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Posts Tagged ‘Ergonomics for Nurses’


Frances Pisano, CEO and founder of Pisano & Associations LLC (the parent company of The ERGOLAB at Ergonomic Edge) was published in the most recent version of the Design-Build Institute of America‘s (DBIA) monthly publication, Design Build DATELINE.  Design-Build is a membership organization bringing together thousands of organizations and individuals representing architects, engineers, public and private owners, general and specialty contractors, manufacturer and suppliers, students, college and university faculty, legal and finance professionals and many more. 

Frances was asked to share her point-of-view on Hospital Ergonomics, the article is titled “Hospital Design; Ergonomics Should Be The Next Big Trend” – check it out!

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The ERGOLAB practice is a part of Pisano & Associates LLC, an Environmental Health & Safety consulting firm headquartered in Pawtucket RI.  A growing part of our Health & Safety consulting work is in support of healthcare providers; hospitals, nursing homes and medical practices.  Hospitals in particular, are under pressure to drive costs down (do more with less), while ensuring 100% quality at the point of patient care.  An often overlooked aspect in this equation, is the role EMPLOYEE SAFETY plays in supporting or enabling patient safety. Healthy employees are more productive, better focused and less prone to mistakes or mental errors. A healthy hospital employee CONTRIBUTES directly to a safe patient experience.

Our mission at Pisano & Associates / ERGOLAB, is to work with clients to assess the current state of employee safety, identify and eliminate risk factors through Health, Safety and Ergonomics programs. Following is a case study of some recent work; our Safety and Ergonomics teams partnered in the ‘deep dive’ analysis of historical OSHA recordable data across a large hospital ownership group.  The objective?  Identify the all risks factors and build a plan to build a “best-in-class’ safety culture. This initiative was the first step on that journey.

Challenge:

As the largest industry in 2009, health care provided over 16 million jobs. Combining medical technology and the human touch, the health care industry administers care around the clock, responding to the needs of millions of people—from newborns to the critically ill.

 In 2006 (most current data available), the incidence of occupational injury and illness in hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4 for industry overall. Nursing care facilities had a higher rate of 9.8. Health care workers involved in direct patient care are at great risk back strain(s) and other MSDs from lifting patients and equipment; potential to exposures to radiation and caustic chemicals; and to exposures to infectious diseases, such as AIDS, tuberculosis, and hepatitis.  

In order to drive holistic safety improvements for both employee and patient across the entire hospital ecosystem a shift in philosophy will be essential to successfully keep up with the demands of this industry.  The symbiotic relationship between patient safety and employee safety cannot be dismissed. As first noted by E. Scott Geller, Ph.D., Professor of Psychology at Virginia Tech, “What impacts one group, impacts the whole”.  Positive changes in hospital safety environments can only come by focusing time, energy and investment on employee programs to compliment already robust patient safety programs.

Our client is large healthcare network operating over 75 Health Care Facilities across the United States and employing over 100,000 associates and their foremost concerns are to maintain a safe environment and reduce both direct and indirect Workers Compensation Costs.  

Solution:

As part their continual improvement efforts Pisano & Associates team was brought in to conduct a 3rd party OSHA Recordable Trends Analysis for (4) hospitals within the client’s network, using the OSHA 300 Log data over a 3 year period.    The P&A team developed a database tool that provided a deep dive assessment of the data and reviewed over 10,000 OSHA recordable looking for key drivers of workplace accidents and injuries.  From there some very basic questions needed to be answered:

  • Which employees’ are at the greatest risk for injury and illness? 
  • Are there common denominators between the high risk group(s)?  Type of Injury? Behavior? Location? Activity?  Job Title?
  • Does the existing Incident Investigation Database System capture the necessary data for an accurate and valuable data analysis? For example, if a patient is also injured during an employee incident does the system make it possible to make a “connection” between employee injury and patient injury?
  • Based on the findings, what existing or new safety and health programs need to be enhanced, or developed and implemented that will drive the greatest reduction in employee injury and result in a safer patient environment?
  • What approach should be taken to efficiently and successfully implement these programs?

 Result:                                                                    

This extensive analysis of 10,000 OSHA Recordable Incidents showed that 80% of the total incidents, restricted/transfer days, and days away from work involved one of the following:

  • Patient Handling
  • Materials Handling
  • Needlesticks/sharps
  • Slips/Trips/Falls

The following programs were recommended:

  • ERGONOMICS: Focus – Patient Handling & Material Handling
  • EXPOSURES: Focus – Needlestick/Sharps
  • SLIPS/TRIPS/FALLS

In addition, RN’s accounted for approximately 30% of the total incidents, the restricted/transfer days, and the total away from work. As a result a Safety & Ergonomics effort both focusing on and involving RN’s was also recommended as part of a total safety culture effort.

Finally the results showed that 40% of all incidents occurred in the Patients room, they accounted for 35% of all restricted/transfer days and 30% of all days away from work.  It was also recommended that they integrate employee and patient incident tracking and reporting in the existing database. This will allow for a much more accurate estimate of potential cost savings and liability cost avoidance when developing and implementing the recommended programs.

As a result of the project our client is doing the following:

  • Moving aggressively towards adopting and embracing the ‘Total Safety Culture’ philosophy.
  • Addressing the limitations of their OSHA reporting system that were identified during the project and investigating how to capture and integrate both employee and patient incidents and how they relate to each other.
  • Targeting an 80% reduction in employee injuries and related workers compensation costs both direct and indirect base based on recommendations
  • The safety and well-being of the nursing staff is at the center of hospital group’s strategy – nurses’ are active in all phases of program development and rollout.
  • Employees and management participate in specific safety task forces to promote both employee and patient safety and to develop programs, policies and procedures. Some of these task forces include: the Needle Stick Prevention Task Force, Safe Patient & Material Handing, Medication Safety, and Emergency Management. Hazard surveillance and environmental rounds are done on a regular basis. This activity provides inspection and review of all work areas. Recommendations for improvements are reviewed by the Environment of Care Committee and evaluated and implemented by management.
  • Working collaboratively with OSHA and other regulatory organizations to ensure a high level of employee safety.

If you’d like to know more about this project – feel free to contact me via email or phone – cdavis@ergonomicedge.com or 401 527 7047

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There is an old carpenter’s axiom, ‘measure twice, cut once’.  The lesson? Careful, informed planning is essential to ensure a positive outcome.  Hurry to complete a project, and you do so at your peril. A lot of wasted wood cut just a skosh too short.  

Ideally, Ergonomics should play a central role in the design and build out of any building where people will work.  Understanding the needs and limitations of the human body at rest and in movement should inform the work of architects, designers and builders.   Have you ever worked in a business environment where the building structure, layout, space allocation for job tasks, movement & pass-through, while up to all current day building codes, seems to interfere or impede productivity?   The workspace allocated per employee in office environments is often driven by cost issues (cost per sq foot), rather than building an understanding of the tasks employees would be asked to perform….THEN DESIGN TO MEET THOSE NEEDS.   Or, perhaps the business, like most, have gone through significant expansion in their use of technology. New tools are forced into existing environments; this reality introduces risk factors into the workplace.  Or, the employer needs to support as many workstations in an area as possible, with little or no regard for human factors and ergonomic realities.  (think CALL CENTER – have you ever walked through a large call center – YIKES – an MSD factory). 

A growing part of our ERGOLAB practice is consulting within a hospital environment.  Nursing injuries are on the rise. OSHA accident and injury data has identified nursing as one of the most dangerous professions in the US.   Why?  THE PERFECT STORM OF FACTORS; 

  • HEAVY LIFTING – On average, a nurse  lifts 1.6 TONS of human body weight every shift.  Injuries from heavy lifting leave 50% or more working in chronic pain
    or at least 12% leaving the profession, many with permanent disabling injuries.  The rate of Musculoskeletal Disorders or MSDs in healthcare workers exceeds that of workers in construction, mining and manufacturing.
  • FATIGUE – Nurses walk 1/3 of every shift due to poorly designed floor layouts and inadequate storage at the point of care. A nurse walks more than 6  miles per shift.
  • TECHNOLOGY – New technologies have transformed healthcare; unfortunately, many of the nation’s hospitals were built before the invention of computers. Tools and technology is crammed into every nook and cranny on patient care floors.  Nurses spend HOURS at computer workstations that are poorly designed, forcing out of neutral body postures and increasing the risk of MSDs. 
  • EMPLOYEE SAFETY NOT A PRIORITY – Present day hospital culture is about PATIENT SAFETY concerns and conversations; employee safety is a distant second.   The typical hospital will have a Patient Safety Officer, with enterprise level responsibilities and resources. That same hospital will relegate Employee Safety responsibilities to any number of ‘owners’ at the middle management level. 
  • MORE WITH LESS – Financial challenges resulted in nursing layoffs – nurses are asked to do more…..much more….with less.  40 % of nurses today work in excess of 12 hours
    per shift. Longer hours, more shifts, less down time.  

Intelligent hospital design, leveraging human factor and ergonomics expertise would alleviate MANY of the factors listed above.  Lifting tools and technologies exist that could eliminate injuries due to heavy lifting.  Floor plan design must evolve to eliminate unnecessary walking that contributes to fatigue, then injury.  Technology can be better integrated at the point of care, with ergonomic solutions to minimize MSD risk.   Any design must have adaptable, changeable and flexible enough to meet accommodate changes in technology. 

The good news….a VERY real opportunity exists in the coming decade to address hospital design issues and create the care center of the future.  The healthcare industry is experiencing a construction boom: 

  • Hospital construction spending is forecasted at $36.8 billion by 2011 with expected annual increases year to year (source – Center for Medicare & Medicaid Service)
  • 58% of existing hospitals plan to add beds in the next few years to accommodate aging baby boomer populations (source – Nurse Executive Center – CNO Survey)

Ergonomics must be one of the guiding principles in future hospital design.   Let’s not ‘assume’ that Ergonomics is central to the design methodology….DEMAND IT.  Make sure the development teams have MEASURED TWICE…before they finalize design.  The costs of business as usual are too high.

Have something to say on this topic?  Please add your comments. 

If you’d like to discuss our consulting services in this area, please contact Frances Pisano at 401-529-8398 or fpisano@pisanoassociates.com

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