Evidence-Based Practices for Safe Patient Handling and Movement

Abstract

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The purpose of this article is to summarize current evidence for interventions designed to reduce caregiver injuries, a significant problem for decades. Despite strong evidence, published over three decades, the most commonly used strategies have strong evidence that demonstrate they are ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. The authors have organized potential solutions into three established ergonomic solution types: engineering based, administrative, and behavioral. For each intervention, the level of evidence to support its use is provided.Key words: work-related musculoskeletal injuries, patient handling, no lift policy, ergonomics, lifting techniques, nurse safety Strategies to prevent or minimize work-related musculoskeletal injuries associated with patient handling are often based on tradition and personal experience rather than scientific evidence. The most common patient handling approaches in the United States include manual patient lifting, classes in body mechanics, training in safe lifting techniques, and back belts. Surprisingly there is strong evidence that each of these commonly used approaches is not effective in reducing caregiver injuries. A major paradigm shift is needed away from these ineffective approaches towards the following evidence-based practices: (a) patient handling equipment/devices, (b) patient care ergonomic assessment protocols, (c) no lift policies, (d) training on proper use of patient handling equipment/devices, and (e) patient lift teams. Promising new interventions, which are still being tested, include use of unit-based peer leaders and clinical tools, such as algorithms and patient assessment protocols. Given the complexity of this high-risk, high volume, highcost problem, multifaceted programs are more likely to be effective than any single intervention. This new call for action includes systematic change in health care facilities across the continuum of care as well as a new curriculum for schools of nursing. Statement of the ProblemNursing personnel are consistently listed as one of the top ten occupations for work-related musculoskeletal disorders, with incidence rates of 8.8 per 100 in hospital settings and 13.5 per 100 in nursing home settings (Bureau of Labor Statistics, 2002). These are considered to be low estimates, since underreporting of injuries in nursing is common (U.S. Department of Health & Human Services, 1999). Aggregated data on prevalence of back injury, compiled from over 80 studies, revealed an international worldwide point prevalence of approximately 17%, an annual prevalence of 40-50% and a lifetime prevalence of 35-80% (Hignett, 1996). While there has been a steady decline in the rates of most occupational injuries starting in 1992, work-related musculos...

Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: An analysis of cross-sectional survey data

“…As reported in the literature, best practices for musculoskeletal injury prevention use an array of multifaceted approaches such as lift equipment, zero-lift policy, training, ergonomic risk assessment, and peer safety leaders (Collins et al, 2004;Nelson and Baptiste, 2006;. Thus, negative findings in this study may conversely suggest the need for comprehensive safe patient handling programs for intervention success.…”

“…Confounders were defined as variables showing a change of 5% or more in odds ratios (OR). As a lift team is also an effective intervention for injury prevention (Nelson and Baptiste, 2006), we conducted additional analyses on the effect of lift team. In these analyses, nurses without lift teams had 1.2-2.6 times higher ORs for all low back pain outcomes and any and significant neck pain than nurses with lift teams, after controlling for lift provision and other confounders.…”

Work-related musculoskeletal risks associated with nurses and nursing assistants handling overweight and obese patients: A literature review

“…patient handling tasks The recruitment and retention of nursing staff has become a significant problem, and the shortage of its workforce has been intensified by occupational injuries and disabilities [14]. One of the challenges that nurses and nursing assistants encounter on a daily basis is overweight or obese patient handling tasks.…”

“…One of the challenges that nurses and nursing assistants encounter on a daily basis is overweight or obese patient handling tasks. Astonishingly, during one typical 8-hour shift a nurse can lift the cumulative weight of 1.8 tons [14,15]. Potential high risk for WMSDs associated with patient handling tasks included: high force (overexertion), awkward postures (stooping, bending, and reaching), and repeated activities (lifting, transferring, and repositioning) [16,17].…”

Ergonomic Explorations for the Safety and Health Improvement in Hospital and Healthcare Professions

“…Many other studies in the literature state a connection between low-back pains in nurses and patient handling, which requires frequent lifting and repositioning of heavy patients [24,25]. Shoulder injuries and pains could potentially be related to the repositioning of the patient in the bed when the nurse leans over the bed and uses his or her upper body to slide a patient up in bed or turn the patient on his or her side.…”