Ergonomics: Identifying Problems in Nursing Homes
Ergonomics: Guidelines for Nursing Homes
Section III. Identifying Problems and Implementing Solutions for Resident Lifting and Repositioning
Identifying Problems for Resident Lifting and Repositioning
Assessing the potential for work to injure employees in nursing homes is complex because typical nursing home operations involve the repeated lifting and repositioning of the residents. Resident lifting and repositioning tasks can be variable, dynamic, and unpredictable in nature. In addition, factors such as resident dignity, safety, and medical contraindications should be taken into account. As a result, specific techniques are used for assessing resident lifting and repositioning tasks that are not appropriate for assessing the potential for injury associated with other nursing home activities.
An analysis of any resident lifting and repositioning task involves an assessment of the needs and abilities of the resident involved. This assessment allows staff members to account for resident characteristics while determining the safest methods for performing the task, within the context of a care plan that provides for appropriate care and services for the resident. Such assessments typically consider the resident's safety, dignity and other rights, as well as the need to maintain or restore a resident's functional abilities. The resident assessment should include examination of factors such as:
the level of assistance the resident requires;
the size and weight of the resident;
the ability and willingness of the resident to understand and cooperate; and
any medical conditions that may influence the choice of methods for lifting or repositioning.
These factors are critically important in determining appropriate methods for lifting and repositioning a resident. The size and weight of the resident will, in some situations, determine which equipment is needed and how many caregivers are required to provide assistance. The physical and mental abilities of the resident also play an important role in selecting appropriate solutions. For example, a resident who is able and willing to partially support their own weight may be able to move from his or her bed to a chair using a standing assist device, while a mechanical sling lift may be more appropriate for those residents who are unable to support their own weight. Other factors related to a resident's condition may need to be taken into account as well. For instance, a resident who has recently undergone hip replacement surgery may require specialized equipment for assistance in order to avoid placing stress on the affected area.
A number of protocols have been developed for systematically examining resident needs and abilities and/or for recommending procedures and equipment to be used for performing lifting and repositioning tasks. The following are some examples:
The Resident Assessment Instrument published by the Centers for Medicare and Medicaid Services (CMS) provides a structured, standardized approach for assessing resident capabilities and needs that results in a care plan for each resident. Caregivers can use this information to help them determine the appropriate method for lifting or repositioning residents. Many nursing homes use this system to comply with CMS requirements for nursing homes. Employers can access this information from www.cms.hhs.gov/medicaid/mds20/.
Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement is published by the Patient Safety Center of Inquiry, Veterans Health Administration and the Department of Defense. This document provides flow charts that address relevant resident assessment factors and recommends solutions for resident lifting and repositioning problems. This material is one example of an assessment tool that has been used successfully. Employers can access this information from www.patientsafetycenter.com. Nursing home operators may find another tool or develop an assessment tool that works better in their facilities.
Appendix A of the Settlement Agreement between OSHA and Beverly Enterprises entitled Lift Program Policy and Guide recommends solutions for resident lifting and repositioning problems, based on the CMS classification system. (A rating of "4" indicates a totally dependent resident. A "3" rating indicates residents that need extensive assistance. A "2/1" rating indicates residents that need only limited assistance/general supervision. Residents rated "0" are independent.) Employers can access this information from www.osha.gov.
The nursing home operator should use an assessment tool which is appropriate for the conditions in an individual nursing home. The special needs of bariatric (excessively heavy) residents may require additional focus. Assistive devices must be capable of handling the heavier weight involved, and modification of work practices may be necessary.
A number of individuals in nursing homes can contribute to resident assessment and the determination of appropriate methods for assisting in transfer or repositioning. Interdisciplinary teams such as staff nurses, certified nursing assistants, nursing supervisors, physical therapists, physicians, and the resident or his/her representative may all be involved. Of critical importance is the involvement of employees directly responsible for resident care and assistance, as the needs and abilities of residents may vary considerably over a short period of time, and the employees responsible for providing assistance are in the best position to be aware of and accommodate such changes.
Occupational Safety & Health Administration (OSHA)
200 Constitution Avenue, NW
Washington, DC 20210