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TEXT VERSION OF SLIDE:

Title: Implementing A Safe Resident Handling Program in Nursing Homes

Type: Text and Picture Slide

Content: [Includes six photos of workers helping residents in a nursing home setting.]

Speaker Notes:

Title Slide


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TEXT VERSION OF SLIDE:

Title: Introduction

Type: Text Slide

Content:

  • The goal of this presentation is to highlight steps for implementing a safe resident handling program in a nursing home
  • Information provided in this presentation comes from a publication* by the Association of Occupational Health Professionals in Healthcare (AOHP), an OSHA Alliance partner

*Source: Beyond Getting Started: A Resource Guide for Implementing a Safe Handling Program in the Acute Care Setting, 2011

Speaker Notes:

The link to this document on the OSHA Intranet page is www.aohp.org/documents/about_aohp/BGS_Summer2011.pdf


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TEXT VERSION OF SLIDE:

Title: Overview

Type: Text and Picture Slide

Content: [Includes photo of three workers assisting a nursing home resident to stand.]

  • Providing care to nursing home residents is physically demanding work
  • Nursing home residents often require assistance to walk, bathe, or perform other normal daily activities

Speaker Notes:

In some cases, residents are totally dependent on caregivers for mobility Manual lifting and other tasks are associated with an increased risk of pain and injury to caregivers. Risk factors include force, repetition and awkward postures


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TEXT VERSION OF SLIDE:

Title: Overview (cont'd)

Type: Text Slide and Picture Slide

Content: [Includes photo of a worker using equipment to move a patient.]

There have been many myths associated with safe resident handling including:

  • Body mechanics training is effective in preventing job-related injuries
  • Back belts are effective in reducing risks to caregivers
  • It is safe to lift a 200 pound patient
  • Mechanical lifts are not affordable

Speaker Notes:

Many of the work-related injuries in nursing homes are the result of common myths and beliefs. Studies have shown these myths to be false. Shown above are a few of these beliefs. Others include:

  • Nurses who are physically fit are less likely to be injured than nurses who are not fit
  • If a facility buys lifting equipment, staff will use it
  • Lifting patients is the only high-risk resident handling task
  • Injuries to nurses can be prevented by screening of nurses before hiring
  • Use of mechanical lifts eliminates the risks involved in manual lifting


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TEXT VERSION OF SLIDE:

Title: Management Support

Type: Text and Picture Slide

Content: [Includes photo of a seven people in a business meeting.]

  • Before establishing a safe resident lifting program, the initial step is to engage management support
  • Management support is needed to allocate human and monetary resources

Administration's fiscal support is the key to the program's success

Speaker Notes:

Before embarking on the establishment of a safe resident handling program, it is necessary to engage the support of the facility's management team related to employee injury reduction, employee safety, ergonomics, and safe resident handling.

Management support is needed for several reasons: to be consistent with the objectives of the organization to begin the process of establishing a program; to allocate human and monetary to implement such a program; and to determine how to integrate safe resident into the facility-wide ergonomics/injury prevention in which occupational health should have an integral role.


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TEXT VERSION OF SLIDE:

Title: Team Formation

Type: Text and Picture Slide

Content: [Includes photo of four nursing home workers.]

  • Team formation is critical
  • Having the "right" team members will lead to the success of the program
  • Team members should be "champions" for the program

Speaker Notes:

Considerations of the following is key to the success of the team:

  • Define who the team will be reporting to i.e. Safety Committee, Occupational Health, or Nursing, or other department.
  • Determine the members of the team. A multidisciplinary team is needed to identify key players and the roles they will play in the process.
  • Identify a team leader. This decision can be made by administration or by another mechanism within the facility. Team leader should be provided with resources of time and support staff to lead the program.
  • Be sure team members view themselves as "champions" for the program. They will help deliver and sell the message as the program is rolled out. In addition, they will serve a vital role in maintaining the effectiveness and support the culture change
  • Involve front-line employees in order to achieve "buy-in" as the program moves ahead.
  • Develop the team's vision, mission, and objectives;
  • Provide training to all team members so that everyone can participate on an equal basis.


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TEXT VERSION OF SLIDE:

Title: Getting Started

Type: Text Slide

Content:

  • Components of a safe resident handling program:
    • Assessment
    • Planning
    • Implementation
    • Evaluation

Speaker Notes:

The components of developing and implementing a safe resident-handling program includes assessment, planning, implementation, and evaluation. The activities in one step can overlap or occur concurrently, and there can be times that it is necessary to back up a step. Members of the team and the leader of the team need to remain focused yet flexible as the steps are accomplished.


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TEXT VERSION OF SLIDE:

Title: Step 1 - Assessment

Type: Text and Picture Slide

Content: [Includes photo of a doctor and nurse reviewing documents.]

  • The basic question that an assessment seeks to answer is:
    • Is there a problem in the facility?
  • Components of the assessment step
    • Needs Assessment
    • Data Analysis

Speaker Notes:

The needs assessment includes three major components:

  • Collection of injury data
  • Worksite analysis
  • Literature review.


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TEXT VERSION OF SLIDE:

Title: Step 1 – Assessment (cont'd)

Type: Text and Picture Slide

Content: [Includes a screen capture of the Summary of Work-Related Injuries and Illnesses, OSHA 300 Form.]

Needs Assessment

  • Collection of Injury Data
  • Worksite Analysis
  • Literature Review

Speaker Notes:

Collection of injury data include: gathering historical data by department, healthcare worker and root cause of injury; collecting OSHA recordable injuries -injuries requires treatment beyond first aid, restricted, or days away from work; obtaining direct worker's compensation from the facility's carrier; determining indirect workers' compensation costs such as decreased productivity and replacement of workers; and gathering of other data such as employee turnover rate.

Worksite analysis refers to a comprehensive evaluation of the department's needs along with existing equipment and how/why it is or not utilized. It includes equipment inventory, patient dependency needs, potential high-risk resident handling tasks, and departments with high risk of special needs related to resident handling.

Literature review involves reviewing literature to see what others have done and reviewing articles about success stories.


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TEXT VERSION OF SLIDE:

Title: Step 1 – Assessment (cont'd)

Type: Text and Picture Slide

Content: [Includes photo of a worker assisting a nursing home resident put on stockings.]

Data Analysis

  • Musculoskeletal injuries related to resident handling
  • Root cause of injuries
  • Staff issues with equipment use
  • Costs from loss run reports
  • Cost-benefit analysis

Speaker Notes:

Data analysis involves the following steps:

  • Identifying the leading types of musculoskeletal injuries related to resident handling, as well as the department and staff involved in the injury
  • Identify the root cause of injuries in high-risk areas
  • Identify what issues prevent staff from using the equipment, i.e., lack of availability, lack of storage, lack of training, etc.
  • Identify the costs from the lost run reports associated with resident handling injuries
  • Completing a cost-benefit analysis of the return on investment and the cost to the organization if nothing is done based on the history projected forward


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TEXT VERSION OF SLIDE:

Title: Step 2 – Developing A Plan

Type: Text and Picture Slide

Content: [Includes a photo of three workers reviewing documents.]

  • Brainstorming of program models
  • Equipment selection
  • Gaining administrative approval
  • Creating implementation plan

Speaker Notes:

Brainstorm options of program models based on the data analysis. When brainstorming, consider various levels of intervention as possible solutions including the costs for human resources, training, equipment, and potential injury reduction with projected cost savings. Determine the best method to roll out and maintain the safe resident handling program. Determine how the methodology for safe resident handling within each department.

Develop a policy on safe resident handling based on the model adopted. Make the case for administration. Once the data is analyzed, an executive summary and report need to be prepared for administrative review. The report needs to include cost justification, a plan for implementation, and staffing requirements for the program.


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TEXT VERSION OF SLIDE:

Title: Step 2 – Developing A Plan (cont'd)

Type: Text and Picture Slide

Content: [Includes two photos. First photo shows two workers using a lateral sliding aid to move position a nursing home resident. Second photo shows two workers using a sit-to-stand lift to move a nursing home resident.]

Evaluate mechanical devices needed to "engineer out" manual resident handling

Speaker Notes:

The evaluation is based on the assessment of patient needs with a focus on: safety for the caregiver; the patient; and rehabilitation goals.

There are a variety of devices that are available including friction reducing repositioning/transfer sheets; lateral transfer devices that can be convert into a sitting position; beds that automatically turn residents or change into a sitting position; ceiling lifts; sit-stand assistive devices and portable passive lifts (sling lifts) that are able to turn and reposition residents.

A variety of vendors should be contacted who would have the type of equipment the program would need. An equipment fair is an opportunity for staff to see equipment, try it and talk to the vendor representatives about their products. The front-line staff should be involved in the evaluation, selection and piloting of new products to obtain buy-in.


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TEXT VERSION OF SLIDE:

Title: Step 2 - Developing A Plan (cont'd)

Type: Picture Slide

Content: [Includes two photos. First photo shows two workers using a floor-based sling lift to move a nursing home resident from a bed. Second photo shows a worker using a transer board to move a nursing home resident from a bed to a wheelchair.]

Speaker Notes:

In addition, develop a process for equipment trials, product evaluation feedback, and ordering equipment. Also, determine if equipment can be re-deployed within the facility. Again front-line people should be involved in this process and develop program components, including policy formation to support the program. Also, remember to identify a coach or champion for every department.

Use resources such as found on the Patient Safety Center at www.visn8.va.gov/VISN8/patientsafetycenter

The mission of the VISN 8 Patient Safety Center of Inquiry: is to support clinicians in providing safe patient care by designing and testing safety defenses related to the patient, provider, technology, and organization. Specifically, our PSCI goals are to:

  1. prevent injurious falls (specifically focusing on the most serious injuries: hip fractures and intracranial hemorrhages) and minimize adverse events associated with hazardous wandering;
  2. promote the safe use of technology associated with injurious falls and hazardous wandering; and
  3. promote a culture of safety to support clinicians in providing safe patient mobility.


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TEXT VERSION OF SLIDE:

Title: Step 3 - Implementation

Type: Text and Picture Slide

Content: [Includes worker giving instructions to nursing home staff.]

  • Roll-out date
  • Staff training
  • Publicize program
  • Beware of barriers

Speaker Notes:

The third major step in creating a safe resident handling program is the actual implementation. In this step:

  • Identify a roll-out date
  • Educate by training all staff, from senior management to front-line employees regarding the ergonomic risk factors inherent in lifting, transferring and repositioning residents. Also, train staff on high risk tasks, and new program and processes.
  • All staff on all shifts need to be included. Work with staff education to implement the training. This may include the vendor providing training or development of a train-the trainer program for the facility.
  • Publicize by working with the media/public relations department to communicate, publicize and promote the new program once implemented
  • Be aware of barriers to change - it is difficult to change behavior. Manual lifting has been the norm for the vast majority of healthcare workers. This culture has been perpetuated . It will not be changed overnight. Incorporate information on change into staff education and acknowledge staff concerns


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TEXT VERSION OF SLIDE:

Title: Step 3 - Implementation (cont'd)

Type: and Picture Slide

Content: [Includes photo of two female nursing home workers talking.]

  • Measuring Success
    • Culture Change
    • Consistent and Patient
    • Staff Competence
    • Support Coaches
    • Ability Assessments

Speaker Notes:

Evaluate these elements for successful implementation:

  • Remember the program is targeted to change the organization's culture and behavior this is not an easy task.
  • Be consistent and patient as the new policy is implemented.
  • Determine clinical staff competence, and identify remedial training needs.
  • Support, encourage, and recognize the department/coaches/champions.
  • Assess the ability of designated individuals to oversee the implementation process.


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TEXT VERSION OF SLIDE:

Title: Step 4 - Evaluating Outcomes

Type: and Picture Slide

Content: [Includes photo of a worker lowering a nursing home patient out of a transport van using a mechanical lift.]

  • Re-evaluate elements of assessment
  • Check employee satisfaction
  • Note employee turnover rate
  • Determine resident satisfaction
  • Review the program
  • Report success
  • Stay the course

Speaker Notes:

The final step, evaluating outcomes, includes the following:

  • Re-evaluate the elements of assessment. Monitor injury data on a monthly basis by using the components of the assessment phase.
  • Check employee satisfaction. Obtain feedback regarding implementation of the program. Encourage employees to report any injury in a non-punitive environment.
  • Note employee turnover rate
  • Determine resident satisfaction. Develop a tool to evaluate resident and family response to resident handling with assistive devices
  • Review the program annually for its accomplishments, and set goals for the upcoming year. Modify the program as indicated
  • Report successes or challenges to management and staff
  • Stay the course!


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TEXT VERSION OF SLIDE:

Title: Summary

Type: Text Slide

Content:

  • Manual resident handling is unsafe for the caregiver as well as the resident resulting in disabling back injuries and musculoskeletal in healthcare workers
  • Safe resident handling can be provided with assistive devices which ensures improved resident care and outcomes and reduced healthcare worker injuries

Speaker Notes:

This presentation has described the components for implementing a successful safe resident handling program in nursing homes, which included:

  • assessment
  • developing a plan
  • implementation
  • evaluating outcomes


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TEXT VERSION OF SLIDE:

Title: References

Type: Text Slide

Content:

Speaker Notes:

Shown above are additional resources that may be useful for implementing programs to reduce injuries and illnesses in nursing homes.

OSHA's Nursing Home e-tool is designed to assist employers and employees in identifying and controlling the hazards associated with nursing homes and residential care facilities. This e-tool addresses the following topics: Bloodborne Pathogens; Ergonomics; Dietary; Laundry; Maintenance; Nurses Station; Pharmacy; Tuberculosis; Housekeeping; Whirlpool/Shower; Workplace Violence

OSHA's Nursing Home Guidelines list essential components that can be utilized as a framework to design the facility's program. Gaining management support and assembling the team for a safe resident handling program are the foundations of the program's success. The essential components identified in the guidelines include:

  • Provide Management Support
  • Involve Employees
  • Identify Problems
  • Implement Solutions
  • Address Reports of Injuries
  • Provide Training
  • Evaluate Efforts

In addition, there is another presentation on the benefits of implementing a safe resident lifting program on OSHA's nursing home page. This presentation can be found at: http://www.osha.gov/SLTC/nursinghome/index.html.


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