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Watch your (staff's) back employ a 'no-lift' policy.

There used to be 10 words that made Prentice Lipsey and Marianne Oliver want to bang their heads on their desks.

"I need a day off because I hurt my back."

In 2002, they heard these words roughly twice per month, resulting in nearly two dozen lost work days from employees at Wexner Heritage House, a 200-bed skilled nursing facility in Columbus, Ohio.

Fast-forward a couple years. Work-affecting back injuries are virtually non-existent at Wexner. "We still have the occasional claim," said Lipsey, assistant administrator at Wexner Heritage Village, WHH's parent firm. "But we have virtually none of the really costly claims--the ones that result in lost work days."

In fact, the facility experienced only one such injury in 2004, resulting in one lost workday. And that injury came at the end of the year.

Lipsey and Oliver credited the turnaround to implementation of a "no-lift" policy at the facility. A "no-lift" policy means that residents who need to be lifted off the ground are moved with a mechanical lift instead of by a staff member.

"Everyone understands that if you don't have to lift and put yourself in an awkward position, you're going to reduce the number of back injuries," said Oliver, director of rehab services at Wexner Heritage Village. "But there are financial implications as well."

Injuries in general are less severe, Lipsey said, meaning reduced liability costs for the facility. Factoring the one large claim, Wexner paid $532 per claim in 2004, compared to $5,352 per claim in 2002.

"We were shocked at how well this program worked," Oliver said. "It takes a lot of effort--you really, really have to put the time into it. But my goodness--it's worth it."

Pump 'em up

Although Wexner actually implemented an official no-lift policy in 2000, not much really happened until the company established a safety committee a couple years later and gave it the responsibility of making sure the policy was being carried out. The 20-member committee--with representatives from all levels of facility operations, including administration, nursing, housekeeping, maintenance and dining services--started by raising awareness of safety in the facility, Lipsey said.

"We wanted to make safety exciting, so we created a mascot--"Slick the Safety Frog"--and started putting flyers with his picture on computers, nurses' stations, on elevators--everywhere he could be seen," Lipsey said. "All the flyers said was 'The Safe Workplace Committee is coming. SWC.' The next thing we knew, staff was starting to ask us who this frog was and what SWC was about."

SWC was basically Wexner's existing safety committee under a new name, Lipsey explained. "We created a buzz about safety that wasn't there before," he said. "By changing the name, we made it clear we wanted to refocus on safety around the building."

Assess your needs

As the facility prepared to re-launch its no-lift policy, Wexner first conducted a material needs assessment. Here's where administration must really stand behind its policy, according to Oliver. "For your no-lift policy to work, you have to have lifts available for the staff," Oliver said. "If they have to go to another unit or floor to get one, they're not going to use it."

This is a major sticking point for many care centers, according to Barbara Acello, owner of Innovations in Health Care, a school for nursing assistants in Denton, Texas, and author of "Nursing Assistants: Essentials for LongTerm Care" (Thomson Delmar Learning, 2004). "There's a lot of facilities out there that are doing things the old way," she said. "The no-lift concept is accepted and received, but I haven't seen a lot of facilities implementing it--largely due to the budget required. You can't implement those kinds of changes for free."

Although mechanical lifts don't cost as much as they used to, it's still a significant outlay of cash for buy enough units to accommodate the staff, Oliver said. The "right amount" of lifts needed for a facility is best determined by a facility's therapy department or nursing department, or combination of the two, she added.

The company acquired a $20,000 grant from the Ohio Bureau of Workman's Compensation to buy what it needed. "A few years earlier, that grant would have had to have been $75,000 to $100,000," Lipsey said.

Maintenance needs also have to be addressed, Oliver added. "You definitely need to keep (the lifts) maintained," she said. "If they don't have the lifts available, or the lift is there and it doesn't work, they're not going to use it. They're going to start lifting again on their own."

Back to school

A few months after introducing Slick, the safety committee reintroduced the written safety policy, Oliver said. The company held in-service meetings with all employees to review the policy, then began the task of training every nurse and nurse's aid how to properly lift with and without a mechanical unit. Oliver later extended her training to others who do any type of lifting around the facility.

"This just doesn't impact the nurses," Lipsey said. "Ergonomics involves everyone who works here, including anyone who has to lift a box or has to sit all day at their desk. For about a year, we went around evaluating everyone's workspaces. If they needed a monitor raiser, we gave it to them. If they needed a chair switched out, we went and did it. Whatever they needed to be able to do their job without aches or pains, we made sure they had it."

The first wave of training took about three months, Oliver said. "I had to get everybody in the building to do a repeat performance for me, and do it right," she said. "A lot of them had to go through it a couple times because they just couldn't get it."

Of the successful ones, some people didn't "get it" for very long. Oliver performs regular audits of the nurses and nurse's aids. She occasionally finds errors and needs to give reinstruction. "The training never ends," she said. "When they go in (a resident's) room and close the door, you don't know what they're doing. They could be doing it completely wrong. We have to keep reinforcing what the policy is and what's expected:

Heave ho, let go

A facility's biggest challenge can be convincing people that they need additional training, according to Acello. Some employees stubbornly always done it," she said.

Oliver said she was surprised by the less-than-overwhelming acceptance of the no-lift program after the safety committee reintroduced it. "We thought we could throw this out there and everyone would jump right on it," she said. "But it wasn't that easy. So many people have such bad habits, it's taken us a year to get all the staff to actually use the lifts and make proper transfers."

"Sometimes, it can simply be impatience," Acello added. "A case of, 'I need to get Mrs. Jones out of bed now and don't have time to wait 15 minutes for (a co-worker) to finish giving her resident a bath. I'm going to do it myself.'

Of course, it's impossible to forgo bad decisions 100 percent of the time. "The best you can hope is that you educate them on the correct methods and give them alternatives, if any," Acello said. "But unfortunately, people are always going to use bad judgment."

Lipsey said tradition-minded employees were a major reason the facility had decided to revamp its safety committee. "Only when we decided to make the safety committee more visible were we able to change the minds of staff," he said. "And you can only do it with education. Once you can educate them on what it means to make these injury claims, and how being more careful affects their health and the quality of care they're able to give, they start to understand."

At Innovations in Health Care, Acello gave each student a personal gait belt that they had to keep and use throughout their training. "If you start them off from the beginning thinking that this is a tool they have to have to keep their backs safe, then they are more likely to use that belt," she said. "We were really strict about it--we basically drilled it into their heads. But when they got out of school, they had a belt of their own, they used it, and we could even show new students that this was a vital piece of equipment because the former students were wearing them. That's a very good thing."

The facility conducts safety competitions among its various nursing units--referred to as "neighborhoods"--to maintain enthusiasm about the program, Lipsey said. "We'll note that one neighborhood has had zero accidents in a certain time period. When one does occur, the reaction is like, 'Oh, dang, the streak is over.'"


Injury prevention begins with good instruction. Remember to emphasize these points with employees if they need to perform any heavy lifting at your facility:

[check] Always get help if the resident is larger than you are, is unable to follow directions, is completely dependent in transfers, or whose actions are unpredictable. If you are unsure of your ability to move the resident alone, always ask for help. Be willing to help others as well.

[check] Use mechanical lifts whenever possible for moving residents from one location to another. Manual hydraulic lifts are two or three person devices; for safety never use a manual hydraulic lift alone. Some of the electronic lifts are designed to be used by one person. Follow facility policies and procedures.

[check] Always use a transfer belt when moving residents; teach residents why using the belt is safer than pulling on their bodies.

[check] When giving bedside care, elevate the bed height to a comfortable level for your body. This reduces back strain by eliminating or minimizing bending at the waist. Lower the bed to the lowest horizontal position when finished or when leaving the bedside. Never walk or turn away from the bed with the rails down and the bed in the elevated position.

[check] Stand upright, keeping your spine straight. Maintain a wide base of support--your feet should be at least 12 inches apart when lifting or moving a resident or heavy object. Use the large muscles in your legs when lifting residents or heavy objects; avoid twisting at the waist. Pivot if you must turn. Always face your work; keep residents and heavy objects as close to your body as possible.

[check] When lifting a resident from the bed or chair, or an object from the floor, squat down.

[check] In all cases, bend from the hips and knees. Avoid bending from the waist or other unnecessary twisting and reaching.

[check] Push, pull, or slide residents and heavy objects instead of lifting. Use both hands. Use your body weight whenever possible. Avoid jerking motions--use smooth, sustained, even movement. Work with the resident or object at waist height, whenever possible.

[check] Avoid shortcuts--do it the right way to protect yourself and your residents.

Source: Nursing Assisting: Essentials for Long Term Care by Barbara Acello, Thomson Deimar Learning.
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Title Annotation:SAFETY & LIABILITY
Author:Naditz, Alan
Publication:Contemporary Long Term Care
Geographic Code:1USA
Date:Feb 1, 2005
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