COMMUNICATIONS and COMMITTEES                                             13-02-012

SAFE PATIENT HANDLING COMMITTEE

POLICY STATEMENT.

The Division of Veterans Healthcare Services (DVHS) requires each of the New Jersey Veterans Memorial Homes (VMHs) to establish a Safe Patient Handling Committee and develop a Safe Patient Handling Program in accordance with P.L. 2007, Chapter 225, the “Safe Patient Handling Act.”  Each VMH, under the direction of the Safe Patient Handling Committee, shall establish a written Safe Patient Handling Policy for all units and for all shifts.  This Safe Patient Handling Policy shall require that an assessment be performed for each resident to determine that resident’s need for assisted patient handling equipment.  All components of the Policy shall be consistent with patient and health care worker safety and well-being.

PURPOSE.

In New Jersey, nurses, nurse aides, orderlies and attendants combined, have the highest number of non-fatal occupational injuries and illnesses involving days away from work of other occupations.  Chronic back pain and other job-related musculoskeletal disorders contribute significantly to the decision by these health care workers to leave their profession.  Studies have demonstrated that assistive patient handling devices and technology reduces workers’ compensation and medical treatment costs for musculoskeletal disorders, and provides a safer method of transferring patients from one position to another.

The purpose of this policy is to minimize unassisted patient handling in order to decrease the number of job-related musculoskeletal injuries suffered by health care workers and to improve the comfort, dignity, satisfaction, and quality of care for patients.

IMPLEMENTATION.

The Safe Patient Handling Program for the New Jersey Veterans Memorial Homes is implemented upon publication of this policy and procedure.

DEFINITIONS.

 

Assessment of Patient Need for Assisted Patient Handling (or Patient Assessment) – means the assessment or evaluation required to determine a patient’s required level of assisted patient handling, taking into account the patient’s physical and cognitive condition, and ensuring consistency with patient safety, well-being, and preference.

Assisted Patient Handling – means patient handling using mechanical patient handling equipment including, but not limited to, electric beds, portable base and ceiling track-mounted full body sling lifts, stand-assist lifts, and mechanized lateral transfer aids; and patient handling aids including, but not limited to, gait belts with handles, sliding boards, and surface friction-reducing devices.

Committee – means the Safe Patient Handling Committee.

Covered Health Care Facility – means a general or special hospital or nursing home licensed by the New Jersey Department of Health and Senior Services.

De-Identified – means information that does not specifically identify the individual(s) involved, either by name or other pre-assigned identification number, and that makes a reasonable effort to prevent the individual(s) involved from being identified from such information.

Health Care Worker – means an individual who is employed by a covered health care facility.

Injury Investigation – means an in-depth analysis of a health care worker’s injury sustained during patient handling that is designed to identify both direct and underlying causes of the injury, in order to develop corrective actions that could reduce the potential for similar injuries in the future.

Interdisciplinary Team (IDT) – a group of staff members, both professional and ancillary, representative of each service, coordinated by a Registered Nurse (RN), and responsible for the development of individual resident care and treatment plans, in accordance with the New Jersey Department of Health and Senior Services’ licensing standards.

Near-Miss – means an occurrence that could have resulted in an adverse event to someone, but the adverse event was prevented.

OSHA – means the Occupational Safety and Health Administration of the U.S. Department of Labor.

Patient – means a patient or resident of a covered health care facility.

Patient Handling – means the lifting, transferring, repositioning, transporting, or moving of a patient in a covered health care facility.

Unassisted Patient Handling – means patient handling using a health care worker’s body strength without the use of mechanical patient handling equipment or patient handling aids.

 

PROCEDURE.

I.          Establishment of a “Safe Patient Handling Committee.”

  1. Safe Patient Handling Committee Membership.
    1. At least 50% of the members of the committee shall be health care workers who are representative of the different disciplines at the VMH.
    2. The committee members shall include supervisors, health care workers, and other VMH staff as appropriate who have experience or responsibility relevant to the operation of a Safe Patient Handling Program.
    3. A Chairperson shall be selected to head the Committee.
    4. The Administration/CEO shall consult with the collective bargaining units regarding the selection of health care worker committee members.
    5. Other Members:  (50% shall be direct care workers)
      1. Representative of Administration who shall oversee the Program.
      2. Director of Nursing or Designee.
      3. Instructor of Training/Nurse Educator.
      4. Representative of the Human Resources Office.
      5. Risk Assessment Officer.
      6. Employee Health Nurse.
      7. Physical Therapist or Designee.
      8. AFSCME Nurse Aid Representative.
      9. CWA Nurse Representative.
      10. IFPTE Local #195 Representative.
      11. Ad Hoc Members (e.g. Representative of the Business Office, Engineer-In-Charge of Maintenance, Quality Improvement Coordinator/or Equivalent).
  2. Responsibility of the Safe Patient Handling Committee.
    1. The Committee shall be responsible for all aspects of the development, implementation, and periodic evaluation and revision of the VMHs Safe Patient Handling Program.
    2. Meetings shall be held quarterly, and as may be needed.
  3. Establishment of a “Safe Patient Handling Program.”
    1. A Safe Patient Handling Program shall be established to reduce the risk of injury to both patients and health care workers in the VMH.
    2. A representative from Administration shall be designated who would be responsible for overseeing all aspects of the Safe Patient Handling Program.
    3. The representative from Administration shall ensure that the VMH supports the Program by providing assistance that includes:
      1. Recognizing problems related to patient handling.
      2. Developing clean goals.
      3. Allowing employee input.
      4. Assigning responsibility to designated staff members.
      5. Allocating fiscal resources for planning and training.
      6. Allocating fiscal resources for the purchase, implementation, and maintenance of the required equipment in the time allowed.
      7. Ensuring follow-up and revisions to the Program.
  4. Establishment of a “Safe Patient Handling Policy.”
    1. Assisted patient handling equipment shall be used for all patient handling tasks (except when not required based on an assessment of a patient’s need for assisted patient handling), or in case of a medical emergency, during which a patient’s life would be threatened if the required safe patient handling equipment were not immediately available.
    2. This Policy shall be signed by the CEO of each VMH.
    3. A statement summarizing the Policy shall be posted in a location easily visible to staff, patients, residents, and visitors.
  5. Assessment of a Resident’s Need for Assisted Patient Handling.
    1. Each resident shall be assessed to determine their need for assisted patient handling.
    2. A uniform system of protocols and procedures shall be used consistently throughout all three VMHs for conducting patient assessments for assisted patient handling.
    3. Each VMH shall identify which staff members shall perform resident assessments for assisted patient handling.
    4. Standardized methods shall be developed that will be used to determine a resident’s strength, physical ability, and cognitive ability.  Resident preferences and any special circumstances likely to affect transfer or repositioning tasks shall be taken into account.
    5. Resident assessments for assisted patient handling shall be performed at the time of initial admission to the VMH and whenever there is a change in any of the factors that determine a resident’s needs.
    6. The results of the assessment for assisted patient handling shall be communicated to everyone who may be responsible for lifting, transferring, or repositioning that resident.
    7. Decisions about the selection and appropriate use of patient handling equipment shall be based on the resident assessment.
  6. Needs Assessment of Nursing Units.
    1. Under the direction of the Safe Patient Handling Committee, each VMH shall conduct a needs assessment of every nursing unit, at a minimum, every three (3) years, or sooner if needed, to determine the type and quantity of assisted patient handling equipment required, and, if necessary, to prioritize the need for equipment among the units or areas within the VMH based on the needs assessment.
    2. This needs assessment shall focus on the typical patient “type” and the care needs on each nursing unit.
    3. Additionally, this needs assessment shall focus on:
      1. Categories of staff and types of patients to whom injuries are occurring.
      2. When and where injuries are occurring (e.g. department, unit, date, time, and shift.
      3. The number and leading types of musculoskeletal injuries and disorders among health care workers; and the types of tasks that caused injury (or are difficult or painful to perform) including at a minimum, lifting, repositioning, and transferring patients.
      4. Specific equipment associated with employee or patient injuries.
      5. Available patient handling equipment and any problems associated with its use.
      6. Potential problems with new equipment and assurance of access, storage, and maintenance.
      7. Facility costs associated with unassisted and assisted patient handling injuries including, at a minimum, medical and workers’ compensation costs.
      8. Indirect impact of injuries on staff turnover and replacement.
  7. Resources for performing these needs assessments shall include at a minimum.
    1. New Jersey Occupational Safety and Health Form 300 (N.J.A.C. 12:110-5.1).
    2. OSHA Log of Work-Related Injuries and Illnesses (OSHA Forms 300 and 301) required by 29 CFR Part 1904, which is incorporated herein by reference, as amended and supplemented.
    3. Reports of workers compensation claims.
    4. Accident and incident reports.
    5. VMH incident reports for employees and patients.
    6. Insurance company reports.
    7. Employee interviews and surveys.
    8. Reviews and observations of workplace conditions.
  8. Equipment Selection, Purchase, Usage, and Maintenance.

    9. The Safe Patient Handling Committee:

    1. Shall assist in facilitating the purchase of Safe Patient equipment, as necessary, to carry out the intent of the Safe Patient Equipment Policy.
    2. Shall ensure that there is a process in place to promote and monitor the use and maintenance of the selected equipment.
    3. Shall ensure that health care workers and other employees who may handle safe patient handling equipment shall have the opportunity to participate in the selection of equipment by trying out equipment from vendors that allow evaluation prior to purchase.
    4. Shall establish an evaluation process to determine whether selected assisted patient handling equipment is appropriate for the task to be accomplished, comfortable for the patient, and safe and stable for both patient and caregiver.
    5. Shall factor in the evaluation of health care workers and employees when making purchasing decisions before the VMH determines which equipment to purchase.
    6. Shall ensure that equipment users have prompt access to, and availability of, assisted patient handling equipment.
    7. Shall ensure that all patient handling equipment shall be used, cleaned, maintained, and stored in a safe manner that complies with manufacturer recommendations.
  9. Training Program.
    1. The VMH shall ensure that the assisted patient handling training for a health care worker is based on researched and proven approaches for performing safe patient handling, and is conducted prior to use of the safe patient handling equipment by the health care worker.
    2. Annual “refresher” training must be provided for all health care workers who use this equipment.  New health care workers will be trained on the use of this equipment before they can work on the nursing units and utilize the safe patient handling equipment.
    3. Training shall be held during paid work time.
    4. Training shall be mandated for all departments and staff that are engaged in patient handling activities.
    5. Training shall include, at a minimum, the following:
      1. An explanation of the VMH safe patient handling policies and practices.
      2. Causes and prevention of musculoskeletal injuries and disorders.
      3. How to recognize and address early indications of musculoskeletal injuries and disorders before serious injury develops.
      4. Identification, assessment, and control of patient handling risks, including use of assessments of patient need for assisted patient handling, and appropriate communication with patients.
      5. Demonstration of safe, appropriate, and effective use of patient handling equipment.
      6. Trainee participation in operating unit-specific patient handling equipment and demonstration that they are proficient in using such equipment for patients with a range of physical limitations.
      7. The VMHs procedure for reporting work-related injuries and illnesses pursuant to the New Jersey Public Employees’ Occupational Safety and Health Act, or OSHA’s injury and illness reporting requirements.
      8. Explanation, demonstration, and practice of researched and proven methods and techniques that one or more health care workers may use for patient handling of a patient who refuses assisted patient handling.
      9. The Safe Patient Handling Committee shall, at least once a year or more frequently as needed, review the training content and methods and make necessary revisions.
    6. Family Educational Material:
      1. The Safe Patient Handling Committee shall appoint a person(s) to develop educational materials to help orient patients and their families to the VMHs assisted patient handling program.
      2. This educational material shall be included in the VMHs admission package, and in a discussion with the patient and family member following an assessment of a patient’s need for assisted patient handling.
  10. Injury Investigation, Reporting, Analysis, and Recordkeeping.

    11. Each VMH shall:

    1. Encourage employees to report injuries and near-misses in a non-punitive environment.
    2. Designate a person(s) to develop procedures for performing injury investigations, preparing investigation reports, and educating staff when an injury or near miss occurs.
    3. Establish a mechanism for reporting all incidents, including near-misses and injuries resulting from patient handling.
    4. Appoint an appropriate VMH representative to receive and analyze the reports required above, and to generate de-identified, aggregated data reports that take into account, at a minimum, the safe and proper use of assisted patient handling equipment, patient refusals of assisted patient handling associated with injuries to health care workers, and the overall efficacy of the Safe Patient Handling Program.
    5. Establish a system for periodic reporting of the reports generated as above to the Safe Patient Handling Committee.
    6. Inform the Safe Patient Handling Committee of any violations of the law.
    7. Maintain records of work-related musculoskeletal injuries and disorders to help identify problem areas in accordance with the New Jersey Public Employees’ Occupational Safety and Health injury and illness recordkeeping requirements, or OSHA’s injury and illness recording and reporting requirements.
  11. Evaluation and Recommendations.
    1. The Safe Patient Handling Committee shall evaluate the redacted, aggregated data developed pursuant to N.J.A.C. 8:43E-12.14(a)4 in order to, at a minimum, identify units and shifts with ongoing injuries related to patient handling and track the impact of injuries on employee turnover.
    2. The Safe Patient Handling Committee shall have access to reports and data collected prior to de-identification and aggregation, as determined necessary by the Committee and in keeping with procedures established by the Committee in order to fulfill its obligations.
    3. The Safe Patient Handling committee shall determine what measures to take to increase patient acceptance of safe patient handling, including changes to the education of health care workers, patient, and family members.
    4. The Committee shall provide evaluation results and recommended improvements regarding the Safe Patient Handling Program to the VMHs governing body, at least annually, or more frequently as needed.
    5. The VMHs shall not take any retaliatory action (meaning discharge, suspension, or demotion of an employee, or other adverse employment action taken against an employee in the terms and condition of employment) because the health care worker refuses to perform a patient handling task due to a reasonable concern about worker or patient safety, or the lack of appropriate and available patient handling equipment.
    6. A health care worker who refuses to perform a patient handling task pursuant to this policy, shall promptly notify his or her supervisor of the refusal and the reason for refusing.

 

Revised:   July 2011

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