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Hospitals say efforts improving to prevent nurses' injuries

Hospitals say efforts improving to prevent nurses' injuries

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When Donna McDevitt, 51, went through nursing school, her instructors wore nursing caps and white stockings with white shoes. They were hardcore, McDevitt said, dedicated and selfless.

You never called in sick. You skipped lunch. You didn’t go home until your job was done.

McDevitt relished it. Her work became her life. She worked 25 years as an intensive care nurse, first at Barnes-Jewish Hospital and then at Barnes-Jewish St. Peters Hospital, closer to her home in St. Charles.

The years of walking the hallways, moving beds and equipment, cleaning wounds and lifting patients took a toll. She had surgeries on her feet, knees and back, each time fighting her way back to work despite the pain.

“Most days it was everything I could do to get to my car without crying,” McDevitt said. “I would drive eight minutes home, and then I could barely walk to the front door.”

Two years ago, the pain became unbearable, and she had to give up her career.

“Doctors wanted me out long before I went out,” she said, “but I love what I did. I am a nurse. That’s my identity.”

Workers in hospitals suffer injuries and illness at nearly twice the national average rate — a total of 58,000 injuries in 2013, according to the Bureau of Labor Statistics. Nearly half of those are from overexertion. Nursing assistants suffered more overexertion injuries than any other occupation — at a rate six times higher than the average — and nurses ranked fifth.

Because of the numbers, the Occupational Health and Safety Administration announced two months ago that it is beefing up its enforcement efforts in hospitals and nursing homes. The federal safety agency, along with nursing advocacy groups, have long warned about injuries and dangerous lifting practices, but it hasn’t been enough.

“Workers who take care of us when we are sick or hurt should not be at such high risk for injuries — that simply is not right,” said Dr. David Michaels, assistant secretary of labor for the agency, in a news release announcing OSHA’s crackdown. “Virtually all of these injuries and illnesses are preventable.”

During inspections of hospitals and nursing homes, OSHA regional offices have been ordered to include reviews of how patients are moved, as well as hazards involving blood-borne pathogens, workplace violence, tuberculosis, and trips and falls. Employers could be fined for dangerous conditions.

“It’s time for hospitals and the health care industry to make the changes necessary to protect their workers,” Michaels said.

Hospitals in Missouri say they are ahead of the game since becoming one of 11 states with laws or regulations requiring facilities to adopt safety initiatives such as installing lift equipment, developing protocols, instituting training and studying outcomes. Missouri’s long list of “safe patient handling” recommendations went into effect in 2011.

Though challenges remain, and some facilities do better than others, area hospital officials say they are turning a corner in efforts to prevent another generation of nurses suffering from painful surgeries, quitting early or living with chronic pain.

“Had all this equipment been in place from the time I started nursing, and it was used and promoted as much as it is now,” McDevitt said, “I would still be working.”

INSIDIOUS TRAUMA

Mike Andreas, 59, of Troy, Mo., wants to run around with his 12-year-old daughter, go to concerts and ride the Harley Davidson sitting in his garage. But he can’t even use his weed trimmer.“I’m paying the price for it,” Andreas said of his more than 30-year career as a paramedic and registered nurse, mostly in the emergency room at Anderson Hospital in Maryville. Years of pulling people out of cars at the ER, catching patients falling from their wheelchairs and protecting people in the midst of seizures have destroyed his back, forcing him to stop work nearly two years ago and live on pain medications. “I wish I would’ve never done it,” he said of his career choice.Nurses have long been trained to use proper body mechanics when lifting patients: how to squat, use leg power, keep the patient close and not twisting. Yet, repeatedly exceeding a person’s biomechanical capabilities causes damage over time.

Lifting more than 35 pounds is such an activity, experts say. Most patient handling injuries are a result of this insidious trauma, developing silently over time until severe damage occurs. In one eight-hour shift, research shows, nurses lift 1.8 tons; nurse assistants or technicians lift 5 tons.

Little equipment such as lifts and standing aids was available, or it was time-consuming to find. Staff lacked training on how to use it properly. Nurses were taught to lift in teams, but others often weren’t available.

“You had to do something right away,” Andreas said, “and next thing you know, you have no help whatsoever, so you say, ‘The heck with it,’ and you just do it yourself.”

In addition, a patient’s room could be an obstacle course that throws body mechanics out the window.

“We used to call it Cirque du Soleil or Chinese acrobats,” McDevitt said, “having to get over everything in a room and move in these ridiculous positions.”

REDUCING INJURIES

Nurse Karin Garrett said she frequently warned the administration when she worked in surgery nearly 10 years ago at Mercy Hospital Springfield that patients were getting bigger and staff was getting hurt. “I just kept complaining,” she said.Research by the hospital’s workers’ compensation staff showed lifting equipment and programs at other hospitals greatly reduced injury rates, especially at the Veterans Health Administration, which was leading the way.The Springfield hospital received $200,000 from its charitable foundation to buy lifts and other equipment. Six months later, Garrett was appointed to develop a patient handling program.

Injuries dropped by 70 percent, Garrett said. Because of the success, she was asked to lead a systemwide safe patient handling program in all of Mercy’s 35 hospitals in four states. That was just before state regulations passed in 2011, which gave the effort even more urgency.

Since 2012, Garrett said, Mercy hospitals have seen a 24 percent drop in the number of injuries from handling patients. Last year, 237 of their 16,000 nursing personnel were injured.

“We are continuing to build our program every year, and we are getting better and better,” Garrett said.

BJC HealthCare and SSM Health describe similar efforts. Officials say they are investing in equipment, educating employees annually on their use, and tracking and studying how injuries occur. They have created specific protocols on what equipment to use and when.

Since 2011, officials with BJC hospitals and home health care report a 33 percent reduction in injuries from handling patients and a 43 percent decrease in lost workdays because of such injuries.

Lifting equipment is being incorporated in new construction and renovations. Each of the 25 intensive care rooms housed in a patient tower under construction at Barnes-Jewish Hospital will have ceiling lifts. “Our goal is to have 100 percent ceiling lifts in all ICUs,” which have 135 beds, said Lisa Wojtak, the hospital’s occupational health manager.

SSM Health hired a consultant more than a year ago to evaluate the patient handling efforts at each of its seven St. Louis area hospitals and recommend needed equipment, said Jerry Rumph, chair of a systemwide safe patient handling committee. Equipment purchases are being made systemwide to drive down cost and standardize the equipment for nurses rotating among its hospitals.

“The (state) rule really heightened our awareness again and got more action and people thinking,” said Sandy Swan, occupational health manager at BJC Learning Institute, which advises the safety program leaders at BJC system’s 12 hospitals. “With that plus the OSHA announcement, the word is out.”

DOG FOOD IN SWEATPANTS

At a recent orientation for new hires at Barnes-Jewish St. Peters Hospital, nurses rotated between training on use of a built-in ceiling lift, a mobile lift and a standing aid.Trainer Teri Dicky told participants to stop thinking they can move a patient on their own. “The biggest thing we are trying to do is change the culture, change your thought process,” Dicky said.Occupational heath managers say having lift equipment isn’t enough. Nursing personnel must be convinced that it saves time, that injuries could happen to them and their careers could be cut short.

Vicki Grimes, 55, hurt her back 12 years ago when she and another nurse assistant tried to move a patient from his bed to a chair at a nursing home in Edwardsville. “It just takes that one time to mess you up, and then you are messed up for life,” said Grimes, of St. Peters. “I never thought it would happen to me.”

Grimes said she had never heard of the dangers of lifting more than 35 pounds. She simply followed directions on residents’ charts on when to use lift equipment.

Despite new policies and options, nurses still need convincing.

Swan at the BJC Learning Institute said she uses a stopwatch to show nurses how using lift equipment saves time. She filled sweatpants with 35 pounds of dog food so they could feel what it is like to lift that amount of unstable body weight.

Nurses put the needs of patients ahead of their own safety, Swan said, so she explains how the policies help patients.

Patients have fewer falls, skin tears and pressure ulcers with the use of lifting equipment. They feel more comfortable and secure being moved, and they become mobile faster.

Changing how nurses are taught to move patients also fosters a culture change. Goldfarb School of Nursing in St. Louis recently installed ceiling lifts in its simulation lab. “If you are exposed to it, and learn how to use it and value it from the very beginning,” said the school’s academic chair Sandra Burke, “you are more likely to use it in your care.”

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