Make Resident Transfers Safer

Maryland nurses review a video series on patient transfers in long-term care

by Jacqueline Vance, RNC, CDONA/LTC

Health-care facilities, especially nursing homes, are environments of ergonomic challenges. Ergonomics, also called human engineering, is an applied science concerned with designing and arranging things so people and objects interact as efficiently and safely as possible.

In the long-term care environment, ergonomics is essentially the practice of designing equipment and work tasks to assist employees in preventing injuries before they occur. Musculoskeletal disorders can result when there is a disparity between the physical requirements of the job and the physical capability of the employee.

Today nursing homes and personal care facilities employ approximately 1.8 million workers at 21,000 work sites.¹ The nursing home industry injury rate is more than double the incident rate of industry as a whole. Federal Occupational Safety and Health Administration data show that an average back injury costs around $25,000 and that nationally nursing home employee injuries cost $1.7 billion a year.

Many nursing home residents depend on staff to assist with activities of daily living, such as dressing, bathing, feeding, and toileting. Most nursing home residents require at least one to two staff members to assist with these ADLs. Each activity involves interactions that may include transferring the resident. These transfers may and often do result in employee injury (see "Transfer Statistics," at right). Employee injuries lead to increased costs, higher turnover rates, increased use of sick/injured time, and staffing shortages. The OSHA "OSH Act of 1970" strove to "assure safe and healthful working conditions for working men and women..." and mandated that "each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."²

According to OSHA, providing an alternative to manual resident lifting is the main goal of ergonomics. Recently, OSHA recommended minimizing manual lifting of patients/residents in all cases and eliminating lifting when possible. On March 13, 2003, OSHA issued an ergonomics guideline for the nursing home industry, "Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders," which is available on the OSHA site.

Within the guidelines, OSHA mandates that a training program "designed and implemented by qualified persons, should be in place to provide continual education and training about ergonomic hazards and controls to managers, supervisors, and all healthcare providers, including new employee orientation."

The guidelines state that training should be updated and communicated at a level of understanding appropriate for those individuals being trained. Because of this mandate, educational companies have developed inservice educational videos for nursing facilities.

Recently, a gathering of Maryland long-term care nurses viewed a three-part video series on safe resident transfers ("Smart Move! Resident Transfers," Caresource Health Communications Inc., Seattle). The first video focuses on why it's important to have employees transfer residents correctly. The second video informs employees on how to transfer correctly. The third video is a consumer-oriented program for family members and residents; it discusses the importance of safe transfers.

The combined comments--both positive and negative--from the Maryland nurses about this video series illustrate the importance of carefully selecting a training program for your facility.

Video 1 Review

The Maryland nurses felt that the first video, "Making Sure Your Workers Do Them Right," on the importance of transferring residents correctly was a great resource. It can help directors of nursing explain the benefits of good lifting devices and how those benefits justify the expense to their administrators and facility owners.

The nurse reviewers liked the advice the video provided on having someone at the facility track your facility's injury rates and insurance costs, and then comparing that data with national data related to how lifting devices reduce injury and turnover. They reported that carefully tracking the data makes the benefits of lifting devices become crystal clear.

Also the nurse reviewers commented positively about the video advice to form a committee of nursing employees--both licensed and unlicensed--for different shifts. Each committee is advised to make decisions about a safe lifting program and even about device purchases.

All reviewers agreed that empowering employees leads to buy-in. The video pointed out that most vendors allow a facility to try a device before purchasing it. This enables employees to determine if they are comfortable with it and to ensure that it fits their facility's needs before making the purchase.

Video 2 Review

The nurse reviewers were not so positive about the second video "Your Role in Doing Them Right." Generally they felt that this how-to video should be used only as a quick overview and that it might be unsafe if some facilities made it their only source of ergonomic inservice training. The reviewers emphasized that good ergonomics training can't be accomplished by video alone.

One nurse reported that she uses her therapy team in her facility's ergonomics training, allowing one-on-one training with the employees after a group demonstration. She also explained that all new employees at her facility receive training by the therapy staff as part of new employee orientation.

The nurses agreed that the transfers shown in the video were too easy. "Show me how to transfer that resident with Parkinson's disease who is stiff as a board, or that resident with Alzheimer's disease who is kicking and screaming," said one reviewer. "Now that would make a good video."

The nurse reviewers emphasized the need for the videos to encourage hands-on training by practicing with the devices, allowing employees ample training time until they become comfortable with the devices and ergonomic lifting methods.

"While the video showed what looked like employees practicing on other employees, they didn't explain how important that is in training," pointed out one nurse reviewer.

Video 3 Review

The reviews were mixed on the third video, "What Residents and Their Families Should Know." Most felt that family members wouldn't take time to watch it. The nurses consented that it would be more customer-service oriented for someone in the nursing department or therapy department to sit one-on-one with the resident and family member to discuss transfers--especially if the resident is in rehabilitation and planning to return home.

The nurse reviewers agreed that if the family understands that the video was an introduction to the subject and that after watching it someone would sit down with them and their loved one to discuss and explain it, then that might be useful.

Conclusion

In summary, the nurses all agree that an initiative for safe resident transfers is essential for any nursing facility and that safe transfers must become a common practice in the facilities. They believe that owners and administrators must realize that not purchasing good lifting equipment is an expensive and risky venture, usually costing much more than the lifting device.

Bottom line, the nurse reviewers support that education and training must be an ongoing and continuous process, and that videos like these can be used as an adjunct to inservice education.

Contributing Writer Jackie Vance is AMDA's director of clinical affairs.

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