NOTE: This document is provided for historical purposes only.
Question and Answer Session
MS. COHEN: I know it's very close to three o'clock, but we're willing to stay until part of the break time if you guys are willing to do that and especially if you have any questions or comments for any of our three panelists. And we'd also like to hear about your success stories. We know that all of you all have been working on different ergonomic interventions where you work, and we'd really like to hear about what's been working in your different facilities as well as asking questions of our panelists.
Q: Hi, I'm Beth Stole, and I'm from Mimic Safety Services in the State of Maine. And I can tell you that our conditions were a little bit different than some that were going on here. For instance, in 1993, we had a new state fund, because we only had one insurance company in our state because we were so bad. That wasn't just health care, that was everything. And at the same time, we had the OSHA 200 pilot program where many of our health care facilities were identified as either poor or good performance, however you want to look at it.
So I think the motivation for people to correct, especially in health care, their facilities and their situation was very different. We had time factors where we had to move, and we, as an insurance company, decided to promote a no lift policy which is using the data and the support of programs that you've talked about here and; in fact, implemented a program very similar to what Diane did.
The thing that we did differently was that we had ergonomic team training which really got into the process. When we first started that process, we had diverse teams, that is, not just nursing was involved, but we had another section that was extra for nursing where we really got into the patient handling issues. One of the things that we found, and this is where the question comes in, because we have shown results that by using mechanical lifts, we went to a no lift policy, use of mechanical lifts, uses of all these devices.
One of the things we found was that our most professional staff members, and I'm a nurse, so I can say this, were the most resistant. I guess that goes back to what Eric says about resistance to change. Nobody has talked about (other than the fact that nursing isn't really in this room too much today) how do you overcome that cultural change, the processing that we need to do in nursing rapidly, because that to me is where our problem really lies.
You can get the nursing aids to participate. I mean, we're shooting them like flies out there, you know. It's nursing where the problem is that won't take the responsibility for the assessment for defining the equipment and the environment and everything else that we need to work on.
DR. OWEN: I guess I can say it, too, because I'm a nurse. That has been my biggest problem, too, nursing and the attitude. But nurses have usually gone into nursing to take care of others and often they do not take care of themselves. They are the ones who do not report injuries, and you can say, "Do you hurt at all?" They will say "Yes" but accept it as part of the job. One time after a presentation I gave, a nurse came up to me and gave me a button that said, "If you do not have back problems, you are not carrying your share of the load." And I think that kind of tells us something in a nutshell.
But I'll tell you what they're doing in England and the European united community. In '92, they had very strict directives that came out about the lifting and handling of patients, and nothing happened.
In 1996, directives came out from the Royal College of Nursing where nursing is taking the stand now and saying, thou shalt not lift patients. And they really have a no lift policy. A nurse can lose her or his license if this is not followed. The under the axilla transfer is called the "drag," and that is out. One can lose her or his license for doing the drag. And if a patient still must be manually lifted, criteria has to be set out explaining why.
What the action will be over time to get to this no lift of patients is a big question but nursing, professional nursing has been the most difficult to work with because of their attitudes. And I'm sorry to say that, but I feel often that I'm a voice crying in the wilderness for nursing.
Q: I would totally agree with that, and I think one of the things that did help us a little bit in Maine was that the OSHA program stated very clearly to the health care facilities that you will have written policies and procedures regarding patient handling. So it forced the management of those organizations to look at written policy and procedures. And so, they kind of dragged the nurses along screaming and kicking. I mean, we're still not there in some facilities, but that was at least a help. We got management support from other management other than nursing.
MS. FACTOR: I just wanted to add, in the long term care facilities that I've been working in, there aren't many nurses.
Q: Absolutely. That's why we get it to work.
MS. FACTOR: Yeah, it may be one R.N. per facility, and she's not doing a lot of patient care. She's more of a supervisor, but in California when we started, we were very close to having an ergonomics standard in the State of California. And that process was politically short-circuited in our state. I think that the main reason employers called us and wanted to participate was because of the cost, but I also think they knew a regulation was in the pike and coming down, and they wanted to be ahead of the game. I think that's very important, and I really hope that we get back on track.
Q : I come from a multi-facility. I have home health care. I have two nursing homes, and an acute care also. But a couple of things: One, I was interested in seeing those pictures of everyone lifting these poor patients under the arms. Has there ever been a study done on the number of injuries to nursing home patients as a result of that type of care? And two, I saw in one of your slides, the Beasy board, and no one mentioned that today. I wondered if anyone's had any experience, good, bad, or indifferent with the Beasy board.
The other thing is, I see a lot of problems within the nursing home as we talked a lot about lifts for a majority of these patients and a no lift policy, but that is a contradiction to a lot of families and physicians. They feel that that patient is going to get better. That they're going to be able to walk, or they have this mindset that they are capable of standing and doing things on their own. And so, then there's a controversy with family and physicians saying that they don't need that lift. Has anybody run into those type of things?
DR. OWEN: You have about five things within one. I'd like to speak to the last one that you talked about. If I encapsulate it incorrectly, tell me. How can the rehabilitation of the resident or the patient continue if you're going to put them in a lift? I get asked that all the time. Now, there are so many different kinds of lifts that you can continue with the rehabilitation of the patient. Even the CNA's, the certified nursing assistants who do not have a rehab background (they are not the restorative aids) can help to carry out the rehab plan.
The patients do not have to go backwards in therapy since we have the mechanical lifts that they can stand in, they can walk in and they can't fall down because the lift holds them up, and there's many different kinds now. I think that we can eliminate that kind of concern now, because we have the equipment that takes care of that.
I don't know of any studies that have been done on the tabulation of injuries in relation to the under axilla lift. I know a lot is hidden in terms of injuries, and I forgot your third question.
Q : It was on the Beasy board.
DR. OWEN: The Beasy board. It is a hard plastic type of a transfer board that's got a disk in it that runs on a little track. You should have upper body strength in order to use a transfer board for one thing. I can't say a lot about it. I have not studied it. I have heard pros and cons with it.
MS. FACTOR: We were given a free one and our experience with it in a couple of our initial training was that we could never get it to work. I don't know if that was us or the board. But I wasn't comfortable in using it in training.
Q: I have a couple of questions. I'm Susan Wilburn from the American Nurses Association. One, I had a call last week from a nurse who was injured, an operating room nurse, who said that her institution told her she couldn't come back to work until she could lift 250 pounds and push or pull 1,500 pounds. She sent me the ad from the newspaper, and they were advertising for operating room nurses. The ad said that that was the physical requirement of the job.
I'm wondering if any or all of you would like to comment on your advice to the administration and the institution as well as -- this nurse is represented by the State Nurse's Association as her union. And my second question -- no, I do want to hear your comments.
My second question is for Eric or for any of you. Are you seeing the increase in use of transport teams in institutions, and what kind of data do you find persuasive in terms of how many lifts per day? I was also wondering in your study, before you implemented the transport team, how many lifts on average were occurring in the institution?
MR. MEITTUNEN: I guess I have to respond to all of the above. First, I'll say good luck. Good luck finding an employee. As far as the data is concerned, I guess pre-team implementation, we did a survey of all the patient transfers 24 hours a day among the six patient care units that we've worked with. We found that upwards of 3,000 transfers in a week are taking place, and we measured the date as well as the time to see when we should schedule this transfer team. Should we schedule them during the day, at night, on weekends? We found that the most transfers occur between 8 and 4:30, so thus our time was established.
We have two teams established in a staggered start time so we can cover more of the transfers. Actually, some of them were coming in. So from a team standpoint, we're doing approximately 60 to 90 transfers a day, and that's with four individuals who should be there. In some cases, we're down to two people because of vacations.
When Bill Charney came to the organization to look at our data, he was very surprised, too. We get our patients up and moving a lot compared to what Bill's doing. So, our transfer team is doing more work than Bill's team. We still have the successful results. Bill has two men working for him, and we heard all women, and we based our criteria on the interview and also a pre-work screen. Mainly, they're confident in teaching these techniques to others.
I found, just relating back to the first question, whenever I go into an area, especially if I'm working with nurses, I ask the supervisor for the most negative and skeptical individuals to speak with first. If you can convince them that this is important, you've got it made. You don't have any problem after that, because they're going to influence everybody else.
With training, traditionally, safety is different than everything else that we've accomplish. Say you have a nursing personnel on a nursing staff who's trained, the safety aspect seems to be treated a little bit differently than other competencies. We're going to start with training the staff before we establish our competency.
Within the next couple of years, we're going to have competency at Mayo for transferring patients which would give them an overview of the availability of equipment as well as the types of techniques, bringing it back to nursing so it really isn't treated as though it's a safety or ergonomic problem or training. It's within the department of nursing, just one of those extra competencies which we have to pass in order to work in the organization in patient care.
MS. COHEN: Does anyone else want to respond to Susan's first part about the ad?
DR. OWEN: I do, because I have been asked that many, many times. And what I've done is I've sent them a copy of the article on ergonomics on the revised NIOSH formula telling them that the formula was never devised for patient care, but look what industry expects when you're loading boxes. And then point out all the variables that are important. That the weight is right in front of you and all of these others where none of it relates to patient care. You would be down to minus, I don't know how many pounds, if you ever applied that to patient care.
And that's what I do, because it's only a max of 51 pounds in industry, how could they go to 250? I've never been asked about 250. I've been asked about 100 pounds, not 250.
Q: Hi, I'm Carol Brodsky. I'm a safety investigator for Minnesota OSHA. First of all, on response to the slides, I've been there, done that. I was a nursing home worker before I became an investigator. Actually, the toughest job I ever had was a Peace Corp worker, and it still is. But that rates second as a nursing home nursing aid. It motivated me on to go on to other things in life. Anyway, my salute to the SCIU workers and all those who are out there in the front lines. In the State of Minnesota, we had a meat packing emphasis program, inspected 26 facilities over a scope of about four to five years targeting ergonomics, had great results. It's too bad that we started with the meat packing industry first versus the health care industry. They've made great strides, and a lot of it was done.
Sure, we had to do a few of the general duty citations, but after a while what was great was that the industry responded immensely, and just did some minor citations with great results. The industry does want to work, but they are looking to a lot of us for assistance and help, including, you know, the vices, et cetera. A lot of people are coming up with their own great results in terms of innovative ways to reduce the hazard.
The other thing that I have found, even with our other ergonomic inspections that are non-related to meat packing, when talking to health care workers, and this is no disrespect to the person who said, "You know, if you haven't had a worker back injury, you haven't carried your load". You know if you can talk to those employees who have worked for 20 years without a back injury and find out what they've been doing and how they've been doing it, it's worth your time to sit down and talk to them, including inspectors, anybody there. Because there's a wealth of knowledge to be shared with those people. Everyone can benefit if you take the time to work and with them. Thanks.
MS. COHEN: Any other questions or comments?
Q: My name is Mike Halter. I work with Marsha McClaudin. This is a question directed to Eric and relates to the patient transfer teams. Could you give us a little more insight into the dynamics of the team? Who's on the team, where they're located, how long it generally takes to get them, what sort of training they have, what sort of equipment they come with, if they're doing manual transfers or if they're Sara lifts or transfer bags?
MR. MEITTUNEN: We have a diverse background from environmental services, our janitorial is what we're calling it, and also nursing assistance. I would suggest if anybody implements a patient transfer team to obtain somebody with a nursing assistant background or a patient care background. Not to say that the two of the staff who come from the environmental services background aren't competent, it's just easier to transition to patient care if you do have some background, especially with the new ruling in organization.
We're on a pager call system, so we have six units which weren't selected based on their geographic location. It was based on the injury rates that we're working with. And we've implemented that, so there's a huge distance between the patient care units. The timeliness is unbelievable, they have to really cruise down the halls in order to arrive on time. We have a paging system, numeric pagers, based on priorities. Priority one is a fall. Priority two is a cart to bed. Three could be a boost up in bed or another type of transfer. And four is an obese patient.
We have implemented eye-beams in several units with modified engine hoists in several of our units, especially the general medical areas. This seemed to help, especially in dealing with some of the larger patients. We had one who was 850 pounds last year, and this person, within the first month before we moved him to this unit, caused four back injuries. So it's really significant.
We've developed a five-week training package which is everything from caregiver relations to a whole week of just technique. We train four people just on techniques alone for a whole week. We also start them out with exercises just like Bill Charney's group does. So they're paid to exercise in the morning in warm up. The equipment we're using is just the basic equipment. We're using some medi-lifters. This is equipment that we were using before, and we haven't even looked at that yet.
We've brought in equipment, or I have, and it's gone the next week, things disappear. Gait belts, they make great luggage holders so they disappear. As a part of the process, we know we want to restock these within the patient rooms and make sure it's convenient and accessible, but we're using the gait belts, medi-lifters, and slider sheets which is similar to the slip sheet that Bernice spoke about.
We're looking at other types of equipment, too, but we really haven't looked at the engineering aspects yet. Because we simply lose it a lot of times. It's so large of an organization that it disappears, so we want to make sure that the equipment is right and then we can implement it.
Q: When your transfer team is there, your nurses and nursing assistants do none of the transfers? All of the transfers are done by the transfer team?
MR. MEITTUNEN: It's a policy that the nurse has to be present. The nurse is in charge of the patient. The lift team is in charge of the transfer itself. And the orderly or escort or transporter is in charge of their equipment. Everybody has their roles, and based on behaviors, from the past, the nurse has suggested that they're in charge of the patient and the transporters have let it be known that they're in charge of their own equipment. So that's the way it goes, it's quite complicated. The coordination is unique every time.
Q: I'm Louise Nelson with Swedish American Health System in Rockford, Illinois. I just wanted to share something that we did. I've heard comments about nurses being resistant. I'm a nurse myself, so I can comment on this as well. Part of the process that you mentioned, Eric, in your presentation was we went to the TQM CQI philosophy or we went to the nurses, because we also found them to be the most difficult people to work with and brought them together to come up with a solution.
One of the things that we've done is what we're calling a re-engineering - such as bringing the physical therapist to the floors so they're going specifically to the units instead of the patients having to go to the physical therapy department. We've been able to decrease our transfers tremendously by that approach. And I think that by going to the nurses directly many of you are saying that nurses are a hard nut to crack, I agree that they are.
Nurses are probably the hardest people to deal with because they don't want anybody to tell them how to do it. If you involve them in that decision, that's certainly very positive.
But rather than having lift teams as you're talking about, we developed what we call team lifts. So as each department, you know, in particular, ortho-neuro, they probably have the hardest lifting of any department in a hospital. No one is allowed to do a lift by themselves. If there's any lifting to be done, they'll team lift, room 316, or whatever it is. Everybody is just expected to go participate and as a result, we have cut our back injuries by over 75 percent.
MR. MEITTUNEN: That's great.
DR. OWEN: That's great.
MS. FACTOR: Great.
DR. OWEN: In support of nursing, in our hospital study, the nurses were very cooperative, but how we did that was through a QA study, because we were looking at the effect of the change on patient care. And they did a really good job, and there definitely was a lot of cooperation; the ergonomic program did improve the quality of patient care from the nurses' perception and from the patient's perception. Those nurses were very cooperative for they were doing it for the patients.
MR. MEITTUNEN: We seem to be bashing nurses, and I have to say that I think they are the best advocates right now. It takes some time, but once they understand that the benefits of safety in ergonomics industrial hygiene, they're some of the best supporters throughout the organization. We also, on our other units, implement this.
The lift team overhear pager announcements, but we've found that some people have selective hearing and move in the other direction when there's a lift called. So we've had marginal results with that, but it seems to have worked in some units. It depends on the morale of that group or that patient care unit.
MS. COHEN: We're going to try to summarize this session very quickly since we're so over time. Turn it back to Guy.
MR. FRAGALA: Thanks, Jamie and thanks to everyone who presented and participated. I just want to make a very brief closing statement.
We, in the health care industry, are charged with caring for and curing the sick of our society. Yet, if you'll look at the way we've treated our workers, we're really behind the times. We're not a leader with regard to our occupational safety programs, and I think we need to do a lot of catching up. If this conference was held a few years ago, we probably wouldn't have been included as a group. So I want to thank NIOSH and OSHA for including the health care industry as a group that needs ergonomics programs, and I hope that the program today was helpful to you and gave you some insights, because we need to look at the way our work is done.
We really need to re-engineer the job tasks that we have in health care. We need to change the way that work is being done. So you've begun to see some ideas, and we need to move much further very, very rapidly. Again, I want thank you all. Jamie, do you have anything else you want to add? Okay. We're going to have a closing session where all of the industries come together. It's going to happen in about five minutes, so you may want to get over there. Thanks again, and I hope this was worthwhile.
(Whereupon, the Health Care session was concluded.)
