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Positioning Patients Safely

The statistics with regard to safe patient handling and mobility (SPHM) are not encouraging. Let’s start with the fact that more than half (51 percent) of nurses say they have experienced musculoskeletal disorder (MSD) pain at work from handling patients, according to research conducted by the American Nurses Association (ANA).

In addition, sprains and strains are the most often reported nature of health care worker injuries, according to OSHA.

And, the Bureau of Labor Statistics (BLS) reports that 12 percent of nurses leave the profession every year as the result of an MSD. The average MSD claim costs $11,771, notes the BLS, while the average cost of a back injury is $37,000.

Highest Rates of MDS Injuries

“Nursing has some of the highest rates of musculoskeletal disorder injuries of any industry,” says Katie Kramer, the marketing communications manager for HoverTech International, which manufacturers safe patient handling devices. “The physically demanding nature of the profession is compounded by factors such as heavier patients and staff shortages due to an aging and injured workforce.”

These MSDs affect muscles, nerves, tendons, joints, cartilage and spinal discs, says Mary J. Ogg, MSN, RN, CNOR, a Perioperative Nursing Specialist with the Association of periOperative Registered Nurses (AORN).

“Many surgical patients are completely or partially dependent on the OR team to move, lift and position them due to the effects of general or regional anesthesia,” adds Ogg.

According to the ANA research, 80 percent of nurses with MSD pain continue working even though they are in pain. “So we know it’s a big problem,” says Ruth Francis, MPH, MCHES, Senior Policy Advisor with the ANA.

“MSD pain occurs over time due to the multiple twists and turns from transporting and repositioning patients manually,” adds Francis, who is also on the board of directors of the Association of Safe Patient Handling Professionals (ASPHP). “It very rarely happens after just one incident.”

Adding to the problem is the aging nurse population. The average age for a registered nurse in the U.S. today is 50 years old, while the average perioperative nurse is 53 years old, according to the ANA.

“The increasing prevalence of obesity is also contributing to the SPHM risks for OR personnel,” says Ogg. “More than one-third of all the patients cared for in the OR are obese.”

“As the patient population gets bigger, the risks for nurses who must transfer and position patients are increasing,” adds Kramer.

Of course, unsafe patient handling and mobility practices also pose risks for patients. The main patient risks are skin abrasions, pulled limbs and fractures due to falls, says Francis.

“The patient transfer from stretcher to OR table using manual handling will involve a great deal of friction and skin shear as patients are pulled from one surface to the other,” says Kramer.

“There are also expectations to get patients up out of bed and moving within 12 hours of surgery to assist with ambulation and early mobilization,” Francis adds. “This can increase SPHM risks for nurses and patients.”

Adhere to SPHM Guidelines

Kramer says that perioperative personnel should adhere to the SPHM guidelines set forth by AORN and the National Institute for Occupational Safety and Health (NIOSH) to keep themselves and their patients safe.

For example, NIOSH has recommended that health care workers not manually lift more than 35 pounds of a patient’s body weight themselves.

Instead, nurses should use assistive lifting devices and technologies like air-assisted lateral transfer devices, new technology transfer boards, friction reducing sheet and ceiling lifts if they have to lift more than 35 pounds.

Believe it or not, lifting the leg of a 250-pound patient could exceed the NIOSH recommendation for safe manual lifting, since a leg can account for up to 16 percent of a patient’s total body weight. “In this situation, at least two perioperative team members should raise or hold the leg in position, or a mechanical device should be used to help,” says Ogg.

In fact, one of the biggest mistakes many perioperative personnel make when it comes to SPHM is not using equipment and technology designed to minimize or eliminate manual patient handling.

While 73 percent of nurses say they have access to SPHM equipment and technology, only 51 percent use it every time they transfer a patient, according to the ANA.

“Maybe they look at a patient and think she’s small so we don’t need to use the equipment, or maybe the equipment isn’t readily accessible,” says Francis. “That’s when injuries occur.

Kramer points to the effectiveness of air-assisted devices like the HoverMatt Air Transfer System in reducing MSDs among perioperative personnel.

“With this system, OR nurses can safely and easily transfer patients in the pre-op and post-op settings with fewer staff,” she says. “The HoverMatt also significantly reduces the friction and shear on the patient’s skin during the transfer.”

U.S. Lagging Behind in SPHM

Dan Allen, the founder and president of D.A. Surgical, believes that the U.S. is behind many other nations when it comes to SPHM.

“In Europe they’ve come up with a number of ways to reduce patient handling and mobility risks to hospital personnel,” he says. “For example, the UK has legislated safe patient handling and lifting for all ORs, and a company in Germany has created a device where no one has to touch the patient to lift him or her off the bed and onto the gurney. But, I’ve never seen one of these in a U.S. hospital.”

Allen believes that money is the biggest obstacle to widespread use of SPHM technology at hospitals in the U.S.

“Does our health care system have the stomach to invest the money that’s needed to bring this technology into hospitals all across the country?” he asks. “Apparently not, because the solutions are there but budgets currently don’t support it.”

In the meantime, he says the best thing health care workers can do to practice SPHM is to follow best practices and guidelines published by organizations like AORN and the ANA.

For example, AORN has created a Safe Patient Handling Toolkit that provides education for perioperative personnel about the correct and safe way to move patients and equipment in the perioperative environment.

Also, AORN’s Ergonomic Tools in the Guideline for Safe Patient Handling and Movement provide guidance and algorithms for transferring and positioning patients. “Hospitals should read the Guideline and incorporate the recommendations into their policies and procedures,” says Ogg.

Meanwhile, Francis says that the ANA is in the process of refreshing the Safe Patient Handling and Mobility Interprofessional National Standards that were first published in 2013.

“The standards themselves haven’t changed, but we’re refreshing the background data behind them to reflect new studies that have been conducted since then,” she says. “The new guide will include assessment tools and information about new technology for practicing SPHM.”

Francis says that the new guide will be available in early 2020 in hard copy form as well as an ebook. “This will make it more easily accessible to all staff members,” she says.

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