# Presentation: 658507

## The NSC Health Care Section PresentsCurrent Issues in Health Care Safety

- Session 18
- Speakers:  Barbara Ondrisek, Dean Klatt, Frank Denny, Jim Ramsay and Kara Szirotnyak
- NSC Congress - New Orleans
- September, 2004

- NSC Congress, New Orleans - Session 18

## Barbara Ondrisek

- Exposure based training matrix for all employees.
- Exposure based training matrix for managers/supervisors.
- Exposure based training matrix for affected employee groups.

- NSC Congress, New Orleans - Session 18

## Barbara Ondrisek

- Exposure based training matrix for maintenance and facilities personnel.
- Exposure based training matrix for emergency preparedness and response personnel.

- NSC Congress, New Orleans - Session 18

## Dean Klatt

- Healthcare and OSHA’s Voluntary Protection Program (VPP).
- This year, OSHA has announced four alliances with organizations to improve safety and prevent accidents and illnesses.
- The alliance with the New Your State On-Site Consultation Program and GNYHCGA.

- NSC Congress, New Orleans - Session 18

## Current Issues in Health Care SafetySession #18“Limited Lifting/Zero Lifting Programs”

**Kara Szirotnyak, MSN, RN, COHN-S/CCM**
**Department of Veterans Affairs**

## Facts to Consider

**7**** out of ****10**** injuries in healthcare facilities are in Nursing.**
**Nursing ****2****nd**** ****nationally for injuries.**
**Average age of nurses is ****47.5 y/o**
**1 ****out of ****3**** ****injuries results in a LTC.**
**1**** out of ****2**** employee injuries results in an injury to the patient.**

- NSC Congress, New Orleans - Session 18

## Nurses are a creative, resourceful bunch who are use to working under less than ideal conditions. We also understand the importance of patient safety, however, when left up to us to prioritize safety issues we may come up with something like this........

- NSC Congress, New Orleans - Session 18

## Slide 8

- NSC Congress, New Orleans - Session 18

## More Facts

- The average cost of one back surgery is **$125,000** (non-complicated).
- The average cost of one room with overhead lift is **$4,000.**
- The average cost of knee surgery is **$8,000** (non-complicated).
- The average cost of lateral lifting equipment is **$3,000.**

- NSC Congress, New Orleans - Session 18

## Nurses are a creative, resourceful bunch who adapt to doing much with very little, however, when it comes to prioritizing equipment needs we may come up with something like this......

- NSC Congress, New Orleans - Session 18

## Slide 11

- NSC Congress, New Orleans - Session 18

## Limited Lifting / Zero Lifting Programs

- NSC Congress, New Orleans - Session 18

## Why Do This???

- Nursing shortage- **55%** VA nursing staff eligible to retire.
- Patient safety.
- Employee safety.
- Retention of staff.
- Recruiting tool.
- Cost management/containment.

- NSC Congress, New Orleans - Session 18

## Effects of Forward Bending & Lifting in a Forward bent Position

- Bending forward to brush your teeth or working at a bench that is **6 inches** to low puts **50%** more compressive force on your back.
- Bending forward at the waist to lift **50#**
- 	puts **1300 **pounds of force into the lower back.

- NSC Congress, New Orleans - Session 18

## Nursing Survey Stats

- Do you anticipate getting injured at some point in time of your career? **90%**
- Have you ever been injured? **75%**
- Have you ever worked injured? **89%**
- Did you report your injury to your supervisor/reporting official? **92%**
- Have you ever missed work d/t an injury? **78%**

- NSC Congress, New Orleans - Session 18

## What Steps To Take

- Top management support
- Nursing support/buy-in
- Site specific needs for equipment
- Leader for each area to monitor
- Training
- Injury data
- Process for handling “pieces & parts”
- Policy to enforce use of equipment

- NSC Congress, New Orleans - Session 18

## What Can You Anticipate? 

- Positive marketing tool (new employees).
- Improved job satisfaction.
- Increased patient safety.
- Increased patient satisfaction.
- Decrease in lost time injuries.
- Decrease in overall cost for injuries.

- NSC Congress, New Orleans - Session 18

## Thanks Folks!

- NSC Congress, New Orleans - Session 18

## The Origins of Nursing Safety:a new look at JHAs for nurses  

- By
-  Frank Denny, US VA
- Jim Ramsay, Ph.D., UW Stevens Point
- NSC Congress
- New Orleans, LA
- September, 2004

## Overview

- The many OSH exposures nurses face present a difficult challenge from a safety management perspective.
- Our thoughts as to what’s been done & what’s not been done about this.
- Future directions  our study.

- NSC Congress, New Orleans - Session 18

## Nurses role in health care

- It is widely acknowledged that nurses are an essential component of the US health care system, holding about 2.3 million jobs (BLS web site, accessed 6/22/04).
- Nurses are the central components across a wide continuum of care ranging from acute care settings to prevention and wellness programming to restorative care.
- The nurse is central to successful patient outcomes and is always “on the front lines”.

- NSC Congress, New Orleans - Session 18

## Nursing exposures

- Given the nature of their working environment and responsibilities nurses are at the frontline for many occupational hazards.
- Communicable diseases – including BBP, TB, SARS, Methicillin Resistant Staph Infections, and Norovirus.
- Musculoskeletal injuries – including those from patient movement and handling.
- Chemical exposures.

- NSC Congress, New Orleans - Session 18

## Nursing exposures

- Workplace violence exposures.
- Unmanaged stress.
- Terrorism/chemical spill victims.
- Slips/Falls.
- Radiation.
- Other physical hazards => such as electrical and flying objects.

- NSC Congress, New Orleans - Session 18

## Ex’s of nursing morbidity

- Blood borne pathogenic exposures: (HIV, HCV, HBV, etc) - due to percutaneous needlestick injuries.
- Between 600,000 and 800,000 NSIs occur/year in all healthcare settings, with injections (21%), suturing (17%) and drawing blood (16%) the top three exposures (Perry, et al., 2003).

- NSC Congress, New Orleans - Session 18

## Ex’s of nursing morbidity

- Airborne exposure from various diseases such as SARS, Tuberculosis (TB), Methicillin Resistant Staph, etc..
- During 2003, CDC received 34 reports of TB outbreak activity, (CDC web site, accessed on 7/6/04).

- NSC Congress, New Orleans - Session 18

## Ex’s of nursing morbidity

- Patient movement and handling - 38% of all nurses are affected by back injuries, which are due to the fact that 98% of the time nurses are lifting and moving patients manually (Meier, 2001).
- Obviously, we could go on....

- NSC Congress, New Orleans - Session 18

## Ex’s of nursing morbidity

- Workplace violence exposures – compared to all other workers, nurses face a higher level of risk of violence.
- 9.5+% of general nurses working in general hospitals are assaulted annually (Wells & Bowers, 2002).
- Gerberich et al. (2004) report that rates for both physical (13.2) and non-physical (38.8) violence are rising in EDs, home/long term care, intensive care psychiatric/behavioral settings.

- NSC Congress, New Orleans - Session 18

## OSHA’s list of ED nurse exposures

- Bloodborne pathogens.
- Hazardous chemicals - e.g., EtO, spilled medications, carcinogenic materials, noxious fumes and flammable liquids.
- Slips/falls - high traffic and compact treatment spaces are a combination for risk.
- Latex allergy – e.g., reaction to gloves made from natural latex and/or materials used to make the gloves._ _
- Tuberculosis.

- NSC Congress, New Orleans - Session 18

## OSHA’s list of ED nurse exposures

- Equipment hazards - e.g., electrical shock (e.g., defibrillators).
- Workplace stress – “Studies suggest work stress may increase a person's risk for cardiovascular disease, psychological disorders, workplace injury, and other health problems.  Early warning signs may include headaches, sleep disturbances, difficulty concentrating, job dissatisfaction, and low morale.” – “factors such as shift work, long hours, fatigue, and intense emotional situations, (e.g., the suffering and death of patients).”

- NSC Congress, New Orleans - Session 18

## OSHA’s list of ED nurse exposures

- Methicillin resistant staph infections.
- Workplace violence - beyond physical attacks - cursing, threats, etc.
- Terrorism – e.g., receiving victims form an unknown terrorist incident.
- Physical agents - such as flying objects - eye injury risk.

- NSC Congress, New Orleans - Session 18

## So what?

- Given the wide range of OSH exposures, are we surprised that nurses suffer such high rates of illness or injury?
- What’s being done to either prepare nurses or to train nurses once they’ve been hired to help them better avoid these exposures?

- NSC Congress, New Orleans - Session 18

## Nursing education and training

- Does nursing education offer enough safety & self-protection practices?
- Are nurses being socialized tobelieve the responsibility for personal injuries is a result of something that is inherent to the nursing profession?
- Do nurses believe there is a dichotomy between self protective measures and the patient needs?

- NSC Congress, New Orleans - Session 18

## Nursing education and training

- What are the core accreditation requirements for nursing schools & how do they match up with what OSHA has identified as the typical exposures faced by ED nurses?
- The _[National League of ](file:///C:/Documents%20and%20Settings/HRA%20User/My%20Documents/JHA%20table%201%20NLNAC.doc)__[Nursing’s](file:///C:/Documents%20and%20Settings/HRA%20User/My%20Documents/JHA%20table%201%20NLNAC.doc)_ core accreditation requirements.

- NSC Congress, New Orleans - Session 18

## Nursing position descriptions (PDs)

- OPM has standardized PDs for nurses.
- Facilities abide by these core standards, but have levity to add additional requirements as they see fit according to their patient population & service needs.
- PD competencies vary from facility to facility depending on the patient population and the level of care administered at each facility.

- NSC Congress, New Orleans - Session 18

## ED nursing hazard experience

- Employees are unlikely to know the standards or regulations to the degree needed in order to comply on their own - plus management may feel unprepared to measure an individual’s performance in this area given their own lack of knowledge and an overriding mission.

- NSC Congress, New Orleans - Session 18

## ED nursing hazard experience

- Odds are that ED nurses will:
- Sustain some type of a work-related injury during their employment;
- Believe it is a normal expectation of their job as a nurse to become injured at some point in time during their careers;
- Likely become injured at one time or another and then will never reported it.

- NSC Congress, New Orleans - Session 18

## Nursing position descriptions (PDs)

- What do ED nursing job descriptions tell us about the “on the job” accountability for OSH exposures?
- Once on the job how is job safety evaluated?
- Our review of 29 _[VA ](file:///C:/Documents%20and%20Settings/HRA%20User/My%20Documents/JHA%20table%202%20PD.doc)__[PDs](file:///C:/Documents%20and%20Settings/HRA%20User/My%20Documents/JHA%20table%202%20PD.doc)_ from around the country.

- NSC Congress, New Orleans - Session 18

## The future

- The question is what to do now...
- There are a clear set of engineering controls and PPE available to most nurses today.
- Ex – the needlestick prevention act of 2001 which modified the BBP standard re percutaneous needlestick injuries.
- However, how well have administrative controls been utilized?

- NSC Congress, New Orleans - Session 18

## Classic administrative controls 

- Job rotation & job enlargement are not well-suited to nursing.
- What about job safety analyses (JSAs)?
- Anecdotal evidence and a general lack of mention in the literature indicate that JSAs are underutilized among ED nurses.

- NSC Congress, New Orleans - Session 18

## 4 steps to JSAs

- Select the job to be evaluated based on some clear criteria like potential for exposure, or severity of exposure, etc.;
- Define the steps required to complete the job task.
- Identify the possible hazards associated with the performance of each step.
- Develop appropriate control strategies in order to eliminate the exposure to the extent possible.

- NSC Congress, New Orleans - Session 18

## The future

- What we plan to do...
- Our manuscript will be reviewed by the J of Safety Research this fall.
- Survey nurses re their training, ed and exposure concerns.
- Develop & pilot an Ed nurse JSA.
- Conduct longer term (2-3 yrs.) study with a treatment & control group and compare relative morbidity rates.
- Revise the ED nursing JSA as advised.

- NSC Congress, New Orleans - Session 18

## That’s it folks!  

- Thanks for your time!

- NSC Congress, New Orleans - Session 18