ANA Handle with Care Program-Injury of Nurses

Nurses Safety

Published

Well, it happened again yesterday! I got notified that I had an admission coming to RMXXX and it was canceled. The reason that it was canceled was because they had a different admission for us due to the obesity of the patient. Huh? I did not know this was a criteria for floor placement. I was told that due to the fact that we have "big" rooms that the other floors send the obese patients to us. This was not a surgical patient (I work a surgical floor) this was a chronic CHF patient that should have been admitted to our Medical Telemetry floor. Everyone was up in arms when the news was spread. Some very unhappy nurses!

Then the patient is rolled up in a wheelchair by a PCT from the other floor. She promptly leaves the patient in the wheelchair in the room and is gone. I gather the Physical Therapy tech and a gait belt and go to the room to get the patient in bed. The daughter tells me that mom has to go to the bathroom. I tell her that we have to get her in the bed and then she can use the bed pan. They say no, she has to go to bathroom. I released the PT tech because he had been working with another patient and could not spend an hour in the room. So, they rolled the patient into the bathroom while I went to find a walker. They put the walker in the bathroom and then said that she had to be lifted out of the wheelchair to a standing position so she could manuver to the toliet. I told the daughter that she could go ahead and do that, that I had to release the tech. She said it took two people to lift her. I told her that I couldn't lift her since I have a bad back (disc, spinal arthritis from, guess what?, lifting patients!) and that we would have to get more help. My PCT jumped in and the daughter and PCT got her up and onto the toliet. Well, I went and did the accuchecks for the PCT because I knew she would be tied up for awhile (an hour, just as I guessed!). However, the patient decided she wanted to sit on the toliet for awhile. So the PCT left and took a patient out for discharge. So of course the obese patient decides she wants to get out of the bathroom and they call the desk. Fortunately for me I was tied up down the hall doing a dressing change. The charge nurse went to the room and helped get her back to bed. Luckily, the MD ordered a foley due to large does of Lasix to be given and the need for accurate I&O. I was able to explain to the patient and family that our original intention had been to get the patient in bed and let her use the bed pan. The only question the daughter had then was how she would have BMs? I told her that we would use the bedpan. I was then able to admit the patient.

Back injury in health care workers, nurses in particular are on the rise. The number of pounds we lift on a daily basis surpasses that of the average warehouse worker (statistic from ANA). I have been promoting the ANA Handle with Care program since I have been at this hospital. We have no equipment and no training on how to safely lift, transfer and move patients. The ANA has a position paper that demonstrates that we should do none of the above, the technology is here to elminate those needs. (http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/HandleWithCare.aspxLack)of awareness and lack of worker advocacy within the nursing profession has allowed the continuation of work related injuries to nurses. Due to my advocacy, we have purchased one transfer device. One. It took 6 months to get a slider board ordered.

Nurses are aging. We can not afford to have nurses injured and not able to work. And frankly, all the lifting and pulling is turning off new nurses. This economy is going to turn around and the shortage is going to come back with a vengenance. We are going to look around and ask "who is going to work with us today?" I can only safely care for 6 Med/Surg patients at time on days, how many more will we have to take to deal with holes in the schedule?

I would like to know if you have a Handle with Care Progam in your hospital and how does it work? If you don't have a formal program how are you handling the safe transfer of patients. I work with total hip replacements, knee replacements, lumbar lams, ACDFs, gamma nailings, fractures, colon resections and other major surgery. The patients are getting larger, heavier and more demanding. What works? What doesn't work?

Thanks in advance for sharing your story.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The problem is going to continue. Since the population is becoming heavier, we are being forced to lift increasingly heavier amounts of weight. When I last checked the most recent statistic, two-thirds of Americans are overweight or obese.

There is no end in sight.

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great point! here is some information that supports your remark:

patient characteristics as a risk for injuries to nurses

patient characteristics are particularly meaningful when determining the risk of injury associated with manual patient handling. patient height, weight, body shape, and condition (e.g., contractures, spinal injuries, orthopedic conditions, post-surgical periods, and drains or intravenous line placement) become significant factors in patient handling. patients are often at some degree of dependence and can offer limited, if any, levels of assistance in moving themselves (nelson, 2003) or may have limited ability to comprehend instructions and to cooperate. some may become agitated or combative, commonly because they experience pain while being moved. the changing profile of today's patient population makes patient handling challenging. in-patient care has been largely populated by patients with higher levels of acuity, a growing elderly population, and the rising numbers of bariatric (clinically obese) patients (thomason, 2003).

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[color=#aa5522]nurses have historically been trained to use "proper" body mechanics to prevent injury...however, questions arise as to the true value of body mechanics training...

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when i went through orientation at this hospital they had extensive training on body mechanics. it consisted of asking how golfers pick up golf balls. the demonstrater proceded to do what i can only describe as a ballet move and bent over with one leg up in the air and bent over and acted out picking up a golf ball. as a long time golfer my only thought is that she would have fallen into the cup if she tried that with out a golf club to lean on. and since my putter cost $300 i am not about to use it as a cane to support me when i pick up my golf ball! the rest of the training was "you know what body mechanics are because you were trained in school on them." good grief!

here is some more info on the value of body mechanics training:

the national institute for occupational safety and health (niosh) offers a "lifting equation" as a tool to determine safe lifting limits (waters, putz-anderson, & garg, 1994). niosh states that the average worker should not lift more than 51 pounds under controlled and limited circumstances. the parameters of this designation, though, cannot be appropriately generalized to nursing practice because it was derived on the basis of defined conditions (e.g., lifting a stable box with handles from ground to waist) that do not translate well to manual patient handling or other ergonomic hazards in the health care workplace. while niosh's 51 pounds is typically cited as a conventional reference number, it is important to note that the developers of the lifting equation explicitly recognize the limits of its application and call for the elimination of manual lifting wherever possible through the use of technologic equipment.

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This particular patient was 5'6" and weighed 405 lbs. 69 years of age. Extremely limited locomotion due to her obesity caused joint issues. Her daughters and sisters all weighed above the 300 lb mark. Remarkably, the men in the family were all very slender! Her husband could not have weighed over 150 lbs. The concludsion could be made that the daughters were feeding their mother. The first question out of all of them as I met them was "when can she eat?" No question about what were we going to do to treat her mother for the pain and the SOB. Just when can she eat?

I refuse to injure myself any further. I have informed my employer that I will not engage in activity that will injure or re-injure my back again. I have documented everything. All the unanswered requests for equipment and trainig. Any injury that occurs in our organization is the liability of the organization. Now I am raising awareness.

And I will not accept assignment of this patient. This patient is an injury waiting to happen.

Did I mention that the family wants a consult with an orthopedist for her knees? Our orhopods will tell her "NO WAY!" They cannot justify knee replacement with her inability to do rehab. Plus the CHF and other problems. It is simply amazing to me how people can practice unsafe health activities and then expect the medical community to fix them when they become broken.

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Specializes in ER, ICU.

You sound like an excellent person to bring this issue to management. It sounds like your facility could use a policy for obese patients (couldn't we all?). We have overhead lifts which are awesome. They can be used with a number of different slings. We have a sling for lifting the patient like a burrito, one in a sitting position (with an opening for toileting), and a small limb lifter for those porky legs and arms. I agree that we should not be expected to lift a 400lb patient onto the toilet. Although more time consuming that the old heave-ho method, I can usually turn and bathe a patient myself. Of course they are expensive, and older facilities might not have the structure to accomodate them. Come up with some solutions to present and you might have some success. Good luck!

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Thanks for reading and responding to my post. Is that a pic of your cats are is it a stock photo? I have 3 little girls myself and they are the joy of my life. One of them is laying on my desk trying to act like she is asleep and then when she thinks I am not looking she is trying to stick her paw in my nacho cheese dip. She will be in for a big surprise when she succeds! Ola!

Could you please respond to my original question? How do you handle lifting obese patients?

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You sound like an excellent person to bring this issue to management. It sounds like your facility could use a policy for obese patients (couldn't we all?). We have overhead lifts which are awesome. They can be used with a number of different slings. We have a sling for lifting the patient like a burrito, one in a sitting position (with an opening for toileting), and a small limb lifter for those porky legs and arms. I agree that we should not be expected to lift a 400lb patient onto the toilet. Although more time consuming that the old heave-ho method, I can usually turn and bathe a patient myself. Of course they are expensive, and older facilities might not have the structure to accomodate them. Come up with some solutions to present and you might have some success. Good luck!

Thanks! I have started my literature search for information. I intend to present an entire packet early Feb 2011 to our new CNO. I want to get it on her Agenda at the top. That is one of the reasons I posted here today. I am hoping folks will provide me with information I am not aware of at this time.

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Specializes in Clinical Research, Outpt Women's Health.

People are going to do what they are going to do. You cannot change that.

However, employers have a responsibility to provide the training, equipment, and staffing to safely care for obese patients because the problem is not going to go away any time soon.

The real issue though is that if nurses do not quit ******** and fighting among themselves, and do not band together to demand the employers provide these things for their safety and the patients safety it will never happen.

Nurses are their own worst enemies......:smokin::uhoh3::devil:

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actually, just getting nurses to focus on this issue would go a long way. there are millons of nurses and if we would come together we would have a mighty voice. here is some results from nurses speaking out:

the national institute for occupational safety and health (niosh) says a dockworker can safely lift a maximum of 50 pounds; a healthcare worker just 35.

did someone forget to tell nurses?

for too long they have lifted, twisted, strained and just "carried on," with grim determination spiked by stress and pain.

organizations traditionally safeguarding health and welfare of most american workers seemed to have looked the other way, to the detriment of a dedicated nursing population.

a new era has dawned

in april 2007, maryland passed safe patient handling legislation (hb1137 and sb 879), requiring hospitals (not nursing homes) to form safe patient lifting committees by december of that year and develop individual safe lifting policies by july 2008.

legislation further suggests considering the appropriateness and effectiveness of ".patient handling hazard assessment; enhanced use of mechanical lifting devices; development of specialized lift teams; training programs for safe patient lifting; incorporating space and construction design for mechanical lifting devices in architectural plans; and evaluating effectiveness of the safe lifting policy." according to information from united american nurses, afl-cio at http://wingusa.org/.

"but legislation should be the floor, not the ceiling," said nancy hughes, ms, rn, director of professional practice and research, american nurse association (ana), silver springs, md.

in fact, hughes pointed out some states without legislation seem to be leading the charge with ana's safe handling initiative dubbed handle with care. in oregon, for example a safe handling coalition has put together what hughes called a "great, impressive model in action."

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Please note posts have been removed.

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