T

here are many challenges each day that can impede the abilities of long-term care administrators, managers, and staff to provide high-quality care in our nation’s facilities. An emerging issue contributing to these challenges, which is gaining attention in today’s environment of care, is workplace injury to staff. The healthcare industry continues to be one of the worst performers when it comes occupational injury incidence.¹ The pain and suffering to direct care staff and associated workers’ compensation costs burden the resources of many organizations. In addition to shortages of care staff and high turnover rates, organizations do not want to lose valuable workers to work-related injuries. The impact of these injuries can create a crisis.
       Data show that back injuries associated with resident-handling tasks are the most significant occupational injury problem for most healthcare organizations.¹ Not only are a high number of injuries reported, but these injuries are usually those that result in significant lost time and disability and add to financial implications. When considering the direct costs (ie, the compensation paid to the injured worker and medical costs required to treat the injury), many organizations find that back strains and sprains account for more than 60% of these costs. The majority of these back injuries suffered by caregivers are related to resident-handling tasks.¹ Although many organizations have attempted to control this problem, it continues without much improvement.
       Traditional injury prevention programs based on training and attempts to modify the behaviors of workers have not shown much success. Traditional approaches have focused heavily on teaching workers how to lift properly. However, studies indicate that training alone has not had significant impact in improving the back injury problem.^2–4 How, then, should a healthcare organization approach the problem of back injuries related to resident handling tasks in hopes of reducing the number of injuries experienced and the associated costs and impact?

Ergonomics

       The science of ergonomics is receiving attention as an effective approach to control occupational musculoskeletal injuries. The concepts embodied in the discipline of ergonomics warrant attention by the healthcare industry and can contribute to achieving some necessary improvements. The Occupational Safety and Health Administration (OSHA) has provided Nursing Home Ergonomic Guidelines in response to the number of musculoskeletal injuries being experienced in this country. The agency has also issued citations (under the “general duty” clause) to nursing homes for exposing workers to the hazard of manually lifting and moving dependent residents.
       Ergonomics is a science that attempts to fit jobs and job tasks to workers rather than expecting workers to adapt to poorly designed jobs. Through an ergonomics process, high-risk jobs and job tasks are identified and analyzed to pinpoint risk factors. Once problems have been identified, action is taken to redesign and change these jobs or job tasks to minimize or eliminate the impact of the risk factors. Lifting and transferring residents in the healthcare environment is a high-risk occupational activity because of the weight involved and the posture of workers when attempting to lift a resident. In addition, loads are not static but rather dynamic and unpredictable. If significant progress is to be made regarding reducing back injuries in the healthcare industry, prevention programs based on the concepts of ergonomics are necessary.
       Many organizations are realizing that the high rate of musculoskeletal disorders experienced by workers in the healthcare industry remains a major problem. If one were to review trends related to occupational injury experience, he or she would notice a steady decrease in total cases beginning in 1992.¹ A closer review of these statistics focusing on healthcare workers who are involved in direct resident care does not, however, demonstrate an improving trend.
       According to the US Department of Labor’s Bureau of Labor Statistics, the occupational injury incidence rates calculated for overexertion, specifically from lifting, are 4.5 times higher than the national average for all industry.¹ In fact, these rates for long-term care direct care staff rank near the top of the list when considering all of the hundreds of industries that report information to the Bureau of Labor Statistics. Back injuries among nurses and nursing aides and others involved in direct resident care remain a major problem that must be addressed.

The Costs of Injury

       The cost of occupational injuries presents a significant burden to the healthcare industry. The money spent on occupational injuries is being wasted and could be put to better use, and the impact is even greater than many realize.⁵ Often, only the direct costs associated with these occupational injuries are considered when investigating cost impact. As stated, these direct costs include the cost for medical care and the compensation paid to injured workers. In addition to these direct costs, there are indirect costs related to occupational injuries. These indirect costs include replacement of the injured worker, additional training, time spent on supervision and administration, loss of productivity, decreased morale, and other related issues. It has been estimated that these indirect costs can exceed 4 times the amount of direct costs.⁶ Organizations will generally protect themselves from direct costs by transferring the burden of risk through the purchase of insurance. However, the impact of indirect costs must be absorbed in the operating revenue of each individual organization. With the need to cut costs and operate more efficiently within the healthcare industry, the reduction of occupational injuries and associated costs offers a significant opportunity for improvement.

The Next Step

       With awareness of the problem growing, many healthcare organizations want to do something to address the impact and burden created by occupational injuries. They may not, however, know where to start or how to best find solutions to the problem. Having worked in risk management and safety for more than 35 years (with more than 30 of these years focused on loss prevention in healthcare), I have gained some valuable insights into how to best help the healthcare industry with its serious and growing problem of managing occupational injuries. I have worked with many organizations (eg, healthcare providers, insurance companies, educational institutions, government agencies, and equipment manufacturers) to develop and implement programs and processes that have been successful in achieving improvements.
       My most current work involves a program, “Creating a Safer Environment” (CASE), being made available to the healthcare industry as a resource to draw upon for assistance. The CASE program will begin by providing organizations with a simple and easily implemented approach to safe resident lifting. My vision is to expand the CASE program to address other safety issues, such as preventing the resident falls present in today’s healthcare environment. The philosophy of the CASE program is to help facilities and organizations create a culture of safety integrated into everyday operations, which will prevent accidents, control losses, and contribute to improving quality of work life for staff and quality of care for residents. Listed below are some basic key elements of the “Safe Resident-Lifting Module” of the CASE program.
1. A process to identify high-risk activities and assess residents
2. A method to analyze environments to determine where change is required
3. A process to formulate recommendations to eliminate or minimize hazards
4. A method to implement processes for improvement, which would provide educational awareness, buy-in, and training of employees in new work methods
5. A method to measure the effectiveness of the program and encourage a process for ongoing improvement.

Conclusion

       This introductory article is intended to raise awareness of the need for organizations to begin to effectively address the problems related to occupational injuries and understand the benefits they can achieve through effective injury-prevention programs. In future ECPN articles, I hope to provide more information and detail about the CASE program and share some success stories about organizations that have effectively implemented the program.