Safe Patient Handling
One major source of injury to healthcare workers is musculoskeletal disorders (MSDs). In 2010, nursing aides, orderlies, and attendants had the highest rates of MSDs. There were 27,020 cases, which equates to an incidence rate (IR) of 249 per 10,000 workers, more than seven times the average for all industries. This compares to the all-worker days-away from work rate of 34 per 10,000 workers. The rate for construction laborers was 85.0, and for laborers and freight, stock and material movers the IR was 154.9, still far lower than that of nursing aides and orderlies. In 2010, the average incidence rate for musculoskeletal disorder (MSD) cases with days away from work increased 4 percent, while the MSD incidence rate for nursing aides, orderlies, and attendants increased 10 percent.
These injuries are due in large part to overexertion related to repeated manual patient handling activities, often involving heavy manual lifting associated with transferring, and repositioning patients and working in extremely awkward postures. Some examples of patient handling tasks that may be identified as high-risk include: transferring from toilet to chair, transferring from chair to bed, transferring from bathtub to chair, repositioning from side to side in bed, lifting a patient in bed, repositioning a patient in chair, or making a bed with a patient in it.
Sprains and strains are the most often reported nature of injuries, and the shoulders and low back are the most affected body parts. The problem of lifting patients is compounded by the increasing weight of patients to be lifted due to the obesity epidemic in the United States and the rapidly increasing number of older people who require assistance with the activities of daily living.
The consequences of work-related musculoskeletal injuries among nurses are substantial. Along with higher employer costs due to medical expenses, disability compensation, and litigation, nurse injuries also are costly in terms of chronic pain and functional disability, absenteeism, and turnover. As many as 20% of nurses who leave direct patient care positions do so because of risks associated with the work. Direct and indirect costs associated with only back injuries in the healthcare industry are estimated to be $20 billion annually. In addition, healthcare employees, who experience pain and fatigue, may be less productive, less attentive, more susceptible to further injury, and may be more likely to affect the health and safety of others.
Industries where patient handling tasks are performed include:
- Long-Term Care (includes facilities that provide skilled or non-skilled nursing care);
- Acute Care - (includes hospitals, out-patient surgical centers, and clinics);
- Home Healthcare workers; and
- Others - such as physical therapists, radiologists, sonographers, etc.
Some examples of areas of a facility that may be identified as high-risk include: bathing rooms, extended care wings, and diagnostic units (e.g., radiology, emergency department, spinal unit, orthopedics department).
Given the increasingly hazardous biomechanical demands on caregivers today, it is clear the healthcare industry must rely on technology to make patient handling and movement safe. Patient transfer and lifting devices are key components of an effective program to control the risk of injury to patients and staff associated with lifting, transferring, repositioning or movement of patients. Essential elements of such a program include management commitment to implement a safe patient handling program and to provide workers with appropriate measures to avoid manual handling; worker participation in the assessment and implementation processes and the evaluation and selection of patient handling devices; a thorough hazard assessment that addresses high risk units or areas; investment in equipment; care planning for patient handling and movement; training for staff; and program review and evaluation processes. The education and training of healthcare employees should be geared towards assessment of hazards in the healthcare work setting, selection and use of the appropriate patient lifting equipment and devices, and review of research-based practices of safe patient handling.
The use of assistive patient handling equipment and devices is beneficial not only for healthcare staff, but also for patients. Explaining planned lifting procedures to patients prior to lifting and enlisting their cooperation and engagement can increase patient safety and comfort, and enhance their sense of dignity.
Hazards and Solutions (Transfer, Repositioning, and Lifting Devices)
Acute Care and Long Term Healthcare Workers
- NEW Safe Patient Handling Tools and Resources. OSHA has developed a series of online resources to help hospitals develop and implement safe patient handling assessments, policies, procedures, programs, training, and patient education.
- Beyond Getting Started: A Resource Guide for Implementing a Safe Patient Handling Program in the Acute Care Setting. Association of Occupational Health Professionals in Healthcare (AOHP), (2014). This resource guide addresses patient handling with the goal of providing the necessary tools for occupational health professionals to implement a safe patient handling program.
The OSHA Hospital e-Tool specific modules that address safe patient handling include:
- A Patient Handling Program module
- An Ergonomics module
- A Patient Handling Controls module
- An Awkward Postures module
- Nursing Home eTool. OSHA, (2000). Assists employers and employees in identifying and controlling the hazards associated with nursing homes and residential care facilities.
- Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders (PDF). OSHA, (Revised 2009). These guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities.
- Safe Lifting and Movement of Nursing Home Residents. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication, No. 2006-117, (2006, November). This guide is intended for nursing home owners, administrators, nurse managers, safety and health professionals, and workers who are interested in establishing a safe resident lifting program. This guide also presents a business case to show that the investment in lifting equipment and training can be recovered through reduced workers' compensation expenses and costs associated with lost and restricted work days.
Home Healthcare Workers
- Home Healthcare Workers: How to Prevent Musculoskeletal Disorders. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2012-120, (2012, February). This is one in a series of six fast fact cards developed to provide practical advice for home healthcare workers and is based on NIOSH Hazard Review: Occupational Hazards in Home Healthcare, NIOSH Pub No. 2010–125. Lifting and moving clients create a high risk for back injury and other musculoskeletal disorders for home healthcare workers.
- NIOSH Hazard Review; Occupational Hazards in Home Healthcare; Department of Health and Human Services, Center for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH). The document aims to raise awareness and increase understanding of the safety and health risks involved in home healthcare and suggests prevention strategies to reduce the number of injuries, illnesses, and fatalities that too frequently occur among wor kers in this industry.
- The Ergonomics Module of the OSHA Hospital e-Tool is relevant to safe patient handling concepts in the field of physical therapy.
- The Radiology Module of the OSHA Hospital e-Tool is relevant to patient handling concepts in the field of radiology.
- The Sonography module of the OSHA Hospital e-Tool is relevant to safe patient handling concepts in the field of sonography.
- Preventing Work-Related Musculoskeletal Disorders in Sonography. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication, No. 2006-148, (2006, November). NIOSH recommends appropriate engineering controls, work practices, hazard communication, and training to prevent these work-related musculoskeletal disorders in healthcare workers giving sonograms.
Training and Additional Resources
- Safe Patient Handling -- Preventing Musculoskeletal Disorders in Nursing Homes. OSHA Publication 3108, (2014, February).
- Safe Patient Handling Training for Schools of Nursing. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2009-127, (2009, November). The NIOSH "Safe Patient Handling and Movement" presentation and CD-ROM download are also available at:
- Safe Patient Handling and Movement. A web-based training presentation based on NIOSH Publication No. 2009-127, (2010, March). Provides an overview of safe patient handling principles. A CD-ROM is also available for advanced users.
- Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement. Developed by the Patient Safety Center of Inquiry (Tampa, FL), Veterans Heath Administration and Department of Defense, (2001). Audrey L. Nelson – Editor. The goal of this guidebook is to reduce the incidence and severity of job-related injuries related to patient handling and movement tasks. This resource guide is targeted for interdisciplinary facility-based safety teams, caregivers involved in direct patient care and patient movement, and risk managers, safety officers, quality managers, and administrators who influence workplace safety and support resources for lifting devices. The guidebook provides technology solutions and their categories for lateral transfers, repositioning, lifting, or transfer from sitting to standing.
Starting a Safe Patient Handling Program
Through the Alliance between OSHA and the Association of Occupational Health Professionals (AOHP) (concluded 10/2012), AOHP and OSHA produced "Beyond Getting Started: A Resource Guide for Implementing a Safe Patient Handling Program in the Acute Care Setting."
The Alliance recognized that patient handling practices impact not only healthcare workers but also patients. Safe patient handling practices reduce the risk of the patient falling or experiencing other negative outcomes. In addition, implementing safe patient handling practices will reduce a healthcare facility's financial burden with regard to patient claims and workers' compensation claims.
Safe patient handling programs frequently are initiated by or become the responsibility of healthcare providers themselves. In some cases, this new responsibility may not include the additional resources to implement a program effectively and efficiently.
"Beyond Getting Started: A Resource Guide for Implementing a Safe Patient Handling Program in the Acute Care Setting":
- Provides background information and reviews the differences between acute and long term care facilities;
- Builds a foundation for a successful safe patient handling program;
- Describes the process (assessment, planning, implementation and evaluation) of establishing a safe patient handling program;
- Provides examples of forms, checklists, job descriptions, etc. which can be developed in support of a safe patient handling program; and
- Lists additional references for more information.
This resource guide identifies the basic steps and processes necessary to implement a safe patient handling program in a comprehensive manner, including the need for adequate funding. Whereas this guide was initially focused upon occupational health care providers, much of the information holds true, is transferrable, and may be easily augmented to address safe patient handling programs in other healthcare fields as well.