The Development of Policies for Patient Lifting

in Acute Care Settings

Rick Barker, MACertified Professional Ergonomist

Practice Leader, Global Safety ProgramHill-Rom

rick.barker@hill-rom.com

Lifting Policies are Cited as a Critical Component for Reducing Caregiver Injuries

And more frequently:The lack of a clear program or enforcement of that program is cited as the reason for poor effectiveness with injury reductions efforts

“No Lift” or “Zero Lift” Policy

Ergonomics Nirvana

OR

Consultant Myopia

“No Lift” or “Zero Lift” Policy

Proponents point to:• Success in Long-Term Care• Application in England

Success in Long-Term Care

Critical Differences:• Length of Stay• Direction of Capability Changes• Speed at Which Capabilities Change• Urgency of Transfers• Therapeutic Handling Activities

Success of Lifting Regulations in England Critical Differences:

• Length of Stay/Payment Structure• Open Floor/Ward Design• No Competition for Patients Descriptions Have Been Overstated, Reality Is:• Law Does Not State That Lifting Patients is Illegal• Many Units Have Little or No Lifting Equipment• Many Facilities Emphasize Training Instead of

Equipment• Funding for Lifting Equipment Difficult to Obtain• Therapeutic Handling Activities Excluded • Few Indications of Success in Past 10 Years

“No Lift” or “Zero Lift” Policy

Fundamental Questions• Can you truly avoid ALL lifting?• What about pushing, pulling,

repositioning, tugging, or holding?

Safe Patient Handling Policy Rather Than

“No Lift” Policy

Value-Added Patient Handling

Is the reason for the caregivers’ physical exertion in handling a patient:•To speed or promote the healing process or•Change the patient’s location

The Need For Unit Specific Policies

Managing Policy Compliance

Making a Plan Work

What works?•Clear discipline policies•Manager/Supervisor accountability•Employee involvement in policy development•Reinforcement of desired behaviors

Discipline Policies

Heavily PromotedCited as Reason for FailuresUnrealistic in Health Care Job MarketImpact on Organization Safety Culture

Manager Accountability

Insufficient in most organizations, rare in health care

You can’t change what you don’t measure

Organization behavior will match organization reward structures, not vision and policy statements

Employee Involvement in Policy Development

Why?• Ownership• Workplace Insight

Reinforcement of Desired Behavior

If you supervise a parts machining department and the policy that you establish is that once a person completes their daily quota, they can spend the remainder of the day in the break room what behavior do you expect to see?

Reinforcement of Desired Behavior

What behaviors among nurses do you want to encourage?

How can you measure these behaviors?

What options do you have for providing reinforcement?

Questions for The Panel