Sustainable SPHM Programs
I’m a doctor. I am concerned with the amount of lifting and pushing the employees do around here. Yesterday, I learned that one of our ICU nurses had back surgery and within 36 hours had re-herniated. When she couldn’t void, her doc was saying he thought it was her meds. I asked, “From what I know about cauda equina, can you tell me why it isn’t cauda equina?” And she was right back in surgery…. Is there any way to change this?
Standard 2. implement and Sustain a Safe Patient Handling and Mobility (SPHM) Program
The employer and healthcare workers partner to establish a formal, systematized SPHM program for reducing the risk of injury to healthcare recipients and the risk of injuries and MSDs in healthcare workers, while improving the quality of care.
Setting Up a Sustainable SPHM Program
A culture of safety can emerge only in the presence of a solid SPHM program. An effective SPHM program requires a complex interplay among a number of disciplines and departments. The goal of the program is to create a partnership between employers and healthcare workers that implements and supports safety goals. Interestingly, many facilities seek data on worker’s compensation reduction as the primary measure of a successful SPHM program. Yet, at Stanford University hospitals and Clinics, John Celano and Ed Hall indicate that analyzing worker’s compensation data alone is simply not enough. Meaningful safety goals are designed not only to reduce the frequency, severity,
and cost of healthcare worker injuries, but also to promote safe, quality care to healthcare recipients. Goals should be individualized to meet the mission of the organization or clinical area/unit. Some suggested goals include: create a safer environment and improve quality of life (QOL) for patients, improve the quality of care for patients, decrease patient adverse events related to manual patient handling, encourage reporting of incidents/injuries, create a culture of safety, empower healthcare workers to create a safe working environment, and increase the frequency with which healthcare workers are able to move and mobilize healthcare recipients.
and cost of healthcare worker injuries, but also to promote safe, quality care to healthcare recipients. Goals should be individualized to meet the mission of the organization or clinical area/unit. Some suggested goals include: create a safer environment and improve quality of life (QOL) for patients, improve the quality of care for patients, decrease patient adverse events related to manual patient handling, encourage reporting of incidents/injuries, create a culture of safety, empower healthcare workers to create a safe working environment, and increase the frequency with which healthcare workers are able to move and mobilize healthcare recipients.
One of the first steps to a successful, formalized SPHM program is to assemble a team of interested individuals from a variety of backgrounds within the organization. Members of the team should have the ability to identify, receive, and analyze baseline loss history/injury data. Facility, unit, and discipline assessments also provide a baseline from a different, but important, perspective. In addition, follow-up assessment to monitor and compare baseline data allows ongoing improvement.
A written SPHM program ought to include goals, objectives, and a plan for ongoing evaluation and compliance. Integrating the eight SPHM Standards serves the goals of safety.
Implementation Ideas and Insights for Standard 2
This section addresses the complexity of developing meaningful interprofessional support by way of teams. What follows are selected ideas and insights on establishing a sustainable SPHM program. The ideas are organized by the sets and subsets of the standards that are required by any facility: one specific to your organization as an employer, the other to your facility’s interprofessional healthcare workers. Addressing the challenges of competing claims for resources is discussed, along with specific and practical ideas for managing the hazards of high-risk tasks. Specific methods to design and sustain a facility-appropriate SPHM program are presented.
2.1 EMPLOYER STANDARDS
2.1.1 Designate a group or groups of stakeholders to develop, implement, evaluate, remediate, and maintain a SPHM program
Implementing Standard 2.1.1
Incorporate experts from the organization’s insurance brokers/stakeholders; because insurance carriers often have dedicated money, this can help with the initial funding of a SPHM program. Such stakeholders can be
identified by working with occupational health, risk management, and quality improvement services within the organization. More specifically, keep in mind that each facility will have a representative of its worker’s compensation provider assigned to manage its case (facility/organization). This single point of contact will be able to provide an organized four-year (three plus one) loss history detailing every injury sustained in the facility, including patient handling injuries. This insurance “case manager” is often responsible for many facilities, so his or her time will be limited. This is all the more motivation for the insurance representative to provide you with a wealth of data as you implement your SPHM program, as this initiative stabilizes the risk due to workplace injuries in their account. Compared to most other classifications of workplace injuries, patient handling injuries present the likelihood of “shock losses,” which are large, unpredictable payouts that are often paid out over years, especially if the worker’s claim, for example, includes extensive rehabilitation following a costly surgery. Stabilizing or eliminating this risk is extremely beneficial to the insurance company and offers the facility the opportunity to renegotiate a lower premium without cutting into the insurance provider’s net profits. Therefore, consider this opportunity when identifying meaningful relationships for successful SPHM program efforts.
Reach out to organizational leaders, stakeholders, and frontline employees to identify 8-10 individuals who are interested in the development of a SPHM program. This is the discovery part of the SPHM program. It involves asking, listening, and connecting with individuals in a way that clarifies roles and responsibilities. Also consider using the “Who can get me what I want?” tool when identifying opportunities for these stakeholders to be included (see the Introduction). Consider the following:
Any individual who expresses interest in SPHM.
An employee who is involved in caregiver safety and prevention of injury, such as the occupational health coordinator, who understands the human and economic costs of injury.
An individual already recognized within the organization’s safety culture; this individual will already understand the barriers and opportunities inherent in framing SPHM as a safety initiative.
Behavioral or organizational culture change agents who may assist in understanding the necessary process to accomplish culture change within the respective organization.
A representative whose primary responsibility is for the fiscal health of the organization, unit, or discipline will serve as a champion once the business case has been established.
The risk management team is instrumental in providing data and serves as a champion once successes become measurable.
The quality improvement team is instrumental in providing data and serves as a champion once successes become measurable.
A representative from engineering is essential to facilitate installation of technology.
A representative from materials management (Central Supply Service) is important, as that department is called on to assist with locating appropriate, available, and compatible technology.
A representative from environmental services is essential, as laundry service is necessary in sling management and more.
Other relevant and interested parties.
Organize an interdisciplinary team comprised of these identified, interested individuals from a variety of backgrounds.
Create a Task Force charter consistent with that of other organizational teams.
Obtain baseline data:
Incidence of MSD.
Severity of MSD.
Costs of MSD.
Number of light/modified/restricted duty days due to handling injuries.
Number of lost workdays due to handling injuries.
Prevalence of musculoskeletal discomfort in healthcare workers.
Adverse patient event: fall-related injuries.
Adverse patient event: DVT/PE.
Adverse patient event: pneumonia.
Adverse patient event: HAPU.
Frequency with which healthcare workers are able to mobilize patients.
Healthcare worker retention.
Readmission within 30 days.
Determine what goals associated with SPHM are important to stakeholders, such as those aligned with current safety initiatives or high-cost, high-risk, or high-frequency outcome goals.
2.1.2 Perform a comprehensive assessment of SPHM
Implementing Standard 2.1.2
Assess attitudes and support:
Administrative support:
Identify economic and resource support; establish who/what departments is/are responsible for financing the SPHM program.
Recognize personal support; determine who are the points of contact and who is willing to be a part of the SPHM committee or task force.
Healthcare worker:
Assess workers’ understanding of SPHM goals.
Identify any role misunderstandings.
Determine compliance with the SPHM technology, policies/procedures, training, and culture.
Assess whether stafffing levels support SPHM goals:
Ensure that staffing levels are appropriate (ratio of healthcare workers to healthcare recipients).
Ensure that staffing mix is appropriate (ratio of appropriate disciplines, such as RN, LPN/LVN, CNS, CNA).
Determine if healthcare workers have opportunities to attend SPHM education and training sessions.
Assess application of appropriate ergonomic principles:
Recognize handling and mobility tasks that stress the body beyond healthy limits, such as (but not limited to) lifting 35 pounds or more of a static load, or lifting a load weighing less than 35 pounds which is awkward, unstable, or moving; portable floor lifts with poorly functioning casters or carpeted floors that create drag or resistance when moving wheeled objects.
Identify unit- or discipline-specific handling and mobility hazards, such as limb lifting by the wound care expert to treat the underside of the lower leg in the home care setting, moving the healthcare recipient from a wheelchair to a radiology table in the clinic setting, or early progressive mobility in the critical care setting. Each such scenario poses hazards.
Determine whether ergonomic principles are applied to match the healthcare recipient to the handling and mobility task.
Assess training methods:
Determine whether relevant unit- and discipline-specific training is available to healthcare recipients, such as educating healthcare recipients on ways they may become involved with their own mobility in the facility, and maintaining mobility once they are discharged. This education should also be received by family members and/or healthcare workers at the next level of care.
Identify healthcare workers who have attended training by title, number, or percent of total; this can be monitored electronically or via written reports.
Assess physical environment:
Identify whether floor coverings are low-resistant.
Determine safe door widths. These are usually designated by building codes; however, from a practical perspective, sometimes the door widths must be enlarged to accommodate the needs of special patient populations. For example, in the case of a bariatric-designated room, the door to the patient care room must be wide enough to allow larger equipment to pass easily. A width of 60 inches is considered sufficient to accomplish this goal. Options for a 60-inch opening include a sliding door or a pair of unequal-leaf swinging doors (one door 42 inches wide, the other 18 inches).
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