NOTE: This document is provided for historical purposes only.
Presentation by Diane Factor, UCLA Labor Occupational Safety and Health Program
MS. COHEN: Our next presenter is Diane Factor. And what Diane is going to share with us is a great example of taking the important research work that Dr. Owen has done and putting it into real application in nursing homes in California.
Diane works with UCLA's Labor Occupational Safety and Health Program out of Los Angeles where she has been working on implementing back injury prevention programs in nursing homes in southern and northern California. She spent the past year loading up a van with samples of lifting equipment and other assisted devices and doing training with all shifts, even for the night shift, like at one o'clock in the morning, she also conducts ergonomic assessments. She's going to be sharing with you some of the successes of that program. Diane.
MS. FACTOR: We received an OSHA targeted training grant in 1995 to look particularly at long term care facilities. And what was so fortunate is because of the work of Dr. Owen and --- and the work of the Service Employees International Union, we had something tangible to go forward with. There really was an ergonomic approach developed for the long term care industry. And I've been an Industrial Hygienist for about 18 years. This was very exciting for me, because there are solutions.
There are solutions here, and so, I was very excited to see if I could really make a change. Because as we've been hearing, change takes a long time and there's a lot of resistance, but this seemed to make so much sense, this approach. We knew in California that as part of the training that certified nurse aids get, it includes a couple of modules on body mechanics. So we knew, even though people were getting training on body mechanics, the rate of injury was still enormous. So we really thought that was even more reason to go with an ergonomic approach, and Dr. Owen showed us some of the technology that she had.
I guess that was the late '80's, and we were even, also fortunate to have available to us technology, you know, now in the mid-90's. So we decided to kind of base our training on the Back Facts Manual developed by the Service Employees International Union. We looked at a number of training programs, and we thought this one was the best. And what we did is in the appendices of that there is a list of manufacturers of assist devices, transfer devices. We called them all, and low and behold, we got a lot of free literature, free videos and actually some free assist devices.
And so, we were able to have, you know what makes the training fun is a lot of show and tell and hands-on, and that was also something we wanted to do. And then we thought -- oh, don't leave. There's our administrator leaving.
We decided to do outreach to companies directly. We said, well, we'll write a letter to the 600 nursing home facilities in Los Angeles County alone, and, why not? And we also -- we were in an article along with a couple of other people, Jamie as well, in the long term, Contemporary Long Term Care Magazine. And out of that direct mail and article in the magazine, we got calls. We got calls from nursing home administrators, from corporate people saying, we want this program. "We've tried lots of things. We've got safety consultants. We've got safety bingo, you know, that game where, if you don't report, then you get a free T.V. It doesn't work. We were using back lumbar support and worker comp costs are still, you know, over the top, out the roof. We were open." I was amazed, you know, I thought it was great.
It was also, because we're under grant, we didn't, you know, charge for our services. It's a free opportunity. So we began doing walk-through assessments at facilities all around L.A. and some in northern California, and we began working with seven different companies that represent over 100 facilities. And most of them were not represented or organized by unions, but some were. And to make a long story short, we did a lot of initial training.
Now, in our second year, we were refunded in the program to work with three primary companies that showed the most commitment. And one of these companies has union representation with Service Employees International Union. And so, we are in a really unusual and great situation of collaborating the university, the union and the corporation.
This is a company that has 28 facilities just in California. So as we began doing walk around assessments, doing record reviews, we really looked at the workers' comp data, counted injuries, you know, correlated them to, you know, job classification and where people were hurt and how much those injuries cost. And again, I was really impressed at how much nursing home facilities were spending on preventable injuries. So we began what we call our level one training which was designed really to learn from the nurse aids, to find out where they were experiencing pain on the job.
And also, I just wanted to test out if what Dr. Owen said was true in her studies about where people are experiencing pain and why. And low and behold, it matches with what we found in these training sessions. And so, we -- we're always making training a little bit fun and interesting. And so, we developed these ouch stickers, ay stickers (Spanish for ouch) and we have array stickers (Tagalog for ouch) Spanish and English were the primary languages we needed. Particularly in L.A., we needed Spanish, and we gave everybody a sticker, and we got one of the workers to stand up and be our model.
And people got to stick stickers on that person where they were feeling or are feeling pain on the job. And in two seconds, we dispensed with telling the statistics about back injury in the nursing home field. Because the bulk of the stickers were on the lower back, but they did include, you know, shoulders and the extremities, and people had a lot of fun doing it. What are you doing?
And here was this perfect model, this person standing up with stickers all over him, and we actually started going through the motions of some of what you saw on the slides of the kinds of transfer, and lifting and movements that you have to do on the job and asked people to really -- what we were trying to do is get them to "think ergonomically" about redesigning the work, not just how they do it, because they have to lift people and they have to do, you know, this work but how these tasks could be done differently.
And we would rate the task they do.
We used Dr. Owen's list of transfer task, that priority list, and we asked them to rate it in terms of discomfort using that lickert scale zero to 10, zero being nothing at all, 10 being very hard. We also used another checklist with the same listing of tasks and we asked frequency. And what people began to realize is that they were doing some of these tasks 50, 60, 75 times a shift, one task. Then you'd add them up, the frequency of doing these tasks, you know, cumulative on a shift. Okay. And we were getting people doing a 100, 150, 200 tasks that put their back at risk on one shift. So they began to see, that's why my back hurts. Okay.
It was very, very interesting, and it also worked getting the supervision to understand what was going on and getting corporate people to think, maybe we need to re-look at how we're doing the job. So then our second level training is regarding the controls, and we purchased a couple ergonomically designed lifts, and we purchased a slip sheet that Dr. Owen showed you. We got the walking belts, the gate belts and the pelvic lift for in-bed toileting. And now I -- if you could put on the first slide.
And we designed a training where we set up stations, and the workers came in and they got to try out on each other all of these kinds of assist devices. And then what we had them do is think about your task and think about where you might be able to use an assist device. And in this facility, we had a lot of people working alone. We also found we had a lot of young workers. And so, this woman is going to get this woman out of bed by herself, and you can see she's a large resident. And she put her on a shower chair. That was good. And took her into the bathroom. And there's a picture of the shower chair which I thought was a pretty good one at that facility, easy to clean, stable.
But we showed -- this is a standing lift. This is in our training, and you can see Dr. Owen in the background. She was able to come out and help us in this training session. This is how that lift could do that task, lifting that patient up and putting her over the toilet. So you see Dr. Owen working with a nursing home worker talking about the pros and cons of this lift. And needless to say, people really liked the equipment, and they tried it out. They're all electric. They have batteries that you plug in at night and recharge. They're beautifully made pieces of equipment.
There's Dr. Owen showing someone how to do the kind of kinetic lift with the walking belt. You get a good shot of her hand on the handle. So actually you're giving people, you know, ergonomically designed handles, something we weren't given at birth. And everybody got a chance in the training to lift each other and experience how else the job could be done. The training had to be experienced based so people would be open.
This is similar to Dr. Owen's picture of two people lifting a resident out of a wheel chair and turning her and putting her back to bed. It took a long time.
Here's another two person lift. Many steps. Getting her back to bed, leaning over, getting her comfortable. Tedious, very tedious work. You know, I've been in a lot of different industries. I primarily have worked in the manufacturing sector. This totally impresses me as one of the hardest jobs I've ever seen. These nurse aids work extremely hard. It's not only physically taxing, but emotionally taxing as well, caring for people. There they are working with a resident.
Now, this is the other lift. It's a much better version of the Hoyer lift. We also heard from companies a lot of horror stories about Hoyer lifts that had broken, dropped patients, tipped, people breaking -- residents breaking their hips after they fell out of a Hoyer. They have those chains. I mean, the whole thing. These lifts are designed so much better. They're electric. The slings are well-designed.
In our training session, we actually let people lift each other up out of chairs, feel how secure they felt in the sling, put it on and play with it. Shows a very simple panel, you know, on/off, up/down and also, you push a button and it weighs the patient. So it eliminates the whole task of putting somebody on a weight chair or a scale. You just hit the button. They would always hit the button on me in the training which I didn't like that.
And this is a woman -- this is a comatose patient who's very constricted. She's very rigid, and she soiled the bed. So she's changing her attends pad and changing the bed. It took about 25 minutes to gently roll this woman back and forth to try to clean her. You know, she sleeps with a pillow between her legs. She's very -- and then leaning over the top of the bed to lift her back up into.
I mean, this took a long time. And you just see, going around the side, lifting, pulling, pushing, nudging. She gave her wonderful care, but it was at her expense. And you could see that the lift we show in the training could be used to lift a person like that right up in the hospital bed and then you change the linens. You could clean them off. Some of the slings are porous, you know, you can use them for washing someone.
This is a couple of my co-workers who are kind of staging this for us, because we weren't able to use residents yet. But it just makes so much sense. It's just incredible. And also you can use the sling and this lift to get someone off the floor which is one of the most difficult tasks and one we saw associated with the number of injuries.
Here is another task -- pulling a resident up in bed. I mean, if you have kids, you know, sometimes you come in the morning, they're all scooted down in bed. Well, that happens a lot with residents in nursing homes. And so, here's two people lifting her under the arms to scoot her back up in bed. Not easy. They're lifting her up in bed. She's more constricted. And a lot of times, they do this alone, again, reaching over the top. It just looks so hard. Pulling her up. And so, that's where -- what Dr. Owen showed you. This slip sheet really works. You put it under the draw sheet, and it just eliminates a lot of the friction.
Here we are in a training session, using it on each other, slipping each other back and forth, up and down.
Here's another training session where we got to do that.
And finally our favorite training device, because you can imagine there's a lot of humor associated with this device where you pump up the pelvis. We would pump each other's pelvis up and feel how, you know, basically spongy bed pan worked. And it really does work. We covered the faces to protect the innocence here, but I thought they were pretty good sports to be the models in this, a really great device. I guess that's it on my slides. Thank you.
So incorporated that into the training. It made the training lively. It was really exciting for people to do. And then we gave each worker this little grid or work sheet. And we also have it in Spanish. And we asked them to list on the column on the left the room number and bed, like 16C or 20C, of all the residents they worked with. We asked them some basic questions about the condition of that patient, whether they were non-weight bearing, excessive body weight, combative, mentally impaired, unstable walking, some other special medical problem so that they would begin to think about when it might be appropriate or not appropriate to use a certain assistive device.
And then we have them check which lift, or stand, or belt, slip sheet or pelvic lift might work with that resident. And I can't tell you the value of this information. The only way we could have gotten this information is through working directly with the nurse aids. By observation, I could never have gotten this.
So we accumulated all this data in this one facility where we were working by station. So we know whether we have 48 residents in one station. This nursing home has five stations. Thirty-eight of them are non-weight bearing. We know the staffing levels on the day, the p.m. and the night shift, the ratio between resident and CNA. We know what people said they felt were the more risky task, where they had a high discomfort which validated Dr. Owen's work again, the transfers, shower chair to chair, chair to bed, bed to chair.
We knew what injuries had happened on that station in the last couple of years, injuries at work, cumulative trauma to back from patient transfer. We also got some numbers about which patients could use different assistive devices. Now what we're trying to do is to come up with a proposal of what equipment we would propose that that facility buy per station and maybe even how many walking belts, slip sheets, and lift stands. This data is really being collected and put together by the Health and Safety Committee which is made up of workers and front level management.
We actually think that it will be a pretty modest proposal financially compared to what they're spending on back injuries. And so, what we hope to do in the next few months is actually have intervention in this one particular facility. We're working with a couple of other companies and then looking again to see how the injuries have been reduced and looking at both patient and worker discomfort surveys to see how that changed.
So thank you very much, and I'm available for questions.
