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Purpose: To identify the parts of a good back injury prevention program for your nursing home.

Task 1:

You are on the joint labor/management safety and health committee. You are reviewing your facility's current back injury prevention program.

You get these two policies to review:

# 1: Page 77: An outline of the lifting training program which occurs once a year.
# 2: Page 78: A memo that explains how to use gait belts.

In your small group, read these two policies carefully and answer the following question.

1. Will these two policies protect you from getting a back injury? If no, why not? Look at factsheets #2 through 6 to help you answer this question. Ask each worker in your small group to look at one or two of these factsheets. Make sure that each factsheet is read by someone in your group.

Task 2:

Your safety and health committee has just attended a training program about back injuries in nursing homes. You learned that there are five (5) important parts of a good back injury prevention plan. Look at factsheet #1 to help you answer this question.

1. Make a list of these 5 parts.

2. Explain why each part is important.

Document 1:

A Back Injury Prevention Program
All nursing home workers who are assigned patient-handling tasks must attend the LIFT SAFE training program once a year. The program lasts approximately one hour. The following topics are included:

I. Introduction
  • Who's at risk

  • Cost of back injuries to the nursing home industry
II. Why and how back injuries happen
  • Correct body mechanics

  • How to reduce the force on your back-posture and conditioning
III. Basic lifting skills: On and off the job
  • How to size up your load

  • Tips for performing lifts and carrying residents

  • Tips for pushing and pulling heavy carts and equipment
IV. Transfer skills for nursing home workers
  • The challenge of handling human loads-variable size and weight

  • How to communicate with residents

  • Team lifting concepts
V. Conclusion: Taking responsibility for your own back
  • Human limitations that can lead to back injury

  • Human traits that can lead to back injury

  • Your role in preventing back injuries

Document 2:

Valley View Nursing Home
Gait Belt Safety

Policy: It is the policy of Valley View Nursing Home, for physical therapy, restorative nursing personnel, and all nursing assistants to utilize gait belts with patients during transfers, ambulation and gait training.
  • Restorative Nursing Program personnel will utilize gait belts on patients during all ambulation and transfers.

  • Physical Therapy Department personnel will utilize gait belts during all gait and transfer training except in instances where patient is wearing a belt with everyday clothing.

  • Nursing assistants will utilize gait belts during all ambulation and transfers.

  • The Gait Belt
    It is recommended that a gait belt be worn by the patient when you are transferring or ambulating a person. The gait belt provides a firm grasping surface or the staff person and protects the resident from accidental trauma to the skin. The gait belt gives the patient a sense of security as it is tightened. The belt also allows the staff person to gradually lower a patient to the floor (if necessary) without injuring self or patient.
    Contraindications for Use of Gait Belt
    1. Recent colostomy/ileostomy surgery
    2. Severe cardiac condition
    3. Severe respiratory problems
    4. Recent abdominal, chest, or back surgery
    5. Abdominal aneurysm
    6. Phobia regarding belts
    Ambulation with Gait Belt

    Policy: To be used in transferring and ambulation activities of patients who need the security of this assistive device.
    Objective: To promote ambulation activity by providing increased security for patient and staff.
    Equipment: Gait belt
    Procedure: 1. Gait belt is applied snugly to the patient's waist.
    2. To bring patient to standing position, keep your back relatively straight and pull on the gait belt.
    3. After the patient is standing, use gait belt to assist in stabilizing and turning patient.
    4. If patient begins to fall, draw patient close to your body using gait belt, and slowly lower patient to the floor.

    Fact Sheet 1

    Five parts make a complete program

    To have a complete ergonomic program you and your employer should take the following five steps:

    1. Learn about the risk factors and conditions that can cause back injury. Then inspect the workplace to look for hazards. Why?
    Knowing the conditions, job tasks and hazards in your nursing home is a key part of a prevention plan.

    2. Use equipment and devices. Get training on how to use these devices. Why?
    Lifting and transferring equipment makes a big difference. You should receive training on all new equipment that is used on the job.

    3. Organize job tasks and work practices in ways that reduce injury. Why?
    Resident assessment: you need to know how each resident should be transferred. Transfer needs don't stay the same. The mental and physical state of the resident can change quickly.
    It takes two: Some lifting and transferring should only be done by two people. Part of organizing a safe workplace is making sure that enough workers are on hand to transfer residents who need more care.

    4. Have a plan to provide care and support for any worker who is hurt. Why?
    If you get hurt on the job, you need and deserve support and follow-up to make sure you get better as fast as possible and can return safely to work.

    5. Conduct ongoing training and education of workers, supervisors, and managers. Why?
    Everyone needs training-workers, supervisors and managers. Training and education help us to understand how we get hurt on the job. Training and education help us to understand how to fix unsafe jobs.

    Get It In Writing!

    Get the ergonomic program in writing. The plan should:
    • Describe the complete ergonomic program.
    • Be made available to all workers.
    • Be easy to read and available in the language you speak.
    • Be endorsed by the highest level of management..
    • Include a timetable that says when certain activities or changes will be made.
    • Updated annually or whenever job tasks change.
    Ask to see the plan for your facility. See if all the pieces are in place. Let the joint labor management safety committee or management representative know what is missing.

    Fact Sheet 2

    A closer look at each piece

    The first step is to do some good detective work. Learn how to identify all existing hazards and conditions that may lead to back injuries on your job. This is called a worksite analysis.

    The best way to do this detective work is with the joint labor/management safety and health committee or ergonomic committee. The whole facility should be inspected. Every visible problem should be discussed, with a solution proposed and a timeline set to fix the problem. Improvements that are made should be followed up to make sure they are working. These inspections make a difference when they cake place on a routine basis, with a firm schedule set in advance. Leave no stone unturned.

    Get plenty of input from workers. They can provide you with information about which tasks are stressful. Workers can provide good ideas about how to fix an unsafe job.

    Other sources of information about hazards include:
    • Incident reports and worker complaints
    • OSHA 200 logs
    • Medical and insurance records
    • Results of surveys and checklists in this workbook
    Fact Sheet 3

    Equip yourself with the best

    Using equipment and devices can help. Machines don't get back injuries. Lifting devices reduce the number of times you have to lift and transfer a resident.

    • A lifting device (hoist) that is well-made, well-maintained, and available when you need it.
    • A shower chair on wheels that is designed to roll right over a toilet. This smart and simple piece of equipment prevents the need for several stressful transfers.
    • A transfer belt with handles to use when transferring residents who need some help getting to a standing position.
    Fact Sheet 4

    Communicate, coordinate, educate

    The way your job is organized can make work safer. Knowing the transfer needs of each resident can make work safer.

    • Ongoing training and education programs.
    • Make sure two nursing assistants are available to perform certain transfer tasks.
    • Provide enough staff to cover for workers who are out sick, on vacation, or working with light-duty restrictions.
    • Assessing residents regularly to find out their transfer needs.
    • Making sure all nursing assistants are told the results of these resident assessments.
    Fact Sheet 5

    A medical management plan

    A medical management plan = support far injured workers. Medical management is a plan to support and follow up with any worker who gets hurt, and to:
    • Encourage all workers to report symptoms immediately.
    • Make sure injured workers are seen by a qualified health-care provider.
    • File injury reports right away and keep track of all injuries.
    • Make sure workers' compensation forms are filled out right.
    • Make sure light-duty restrictions aren't violated.
    • Get your facility, supervisor, doctor, and union talking to each ocher.
    • Make sure unsafe job tasks are fixed.
    Fact Sheet 6

    Lift and learn

    Ongoing training and education programs. You should get information about the hazards on your job and how to prevent injuries. Training should:
    • Draw on your wealth of experience.
    • Encourage active participation.
    • Be evaluated by you and other workers.
    • Be changed to meet your needs after each evaluation.
    • Take place on a regular basis. Every time a new job task or piece of equipment is introduced, training should follow.
    The trainer should be very familiar with the hazards of nursing home work. Trainers should be able to demonstrate transferring techniques and the correct use of transfer devices. Supervisors and managers should receive this training as well.

    The training program should include the topics in this workbook:
    • Why nursing home work may lead to sprain and strain injuries.
    • How to identify risk factors in nursing home work.
    • Why early reporting of the first signs and symptoms of back pain is important.
    • How to fix the job before you, your co-workers, or residents get hurt.
    • What should be in your facility's ergonomic program.
    • How to work with a joint labor/management safety and health committee to make a safer workplace.
    Fact Sheet 7

    Who's in charge?

    An ergonomic program can't run by itself. A well-run program requires a serious commitment from everyone concerned.

    A responsible person, selected by management, should be in charge of making sure each piece of the program is working. This person should be experienced in preventing back injuries in nursing homes and must know about ergonomics. Every nursing home employee should know the name of the responsible person and how to get in touch with him or her.

    A Team Effort

    The responsible person can't do it alone. A team is needed to make it work, including:
    • Top management staff who have the power to make decisions to buy new equipment and maintain the equipment already in use.
    • Physical therapy staff who can help with their expertise.
    • Trainers who provide ongoing programs to workers and supervisors.
    • Worker involvement and input from all job titles

    • Get the word out about how to prevent back injuries.

    • Articles in newsletters
    • Notices on bulletin boards
    • Educational programs
    • Communication between facilities.

    Everyone benefits from an ergonomic program

    1. Only a comprehensive ergonomic program can successfully prevent disabling back injuries and strain of sprain injuries. This program should:
    • Identify the hazards in your facility.
    • Use equipment and devices that make transfers safer and train everyone to be able to use this equipment correctly.
    • Specify work practices like resident assessment and enough staff to help you perform a lift safely.
    • Include a plan to support any worker who gets hurt.
    • Have ongoing training and education of workers, supervisors and managers.
    2. A team effort will make an ergonomic program work. Commitment from everyone is important.

    3. Request a copy of your facility's ergonomic program in writing. Check to see if any of the important pieces are missing. An ergonomic program will work best if it is comprehensive and every player does their part.