Nursing is, in fact, the riskiest occupation in terms of back injury. Indeed, over 50 percent of nurses report chronic back pain … and 10 percent must leave their profession entirely due to back injuries.

Years of repetitive high-risk tasks -- primarily lifting, transferring, and repositioning patients -- account for the vast majority. “Studies show that nurses induce silent but cumulative trauma to spines,” said Alexandra Rella, PT, DPT, Injury Prevention specialist.

Three years ago, HUP initiated a two-prong approach to reverse the trend, combining the installation of ceiling-mounted lifts in every adult patient room with a comprehensive educational outreach program to the staff.

The result: Lost days due to nursing injury plummeted from a high of over 4,000 in 2007 to under 600 in 2009.

Making it Work

Between 2007 and 2009, HUP installed more than 600 ceiling-mounted lifts. It also established two safe-patient-handling policies requiring the use of lifts when lifting, transporting and repositioning patients.  But while the tools for safety were in place, achieving consistent use required a culture change. Why the hesitancy? “Many nurses are used to doing it manually but don’t realize the impact it has on their back,” said Jean Romano, MSN, RN, manager of Nursing Products and Operations. “Also nurses want to be very hands-on. This is a different way of taking care of patients.”

Romano created a plan and, with help from Rella, tackled the challenge on multiple levels. Initially, Romano went from unit to unit with a specialist from the lift manufacturer,  teaching staff how to use each of the slings, how to identify risks in their environment, and how to find solutions for each of the risks. “We found that many nurses thought the lifts were only for heavy patients,” she said. “It’s for every patient! NIOSH [National Institute of Occupational Safety and Health] recommends a 35-pound limit for manually lifting.”

They videotaped some of the instructional sessions and put these training videos on Knowledge Link, demonstrating how to use the ceiling-mounted lift as well as safe patient handling. They also held hands-on practice sessions at the Simulation Center at Penn Medicine at Rittenhouse. “We let them know that every movement – pushing, pulling, or turning patients – is causing damage to their lower spines,” Romano said.

Keeping the Momentum Going

To pass the message along to new hires, Rella meets with all new nurses during their orientation class and instructs them in safe-patient handling. “Our goal is to stop the progression of injury. We want to make sure that no new nurses have to experience this,” Romano said.

She noted that although the compliance rate in using lifts has increased significantly, “we need to remain vigilant to ensure the change in culture remains embedded at the bedside, to keep our clinicians safe.”

Unit champions – RNs and CNAs -- help them keep the momentum going. “They received education in ergonomics and safe patient handling,” Rella said, “and do monthly rounds, getting feedback and learning about potential barriers to using lifts. We meet with them quarterly to review injury data and strategies to improve compliance.”

One champion is a nurse who injured herself changing sheets. “She became a champion to help others,” Romano said. “We worked with her on techniques to change sheets using the sling and videotaped the process.”  (The videos are available online. Go to the HUP Nursing site and click on Safe Patient Handling.)

“We’re putting forth the effort not because federal legislation demands it but because we recognized that it’s the right thing to do,” Rella said. “When transferring a patient is safe for the nurse, it’s the safest way for a patient as well.”