Debra Wood, RN,
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
"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
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’
"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
"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:
Center of Inquiry
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