By Mark Santoleri, CHSP, MS and Betty Z. Bogue, R.N., B.S.N.
This white paper provides an overview of the healthcare industry’s readiness to change patient mobilization protocols in an increasingly challenging healthcare environment, describes the mounting pressures for change, and shares lessons learned over 20 years with implementing and developing patient mobilization programs. An illustrative patient-case scenario is used to outline best practices for effectively improving the safety of the healthcare workplace and strategies for achieving the safest healthcare workplace possible.
Acute care nurses and other healthcare staff are at high risk of injuries, particularly musculoskeletal disorders, due to the intense physical demands of manually lifting and moving patients. In addition to time away from work, injuries may be life-altering and career-ending. The intense physical demands of the job alone can lead to low morale and job dissatisfaction, further increasing the risk of staff turnover.
Patients in a hospital setting who require partial or total support for their mobilization also have an increased risk of injuries and complications. This increased risk is directly related to the support needed to move them, which often exceeds safe lifting limits for caregivers. This disparity between capability and demand increases the risk of a patient injury during manual lifts, transfers and repositions as well as reduces the opportunities for mobilization which in turn increases the risk of complications during the hospital stay.
An effective patient mobilization program determines each patient’s needs for lifting, transferring, and repositioning, and uses mechanical lifts and assist devices to provide support instead of caregivers’ physical strength.
Reducing manual demands significantly reduces the risk of caregiver and patient injuries, improves job safety and satisfaction, preserves profit margins by reducing professional liability exposure and workers compensation costs associated with injuries, enhances patient recovery time and reduces staff turnover.
Patient Mobilization Challenges Facing Hospitals Today
Statistics show that the healthcare environment is becoming increasingly challenging.
- Over the next 20 years baby boomers will balloon from 14% of the American patient and caregiver population to 21% (70 million). [Anderson_2014]
- 35% of the general population is overweight and 28% is obese. [CDC_2014]
- In 2015, the turnover rate for acute care bedside RNs increased to 17.2% from 16.4%. [NCi_2016]
- The turnover rate for certified nursing assistants was 23.8%, exceeding all other positions.
- 50% of all nursing injuries in the hospital were musculoskeletal and related to patient handling, with cost per injury averaging $15,600. [OSHA_Safe Patient Handling Pamphlet]
- In 2008 Medicare deemed the cost of treatments related to in-hospital patient falls and acquired pressure ulcers non-reimbursable.
In light of these startling statistics, safer methods to mobilize patients may help hospitals recruit and retain experienced nurses, reduce the risk of injury to patients and employees, and enhance financial efficiencies. The methods needed to dramatically improve patient mobilization are already available, feasible, and have been proven to dramatically improve the safety of a healthcare environment.
Lessons Learned From 20 Years of Safe Patient Handling
Lesson #1: Addressing Culture Change
The first step toward improving the safety of patients and caregivers in healthcare environments is recognizing that workplace culture surrounding patient mobilization needs to change. Once that is achieved, best practices can be applied to patient mobilization protocols and tailored with increasing experience to ensure outcomes and preservation of healthcare dollars are optimized.
Many institutions have purchased and provided staff with training on the use and function of ceiling lifts, mobile mechanical lifts, and other assist devices only to find that lack of use leads to a wasted investment.
Over the past 20 years, observations of more than 1,000 diverse healthcare organizations, 100 of which are acute care hospitals throughout the United States that have successfully implemented safe patient mobilization practices and dramatically reduced injuries, reveal what must occur to permanently change the culture of this workplace. All of these organizations have the following attributes in common:
- Mentorship to help ensure new practices are adopted.
- Clearly defined roles and responsibilities for administrative, nursing, and department leaders around implementation of a new mobilization strategy.
- Bonus and performance reviews and organizational goals tied directly to patient mobilization outcomes.
- Sponsorship of change by nursing leaders.
- Designation of key personnel to support the program, including a liaison position to oversee and manage the program.
- Monthly review and evaluation of patient mobilization outcomes followed by action to resolve revealed opportunities for improvement.
- Defined annual, expected outcomes and considered these an organizational goal.
Lesson #2: Applying Best Practices
The dramatic improvement in patient care and the significant reductions of caregiver injuries related to patient mobilization achieved by these organizations was a result of these requirements:
- Air Mats, or total lifts for patients who require weight-bearing support to transfer across surfaces, up in the bed or to/from the side of the bed.
- Stand Aids post-procedure and first time up.
- Sit to Stands for transferring patients able to sit upright and demonstrate leg strength but not pulling self to standing.
- Stand Aids for transferring patients able to sit upright, demonstrate leg strength and pull to a standing position but cannot transfer self.
In addition to the above requirements, these attributes were displayed across successful acute care programs:
- All employees, physicians, community participants, and partners have a clear understanding of the expectations, roles, and responsibilities related to patient mobilization practices.
- Patients’ mobilization support needs are determined and the appropriate equipment is used.
- A defined procedure exists for communicating patients’ mobilization support needs, which are customized by department and patient care area.
- On hire, all direct-care employees complete training on patient mobilization practices; skills are mentored and competency is verified at the point of care.
- Mobilization equipment is adequate, functional, and available for use.
- Any injury or incident related to patient mobilization is investigated, opportunities to strengthen the practice are defined, and interventions are developed, implemented, and verified as being effective to prevent another injury by the same cause.
- Employees who refuse to comply with patient mobilization practice are provided counseling and additional education and mentoring; repeat offenses result in termination based on the organizational disciplinary practice.
- All barriers to the use of equipment are identified and eliminated.
- There is ongoing analysis of defined outcomes to identify opportunities to strengthen the practice.
In the increasingly complex healthcare environment, organizations must find ways to attract and retain staff and reduce negative outcomes to patients and caregivers. An often neglected but highly effective solution is to integrate effective patient mobilization practices into patients’ plans of care. These practices can enhance healing time while reducing the length and cost of hospital stays. Additionally, the physical demands placed on nurses and other healthcare providers are lessened, thereby decreasing the risk of injury.
An effective patient mobilization program saves precious healthcare dollars by enabling healthcare organizations to retain healthcare staff, including older workers; prevent costly injuries among patients and staff; and reduce unnecessary hospital expenses.
NSI Nursing Solutions. 2016 National Healthcare Retention & RN Staffing Report. http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf. Published March 2016. Accessed May 2, 2016.
Occupational Safety & Health Administration (OSHA). Safe Patient Handling Programs. https://www.osha.gov/dsg/hospitals/documents/3.5_SPH_effectiveness_508.pdf. Accessed May 2, 2016.
Stokowski LA. Old, but Not Out: The Aging Nurse in Today's Workplace. http://www.medscape.com/viewarticle/585454. Published December 29, 2008. Accessed May 2, 2016.
Centers for Disease Control and Prevention. Adult Obesity Facts. http://www.cdc.gov/obesity/data/adult.html. Accessed May 2, 2016.
Occupational Safety & Health Administration (OSHA). Facts About Hospital Worker Safety. https://www.osha.gov/dsg/hospitals/documents/1.2_Factbook_508.pdf. Published September 2013. Accessed May 2, 2016.
Hitcho EB, Krauss MJ, Birge S, et al. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med. 2004;19(7):732-739.
Brem H, Maggi J, Nierman D, et al. High cost of stage IV pressure ulcers. Am J Surg. 2010;200(4):473-477.
AHC Media. Needlesticks, sharps injuries dropping but safety device push must continue. http://www.ahcmedia.com/articles/21055-needlesticks-sharps-injuries-dropping-but-safety-device-push-must-continue. Published November 1, 2010. Accessed May 14, 2016.
Nelson A, Baptiste AS. Evidence-based practices for safe patient handling and movement. Online J Issues Nurs. 2004;9(3):4.
Vollman KM. Introduction to progressive mobility. Crit Care Nurse. 2010;30(2):S3-S5.
Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Critical Care Nurse. 2013;33(6):57-67.
About the Authors
Mark Santoleri is a senior vice president in Integro’s Philadelphia Office. He provides technical loss control advice to clients regarding the identification, assessment and mitigation of their risk exposures
Betty Bogue, R.N., B.S.N is the President and Owner of Prevent, Inc. and originator of its successful Safe Patient Handling Program.
Integro is an insurance brokerage and risk management firm. Clients credit Integro’s superior technical abilities and creative, collaborative work style for securing superior program results and pricing. The firm’s acknowledged capabilities in brokerage, risk analytics and claims are rewriting industry standards for service and quality.
Integro maintains a robust healthcare practice, and since 2005 has pioneered a unique approach to managing risk for their healthcare clients. The firm has offices in the United States, Canada, Bermuda and the United Kingdom. Its U.S. headquarter office is located at 1 State Street Plaza, 9th Floor, New York, NY 10004. 877.688.8701. www.integrogroup.com
Prevent, Inc. has 20 years of experience implementing safe patient mobilization initiatives. Its mobilization strategies and best practices solutions have resulted in an 80% reduction in mobilization injuries among caregivers at institutions that have adopted its “Get A Lift!”® program. www.getalift.com
The content contained herein is not intended as legal, tax or other professional advice. If such advice is needed, consult with a qualified adviser.
© 2016 Integro Insurance Brokers