Prompted by pressure from professional nursing groups, labor organizations, regulatory agencies, and the scientific community, state and the federal governments are enacting Safe Patient Handling laws.

Lifting, transferring, and repositioning residents who need such help, even temporarily, is dangerous work. It leaves healthcare professionals susceptible to disabling musculoskeletal disorders (MSDs) and residents at risk of injuries that can complicate their underlying health problems.

As reported by the Bureau of Labor Statistics, health-care workers are 4.5 times more likely to experience overexertion injuries than workers in any other industry and have a lost-workday-injury and illness rate 2.5 times the average of all industries. By far the majority of these injuries are due to work-related musculoskeletal disorders, including back injuries and other ergonomic-related problems. The problem of worker injury is so serious that The Joint Commission implicitly included it among its National Patient Safety Goals for long-term care, assisted living communities, and other health-care organizations. The National Patient Safety Goals for 2006 require health-care facilities to implement a fall reduction program, including a protocol for transferring patients and residents.

Prompted by pressure from professional nursing groups, labor organizations, regulatory agencies, and the scientific community, the states and the federal government have begun to enact Safe Patient Handling laws. In addition to protecting health-care workers from work-related MSDs, these new laws are also aimed at protecting residents from unintentional pain and injuries, such as skin tears, bruising, dislocations, and being dropped, which sometimes occur during attempts to lift and move them manually.

Safety at the Federal Level

In March 2003, the Occupational Safety and Health Administration (OSHA) released its Guidelines for Nursing Homes—Ergonomics for the Prevention of Musculoskeletal Disorders. In the guidelines, OSHA explicitly recommends that “manual lifting of patients be minimized in all cases and eliminated when feasible.” Although only a guideline (and not a regulation), the statement still reflects the federal government’s recognition that manual patient and resident handling is an extremely high-risk endeavor.

On January 10, U.S. Rep. John Conyers Jr. (D-MI) introduced the Nurse and Patient Safety and Protection Act of 2007. While this bill is still in the initial steps of the legislative process, if enacted it would require OSHA to enact a Safe Patient Handling Standard that would require the elimination of manual lifting by direct-care registered nurses and other health-care providers. Instead, healthcare providers would be required to use mechanical lifting devices to move people in their care, except during a declared state of emergency. Among other things, the bill’s Safe Patient Handling Standard would require all health-care facilities to:

• Purchase, use, and maintain safe lift mechanical devices;
• Establish a program to identify problems and solutions regarding safe patient and resident handling;
• Establish a system to report, track, and analyze trends in injuries, as well as make their injury data available to the public;
• Conduct training for staff on safe patient and resident handling policies, equipment, and devices on an annual basis; and
• Conduct annual evaluations of safe patient handling efforts, new technology handling procedures, and engineering controls.

Safety at the State Level

States are also recognizing the need to enact Safe Patient Handling legislation. In fact, five states— New York, Ohio, Rhode Island, Texas, and Washington—already have Safe Patient Handling laws on their books. In addition, Hawaii has passed a resolution calling for its state legislature to support the policies contained in the American Nurses Association’s Handle with Care Campaign. A number of other states have introduced some type of legislation designed to address lifting in health-care facilities and/or to study musculoskeletal injuries of health-care workers and examine ergonomic remedies.

Texas and Washington have been at the forefront of enacting such legislation. In 2005, Texas enacted TX SB 1252, the first state legislation signed into law requiring hospitals and nursing homes to implement a Safe Patient Handling and Movement Program. Effective Jan. 1, 2006, this legislation requires the governing body of a hospital or the quality assurance committee of a nursing home to adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to a patient and nurses associated with the lifting, transferring, repositioning, or moving of a patient. The policy must include an evaluation of alternative ways to reduce risk associated with patient handling, including an evaluation of the equipment and the environment, as well as a restriction on manual patient handling, to the extent feasible with existing equipment and aids. The law also requires the health-care provider’s plan to include “procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury.”

Washington’s Safe Patient Handling law is the first legislation in the country that requires hospitals to provide mechanical lift equipment for the safe lifting and movement of patients. Washington House Bill 1672, enacted in 2006, provides a timetable of Feb. 1, 2007 to Jan. 30, 2010, during which Washington hospitals must implement a safe patient handling policy and acquire either one readily available lift per acute care unit on the same floor, one lift for every 10 acute care inpatient beds, or lift equipment for use by specially trained lift teams. This new law also provides for hospital employees to refuse to perform, without fear of reprisal, patient handling or movement the employee believes in good faith would expose a patient or employee to an unacceptable risk of injury.

Results and Considerations

The long-term benefits of proper lifting equipment far outweigh the costs of work-related injuries. In nine case studies evaluating the impact of lifting equipment in health-care facilities, injuries decreased by 60-95 percent, workers’ compensation costs decreased by 95 percent, insurance premiums dropped 50 percent, medical and indemnity costs decreased by 92 percent, lost work days decreased by 84-100 percent, and absenteeism due to lifting and handling was reduced by 98 percent. In addition to these benefits, moving/ lifting patients with proper lifting devices requires fewer employees, enabling health-care providers to redeploy their workforce.

While safe patient handling laws are primarily aimed at patient lifting in hospitals and nursing homes, these safety issues are equally applicable in the assisted living setting. Assisted living communities should consider the following factors when evaluating their safe resident handling procedures:

• Know your state requirements. Make sure management is clear about how this legislation applies to residents of an assisted living community.
• Assess your community or communities’ needs for assisted lifting devices. Evaluate your physical space, as well as the needs of your residents and workforce.
• Develop a comprehensive employee training program that addresses body mechanics and proper lifting techniques. Your workforce should be trained in the use of all lifting and transfer aides, devices, and equipment.
• Consider implementing a minimum lift policy and be willing to commit to a culture that avoids manual resident handling to the greatest extent that’s practical and obtain a written acknowledgement of each staff member’s understanding and receipt of the policy.

Michael E. Anderson is the general counsel of ALFA and also an attorney with the law firm Arent Fox in Washington, DC. Reach him at 202/715-8410.
Nihal Fayad is an attorney in Arent Fox’s New York office. Reach Fayad at 212/457-5478.
Jo-Ann Marchica is also an attorney in Arent Fox’s New York office. Reach Marchica at 212/492-3311.

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