In Maryland Long Term Care Facilities

Transcription

1 In Maryland Long Term Care Facilities Pat Gucer., PhD Marc Oliver, RN, MPH, MBA Tracy Roth, BSN Melissa McDiarmid, MD, MPH, Director of the Occupational Health Program University of Maryland, School of Medicine

2 Purpose of the Safe Lift Program Work with managers and caregivers in long term care facilities to: Reduce caregiver injuries and costs Reduce turnover Improve caregiver productivity Evaluation of the Safe Lift Program Survey caregivers on issues above before and after the intervention Survey caregivers on issues above in a comparison group of facilities after the intervention Recruitment - With the help of Joe Gillian and Adrienne Kaspar at IWIF, we identified a group of long term care facilities in Maryland and invited them to participate. Five agreed to participate in the intervention. Three, expressing Interest in the study, are invited to be controls and will be offered intervention materials will be controls after the survey.

3 Why is safe lifting important? Caregiver injuries

4 * 2003* 2004* 2005* 2006* BLS Recordable Illness and Injury Cases/100 Workers Private industry Home health Hospitals Nursing facilities Construction * not comparable to previous years due to changes in case definition

5 BLS Recordable illnesses and injuries in 2009 Nursing homes: Construction: 8.4/100 workers 4.3/100 workers As of 2009, it was still more dangerous to work in nursing homes than in construction.

6 Resident Transfer Injuries in Long-Term Care in 2006 Repositioning in bed Percent of Transfer Injuries in LTC Lifting (not further specified) Lateral transfers Assisting into or out of bed Bed to chair transfer Transfer to toilet or BSC Pushing beds From Ergonomist Gary Orr

7 SPINAL TOLERANCE LIMITS DURING PATIENT LIFTING Lifting Phase Compression Forces Lowering Phase 0 One Person Transfer Two Person Transfer 0 One Person Transfer Two Person Transfer Anterior-Posterior Shear Forces 1400 Lifting Phase 1400 Lowering Phase One Person Transfer (N) Two Person Transfer (N) 0 One Person Transfer (N) Two Person Transfer (N) 1400 Lifting Phase Lateral Shear Forces 1400 Lowering Phase One Person Transfer (N) Two Person Transfer (N) 0 One Person Transfer (N) Two Person Transfer (N) From Bed to Wheelchair From Wheelchair to Bed From Hospital Chair to Commode Chair From Commode Chair to Hospital Chair To Wheelchair from Bed To Bed from Wheelchair To Commode Chair from Hospital Chair To Hospital Chair from Commode Chair Maximum = 6400 Newtons Point at which 50% of the population would experience micro-factures of vertebral end plates. 2 Minimum = 3400 Newtons Vertebral end plate micro-fractures begin to occur. 2 Maximum = 1000 Newtons Point at which 50% of the population would experience annulus fibrosis damage. 2 Minimum = 750 Newtons Estimated force necessary for annulus fibrosis damage to begin to occur. 2 1 Marras, WS, et al. A Comprehensive Analysis of Low-Back Disorder Risk and Spinal Loading During the Transferring and Repositioning of Patients Using Different Techniques. Ergonomics Vol. 45. No Marras, WS. Occupational Low Back Disorder Causation and Control Ergonomic. Vol. 43, No

8 Safe Resident Lifting and Maryland Law 2008 Maryland extended safe patient handling practices to residents and employees in nursing homes. On or before December 1, 2008, each nursing home will establish a safe patient handling workgroup with equal membership between management and employees. On or before July 1, 2009, the workgroup shall have developed policy to reduce employee injuries associated with lifting; developed or enhanced the use of patient handling hazard assessment processes; enhanced the use of lifting devices with the incorporation of lift teams (role not defined); and determine the process for evaluating the program.

9 The Solution: Full lift Sit stand lift Overhead lift In a Comprehensive Safe Lifting Program

10 What works? Employee involvement in policy development Employee driven selection of lift aids Time for testing and acclimation to the change Training and mentoring Clear discipline policies Manager/Supervisor accountability and leadership Reinforcement of desired behaviors Communication, (over and over, and again)

11 What do you want the policy to achieve? Reduce manual lifting Intelligent lifting Value-Added Safe Patient/Resident Handling How does the policy contribute to the patient/resident s care? Compliance with regulations

12 Maryland Facilities developed alongside of University of Maryland Form Safe Lift Committees, members to include caregivers Ergonomic walk-throughs with Ergonomist Gary Orr, who prepared a report for each facility Review of Policies and Procedures to include procedures on lift use Root cause analysis of each lift related injury Review of caregiver training procedures Walk through with committee members to view lifts in progress

13 Between the initial recruitment and the beginning of Occupational Health Program (OHP) participation in their Safe Lift Program Acquired More Powered Mechanical Lifts Resident and Family expectations are key. Inform them know about Facility lift policy in their admission materials is important. To train caregivers, facilities, with the help of lift vendors, develop proficiency checklists

14 Things we learned from the first wave of surveys of 210 Caregivers Demographics and musculoskeletal health status of caregiver respondents (Table 1). Caregivers are on average just under 40 years old. Almost all (94%) are women. Most (80%) have a high school degree or equivalent, and around 15% have college experience or higher.

15 N=210 Demographics Age Mean 39.2 SD 12.1 N % Gender Female Education Less than high school high school or GED some college RN 2 1 College degree 9 4.3

16 Musculoskeletal symptoms N % Any *Chronic condition MSD pain in the past year Of those with pain, how frequent has it been in the past year every day almost daily about once a week about once a month every two or three months almost never (every 6 months or less) Take over the counter pain medication every day or every other day % *diabetes, gout, thyroid problem, lupus, degenerative joint disease, chronic fatigue syndrome, arthritis, kidney failure, or osteoporosis.

17 Characteristics of their work Job Title N % Certified Nursing Assistant Geriatric Nursing Assistant Certified Medical Assistant 14 7 Restorative Aide 6 3 Charge Nurse Work Status Full time Part time Work this job only Shift Day Evening Night hour day hour night Years as a caregiver Years at current facility mean mean 6.64 median 8 median 3.17 sd 9.89 sd 7.94

18 Job Stability In the past two weeks did you: a lot occasionally rarely think about Looking for a job 32 (16.7%) 63 (30%) 29 (13.8%) look at job ads 22 (10.5%) 39 (18.6%) 21 (10%) talk to friends about job openings they know about recommend your job to a good friend 18 (9.6%) 41 (18.5%) 24 (11.4%) yes, a lot In the past two weeks did you do any of the following to work somewhere yes else? pick up a job application 21 (10%) fill out a job application 21 10%) ask someone to recommend you for a job 26 (12.4%) submit a job application 21 (10%) yes, but not a lot not very strongly 103 (49%) 83 (39.5) 14 (6.7%)

19 Is Caregiver Pain related to the decision to look for another job? Job stability and musculoskeletal pain in the past year Acts showing interest in working elsewhere in the past two weeks Numbers of respondents pick up a job application fill out a job application ask someone to submit a job recommend application you no pain no yes pain no yes Chisqr. Prob

20 This is how we measure it. University of Maryland Occupational Health Program (OHP) Productivity Impairment Scale. Caregivers who had reported pain in the past year were asked if that pain Made you reduce work or duties Made sit hard to work Made you cut down on extra work Made you work more slowly Made you take more frequent breaks Made you less able to concentrate Made you ask co-workers for Made it hard to transfer residents Coded 0 if no, 1 if yes. We add them up, divide by 8, and that is the impairment score.

21 Table 5: OHP Productivity Impairment Scale* by frequency of Caregiver Musculoskeletal Pain Caregiver Musculoskeletal Pain in the Past Year OHP Productivity Impairment Scale Score Daily Almost daily Frequently (about once a week) Sometimes (about once a month) Rarely (every 2 or 3 months) Almost never (every 6 months or less) Tota l mean N std. deviation ANOVA prob. =.027

22 PLANS FOR THE FUTURE: Continue analyzing the pre-intervention caregiver surveys, examining the relationships among. musculoskeletal pain, job instability and work productivity impairment. Complete the post intervention interviews, analyze post intervention survey data determine the effectiveness of the intervention Prepare manuscripts for peer-reviewed publications. We will prepare reports and disseminate them to nursing home staff, administrators and influencers through our website, newsletters, publications reaching nursing homes and through quality improvement organizations. We expect to have completed these activities by June 30, 2012.