Care of the Staff is as Important as Care of Residents

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ike most nursing homes, Wyandot County Nursing Home (WCNH) employs mostly nurse aides to work with residents and assist them in their activities of daily living, including routine lifting and transferring. The nursing staff members at Wyandot were taught that if they used the traditional two-person manual technique, with proper body mechanics, they would not get hurt. However, as is the case with other nursing homes around the country, WCNH nurse aides and nurses continued to experience a high rate of injuries including back injuries and musculoskeletal disorders (MSDs). It was a single worker's compensation claim over an employee's back injury in 1995 that cost WCNH $240,000 that prompted the facility's director of WCNH, Joe Jolliff, to investigate a better way to protect staff and care for residents.
       Since WCNH instituted its strict No Lift Policy, the nursing staff has been virtually pain free. The No Lift Policy calls for the nursing staff to use only mechanical equipment when lifting and transferring patients. The equipment includes state-of-the-art Liko lift systems, as well as fast electric beds. Because the nursing staff was instructed not to manually lift patients, back injuries stopped occurring, and the nursing staff was working pain free. The reduction in staff turnover and workers' compensation resulted in big savings for WCNH. Hiring five rather than 30 nursing assistants translated into approximately $125,000 savings. In addition, back injuries that were patient lifting related were eliminated, and none have occurred since 1997. Workers' compensation claims for nursing employees were reduced from $66,625 in 1995 to $2,656 in 2001.
       Wyandot County Nursing Home in Upper Sandusky, Ohio, is a 100-bed facility in a rural, farming community. It is owned and operated by the county and employs 90 staff, half of which are nurse aides.
       Jolliff explains how things were seven years ago when they first started considering patient lifts as an alternative to manual lifting. "We needed to do something, because our staff had sustained back injuries prior to 1997."
       Back injuries are the nation's number one workplace safety problem. According to the United States Bureau of Labor Statistics, more than one million workers suffer back injuries each year, and back injuries account for one of every five workplace injuries or illnesses. One fourth of all compensation claims involve back injuries, costing the industry billions of dollars on top of the pain and suffering of injured employees. Despite these facts, ergonomic lifting techniques, including the two-person lift, are still taught, and many of those in the medical profession continue to believe that people will not get hurt using traditional lifting techniques.
       Musculoskeletal injuries (MSIs) sustained by the nursing staff in the healthcare industry, including acute care facilities, are not limited to back injuries. Wrist, arm, shoulder, and neck injuries rank high on the scale of incidence. The mechanism of injury is also not limited to the lifting motions involved during patient transfers. Sudden patient movements, including falls, are responsible for many caregiver injuries as well as the movements required to reposition a patient in bed manually.
       Using two people to lift patients poses a significant risk of back injuries, according to Dr.William Marras, professor of industrial, welding, and systems engineering and physical medicine and rehabilitation at Ohio State. By studying different methods that caregivers used to lift patients in hospitals and nursing homes, Marras found that no matter what method was used, lifting patients seems to impose an excessive amount of stress on the spine. Dr. Marras commented on his findings, "The moral of the story is changing the way people lift doesn't seem to control risk in these situations, so we're going to have to get lifting devices to help workers transfer patients. That way, the workers help, but they're using a machine, not moving the patient directly. Those will be the kinds of measures that will significantly lower the risk of back injury."
       In addition to the reduction in injury, approximate cost savings can be calculated in terms of the reduction of musculoskeletal disorders (MSDs) and complaints, especially the lower-back injuries sustained during standard manual lift-transfers. According to the US Department of Labor, facilities can save an average of $27,700 each time a severe MSD is prevented. Thus, the argument can be made that money already being spent on MSDs in the form of workers' compensation costs can be shifted to pay for the implementation of a no-manual-lift program whereby all patient lifts are accomplished using mechanical equipment to prevent such injuries.
       In 1996, a volunteer safety committee was formed and tasked with solving the lifting injuries problem at WCNH. After some initial research, the committee evaluated about 30 different types of lifts. Initial lift equipment chosen by the committee was in place by January 1997. While some staff members were impressed with the new equipment, others were reluctant to accept changes. However, they soon realized that the lifts dramatically improved their physical health and ability to perform their jobs more effectively.
       The equipment purchased by the nursing home included a Liko Golvo lift in 1998, Likorall ceiling lifts in 2001, and the Sabina sit-to-stand lift, also in 2001.
       Designed to handle the full range of patient lifting applications, the Liko Golvo mobile lift is a lightweight floor lift with a capacity of 440 pounds. The Sabina sit-to-stand lift is designed for patients who can partially bear weight in a standing or semi-standing position from a sitting position. The lifting motion can incorporate the use of a wide variety of lower-extremity and trunk muscles, as well as long bone loading. This can have a number of therapeutic benefits from maintaining range of motion to preserving bone density.
       During October 2000, Liko's Likorall ceiling lifts (with a capacity of up to 440 pounds) were installed in two resident rooms with a shared bath. The ceiling lift lets staff move residents from bed to bathroom to chair anywhere in the equipped rooms. In fact, because the ceiling lifts were so helpful with residents with significant physical limitations, the number of lifts was extended to cover 18 beds. By the end of October 2000, at the request of the committee, the WCNH administration officially instituted a No Lift Policy. By officially implementing the No Lift Policy, all staff members were required to use lift systems.
       "I consider it a privilege to share the breakthrough we have experienced at WCNH," said Jolliff."Our breakthrough came by implementing several pieces of equipment including sit-to-stand lifts, ceiling lifts, repositioning slings, and fast electric beds over a four-year period and also by officially instituting our No Lift Policy for employees."
       Wyandot County Nursing Home spent approximately $116,000 on lift equipment, including fast beds, and the return on investment has been significant. "The dollar savings that resulted each year by using the Liko equipment makes it a worthwhile investment," said Jolliff."We continue to use mobile and overhead lift systems today, and we continue to report an absence of patient lifting related back injuries."
       "Since our No Lift Policy has been put in place, I no longer move residents without a mechanical lift," said Christine Moses, nursing assistant, WCNH. "This is much easier for me. Also, it is more comfortable for the residents, as it is a constant movement and not a jerk or yank on their limbs. We used to move many of our patients using two staff members, and we always had to find someone to help us. Now we can use the mechanical lifts with one staff member and save time."
       Patients can benefit from the use of mechanical lifts in various ways. With the machine doing the physical work, caregivers may concentrate more on the patient's psychosocial needs. Furthermore, incidental skin tears and bruises can be eliminated as well as the more serious consequences of a patient fall. When lifts are integrated into a bowel and bladder program, benefits can be realized by a portion of the almost 70 percent of reversible incontinence in patients, whose problems do not result from medication, surgery, or infection.
       The success of the No Lift Policy at WCNH proves that the facility can maintain a safe working environment for its employees while providing a high quality of care for residents.
       "As I played the caregiver role and used an overhead lift to transport a large male into the bathroom, my back and legs tensed as I prepared to help lift this man," said Nancy Bucci, RN, BSN. "But the overhead lift didn't require my help. Without any exertion on my part, this gentleman began an elegant glide across the room. I actually felt disoriented for a moment, as there was nothing for me to do. So I started talking to the gentleman. It was then that the quality of life implications began to manifest."

Future of Nursing Homes
       On July 15, 2002, the Occupational Safety and Health Administration (OSHA) announced a new National Emphasis Program (NEP) to focus outreach efforts and inspections on specific hazards in nursing and personal care facilities with high injury and illness rates. The program will focus outreach efforts and inspections primarily on hazards most prevalent in the facilities.
       Resident handling and slips, trips, and falls account for the majority of injuries suffered by nursing home workers. The nursing home industry is earmarked for emphasis in OSHA's strategic plan. OSHA first implemented a seven-state initiative in 1996 to address injury and illness concerns in nursing homes and personal care facilities. That initiative was absorbed into the agency's site-specific targeting inspection program until this year. About 9,000 of the approximate 33,000 nursing homes in the United States were asked to report their 2000 injury and illness data to OSHA last year.
       Wyandot County Nursing Home is likely to fare well under the guidelines and to come through inspections with flying colors. The facility is small and in a rural area, but WCNH sets an example for other nursing facilities around the country.