. After introducing them in seven facilities, the VA saw a net savings of $200,000 per year with a return on investment achieved in about four years. ²

So why aren’t more facilities doing the same? Gallagher suggests one reason may be that healthcare leaders feel inundated and stretched thin by too many competing interests.

"If they look at each one of their initiatives individually, it’s overwhelming," said Gallagher. Conversely, SPHM programs can actually lessen the overall burden. "I’ve spoken with members of executive leadership teams who say they really don’t have the time to talk about safe patient handling right now; ‘I really have to bring the costs of the registered staff down at my hospital.’ I said well then we’re talking safe patient handling. We talk about the cost of the program but we don’t talk about the cost of not having a program. For example, what are the costs of hospital-acquired pressure ulcers? We know that it’s just more than cost of liability and claims. "

Gait training with Guldmann GH3+ Patient Lift

Linda Bowman, Vice President, Guldmann Inc., a manufacturer of lifts and other patient mobility products, underscores Gallagher’s point and says doing nothing can be a big, costly mistake.

"When you consider the cost of finding, hiring and employing caregivers plus the cost of workers’ compensation insurance premiums, treatment of injuries, plus the cost of possible patient injuries from falls, it is self-evident that the cost of furnishing the facility with patient lifts is minimal by comparison," Bowman asserted. "Ceiling-mounted patient lift systems move patients from bed to bath to chair; lift and reposition patients in the Operating Room, Burn Unit, Ob-Gyn, CT Scan and other departments; as well as provide body support in rehab and gait training. When suspended in the lift, the patient can be moved throughout the track system with ease and dignity and the caregiver is protected from musculoskeletal injury."

Gallagher says in some instances expensive equipment isn’t always necessary, particularly for Ob-Gyn departments where a small investment in some basic tools and training can go a long way in preventing falls and injuries.

"In that area, postpartum, the women may be weak from giving birth so, for many, they simply need a walker, which costs about a dollar a day," Gallagher said. "Or maybe they need a sit-to-stand. It’s a really awesome product where the patient’s feet are placed on a plate and it’s very easy to help the patient stand up. It’s a low-budget product, easy to store and easy to use. And they may need a device to get a patient from the bed to the gurney or the delivery table to the gurney (lateral transfer). That may be all they need — a walker, a sit-to-stand and some type of lateral transfer device — and that’s it. "

Patient transfer and positioning products  from Sage Products

Marko Cikara, Product Manager, Sage Products, wonders also if some hospitals feel dissatisfied with the investments they’ve already made because of low compliance.

"Hospital leaders looking for the one-size-fits-all approach to this problem will be disappointed," Cikara said. "Partnering with a company, like Sage, will enable you to implement ANA SPHM Standards and promote a culture of safety."

Sage’s Prevalon Liftaem Mobile Patient Transfer System has a cushion of air that moves patients laterally from surface to surface with significantly less pulling and no lifting required. The Prevalon Turn & Position System reduces the amount of exertion needed to turn patients by 90 percent, and the Prevalon Seated Positioning System makes it easier to glide patients to an upright-seated position without any lifting. All of Sage’s products come with unlimited hands-on education and training.

David Daisher, Regional Sales Director — West & International, TransMotion Medical, a Division of Winco Manufacturing LLC, says employing proper body mechanics when moving patients — back straight, knees bent, etc. — is fundamental to preventing injury but it’s not enough.

TMM4 Multi-Purpose Stretcher-Chair by Winco, Mfg LLC

"The ergonomics involved when moving/lifting a box are different than moving a patient; healthcare workers move patients — there are no handles, no square edges and the distribution of weight is not consistent," said Daisher, also a Lean Six Sigma Black Belt. "Purchasing objectives of the organization are often not in tune with risk management objectives. Healthcare facilities need to look at patient handling from a value stream perspective, eliminate patient movement as much as possible by implementing multiuse equipment that eliminates the need to transfer a patient and then inject patient handling equipment where transfers cannot be eliminated."

TransMotion Medical’s One Patient, One Surface concept helps reduce or even eliminate patient transfers using motorized positioning via its TMM Multi-Purpose Stretcher Chairs. The push-button motorized positioning provides safe, controlled patient positioning, and height, back and leg adjustments. The equipment offers a 500-pound weight capacity, a fully radiolucent back, and additional options and accessories to meet the needs of multiple departments. "The ability to convert from stretcher to chair enables patients to travel comfortably through the entire care cycle on one device — from admission to discharge," said Daisher.

McAuley Medical’s Rollboard for Lateral Transfer

John McAuley, BSET, President, McAuley Medical Inc., says SPHM equipment and training does cost money but "rather than try to fund an entire program all at once, many have found success by addressing one patient handling task at a time showing success and then asking for more funding to address another high-risk task. This demonstrates to senior management that an investment in safe patient handling really does pay off in injury reduction and reduced workers’ comp costs."

McAuley Medical’s Rollboard for Lateral Transfer greatly reduces the friction between patient and surface so that the transfer can be accomplished without lifting and the associated compression force that it puts on the spine. "Lateral transfer is a high-risk task that takes place in almost every department in a hospital, said McAuley. "The investment in equipment to assist with lateral transfer costs far less than mechanical lifting technology, training takes minutes and the return on investment can be immediate. "

With today’s swelling obesity population — 40 percent of middle-aged Americans are obese according to the latest CDC figures — moving patients has become an even weightier task than before.

Patient Shifter by Alimed

"Lifting a 250-pound patient 10 times is the equivalent of lifting 2,500 pounds, even with proper body mechanics the human body wasn’t intended for that much weight," said Steve Dunn, Product Manager, AliMed, a manufacturer and distributor of rehabilitation and ergonomic products. "Imagine losing a leader among the staff because they are unable to perform 20 percent of their duties due to an injury. This leads to decreased morale, which affects patient outcomes, reducing payouts from insurance. "

Dunn says in a perfect world, every room would have a ceiling lift but in reality, few facilities can afford such an expense. However, there are affordable alternatives that can still do the job well.

"Mobile Hydraulic Lifts are a cost cutting measure that most any facility can get backing for, one for each floor or even each wing," said Dunn. "Rollerboards and patient shifters, placed in high-visibility areas help to ensure their implementation. Once they are being used consistently they will become habit."

Dunn suggests that organizations make a greater effort to publicize SPHM successes and educate and encourage their own staff to emulate them. "Make the studies and results of implemented programs more visible, though blogs, PDF’s and printed materials, to show that injuries can be avoided," he said.

Gallagher adds that to make SPHM programs stick there also needs to be a task force actively in place — champions who can provide training at the bedside, repeatedly, until the staff is competent enough to operate the equipment independently.

"My facility might have everything in sight but if I’m not comfortable using the technology then we’re going to do it manually; I think that’s the feeling of most providers," she said. "Of course there’s a learning curve and I think we need to recognize that. That’s one of the barriers. People think it takes so much time to use the equipment but just like anything, once you become comfortable with the technology — and it’s the right technology — then it is used. What happens when we move a patient manually and that patient falls to the floor? Do you have time for another occurrence report, to have to assess the patient for injury, transfer the patient if the patient is injured? If we begin to think about it even purely from a patient safety aspect and balance that around time, it just makes sense."

Larry Baumann, Executive Director, Corporate Communications, Hill-Rom, understands that hospitals are juggling numerous priorities with limited budgets.

The Compella Bariatric Bed by Hill-Rom

"We’re sympathetic to the challenge of marshalling resources for multiple needs; that’s why we have made it a priority to do more than provide products," Baumann said. "You also need the right people and the right program. With support, implementing a safe patient handling program can be straightforward, cost-effective and ease some of the burden on hospitals. Hill-Rom’s Safe Transfers and Movement Program provides built-in resources to help achieve a safe lifting environment. We provide a collection of customizable tools, industry-standard resources, and educational materials to support them."

Preserving dignity and comfort is also an important consideration, according to a recent suvey from Hill-Rom of hospital patients. Heavier patients are more likely to experience embarrassment, self-consciousness and discomfort compared to lighter-weight patients. Hill-Rom’s Compella Bariatric Bed features powered transport, length and width expansion, and on-board skin and lung therapies to provide a comfortable, dignified and clinically advanced care environment.

Lindsey Ellis, Marketing Director, LINET, America, says facilities can prevent problems associated with embarrassment and worker stress and strain by replacing outdated equipment with newer, more innovative solutions.

"Traditional repositioning methods such as draw sheets, slide sheets, ceiling and mobile lifts, which use slings, are cumbersome to use and require two to six caregivers to operate, depending on the size of the patient, all which can take up to 20 minutes," said Ellis. "Additionally, if these products are not readily available to the nurse, she is more likely to move the patient manually in essence of time."

LINET Multicare bed with Hercules Patient Repositioner

LINET’s patient room beds, which have mobilization features built into the frames, can be used in place of lifting systems. The Mobi-Lift has a built in cane-like device that assists nursing staff in getting the patient in and out of bed, while the Lateral Tilt system activates the entire bed frame to assist in patient turning and mobilization. LINET also partners with The Morel Company which manufactures the Hercules Patient Repositioner, a push-button tool that automatically boosts the patient up in bed.

"The LINET bed with the Hercules Patient Repositioner makes routine nursing activities safer, easier, and faster, for enhanced nursing efficiency — it’s like having an extra set of hands at all times," said Ellis.  

Steve Bellisari, Director, Marketing — PH, Stryker Medical, says the best products are simple and intuitive to use. "Just as caregivers are committed to the well-being of their patients, we are committed to their health and safety; we put ergonomics at the forefront of

Stryker Prime Big Wheel Electric

our design process to help reduce common repetitive-use injuries among caregivers," he said. "With BackSmart product design built into Stryker products, the amount of awkward bending and reaching caregivers do on a daily basis is reduced, empowering them to provide the best care for their patients."

Stryker’s Prime Series Stretchers, for example, are designed to help reduce or eliminate awkward body positions that can lead to injury by incorporating ergonomic and electric functionality. Bending or reaching to access controls is minimized and the easy-to-operate switches and releases require low force. The stretcher’s Zoom Motorized Drive System and Big Wheel Advanced Mobility also reduces steering effort significantly, making patient transport a smoother and less strenuous activity.

Steve Schmutzer, Co-founder, Director of Clinical Programs, Firefly Medical, maker of the IVEA patient mobility solution, says having supports in place that enable patients to ambulate on their own should also play into a good SPHM program.

The IVEA patient mobility solution by Firefly Medical

Introduced last year, the Edison Award-winning IVEA — designed by nurses and other healthcare professionals — functions like an IV pole at the bedside, consolidating equipment and supporting patient ambulation. Reducing the need for additional staff, not only does it free up caregiver time but research shows patients who ambulate as soon as possible have better clinical outcomes.

"We’ve been impressed by the number of safe-patient-handling programs that have reached out to us in recent months," said Schmutzer. "Decisions to purchase it have been quickly supported by leaders and committees focused on value analysis, falls, risk mitigation, and workplace safety. Caregivers instantly recognize it as a solution to the myriad challenges around safe patient mobility.

"You can give eight guys shovels and tell them to dig a ditch; they’ll get it done, but one guy with a small excavator will get the same job done more quickly," Schmutzer remarked. "We think that relatively soon the hospital without a safe-patient-handling program, the proper equipment to implement it, and specially-trained professionals to manage it will be the exception."

Just notice how the dots connect. You’ll begin to see how vital SPHM programs are to succeeding in today’s changing healthcare environment.

"What I would challenge healthcare providers to think about is how patient handling and mobility is the common thread in so many of our safety initiatives — pressure ulcers prevention and reduction, fall-related injuries, surgical site infections, readmission within 30 days," said Gallagher. "All of these quality indicators that we’re measuring indirectly link back to patient handling and mobility. So thinking of it as a completely separate initiative just seems to be counterintuitive in the way we’re moving forward with collaborative practice models in hospitals."

2. Occupational Safety and Health Administration, "Safe Patient Handling Programs: Effectiveness and Cost Savings," https://www.osha.gov/Publications/OSHA3279.pdf.