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Safe patient handling may become an imperative in the nation’s hospitals — not because of any proposed legislation or regulation, but because of rising financial pressures related to both patient safety and workers’ compensation.
Patient falls and pressure ulcers are among the "never events" that insurers consider to be preventable — and that can be mitigated by safe patient handling and mobility. The Centers for Medicare & Medicaid Services (CMS) stopped Medicare reimbursement for "provider preventable conditions" in 2007, and the Affordable Care Act extended that policy to Medicaid. Many private insurers have followed suit.
Greater access to lift equipment leads to lower rates of pressure ulcers and patient falls in long-term care, recent research showed.1 Cost-savings from safe lift programs produce a return on investment of one to three years in long-term care.2 The benefits are similar in the acute care setting, safety experts say.
"You can’t afford not to [adopt safe patient handling]," says Melissa McDiarmid, MD, MPH, DABT, director of the Occupational Health Program at the University of Maryland School of Medicine in Baltimore.
McDiarmid developed a "safe lift index" that measures the key components of a safe patient handling program: Lift equipment, training, enforcement of safe lifting policies and support from directors of nursing. A higher safe lift index was associated with lower workers’ compensation costs. Increasing the availability of lifts by just one lift per 100 long-term care residents reduced costs by 11%.1
"This is a win-win — good for patients and residents, good for workers, good for the bottom line," says McDiarmid.
Despite the cost-savings, implementing safe patient handling has been a challenge in a time of budget constraints.
Each year, ECRI Institute in Plymouth Meeting, PA, assists hospitals with their safe patient handling programs. Yet faced with other patient safety initiatives and cost pressures, hospitals may not devote the resources that are needed to achieve a sustained result, says Robert P. Maliff, director of Applied Solutions for ECRI. A budget for lift equipment competes with other priorities for capital expenses.
Hospital leadership needs to support safe patient handling as an integral part of an overall safety culture, with regular education and enforcement of lift policies, he says. Otherwise, lift equipment may be inadequate, the existing lifts may sit unused, and the hospital may need to re-start a safe patient handling program every few years, he says.
"It needs to be something that is incorporated into everyday practice," Maliff says. "The real challenge is how to sustain a culture that encourages and rewards safe patient handling."
Risk managers are natural partners for employee health professionals who want to improve the patient handling program, says Maura Crossen-Luba, MPH, CPH, an ECRI risk management analyst.
In a risk analysis, Crossen-Luba noted that manual handling can lead to pain or discomfort for patients, including skin tears and joint dislocation, in addition to high rates of musculoskeletal injury among workers.
"Worker safety is very much related to patient safety," she says.
Political momentum to require safe patient handling has sputtered, with most activity occurring in state legislatures.
Ten states currently require hospitals to have a comprehensive safe patient handling program. New York added the Safe Patient Handling Act to the state budget language this year, requiring safe patient handling programs by Jan. 1, 2017. It was the first new state law since 2011. Legislation also was pending in Massachusetts and Vermont, but at presstime they had not moved forward.
"It’s going to be dependent on the states to keep moving forward and I think that will happen," says Aaron Trippler, director of government affairs for the American Industrial Hygiene Association. "I think you will see additional states consider this issue and address it on their own."
Meanwhile, the federal Nurse and Health Care Worker Protection Act of 2013 remains politically out of reach.
The American Nurses Association scheduled a Congressional briefing in May — a kind of unofficial hearing — and planned a lobbying day for nurses to meet with their representatives in June. The ANA issued inter-professional safe patient handling and movement standards last year, which were cited by the U.S. Occupational Safety and Health Administration in its "Worker Safety in Hospitals" web resources (www.osha.gov/dsg/hospitals/patient_handling.html).
"It’s definitely a marathon, not a sprint," says Joe Mayer, associate director for federal government affairs at the ANA in Silver Spring, MD. "A lot of times you’re facing some uphill battles. It doesn’t mean you don’t keep fighting. It’s a long campaign and we’re in it for the long haul."
Hospitals that fail to adopt to safe patient handling will eventually pay the price in higher workers’ compensation premiums, says Harry Shuford, PhD, practice leader and chief economist for the National Council on Compensation Insurance (NCCI) in Boca Raton, FL. Employers with a workers’ compensation claims experience that is worse than the industry average will see their premiums rise, he says.
Even low-cost injuries, such as back strain, may be the precursor to more significant claims, he cautions. "Minor injuries, if they continue on a repetitive basis, can ultimately become a very expensive injury," he says.
Shuford predicts that safe patient handling will eventually become the accepted practice.
"It’s like so many things where there is new technology or new ways of doing things," he says. "There are the early adopters. Then it begins to pick up until eventually it becomes an industry practice."