# Presentation: 486880

## Ergo Blitz!

*How To Establish A** Zero Lift Policy That Works*

## Lessons

- BLITZ!  Nursing home ergonomic problems can be addressed QUICKLY
- Payback is fast
- Management commitment/employee involvement is the key to success

## OSHA Intervention? 

- Nursing Home Administrator attended OSHA Outreach Activity
- Thereby motivated to avoid OSHA Nursing Home Programmed Inspection
- State of Illinois OSHA On Site Consultants were used
- No inspection by Federal OSHA

## The Facility

- 207 bed long term care skilled nursing facility in Aurora, IL
- 160 employees  (65-70 aides)
- 2002 injury/illness rate was high - 24.0!
- Many lifting injuries
- Beds
- Chairs
- Toileting

**Notes:**
Rate to schedule an OSHA inspection is 14.0 on the primary list.  This facility is only five miles from the area office, and a number of OSHA compliance officers live in this area.  

## The Process, Step By Step

*Evaluate Injuries and Costs*
*Obtain Approval For Funding*
*Establish A Lifting Committee*
*Evaluate and Select Equipment*
*Resident/Family Notification*
*Receive and Prep Equipment*
*Training*
*Resident Assessment*
*Coordination with Other Staff*
*Enforcement*
*Performance Measurement*
*Evaluate Efforts Regularly*

**Notes:**
Don’t necessarily have to go in this process order.

## Evaluate Injuries and Costs

- OSHA recordables and non-recordables
- Cost data from workman’s comp carrier
- Resident injuries such as skin tears
- Employee turnover rate and costs of turnover

**Notes:**
A step by step process flow begins here.

## Obtain Approval For Funding

- Present injury/cost data to owner
- Ballpark estimate for buying lifting equipment
- Note other expected results
- Reduced risk of OSHA inspections/penalties
- Reduced employee turnover, better morale
- Injury reduction from dropping residents
- Increased admissions from improved PR
- Overall better resident care

## Establish A Lifting Committee

- CNA based committee
- Select outgoing CNAs
- 45 minute meeting
-     per week
- Food, fun, praise
- Leader has budget authority, is committed to project, and is a motivator

**Notes:**
The most outgoing CNAs made the best communicators for the program, and they were not afraid to speak up and offer suggestions during team meetings.  10 CNAs were selected.

This committee was a coveted position.  It created a lot of recognition.  When one committee member left employment to move to California, a CNA approached the nursing home administrator and said feelings were hurt when not selected for the original group, and could they get on board now.

## Evaluate Equipment 

- Hold open house for several different vendors
- Demo equipment never seen before
- CNAs test equipment in the facility/provide feedback
- Four inch
- extenders
- added to
- bed legs
- so lift will
- fit under
- lowboy
- bed.

**Notes:**
Three open houses were held from 11 am to 4 pm, one for each of three vendors.  Vendors were asked to bring everything they could.

Test equipment in bathrooms, showers, and at beds.  You wil find that some equipment won’t fit your facility!

Note:  this bed has been modified.  None of the lifts fit under lowboy beds, so maintenance fitted a 4 inch extender on the legs of the bed.

Make sure you also get a core sample of all types of slings needed.  Some slings can get wet (for use in showering), and some can’t.

## Equipment Selection

- Equipment feedback list from CNAs
- Identify all different accessories needed for lifts such as scales and extra slings
- Decision meeting with lifting committee
- Final budget approval and purchase
- Set date for zero lifting policy

**Notes:**
Equipment selection:
Consider resident needs
Consider environmental conditions
Identify all different accessories needed for lifts such as scales and extra slings.  

Show the committee how much each piece of equipment costs.  They were shocked at some of the costs and were actually more frugal than the administrator when it came to purchasing the equipment.

Don’t overpurchase.  This facility initially bought five sit-to-stand lifts, three hoyer lifts, and three pivot disks.  After implementing the policy they found that they needed another hoyer, which was then ordered.

Set date for zero lifting policy
Three months on the outside, can do in 6-8 weeks
Do for entire building, don’t phase-in area by area

## Resident/Family Notification

- Send letter to families advising of change
- Advise Resident’s Council

**Notes:**
Residents and family need to buy into the program, too.  Send letter to families telling them of changes and that employee’s health is just as important

## Equipment Prep

- Copy manufacturer instructions, laminate, and attach to equipment
- Attach a warning sign that each lift must be checked prior to use
- Charge battery operated equipment
- Develop competency checklist on use of equipment

## Equipment Location

- Right number of lifts in the appropriate locations
- Lifts need to be available to aides, NOT the residents moved to be accessible to the equipment!

**Notes:**
At this facility the lifts were located on the second floor, where the residents needing assistive devices were located.

Lifts are located in the halls and are not considered to be “stored” because they are used on a high frequency. 

## Training

- CNA one-on-one training for each employee
- Employees competency checked on each piece of equipment
- Competency check signed off by aide
- Not use equipment until competency checked
- 3 day suspension for not using lift

## Resident Assessment

- Needs to identify the type of equipment needed for each resident
- Develop assessment sheet
- Review assessment sheet with staff

## Coordination

- Maintenance staff – new equipment maintenance info
- Laundry staff – sling cleaning information (some slings can’t be laundered).
- Rehab staff – info on lift type(s) used with each resident (because lifts require use of muscles)

## 5  Sit to Stand Lifts

4  Hoyer Lifts

3  Pivot Disks

- 4  Hoyer Lifts
- 3  Pivot Disks

*Equipment Selection by this Nursing Home*

## Sit To Stand Lift

- Equip one sit-to-stand lift with a scale for weighing residents

**Notes:**
Sling used to assist resident to stand with electric sit to stand lift.

Four sit to stand lifts purchased at $3000 each
One sit to stand lift with a scale was purchased at $4600.

## Hoyer Lift

- Decision:
-  Electric or Hydraulic
- Purchase extra slings
- Equip one lift with weigh scales to eliminate extra handling for resident weighing

**Notes:**
Hydraulic lift is pictured, hydraulic lifts were selected by the committee
no battery charging
no worry about battery failure in the middle of a lift
no problem with damaging the cord by taking the lift when it’s on charge (don’t see it’s plugged in and grab it for quick use, yanking the cord out of the wall and damaging the cord)
Lift is raised by pumping the handle.  Does not require a lot of strength to pump it.

$700 for hydraulic hoyer lift, electric lifts are in the $3000 range
$1400 for hydraulic hoyer lift equipped with a scale
Slings are $60-$90 each

## Pivot Disk

- Like a Lazy Susan with handles
- Great for bathrooms, can be rotated using little space

## Enforcement

- 3 day suspension for not using lift
- Policed by Lifting Committee members,  empowered to recommend suspensions
- Nine suspensions were levied here
- Pick suspension days for best use of facility resources and less impact on employee’s paycheck at one time

## Results:  Costs and Savings

- Costs at this facility
- $24K for lifting devices and slings
- Time: 45 minutes weekly X approx 10 aides
- Team leader time of approx 1 hour/week in addition to above meeting
- Claims paid by comp carrier
- 1/1/02 - 8/15/02  $67.5K paid 31 recordables
- 1/1/03 - 8/15/03   $1215 paid 3 recordables

## Employee Testimonials

- “I have much more energy at the end of the day.  My quality of life is so much better when I am home.”
- “If interviewing at another nursing home, I would ask them about the equipment they have and their lifting policies.”

## Performance Measurement 

- Worker’s comp costs
- OSHA recordable and nonrecordable injuries
- Employee satisfaction
- Number of resident transfer injuries

## Evaluation

- Continue regular committee meetings and solicit feedback
- Make changes in equipment, procedures, or training where necessary

## Lessons Learned

- Hazard Resolved:  nursing home ergonomic problems addressed in less than 3 months!
- Payback:  almost immediate from a comp payout standpoint
- Safety Management:  Administrator involvement and employee lifting committee were the key to success.

## Contact                         October 2003

- _[shields.charlie@dol.gov](mailto:shields.charlie@dol.gov)_
- Charles J. Shields, MS, CIH, CSP
- U.S. Department of Labor – OSHA
- 365 Smoke Tree Plaza
- North Aurora, IL  60542
- 630-896-8700
- Six Year Anniversary of Aurora Area Office Electronic Mail Newsletters