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Health Bulletin - Benefits of comprehensive patient handling programmes

International case studies

Fragala and Santamaria (1997)

This paper described an intervention over a three-year period which used a four step approach:

  1. risk identification and assessment;
  2. risk analysis;
  3. formulation of recommendations; and
  4. implementation.

Through this process, involving all staff at the hospital, the two highest risk areas (orthopedics and medical/surgical unit) were identified and patient lifting devices (hoist and stand hoist) were implemented. The implementation involved an educational awareness and training programmes for the managers and nursing staff.

The results showed an overall reduction of 48 percent in patient transfer incidents resulting in musculoskeletal injury, a 67 percent reduction in lost work days, and costs were reduced by 32 percent in the first year and 44 percent in the second year.

The three key points from the programme were summarised as:

  1. there must be a champion (individual or group) for the effect;
  2. a system must be in place to design, implement and measure the impact of the programme; and
  3. unacceptable high-risk job activities must be physically challenged.

Garg and Owen (1992)

This four-year ergonomic intervention in nursing homes aimed to reduce back stress.

The intervention had six stages:

  1. determination of patient-handling tasks perceived to be most stressful by nurse aides
  2. ergonomic evaluation of the work performed by nurse aids prior to the introduction of change
  3. pilot study to identify and locate patient handling equipment, to establish criteria for their selection and perform preliminary trials
  4. laboratory study on patient handling equipment
  5. intervention of selected equipment into nursing homes and the training of the nurse aides to use them with patients
  6. post-intervention measurement of back-injury incidence and severity rates, acceptability rates, biomechanical task demands and perceived level of physical stress.

Overall, there was an 81 - 96 percent acceptance for the equipment; the biomechanical stresses were significantly reduced (below the NIOSH) action limit); the injury rates fell from 83 per 2000,000 work-hours lost to 47 per 200,000 work hours lost.

The authors concluded by saying that a systematic and appropriate ergonomic intervention could significantly reduce physical stresses to nurse aides and therefore reduce the future risk of musculoskeletal injuries.

Hignett (2001)

This paper gave retrospective information about a five-year ergonomics intervention programme which used a risk management approach to tackle musculoskeletal and manual handling problems. The risk management approach was described as a top down and bottom up strategy and included:

  1. organisational policy
  2. risk assessments (including a patient assessment system) and audit programme
  3. a participatory ergonomics projects (equipment user-trials, product development involving research and development of specific equipment)
  4. building design
  5. equipment and furniture evaluation and purchase
  6. training (problem solving)
  7. procedures and

The results showed 36 percent reduction in musculoskeletal sickness absence; 33 percent reduction in manual-handling incidents; and an increase in completed risk actions from 33 to 76 percent over the five years. The author recommended using an ergonomic approach with top down and bottom up strategies to embed ergonomics in the organisational culture.

Passfield, Marshall and Adam (2003)

This paper described the implementation of a "no lift" patient handling policy in a 350 bed Australian hospital. Comparing manual handling incident data and workers compensation claims from both before and after the implementation of this policy, the authors found:

The authors noted no impact from the no lift policy related to other manual handling tasks, suggesting "this program had a specific behavioural effect on the class of activities related to [patient handling] without any detectable carryover to other tasks or a generalised attitudinal shift." Further to this the authors reviewed previous research that has established "having an understanding of safe lifting does not necessarily translate to reduced injury rates."

Victorian Nurses Back Injury Prevention Project Evaluation Report (VNBIPP) (2002)

The VNBIPP was established in October 1998 to assist health care organisations to implement the state of Victoria back injury prevention programmes based on no lifting principles. The back injury prevention programmes is a comprehensive approach including:

The evaluation report was conducted by nurses in 72 participating wards for the periods two years before and one year before programme implementation and one year after programme implementation.

Results showed that there was:

The report concludes that the state of Victoria back injury prevention programme has been effective in significantly reducing injuries incurred by nurses in participating wards

UK data - What is 'grossly disproportionate' in respect of the costs of a patient handling programme?

There is evidence from the UK of the balance between the costs of implementing a programme and the likely cost of harm if steps are not taken.
The following extract from the referred publication shows where this balance lies.

" The evidence now accumulating suggests that . . . (a comprehensive patient handling programme) . . . is reasonably practicable. It appears that the largest item of expenditure, the cost of lifting equipment, amounts to a once only cost of 0.3% of the employer's budget, with a recurring cost of 0.03% of the employer's budget for maintenance and replacement in subsequent years."

To justify not spending such sums the employer would have to be able to show that such a cost was grossly disproportionate to - several times greater than - the size of the risk and the indirect and direct costs of sickness and injury attributable to the manual handling of patients.

The items of expenditure which can be attributed to a handling accident in the NHS can include:

A rough estimate of the direct and indirect costs of all accidents and incidents in a UK National Trust Hospital was 5% of the annual running costs.
It has been estimated by the UK Health and Safety Executive that 50% (2.5% of annual running costs) of these costs are due to manual handling incidents and injuries.

There is evidence that a comprehensive patient handling programme can save 20 - 30% of these costs (or 0.75% of the annual running costs).
Clearly, there is no disproportion between the costs of a comprehensive programme and the cost of harm (0.75%). In fact, the disproportion is the other way, as the cost of the programme is 40% of the cost of the harm in the first year, and only 4% thereafter, given the quoted figures.

Commentary

The true costs of injury to staff are often under reported. Although the direct costs associated with injury of lost workdays, (wages x hours) and medical expenses are commonly recorded indirect costs are often missed.

What are indirect costs?

  1. Productivity losses due to an injured worker's absence and reduction in co-workers productivity following the injured worker's return to work.
  2. Lost time for managers while they are sorting out issues and managing the injured workers absence etc.
  3. Workers with musculoskeletal injuries lost approximately 21% of their potential productivity due to a combination of absenteeism, disability leave, and lower productivity while working, (Burton, 1999).
  4. Overtime paid to others during lost workdays
  5. Personnel and training time to hire replacements.
  6. Cost of emergency treatment.
  7. Cost of light duties.
  8. Costs of processing claims.
  9. Additional recruitment cost for dealing with the injury episode.
  10. A hospital with a high level of WMSD injuries may have to resort to over-employment in order to maintain standards.

A conservative formula that is supported by the peer-reviewed literature suggests that indirect costs outweigh direct costs by 4:1. (Heinrich, 1959; Oxenburgh M, 1991.)

References:

  1. Fragala, G. and Santamaria, D. (1997) 'Heavy duties', Health Facilities Management 10 (5).
  2. Garg, A. and Owen, B. (1992) 'Reducing back stress in nursing personnel: an ergonomic intervention in a nursing home', Ergonomics 35 (11): 1353-75
  3. Hignett, S. (2001b) 'Embedding ergonomics in hospital culture: top-down and bottom-up strategies', Applied Ergonomics 32: 61-9.
  4. Passfield, J., Marshall, E. and Adams, R. (2003) '"No Lift" patient handling policy implementation and staff injury rates in a public hospital', Journal of Occupational Health and Safety Australia New Zealand 19 (1): 73 - 85.
  5. Victorian Nurses Back Injury Prevention Project Evaluation Report (VNBIPP) (2002), Victorian Government Department of Human Services, Melbourne, Victoria
  6. The Guide to the Handling of Patients. Revised 4th Edition. 1998. National Back Pain Association and the Royal College of Nursing. Middlesex.
  7. Burton, W., The role of health risk factors and disease in worker productivity, J. Occup. Environmental Med., 41, 863 - 877 , 1999.
  8. Heinrich, H.W., Industrial Accident Prevention: A Scientific Approach, 4th ed., John Wiley & Sons, New York, 1959.
  9. Oxenburgh M. Increasing productivity and profit through health and safety. CCH International Sydney. 1991.

Much of this material was supplied by:

Janelle Aitken, MSc Ergonomics (Hons), Post Grad Diploma Ergonomics.

Registered N.Z. Occupational Therapist.
Technical Specialist New Zealand Patient Handling Guidelines.
Director of Health Ergonomics Ltd.

Issued by the Department of Labour, New Zealand
http://www.osh.govt.nz

No. 27 - January 2007