An Uplifting Initiative—

Danbury Hospital Substantially Reduces Staff Back Injuries

And Improves Care to Patients

By Beth Werner-Young

When injuries associated with patient lifting, transferring, or repositioning hit a record high in 2002, Danbury Health Systems’ (DHS) Workplace Safety and Nursing teams sprung into action. Organizing a multidisciplinary team that included all patient care areas, the two groups spearheaded an effort that included a review of the hospital’s policies and procedures, as well as an analysis of lifting and transferring equipment.

The result: a new program that has led to a 58 percent reduction in injuries since the program began in March 2004.

Dubbed “Project Uplift,” the program has added 30 patient lift machines and 360 gortex-slip sheets in 14 nursing and patient care units. In addition, DHS has instituted a “minimal lift” policy that includes proper training on the use of lifting and transfer equipment, and a nurse assessment of each patient to determine the need for mechanical lift.

The Safe Patient Lifting Initiative Team (SPLIT) started brainstorming ways to reduce injuries — and, ultimately, improve patient care — two years ago. While the main goal was to reduce the injuries associated with lifting and transferring patients, the team also wanted to accomplish other things. For example, they wanted to be sure that the equipment they used was accessible and easy to maneuver so that staff would use it. And, they wanted to involve staff in the process so that they would take ownership of the new policy and ensure its success.

Examining the Issues

SPLIT applies the Performance Improvement process “FOCUS-PDCA” to tackle the lifting and transferring issues. By following the FOCUS (find, organize, clarify, understand, select)-PDCA (plan, do, check, act) process, they explored a number of topics, ranging from identifying key factors contributing to injuries to evaluating existing and new equipment. SPLIT consisted of 15 managers, registered nurses, and staff from departments including workplace safety, nursing, nursing education, transportation, and other disciplines including infection control, housekeeping, and facilities.

Realizing early on that new, more efficient equipment was in order, the SPLIT team researched best practices to fully determine what equipment worked best and why. That process narrowed the field to equipment and associated service and training from two companies. The team then conducted an on-site trial of multiple pieces of equipment from the two companies over a two-week period. The vendor was not present during this trial period because the team did not want to be influenced by any sales pitch. The equipment was tested on staff and, with the input of the hospital’s purchasing department, they ultimately decided to go with Arjo/Diligent (www.arjo.com).

Geared towards all levels of care — from the most dependent patient to those with minimal needs — the new equipment not only offered what the team deemed to be superior mechanics, but it also came with a comprehensive service program, including a monthly visit by a nurse. Add to that a financial guarantee that the equipment would reduce injuries by 60 percent during the first year of use, and the SPLIT team had a package it could not pass up.

Also on the team’s to-do list was to conduct a needs assessment across the hospital. While most units required various levels of equipment, it was determined that some of the specialty areas, such as pediatrics, Family Birth Center, and psychology, required only equipment geared to their patient population. Other units, such as ortho/neuro/trauma and physical rehabilitation, had special needs and required equipment that was specially designed to assist with movement of patients who have had total joint replacements.

The SPLIT team also recognized the need to improve the assessment process used by staff. Accurately assessing and communicating the mobility needs of the patient leads to the best determination of the proper equipment to use. In order to make that happen, the team developed a tool to assist in this effort. The language on the tool is also connected to the language used on documentation forms.

A number of important challenges were raised — and issues resolved — during the assessment phase of Project Uplift. For example, the team had underestimated the impact of the new program on housekeeping. Since DHS outsources the cleaning of linens, there needed to be a process for cleaning the slings and nylon sheets internally, as they require specific washing temperatures and regular changing. Where to store the gortex-slip sheets for easy access was another issue. In this case, the team decided to put a hook behind each door of every in-patient room.

As for the larger equipment, it is now stored on each unit, alleviating the need to contact someone to retrieve it. And, since the initial rollout occurred in only two areas — physical rehabilitation and surgical — the team was able to tweak its education and training program before it was implemented hospitalwide.

Education Is Key

Perhaps most key to the success of Project Uplift has been the training developed by the team. All employees who lift or transfer patients were required to attend a four-hour, hands-on training on how to use the equipment. Both nursing administration and workplace safety took an active role in providing oversight in the education process, and coordinated their plans with nursing education. In addition, each department/unit has a transfer mobility coach who is responsible for assisting in training new employees on the equipment and providing ongoing support and advice.

While the manufacturer suggested training transfer mobility coaches prior to training all employees, SPLIT decided to train employees first, then ask for volunteers for the coaching job. This enabled the team to find volunteers that they knew would be champions of the equipment, leading to better adoption rates.

The biggest challenge has been to get staff to make the leap from their old habits of manually lifting or transferring patients to using the equipment. While it takes more time to use, it allows for far less strain on the back and affords the patients a comfortable and secure move. The team has found that the more staff uses it, the more they like it.

Beth Werner Young is a certified nureoscience registered nurse and manager of care delivery systems for Danbury Health Systems.