Devices & Technology

Nurse Safety: Investments in Equipment, Training Help Prevent Back Injuries


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Debra Wood, RN, contributor

Outwardly, back pain seems to happen in a flash, with injuries often forcing nurses from the profession. But with the right tools, some experts believe the chance of cumulative damage and, ultimately, injuries produced from repeatedly lifting and repositioning patients could be reduced.

"Technology that is currently available, for whatever reason, is not being fully utilized by hospitals," said Audrey Nelson, Ph.D., RN, FAAN, director of the Patient Safety Center of Inquiry at the Veterans Administration Medical Center, Tampa, Florida. "The idea with cumulative injuries, like we have in nursing, is to limit the exposure."

Nurses continue to be ranked among the top occupations for musculoskeletal injuries. The Bureau of Labor Statistics reported 11,800 registered nurses and 40,800 nurses aides lost time away from work due to such injuries in 2001.

While faring better than truck drivers, health care workers’ odds of avoiding such injuries must improve to maintain the workforce. Nelson’s research shows that traditional ways to prevent back problems, such as body-mechanics classes and back belts, are not effective.

The United Kingdom implemented a "no-lift" policy in 1993 and saw an 84 percent reduction in lost work hours and a 98 percent drop in absenteeism due to lifting and handling, according to a 1996 report in Community Nurse. Nurses in the United Kingdom use sling lifts, stand-assist lifts, lateral transfer equipment and other devices to lift patients. More than 250 nursing homes in the United States have followed suit, but fewer hospitals have made the transition.

North Colorado Medical Center began a no-lift program in 2002, with assistance from Prevent Inc., a North Carolina-based consulting firm founded seven years ago by Betty Z. Bogue, RN, BSN.

"Lifts are considered part of our personal-preventive equipment," said Martha Schmidt, RN, employee health nurse. "In order to create a safe-lift environment, for both patients and our staff, we state they must be used during patient care when indicated."

When admitting a patient, nurses conduct an ergonomic assessment to determine what equipment to use. That becomes part of the patient’s care plan. Slings and lifts stay easily accessible and the devices’ batteries charged up. The hospital trains someone on each unit to serve as a "lift champion," able to show the staff how to properly use the equipment, assess difficult situations and develop solutions. Nelson calls this a Back Injury Resource Nurse.

"For the most part, people are getting on board with it," Schmidt said. But a few still need enlightening with more education. She said the program has already resulted in a significant decrease in injuries and she expects the number will continue dropping as more nurses embrace the concept.

Duke University Medical Center has adopted some low-tech solutions, such as placing large, plastic trashcan liners under the draw sheet to reduce friction during lateral transfers. The hospital will pilot the no-lift program on one unit, then study patient perceptions as well as injury rates.

"What we’re moving toward now is lift equipment," said Tamara James, MA, CPE, ergonomics director, Duke Occupational and Environmental Safety Office. "There are solutions that are a little more high tech, more expensive and require more of a culture change."

Convincing management that investing in multiple $2,000 to $5,000 lifts, slings and employee education can be a tough sell. But the average back injury costs $20,000, according to Nelson.

"In comparison, it doesn’t seem very expensive to me to purchase the lifts, but it does require an administrator to put a crowbar in the wallet and have this initial expenditure to save money," Nelson said. "In every study, if you just buy a few lifting devices on the unit, you’re likely to have a 30 percent decrease in injuries. And if you do a full, comprehensive back-injury prevention program, you’re likely to see a 60 [percent] to 70 percent decrease. In most cases, the cost of the equipment is recouped in a year or less."

Bogue reports that a study she conducted involving 103 nursing homes following her protocol showed the homes maintained a 90 percent reduction in lift-transfer injuries and had a 49 percent reduction in overall workers’ compensation costs.

"It’s a financial decision initially," Bogue said. "Hospitals—although the ones we are going into have a financial incentive—they probably see it equally as an incentive for retention purposes."

Nelson has developed a nine-step process, which helps identify high-risk tasks by unit and steers readers toward the type of equipment needed. Critical care units generally need more devices to help with lateral transfers. A long-term-care unit needs sling lifts and rehabilitation units stand-assist equipment. She recommends administrators invite several venders to display their lifts and allow nurses to check them out, before deciding on products.

Many nurses remain unaware of the technological advances that can decrease their risks of injury. As we become more familiar with the options, experts hope bedside caregivers will discuss lift equipment and protocols with managers and administrators, then take an active role in making health care a safer environment.

"People are being hurt every day in our profession," Bogue said. "We must trigger nurses to say, ‘This has got to change.’ That is my goal, because we’re the ones that have to change it."

For more information:

Patient Safety Center of Inquiry

Prevent Inc.

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