Safe Patient Handling and Mobility
Nurses and patient assistive personnel are at high risk for musculoskeletal injuries related to routine activities such as lifting and maneuvering of patients. Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. The Bureau of Labor Statistics of the Department of Labor defines MSDs as musculoskeletal system and connective tissue diseases and disorders when the event or exposure leading to the case is bodily reaction (e.g., bending, climbing, crawling, reaching, twisting), overexertion, or repetitive motion (CDC, 2020). Musculoskeletal disorders are associated with high costs to employers such as absenteeism, lost productivity, and increased health care, disability, and worker’s compensation costs. MSD cases are more severe than the average nonfatal injury or illness (CDC, 2020). Injuries to healthcare personnel are mostly due to overexertion, repeated manual patient handling, heavy lifting and awkward positioning required by the staff member. Examples of these activities are transferring (moving) patients from bed, chair or toilet or other equipment, repositioning a patient, or utilization of other types of equipment with or without occupancy of an individual (NIOSH, 2023).
Labor assembled a work group called the National Advisory Committee on Ergonomics (NACE) with the task of advising the Secretary of Labor and the Assistant Secretary for the Occupational Safety and Health Administration (OSHA) on Ergonomic Guidelines, Research, Outreach, and Assistance over the next two years. In 2004, the American Nurses Association (ANA) introduced safe patient handling as a priority and launched the Handle with Care® campaign. In response to the OSHA and ANA initiatives, a taskforce of the Association of Rehabilitation Nurses (ARN), the American Physical Therapy Association (APTA), and the Veterans Health Administration (VHA) was convened in 2004 to proactively address the use of patient handling equipment not only for patient and staff safety, but also for therapeutic purposes. The taskforce published a white paper, Strategies to Improve Patient and Health Care Provider Safety in Patient Handling and Movement Tasks which was presented at the 2005 Safe Patient Handling and Mobility Conference.
Current Status:
The Healthcare and Social Assistance sector (HCSA) has one of the highest rates of work-related injuries and illnesses and it continues to rise. In 2020, the Bureau of Labor Statistics (BLS) reported a 40% increase in injury and illness cases (CDC, 2020). MSD disorders make up 52% of all days away from work cases for nursing assistants. Manual patient handling which includes manual lifting, moving and repositioning of patients, residents or clients is the greatest risk for healthcare workers (NIOSH, 2023). Per the Institute of Medicine, the annual impact of work-related MSDs is between $45-$54 billion annually as measured by compensation costs, lost wages, and lost productivity (CDC, 2020). According to the largest workers’ compensation insurance provider in the United States, overexertion injuries—lifting, pushing, pulling, holding, carrying or throwing an object—cost employers $13.4 billion every year (CDC, 2020).
Healthcare workers in acute rehabilitation hospitals are particularly challenged with musculoskeletal injury because of demanding work schedules, staff shortages, and intensive patient mobility tasks (Waters, 2010). Obesity rates continue to rise steadily in all 50 states, many with an obesity rate around 20%. Morbidity rates affect inpatient hospitalization, as although the 10 leading causes of death are unchanged, many of these conditions require extended inpatient care leading to increased risks from immobility and increased need for patient handling devices and rehabilitation (ANA. 2021). The rehabilitation field has the unique challenge to develop programs that protect our staff while maintaining a safe and therapeutic environment for our patients. Patient mobility is a primary functional need of patients admitted to an inpatient rehabilitation facility (IRF) and promotes safe discharge home, and to the community. A workplace ergonomics program can aim to prevent or control injuries and illnesses by eliminating or reducing worker exposure to MSD risk factors, such as awkward postures, repetition, force, mechanical compression, and duration of exposure (ANA. 2021).
In addition to the risk of musculoskeletal injuries in nurses and previous nursing assessments, there are many unintended patient adverse events associated with patient handling tasks including decreased patient comfort, fear, pain, damage to the shoulder from manual lifting techniques, hip fractures from dropping the patient, bruising of arms, loss of dignity during lifting procedure, increased dependency, skin tears, and pressure injury (Tuohy-Main, 1997; Nelson 2004). Research indicates reliance on manual lifting techniques and proper body mechanics alone is ineffective in reducing staff and patient injury. Patients may feel more secure and comfortable when a mechanical device is in use (OSHA, 2020). A culture of safety for hospital personnel can be reached by reducing work injuries, decreasing injury costs, improved patient outcomes and employees supported by employers (Mayeda-Letourneau, 2013).
Despite the focus on safe patient handling and mobility and availability of safe patient handling devices since 2004, nurses continue to report pain and risk of injury due to patient handling and other tasks. According to the 2018-2019 Heathy Nurses Healthy Nation survey, 58% of nurses indicated that they had experienced pain at work in the past year, even though 80% of them either agreed or strongly agreed that they have access to safe patient handling and mobility devices (ANA, 2021).
There is currently a more active partnership between the provider and healthcare recipient to progress the healthcare recipient’s achievement of positive mobility outcomes which is consistent with the rehabilitation goal. To date there have been several other publications and initiatives addressing safe patient handling and mobility including the passage of laws or regulations in 11 states requiring safe patient handling policies and ANA’s 2021 publication of Safe Patient Handling and Mobility: Interprofessional National Standards (ANA, 2021).
Definitions
Culture of safety: A culture of safety is an agreed upon commitment among clinicians and administrators to empower front line personnel to identify and report unsafe situations, dialogue about unsafe situations between clinicians and leadership, and to collaborate on improvement strategies that are supported at all levels of the organization. (Association of Rehabilitation Nurses Task Force on Safe Patient Handling and Mobility, 2014).
Ergonomics: The science of coordinating the workplace and the demands of the job to the working population, with the goal of reducing workplace stress, and musculoskeletal disorders associated with over-exposure to risk factors and hazards (CDC, 2020).
Lifting equipment: Mechanical devices used to assist caregivers in performing patient handling tasks, including lifting, transferring, wound care, ambulation, and others. Lifts fall into two categories: powered and manual sit-to-stand lifts and full-body sling lifts. The latter category is further broken down into overhead/ceiling, gantry, and floor-based lifts (Facility Guidelines Institute, 2019).
Manual handling: Lifting, transferring, repositioning, and moving patients using a caregiver’s body strength without the use of lifting equipment/aids that reduce forces on the worker’s musculoskeletal structure (Facility Guidelines Institute, 2019).
Safe patient handling and mobility: Refers to the use of the hands and/or assistive devices to perform an activity and encourages more active involvement of the healthcare recipient and healthcare worker, in progressing the activity and mobility level of the healthcare recipient with the potential to improve health and safety outcomes (ANA 2021).
Position Statement
ARN supports a culture of safety, endorsed at the administrative level, and supported throughout the organization. In order to create and maintain a safe environment for nurses and patients, ARN supports actions and policies that result in the therapeutic use of equipment including:
Recognition and support of the benefits of the principles to improve early mobilization safely for both the healthcare recipient and healthcare provider
Encouragement of the healthcare recipient to engage in movement mobility while avoiding manual lifting techniques.
Support of the principles and standards of Safe Patient Handling, referring to the use of assistive devices to perform activities when needed for the dependent patient.
Urging active involvement of the healthcare recipient in progressing their mobility level with the potential to improve health and safety outcomes as outline in Patient Handling and Mobility Assessments (Matz, 2019).
Use of ergonomic adaptions to create a workspace for healthcare providers.
Recommendations:
Use of ANA’s Safe Patient Handling and Mobility: Interprofessional National Standards (SPHM Standards) 2nd edition, published in 2021.
The 8 Evidence-based Standards for Safe Patient Handling and Mobility:
- Establishing a culture of safety
- Implement and sustain a safe patient handling and mobility program
- Incorporate ergonomic design principles to provide a safe environment of care
- Select, install and maintain safe patient handling technology
- Establish a system for education, training and maintaining competence
- Integrate patient-centered safe patient handling and mobility assessment, plan of care and use of safe patient handling and mobility technology;
- Include safe patient handling and mobility in reasonable accommodation and post-occupational-injury return to work; and
- Establish a comprehensive evaluation system.
Further research to investigate the benefits of early mobility, such as reduced injury, improved respiratory status, improved dignity, reduced skin breakdown.
Manual lifting should be minimized in all cases and eliminated when feasible.
Use of technology that maximizes patient effort.
Assess patient ability or degree of dependence.
Assess the environment to determine what will work safely within the constraints of the work area.
Educate staff about appropriate ergonomics.
Promote a culture of safety that encourages staff to take the additional time necessary to enhance patient care and safety.
Educate students about methods that make patient handling safe.
Refer to and follow your state’s safe patient handling law if applicable as well as hospital/organizational policies and procedures.
Updated by the Continuing Education Provider Unit in 2024.
References:
American Nurses Association. Safe Patient Handling and Mobility: Interprofessional National Standards 2nd edition, American Nurses Association, Silver Springs, MD; 2021
Association of Rehabilitation Nurses. (2014). Task Force on Safe Patient Handling and Mobility.
Center of Disease Control (CDC). (2-12-2020.). Work-related Musculoskeletal Disorders & Ergonomics. Retrieved https://www.cdc.gov/workplacehealthpromotion/health-strategies/musculoskeletal-disorders/index.html
Matz, M.W. (Ed.) (2019). Patient Handling and Mobility Assessments, A White Paper (2nd ed.), Facilities Guidelines Institute (FGI). https://www.fgiguidelines.org/wp-content/uploads/2019/10/FGI-Patient-Handling-and-Mobility-Assessments_191008.pdf
Mayeda-Letourneau, J. (2014). Safe Patient Handling and Movement: A Literature Review. Rehabilitation Nursing, 39, 123–129.
National Institute for Occupational Safety and Health (NIOSH). (March 9,2023). Safe Patient Handling and Mobility (SPHM). Retrieved, 7/9/2021: https://www.cdc.gov/niosh/topics/safepatient/default.html
Occupational Health and Safety Administration (OSHA). (n.d.). Safe patient handling. Retrieved 7/9/2021: https://www.osha.gov/hospitals
United States Bureau of Labor Statistics, Monthly Labor Review. (November 2018). U. S. Department of Labor. Retrieved 7/9/2021: https://www.bls.gov/opub/mlr/2018/article/occupational-injuries-and-illnesses-among-registered-nurses.htm
United States Department of Labor, Occupational Safety and Health Administration (n.d.) Healthcare Safe Patient Handling. (Retrieved 7-9-2021): https://www.osha.gov/healthcare/safe-patient-handling
Waters, T.R., & Rockefeller, K. (2010). Safe patient handling for rehabilitation professionals. Rehabilitation Nursing, 35 (5), 216-22.
Online, free publications:
National Institute for Occupational Safety and Health (NIOSH)
Safe Lifting and Movement of Nursing Home Residents https://www.cdc.gov/niosh/docs/2006-117/pdfs/2006-117.pdf?id=10.26616/NIOSHPUB2006117
NIOSH Hazard Review: Occupational Hazards in Home Healthcare https://www.cdc.gov/niosh/docs/2010-125/pdfs/2010-125.pdf?id=10.26616/NIOSHPUB2010125
Safe Patient Handling Training for Schools of Nursing https://www.cdc.gov/niosh/docs/2009-127/pdfs/2009-127.pdf?id=10.26616/NIOSHPUB2009127
Safe Patient Handling and Movement CD ROM Download https://www.cdc.gov/niosh/docs/2009-127/download.html
