Text For Citation: 01 Item/Group: 001 Hazard: ERGONOMIC

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employees were exposed to the caused, aggravated, or precipitated employee injuries to the trunk and upper extremities. The exposure occured at the following operation: a) Nursing Department: Nursing personnel including nursing assistants (NA), licensed practical nurses (LPN) and registered nurses (RN) while performing routine patient transfer activities. the injury records for 1988, 1989, 1990, 1991 document a pattern of such injuries. The following conditions contributed to the existence of this hazard: 1. Administrative procedures did not provide for effective communication to employees of information relating to resident transfer methods. This information is necessary to reduce the risk of employee injury. This condition was evidenced by inadequate transfer information on resident care plans and by the practice of employees performing solo transfer of residents. 2. Management involvement in addressing ergonomic hazards was inadequate as evidenced by the absence of an effectively implemented written program outlining ergonomic program goals, policies, procedures, and workplace evaluation techniques. 3. Assist devices were inadequate as to variety, quantity and policy of use. 4. An injury prevention program had not been developed and implemented that would allow for expert review of work place conditions, work practices, and work routines that contribute to employee injuries. 5. Training did not include an adequate opportunity for employees to practice transfer methods or discuss the information presented during training sessions. Among other methods, a feasible and acceptable abatement method to correct this hazard would be implementation of an affective program for dealing with resident transfer. At a minimum include the following elements in the program: I Management Commitment Implement an ergonomics program. Ensure that the program includes a clear statement of managements commitment to effectively deal with the problem of employee injuries related to resident transfers and other strenuous activities. Ensure that the program is written; addresses the area of employee involvement; and provides a mandatory mechanism for regular program review and evaluation. II Worksite Analysis 1. Analyze medical, safety, and insurance records including the OSHA-200 log and information compiled through the medical management program; 2. Identfy those employee jobs that are the most physically stressful and may be related to employee injuries; 3. Develop and implement ergonomic solutions to resident transfer and handling problems; 4. Conduct periodic workplace surveys to evaluate the implementation and effectiveness of resident transfer methods. III Hazard Prevention and Control 1. Ensure that patient chairs and other furniture are designed to facilitate safe transfer. For example select chairs that allow for proper positioning of employee's feet during a resident transfer. Use of wheelchairs with removable arms whenever possible. Give consideration to location of controls and the range of height adjustments for beds. 2. Assure that assist devices such as hoist are available in sufficient quantity to ensure resident transfers are performed according to care plans. When selecting a particular type of assist device include consideration of resident comfort and employee preference. Use Gait Belts in a manner consistant with correct resident handling procedures. 3. Develop and implement a maintenance program for lift assist devices. Ensure that sufficient back up equipment is available during periods when primary equipment is out of service. 4. Reduce the number of resident transfer to the maximum extent feasible by use of equipment such as a chair scales that require no resident transfers and use of shower chairs that are compatible with toileting facilities. 5. Assure that two person lifts occur when the situation dictates their need and that the employees are trained to recognize the need for additional assistance and make appropriate requests. IV Training 1. Supervisory nurses will be trained to properly evaluate the resident transfer techniques practiced by the nursing staff. 2. Training on resident transfer techniques will be presented by instructors who have been certified in the existing "Lift with Care Program" or equivalent. 3. Orientation training for new employees will include practice and discussion of proper resident transfer techniques as indicated in the existing "Lift with Care Program". On the job orientation will include the opportunity for the training officer to observe the trainee during resident transfer procedures. 4. Refresher training will be provided that includes practice and discussion of proper resident transfer techniques. Employees who miss training sessions will be provided with equivalent training sessions. Employees returning to work after time off from a work related injury will be reevaluated in resident transfer techniques and retrained as necessary. 5. All employees expected to use lift assist devices will be trained in the proper use and limitations of the equipment. V Medical Management Program 1. Insure that the medical management program includes a worksite review to verify that restricted duty workers are not exposed to stresses which may complicate or delay recovery. ABATEMENT SCHEDULE Step 1 - Submit to the Area Director a detailed plan of abatement outlining a schedule for the implementation of engineering and/or administrative measures to control employee injury due to resident transfer tasks. All proposed control measures shall be approved by a person knowlegable in the evaluation of workplace conditions which cause lifting disorders and injuries. Sixty day progress reports are required during the abatement period. Step 2 - Abatement shall have been completed by the implementation of feasible engineering and/or administrative controls.