Economic Impact of a Safe Patient Handling and Mobility (SPHM) System on Staff and Safety in a Long Term Acute Care Unit

Topics: 

Abstract

Background:

Nurses and Nursing Assistants consistently rank in the top 5-10 of occupations that suffer the most musculoskeletal disorder (MSD) injuries.1 Injuries related to patient handling result in 31% to 66% of the MSD injuries that afflict nursing staff.2 Currently, eleven states including California, are mandated to implement Safe Patient Handling Mobility (SPHM), which includes provision of technology to aide in the movement, transfer and positioning of patients.3 In 2011, the cost of a patient handling injury claim averaged $15,600.00 (modified duty, not including litigation) per episode nation-wide.4 Research shows that a comprehensive SPHM program reduces workers’ compensation claims and associated costs by 30-40%.5

Setting:

Sharp Coronado is a 210 bed community hospital, with a 64 bed long term subacute care unit that serves a chronic critically ill patient population. Typical diagnoses include amyotrophic lateral sclerosis, multiple sclerosis, traumatic brain injury, muscular dystrophy and cerebral vascular accident. The patients are predominantly ventilated, immobile, and dependent on repositioning which puts nurses and caregivers at risk of MSD injuries. Pillows and draw sheets were utilized as the standard of care for patient repositioning.

Problem:

From 2014 to 2015, nine injuries in our subacute units were directly related to patient repositioning. Based on OSHA data, the direct claim costs for 9 MSD would be approximately $$140,400.00.4 Lack of a standardized, effective turning and repositioning system posed an expensive caregiver safety challenge.

Method:

To reduce caregiver injury, a standardized protocol utilizing an ergonomically sound, Non-Powered Reactive Support Surface Position System (NRSSPS) was implemented on 60 patients aged 20-60 who met inclusion criteria. See Figure 1. The product was chosen based on attributes listed in Table 1. The number of caregiver injuries over the year was then compared to the number of caregiver injuries from the prior year and cost savings from reduced staff injuries was tabulated.

Results:

The reported number of staff injuries (MSD) in the subacute units decreased from 9 in 2014 to 1 in 2015 resulting in an estimated cost avoidance of $124,800.00.4 The cost of implementing the NRSSPS for 60 patients over the one year period was $15,852.00; resulting in a direct cost savings of $108,948.00. See Figure 2. The staff found this type of NRSSPS to be more effective at maintaining the patient’s position than the prior standard of care resulting in less staff time spent repositioning patients.

Based on reduction of MDS injuries and cost avoidance, the NRSSPS was adopted as a house-wide ‘Best Practice’ for patients meeting the inclusion criteria.

Conclusion:

Implementing a NRSSPS with the specific features shown, as part of a comprehensive SPHM program, played an integral part in the reduction of MSD staff injuries by 89% over one year.

Further research is indicated to determine the effects of using a NRSSPS to offload bony prominences and decrease hospital-acquired pressure injury incidence across the care continuum.

  1. Bureau of Labor Statistics (BLS), U.S. Department of Labor, (2016 November 10). Nonfatal Occupational injuries and illnesses requiring days away from work, 2015. News Release USDL 16-2130. Retrieved from: https://www.bls.gov/news.release/pdf/osh2.pdf.
  2. Power, J. Two methods for turning and positioning and the effect on pressure ulcer development: a comparison cohort study. J Wound Ostomy Continence Nurs. 2016;43(1):46-50.
  3. California Labor Code Section 3403.5. Signed into law October 7, 2011.
  4. Safe Patient Handling Programs: Effectiveness and Cost Savings. OSHA Publication 3729 (9/2013) Available at: https://www.osha.gov/Publications/OSHA3279.pdf
  5. Borden B, C. M. (Ed.) (2010). Patient movement and handling assessments: A white paper. The Facilities Guidelines Institute. Retrieved from: http://www.wsha.org/wp-content/uploads/Worker-Safety_4-Equipment-needs-F...

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