Back Injuries

Ergonomic Issues for Health Care - Back InjuriesBSO Course 3/2002

Gregory M. Heck MPH, CSP, REHSDavid McMahon, RS, MPHPhoenix Area Indian Health Service602-364-5068

IHS ERGO Primary Risk BACK INJURIESCOMPUTER WORKSTATION CTD INJURIESDENTAL STAFF CTD INJURIESHOUSEKEEPERS AND MAINTENANCE INJURIES

Back Injuries - NursingBack Injuries to nurses continues to be one of the most expensive injuries in health careNationally, estimated costs associated with occupational back disorders is $5 billion per year. Average direct cost was $37,000 per incidentIndirect costs ranged from $145,000 - $370,000 per incident (1996 - NSC)38% of all nurses report having a back injury during their career.

The Cost of Back Injuries Direct CostsMedical/Compensation Costs (US Army reports cost of a back injury needing surgery at $180,000)High-paid employees = High Workers Compensation CostsPhoenix Area (6/96 - 1/00) $925,000 (all occupations) for low back injuries. Data excludes Commissioned OfficersPIMC (CY 90 -99) $265,000

The Cost of Back InjuriesIndirect Costs (hidden/soft costs)Overtime costsCost of training new staff membersCost of recruiting/replacement hiringAdministrative (paper-trail, investigative)Loss of efficiency to health care teamPossible risk to patient, understaffed , over stressed facilitiesRetention of staff/morale4 to 10 times direct costs

ERGO INJURY TRIANGLEInjuryForceFrequency/DurationPosture

Lifting Limits - Posture

Limiting loads to recommended levels (NIOSH)NIOSH Action Limit is approximately 19.8 pounds. Maximum permissible limit: 51 pounds. Unless the patient can assist the caregiver, no more than 19.8 pounds should be lifted.

Lifting Limits - ForcePhysiological limitations of the human body. Studies have shown that during patient lifting, the average force on the L5/S1 disc exceeded the upper limit for disc compression specified by NIOSH (770 lbs.). Excessive levels of force can lead to micro-fracture of the spine. (Frequency-Duration)

Prevention StrategiesSuccessful Back Injury Prevention ProgramsFour part approachZero Manual lift policyRisk IdentificationAppropriate EquipmentTrained personnelLeadership Support

Prevention StrategiesSuccessful Back Injury Prevention ProgramsZero manual lifting policy for non-ambulatory patientsDevelop policies definingTotal body transfer;Mandating use of mechanical lifting devices; Define procedures to be followed; and responsibilities. Applicable to inpatient/outpatient, radiology and emergency departments (define locations during risk assessment)

Prevention StrategiesSuccessful Back Injury Prevention ProgramsRisk IdentificationInventory existing equipment Determine need for additional devices.High risk activities:bed to chair; bed to stretcher;bed to bed pan; bed to toilet;floor to bed; and any other lift where total body movement of the non-ambulatory patient is required.

Prevention StrategiesSuccessful Back Injury Prevention ProgramsAppropriate Equipment At least one Horizontal (lateral) and Vertical Lift for staff per ward. Ceiling liftsBariatric lifts (up to 600-800 lbs)Beds being designed to meet ergonomic and patient

On3 Lateral Transfer Device - Hill-Rom Approximate Cost - $9000

TotalCare Bed System - Hill-Rom Approximate Cost $6500

TotalLift 250 Stretcher by WYEast Medical Approximate Cost $5000

Bariatric Equipment - Purchase or Rent

Lift Aid 2000 Patient Lift

Sling LiftPower Lift

Prevention StrategiesSuccessful Back Injury Prevention ProgramsTrained personnel: The Lift Team Concept Staff competent in using devices. Specialized staff using the lifting devices is preferred.Lift TeamsMandated, by hospital policy, to use mechanical lifting devices such as mechanical vertical lifts, transfer stretchers, full length slide boards, and gait beltsLift team technicians are trained to perform the task of lifting/transferring patients. Nurses should not lift patients.

Prevention StrategiesSuccessful Back Injury Prevention ProgramsTrained personnel: The Lift Team ConceptModified Lift TeamsUses an already existing transport team as a lift team or other personnel.

Prevention StrategiesSuccessful Back Injury Prevention ProgramsLeadership SupportMedical staff attitudes about lifting equipment, movement of patients is a part of treatment and care.Strong nursing representation and support

Prevention StrategiesSuccessful Back Injury Prevention ProgramsSuccess StoriesIn a 10 hospital study using the lift teams, showed a 90% reduction in lost days, 65% reduction in injuries, with a substantial reduction in compensation dollars and medical expenses. (American Journal of Occupational Health Nurses) Significant reductions in lost time and costs were experienced at the Alaska Native Medical Center when the program was implemented in 1995.

Lost Work Day Rate Due to Back Injuries1989-1998Alaska Native Medical Center

17

No Data

40

27

91

Rate per 100 Employees

28*

22

2

115

15

* Excludes January (Prior to lift team inception)

Lost Work Days Due to Patient-Related Occupational Back Injuries Day Shift 1993-1998

438

484

18

Number of Cases

16*

13

5

* Excludes January (Prior to lift team inception)

Unsuccessful ProgramsTraining on proper body mechanics has not been successful. Studies have shown this method to have no significant impact on reducing the incidents of injuries.Many studies have found that the use of backbelts is ineffective in preventing back injuries

Indian Health ServicePhoenix Area IssuesMost facilities have a vertical lift. However, they are not available for all wards or floors. Storage space for equipment and maintenance of devices is a concernOnly two facilities had a horizontal or lateral lift.No facilities had policies and procedures limiting manual lifts.Training was minimal, mostly dealing with body mechanics. Some facilities showed a video.

What can you do as a Safety Officer?Solicit management support for needed equipment ($$$) Place a high priority on eliminating ergonomic hazardsCommunicate ergonomic responsibilities to managers and employeesForm a task force. Nursing, Radiology, PT, ER, and Safety. Assign one individual to lead this program.

What can you do as a Safety Officer?Review existing equipment. Is it used? Why not? Trend injury and workers compensation data Identify high risk procedures, review how these tasks are currently handledDevelop ergonomic policies and procedures

Patient Safety AspectsJCAHO focus on patient safety and pain managementFocus back injury efforts as a two-fold benefitBenefit to the employee and organizationReduced Injury and costBenefit to the patientReduced risk of patient injury from falls, miss-handling, etc.Reduced pain and discomfort from poor transfer devices, inappropriate chairs, etc.Lifting equipment should have the same priority as medical equipment