Nelson A, Matz M, Chen F, Siddharthan K, Lloyd J, Fragala G, et al.
International journal of nursing studies. Date of publication 2006 Aug 1;volume 43(6):717-33.
1. Int J Nurs Stud. 2006 Aug;43(6):717-33. doi: 10.1016/j.ijnurstu.2005.09.004.
Epub 2005 Oct 25.
Development and evaluation of a multifaceted ergonomics program to prevent
injuries associated with patient handling tasks.
Nelson A(1), Matz M, Chen F, Siddharthan K, Lloyd J, Fragala G.
Author information:
(1)Patient Safety Center of Inquiry, James A. Haley Veterans Hospital, 11605 N.
Nebraska Avenue, Tampa, FL 33612, USA. audrey.nelson@med.va.gov
PROBLEM STATEMENT: Nurses have one of the highest rates of work-related
musculoskeletal injury of any profession. Over the past 30 years, efforts to
reduce work-related musculoskeletal disorders in nurses have been largely
unsuccessful.
SPECIFIC AIMS: The primary goal of this program was to create safer working
environments for nursing staff who provide direct patient care. Our first
objective was to design and implement a multifaceted program that successfully
integrated evidence-based practice, technology, and safety improvement. The
second objective was to evaluate the impact of the program on injury rate, lost
and modified work days, job satisfaction, self-reported unsafe patient handling
acts, level of support for program, staff and patient acceptance, program
effectiveness, costs, and return on investment.
INTERVENTION: The intervention included six program elements: (1) Ergonomic
Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision
Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4)
State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy.
METHODS: A pre-/post design without a control group was used to evaluate the
effectiveness of a patient care ergonomics program on 23 high risk units (19
nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury
rates, lost work days, modified work days, job satisfaction, staff , and patient
acceptance, program effectiveness, and program costs/savings were compared over
two nine month periods: pre-intervention (May 2001-January 2002) and
post-intervention (March 2002-November 2002). Data were collected prospectively
through surveys, weekly process logs, injury logs, and cost logs.
RESULTS: The program elements resulted in a statistically significant decrease
in the rate of musculoskeletal injuries as well as the number of modified duty
days taken per injury. While the total number of lost workdays decreased by 18%
post-intervention, this difference was not statistically significant. There were
statistically significant increases in two subscales of job satisfaction:
professional status and tasks requirements. Self-reports by nursing staff
revealed a statistically significant decrease in the number of 'unsafe' patient
handling practices performed daily. Nurses ranked program elements they deemed
to be "extremely effective": equipment was rated as most effective (96%),
followed by No Lift Policy (68%), peer leader education program (66%), ergonomic
assessment protocol (59%), patient handling assessment criteria and decision
algorithms (55%), and lastly after action reviews (41%). Perceived support and
interest for the program started at a high level for managers and nursing staff
and remained very high throughout the program implementation. Patient acceptance
was moderate when the program started but increased to very high by the end of
the program. Although the ease and success of program implementation initially
varied between and within the facilities, after six months there was strong
evidence of support at all levels. The initial capital investment for patient
handling equipment was recovered in approximately 3.75 years based on annual
post-intervention savings of over $200,000/year in workers' compensation
expenses and cost savings associated with reduced lost and modified work days
and worker compensation.
CONCLUSIONS: This multi-faceted program resulted in an overall lower injury
rate, fewer modified duty days taken per injury, and significant cost savings.
The program was well accepted by patients, nursing staff, and administrators.
Given the significant increases in two job satisfaction subscales (professional
status and task requirements), it is possible that nurse recruitment and
retention could be positively impacted.
DOI: 10.1016/j.ijnurstu.2005.09.004
PMID: 16253260 [Indexed for MEDLINE]
