Healthcare patient handling

Scope

Industries where patient handling tasks are performed include: Long-term care (includes facilities that provide skilled or non-skilled nursing care); acute care (includes hospitals, out-patient surgical centers, and clinics); home healthcare workers; and others (such as physical therapists, radiologists, sonographers, etc.) Some examples of areas of a facility that may be identified as high-risk include: bathing rooms, extended care wings, and diagnostic units (e.g., radiology, emergency department, spinal unit, orthopedics department).

Regulatory citations

• General Duty Clause of the OSH Act
• State legislation/regulation — see www.osha.gov/SLTC/healthcarefacilities/safepatienthandling.html
• Note: There may also be related criteria for various healthcare accreditation organizations.

Key definitions

• Biomechanics: The study of the mechanics of muscular activity and how muscular activity leads to internal loading of body tissues, such as the ligaments, joints, and other soft tissues. Biomechanics is useful in determining whether a specific manual patient handling task will create unacceptably high forces inside the body and whether a manual lift is “safe” or not.
• Body mechanics: A belief that reliance on “correct” body positions or “body movements” will somehow provide protection from the force associated with lifting and moving patients. Body mechanics is also used to assess the alignment of patients when they are standing, sitting, or lying down.
• Ergonomics: The science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, work-related musculoskeletal disorders (MSDs) can result. Ergonomics is also the practice of designing equipment and work tasks to conform to the capability of the worker, it provides a means for adjusting the work environment and work practices to prevent injuries before they occur. Health care facilities, especially nursing homes, have been identified as an environment where ergonomic stressors exist.
• Musculoskeletal disorders (MSDs): Disorders of the muscles, nerves, tendons, ligaments, joints, cartilage and spinal discs. These injuries are due in large part to repeated manual patient handling activities, often involving heavy manual lifting when transferring and repositioning patients, working in extremely awkward postures, and in pushing and pulling heavy objects.

Summary of requirements

Employers should:

• Assess all patient handling activities. Identify high-risk areas, such as bathing rooms, extended care wings, and diagnostic units (e.g., radiology, emergency department, spinal unit, orthopedics department), keeping in mind that what works in critical care may not be appropriate for emergency room settings or operating rooms. The assessment and controls should be setting-specific.
• Develop a patient handling program. Essential elements of such a program include management commitment to implement a safe patient handling program and to provide workers with appropriate measures to avoid manual handling; worker participation in the assessment and implementation processes and the evaluation and selection of patient handling devices; a thorough hazard assessment that addresses high risk units or areas; investment in equipment; care planning for patient handling and movement; training for staff; and program review and evaluation processes.
• Form a safe patient handling committee. Employers should form committees that include a range of staff from all affected departments, including members representing administrators and frontline staff.
• Design for safety where feasible. It is much easier to accommodate lifting equipment if it is built into the design of the facility/workspace.
• Utilize/acquire assistive patient handling equipment where feasible. The use of assistive patient handling equipment and devices is beneficial not only for healthcare staff, but also for patients.
• Use established safe patient lifting algorithms to assess the needs for each lift. Every patient has unique characteristics and abilities that need to be assessed on a regular basis. Each patient should have a systematic assessment—focused on the patient’s mobility—to protect both the patient and caregivers against injury.
• Train workers. The education and training of healthcare employees should be geared towards assessment of hazards in the healthcare work setting, selection and use of the appropriate patient lifting equipment and devices, and review of research-based practices of safe patient handling.
• Evaluate all worker reports of injuries or hazards. Review the OSHA logs each year.