I recently wrote a blog about the danger of falls among the elderly and was surprised by the comments I received. I suppose that simply further highlights my naivety when it comes to this subject. I expected to hear from my fellow urologists with stories of similar patients, but instead, I primarily heard from nurses, specifically inpatient nurses.
Interestingly, not only were they concerned about the danger of falls to patients (think of all the elderly, narcotized, confused patients they deal with) but also to themselves.
Excuse me, I asked? The danger of patient falls to a nurse? I’ll admit that the first mental picture I had was of a particularly overweight patient literally falling on top of a diminutive nurse, but I was smart enough to keep that thought to myself. Yes, one nurse went on to explain, safely picking up a patient after a fall is very challenging.
Thinking back to medical school, I remember a session we had with a very charming yet grizzly old nurse, sometime in my first or second year, who taught us how to use “proper body mechanics” to pick up and help transfer patients. I remember the incident well because of a comment she made at the end of the session: “At least now, you guys can do something useful when you get to the floors.”
I guarantee that while not everyone may be familiar with the term “proper body mechanics,” everyone has at least once heard the phrase, “Lift with your legs and not your back.” Other keys to proper body mechanics include keeping the object you are lifting close to your body, using your stomach muscles to protect your spine, and bending at the knees and not the waist.
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The problem is that proper body mechanics are not proper at all. It turns out that according to the best data on the subject, there is basically no safe way for a person (or even a group of people) to lift a patient. National Public Radio recently published a great article on the subject that not only goes over some of the basic science data—and yes, it turns out that an incredible amount of research has gone into this subject—but also on the implications of this research for hospitals.
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How dangerous is the situation? Nurses, orderlies, and nursing assistants all fall into the top 10 professions for chances of having on-the-job back injuries, according to the Department of Labor’s Bureau of Labor Statistics.
Further, this is not a new idea. In 1999, William Marras, PhD, CPE, now head of Ohio State University’s Spine Research Institute, published an article describing a technique to assess for injury to the spine during movement which, when applied to nurses, shows the significant dangers involved in lifting a patient (Hum Factors 1999; 41:373-88). His later research can be summarized as follows:
- Nurses place themselves in danger because they can’t stand immediately next to a patient when moving them (think of trying to move someone from a bed), which increases stress on the back.
- Nurses tend to bend over while moving (think about sliding a patient from a stretcher to an operating room table), which increases horizontal stress on the back and is particularly bad for it.
- Nurses tend to do these tasks frequently, which causes micro-tears in connective tissue of the spine that over time create significant problems.
What are the implications of this? For the answer, all you have to do is walk around a modern hospital and look at the gear that now exists to help nurses move patients. How many Hoyer lifts can you find on your inpatient floor? I counted three on one floor at my hospital. How many rooms have mechanical lifts hanging from the ceiling? The official position of the American Nurses Association (ANA) regarding safe patient handling and mobility is (my emphasis in bold): “In order to establish a safe environment for nurses and patients, ANA supports actions and policies that result in the elimination of manual patient handling.”
You read that correctly: “the elimination of manual patient handling.” Is that possible? Going back to that NPR article, it turns out the VA is in the process of implementing a system called “safe patient handling” that has reduced injuries to its nursing staff by 80% through the use of motorized lifts for all patient moves and transports. This process is based on the ANA’s Handle with Care campaign, started in 2004, which supports the transition to machine-assisted patient moving in all situations. The final results on the the success of this program aren’t in yet, and there certainly isn’t any federal requirement for these procedures nationally (although the ANA has been campaigning for that and has a briefing paper to Congress on the subject), but the trend toward implementing these techniques is certainly gaining speed.
This trend has also been noticed by the federal government. The Occupational Safety and Health Administration (OSHA) recently announced that it will start inspecting hospitals to ensure that all employees are safe when they are moving patients.
What does this mean for us? Moving a patient isn’t easy and isn’t safe. After reading about its dangers, I have certainly been a bit quicker to use some sort of manual aid when moving patients from cart to OR table and have even gone so far as to suggest that my nurses use the Hoyer lifts more liberally. Further, I have become a bit more patient when the transport team seems to take an eternity to get the patient from the floor to the OR; we’ve all been tempted to walk to the floor and simply bring the patient down ourselves.
If you are experiencing the transition from the old-school method of moving patients to the modern “gear-centric” approach in your hospital, I look forward to hearing how it’s going and learning any tips you can share with the rest of us. Until then, the next time you are asked to move a patient, think about using some sort of aid. Back injuries are simply too common and too debilitating to ignore.
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