One of the biggest problems for the causation of back injuries in nursing, both in acute
care and home health care and long term care is that none of the facilities that I've studied
and I've researched over my 15 years as being a safety director in this field, have ergonomic
policies.
Nor do the facilities have standard operating procedures on how to lift patients.
Therefore, ah, since there are no procedural requirements, anybody can lift, anybody can
lift anybody.
Most of the NIOSH studies now show that the average lift exceeds the NIOSH guidelines
by orders of magnitude for each particular and specific lift.
The concept of Team lifting emerged from research into back injury rates among nursing staff
in the United States.
This research, conducted by Bill Charney and his colleagues, found that there are
epidemic levels of back injuries among nursing personnel in all sectors: acute care, long
term care and home health.
The research team looked at the problem with the idea of finding a solution to the problem.
A review of the literature produced over the last twenty-five years showed that none of
the interventions tried had any appreciable impact
on injury rates.
With this information the research team developed the notions and methodology of
Team Lifting.
The two most important elements of this methodology were one, that lifting is a skill
not a random task, and secondly, that you have to
put risk where it can be controlled, that's the basic
A-B-C's of risk management.
And you cannot control all the variables of risk in a whole nursing
department; it's impossible.
So the concept of team lifting was we would develop professional
lifters.
And their only responsibility would be to do the total
body transfers in every facility.
That's the concept of team lifting.
In the past, almost every medical facility and
convalescent home in the country has tried to
reduce back injuries by training their staffs in proper lifting techniques.
Researchers who have tracked the results of this training have found that there is a
negligible dose/response.
That is, teaching hospital staff proper lifting techniques does
not impact injury rates in any meaningful way.
Even though implementing a Team Lifting program may seem like a radical step at first,
it has proven to be the single most effective solution to the problem of back injuries.
Administrators need to feel comfortable with the
concept of Team Lifting; they need to be convinced that the team can fulfill all of the lifting
responsibilities that exist in their facilities.
There's a mythology of how many patients need to be
moved.
What we find in our studies is only 10 to 15% of patients are non-ambulatory and
need to be moved on a given shift in any one facility.
Therefore, for example, in a 500 bed hospital we find that through our studies that one
team of two per shift can answer the needs of moving
ambulatory patients.
Team Lifters must have he ability to communicate -- both with patients and with nursing staff.
Putting patients at ease and eliciting their help
with transfers makes lifts far easier and safer.
The team must be able to follow the ergonomic policies that are in effect at their facility.
And, those policies should include as their number
one priority that every total body transfer must
be done using mechanical lifting aids.
Using these tools is the key to the system.
Manual lifting is the cause of the high epidemic injury rates that we have in this country.
Therefore, for every total body transfer, and we
define that as patient from bed to chair, from bed
to gurney, from chair to bed, from chair to wheelchair, any total body transfer of a non-
ambulatory patient has to be done mechanically.
The lifts have to be mechanized.
How to contact a lifting team when they are needed is a fundamental question when
considering setting up a Team Lifting program.
The communication systems that are set up to
contact the lifting team are dependent on each
facility's technology.
For example, some facilities use overhead paging systems, while other hospitals
have been using telephone beeper systems and other paging systems with excellent results.
Most hospitals are on a complete on call system.
You can design a response system that has a
scheduled structure within it.
For example, the team can start in the morning and go from
the top floor to your bottom floor where your wards
are and make rounds.
In between the rounds the lifting team can be on call.
Or they can be on a completely scheduled system.
For example, at the end of each day the nursing staff can make up a list of patients that
need to be lifted that the team would pick up in the
morning.
Emergency lifts can be given a special code either through a paging system or an overhead,
system so that the team can respond immediately to an emergency lift.
An emergency lift can be defined as a patient being
on the floor.
For example, a patient is being walked by two nurses and he falls.
The general policy in an emergency is that the nurses make the patient
comfortable on the floor and they page the lifting
team for an emergency lift.
The team then lifts the patient back to the bed using a mechanical
lifting device.
Once the program is in place, lifting team members need to maintain their physical
conditioning.
Lifters don't have to be body builders, weight lifters or huge males.
What they need to be is in good physical condition, and they need to be well versed
in proper lifting techniques.
It is very important that they exercise before coming on to each shift.
A body that is warmed up is a body that will have much less
chance of injury, and if an injury should occur,
the severity will be reduced if the body is warmed up properly.
The start up costs for implementation of a lifting
team include salaries for the, the two team members per shift.
We recommend that each hospital start implementing a team on the
day shift which traditionally has the highest
rates of injury.
Secondly the start up costs include equipment costs.
If your hospital has mechanical lifting equipment already budgeted and already
within the facility, those start up costs, again,
become less.
Quick access to mechanical lifting devices like a
Hoyer or other hydraulic lifting device is essential
to Team Lifting's success.
And each medical ward should be supplied with at least one slide
board.
The cost of purchasing this equipment, if you do
not already have it, should figure into your start-up
cost for a lifting team.
Team training costs include a three day course for team members in body and bio-mechanics,
body physical therapy and pre-visualization techniques.
Also needed is training in using mechanical lifting devices, and managing forms
and administrative responsibilities for the team.
Those costs usually run approximately $200 per
day, per lifting team member.
In facilities that can afford to hire only two
full time employees for the lifting team, the
best way to administer sick leave and vacation time would be to have one professional lifter
work with the nursing staff.
The professional lifter organizes and directs the lift, while
the nursing staff member is there for support.
In hospitals studied that use this method no
injuries
were reported.
The researchers designed a 10 hospital national study, which included one nursing
home, in order to get statistically usable data on the effectiveness of the Team Lifting
method.
The main criterion for being in the study was
that the hospitals had to have a high enough back injury rate to able to retrieve statistically
significant information.
Each hospital implemented a lifting team, and
data was taken of their injury rates, their medical
expenses due to back injuries, and their compensation costs one year before they started
the lifting team.
That data was compared with all the data one year after implementation of
a lifting team.
What we found as a result of the studies was the
compensation costs in all hospitals studied were
reduced 90%.
Days lost in all hospitals studied were reduced 90%.
Medical costs in the hospitals that were able to retrieve this
data were reduced substantially.
And workers compensation costs in the hospitals that were able to retrieve
the data was also reduced substantially.
Through quality assurance questionnaires we were able to establish patient satisfaction
with the team.
In all areas, nurses were a 100% satisfied with the team, both to response
and for quality assurance.
The reason we feel for this is that the lifting team removes the
highest compensable risk in nursing and that is back
injury that can end a career.
The key to making Team Lifting work for your facility lies in reducing the population at
risk to back injuries.
Team Lifting is a solution that works.
It is up to you to make a change that will effectively
reduce your facility's injury and compensation costs.
For more information contact your SCIF Loss Control
representative.