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When staff at Southern Ohio Medical Center Home Health Services in Portsmouth reported a total of 777 days lost due to work-related injuries in one year, managers knew that something had to change.
By tapping into the expertise of an occupational therapist and developing a well-defined policy that limits employees’ risk of injury due to transferring patients, the number of lost workdays due to injury dropped to just 80 the following year.
"We are self-insured for workers’ compensation injuries, so finding a way to decrease injuries was a real financial incentive," says Karen L. Marshall, MS, RN, administrator of the home health agency.
"We asked for help from a staff occupational therapist with a focus on work hardening and return-to-work patients," she says.
Along with continuing the agency’s inservices on injury prevention, proper transfer of patients, and proper lifting techniques, the occupational therapist developed a set of guidelines to determine which patients require extra assistance, she explains.
"We titled the policy Client Safety Classification’ since weight classification is a sensitive term," Marshall says. There are four classifications that are defined by patient description and type of assistance needed for transfer.
The classifications are:
"Patients are assigned a classification based upon their ability during their initial assessment," Marshall says.
Home health employees who have weight restrictions on lifting following a previous injury only are assigned to patients that are consistent with their restrictions, she adds.
If the patient is a Class 4 client, he or she cannot be transferred without the assistance of two people. This need can be addressed in different ways, Marshall says.
"Family members can help with the transfer, or we can evaluate the feasibility of sending a second staff member who might be in the area," she says.
If these options are not viable, Marshall sends a physical therapist to the patient’s home to assess the feasibility of a hoyer lift.
"We conduct this evaluation whether or not it will be reimbursed because it is an important part of protecting our employees," she adds.
The assessment of patients and employees’ ability to transfer them is conducted by RNs at Helping Hands Home Care in Jackson, MI, says Judy Cappell, RN, CCM, clinical manager of the home health agency. "We conduct the initial assessment and perform a transfer to make sure an employee can do it safely," she says.
While her agency’s guidelines are not as detailed as Marshall’s, every job description limits lifts to 40 pounds, Cappell says. If a transfer requires more lifting, two employees are assigned to the patient or a family member assists, she says. "We do evaluate the family member’s ability to help, and sometimes, there is no one who can safely assist us."
Cappell’s agency will request a physical therapy evaluation to see if there is other assistance, such as a Hoyer lift, that will work only if the family can cover the expense of the evaluation. "We also require the family to cover the cost of the lift or other equipment, but we do have a relationship with an equipment supplier who offers discounts," she adds.
Sometimes, Hoyer lifts are not feasible due to space limitations in the patient’s home, Marshall says. If the equipment is not feasible and there is no possibility that someone can help with the transfer, the patient is referred to another agency, she says.
"We also refer patients to other agencies after explaining to the families that this is a safety issue," Cappell says. "We will provide names of other home health agencies, but we also try to introduce the idea that it might be the right time to consider long-term care."
"If a family insists on keeping the patient at home, we tell them that the only way we can provide care is if the patient is bed-bound," she says.
"We have referred patients to other agencies as a result of this policy, but the numbers have been so few that it is not a concern," Marshall says. "The cost of losing a few patients is far less than the cost of lost workdays and workers’ compensation payments for our injured employees."
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