Have you heard ever the term “safe patient handling” (SPH)? Are you aware of the new Minnesota Safe Patient Handling (SPH) for Clinical Settings legislation (MN Statute 182.6554)?1 If not, you are not alone. Although SPH is widely known in hospitals and long-term care facilities, it is new to clinical settings. Before we go any further in describing the law and detailing its requirements, some background knowledge of SPH is needed.
Background of Safe Patient Handling (SPH)
The repetitive manual lifting and moving of patients and residents has been the leading cause of musculoskeletal injuries to health care workers for years. In fact, the rate of musculoskeletal disorders among health care workers exceeds those of construction, mining, and manufacturing.2 Research has shown that the safe limit for manually moving patients is only 35 pounds.3 In recent years there has been a push for health care facilities to adopt safe patient handling practices. To date, there are nine states with SPH legislation, Minnesota being one of them, and nine with pending legislation. There is also a federal bill awaiting hearings in Congress, the Nurse and Health Care Worker Protection Act of 2009, that would bring SPH to all 50 states. In 2007, the Minnesota Safe Patient Handling Act was passed, which applied to hospitals, long-term care facilities, and outpatient surgical centers. This required those facilities to establish policies and committees as well as to purchase equipment and provide training on SPH for all direct patient care provider staff. In 2009, an additional SPH statute was added to Minnesota’s SPH law. Minnesota is the first state to include all clinical settings in SPH legislation.
SPH for Clinical Settings Overview
The Minnesota Safe Patient Handling for Clinical Settings law applies to “every clinical setting that moves patients”. In order to know if this law applies to a given individual clinic we first have to define the meaning of “moves patients”. According to my conversation with Ben Bloom, Minnesota OSHA safety investigator, on December 18, 2009, the law is “very broad in scope” in its definition. He stated the moving of patients includes providing “physical assistance” such as “lifting, transferring, and repositioning” of patients. Some examples that he gave were repositioning a patient in the dental exam chair, transferring a patient from a wheelchair, and providing significant assistance to help patients get in and out of the exam chair. There are numerous possible cases where moving of patients can occur, so it would be impossible to list them all. He said this law would not apply to any clinic in which “all of their patients are ambulatory and able to move themselves”.
The law states that by July 1, 2010, each clinic must have a written SPH plan to achieve by January 1, 2012 the “goal of ensuring the safe handling of patients by minimizing manual lifting of patients by direct patient care workers and by utilizing safe patient handling equipment”.
The plan needs to include:
• Assessment of risks with regard to patient handling that considers the patient population and environment of care;
• Acquisition of an adequate supply of appropriate safe patient handling equipment;
• Initial and ongoing training of direct patient care workers on the use of this equipment;
• Procedures to ensure that physical plant modifications and major construction projects are consistent with plan goals; and
• Periodic evaluations of the safe patient handling plan.
• A health care organization with more than one covered clinical setting that moves patients may establish a plan at each clinical setting or establish one plan to serve this function for all the clinical settings.
A Closer Look at Each Requirement
An accurate and comprehensive risk assessment of patient handling tasks is needed as that is the basis upon which decisions about what type and quantity of SPH equipment are needed are made. In order to get a true picture of the risks, it is recommended that the following should be included:
• Patient population profile: age, size, mobility level, use of any walking aides (walker, cane, etc.) and wheelchairs
• Physical environment of patient care areas: assessment of the space — i.e., do exam rooms have space for walkers and wheelchairs; are there electric dental chairs in exam room
• List of existing SPH equipment — if clinic has any
• Types and frequency of patient-moving tasks: assist patients on/off dental exam chair, repositioning of patients on exam chair, etc.
• Input from management and staff
• Peak workload periods: are there certain days/times of the week that the majority of mobility-impaired patients come to the clinic
Many different types of SPH equipment are available. The type and quantity that an individual clinic will need is dependent upon the results of the risk assessment. Let’s take an example. The results of the risk assessment for XYZ Clinic show that approximately 30% of its patient population is more than 60 years old, and of those, approximately half use walkers or canes. All but one of the dental exam rooms is just large enough to accommodate the use of a walker. There is one exam room which is larger and has ample space at the side and foot of the exam chair to accommodate a wheelchair. All of the dental exam chairs have adjustable seat backs that allow for a sitting to a fully reclined position. The exam chairs do not adjust for height and do not go into a chair position. The primary patient handling task occurs when helping patients stand up from the exam chair. Feedback from staff states that the level of assistance patients need is usually minimal, but there are a few patients who require significant physical assistance by one or two people to help the patient on and off the exam chair. In this scenario, there is only one task that has to be addressed for SPH: assisting patients on and off the exam chair. Equipment options could include transfer belts to use with patients who require moderate assistance by one person and/or a sit-to-stand device for those patients who require greater assistance.
SPH is likely to be new to you and all of your direct patient care staff. There are two training requirements that must be met. First is the initial SPH training of the staff. Obviously, staff will need to know how to use the equipment. As with other new products and equipment, vendors are usually very willing to provide this training. This training should be hands-on so everyone gets to be the “patient” as well as the user. When staff experience firsthand what it is like to be the patient, it will be easier for them to explain to their patients what to expect from the equipment and what it will feel like. Since SPH is likely to be new to everyone, it is also recommended that staff receive additional education on what SPH is and why it is important, how to know when SPH equipment should be used, and go through different patient scenarios to reinforce their learning.
The second requirement that has to be met is ongoing SPH training. This should be done on an annual basis and whenever new equipment is brought in. Annual training or competency can be done by different methods, which include hand written, online, and/or hands-on. Since the proper use of SPH equipment is vital in preventing patient harm, it is highly recommended that the competency include some form of hands-on performance to ensure staff truly knows how to use it.
All training should be tracked and recorded. All new employees hired after the initial SPH training must receive the same training. It is advisable to designate one or more employees as “SPH experts”. As “SPH experts”, they should receive extra training so they are very comfortable with the equipment, are at ease being the “go to” person when people have questions, and are able to train new hires and conduct annual competencies.
New Construction/Remodeling Site Planning and Design
Any clinic remodeling or new construction of patient care areas must be evaluated to make sure the design incorporates SPH equipment and goals. Be sure to inform the architect and/or project manager of the need to include SPH in the design. If they are not familiar with SPH, then you may want to consult with an ergonomist to ensure that the design will be effective and functional for the end user for patient handling.
As with any program or system that you implement, you will want to know if it is successful and achieving the expected outcomes. All successful systems are regularly evaluated and improvements are made if needed. In order to do this, performance metrics need to be developed. Performance metrics should be “SMART” — Specific, Measurable, Actionable, Relevant, and Timely. For all performance metrics (PM), you should have a performance object (PO) and a performance goal (PG) associated with it. This is one example of a SPH Metric related to initial staff training:
PO: All direct patient care providers have been trained in SPH
PG: 100% of direct patient care providers completed initial SPH training upon roll out and/or upon hire
PM: Actual percentage of direct patient care providers trained upon roll out and/or upon hire
When developing and implementing anything new, usually there is a point person or leader, a policy around the new procedure, and, depending upon the size and scope required, a committee may be formed. It is advised that one person in the clinic is appointed the SPH “leader”. There needs to be someone responsible for overseeing the SPH system, to make sure that all of the required tasks have been completed, and to monitor and evaluate the system. A clinic policy that is specific to SPH is recommended so the purpose, goals, and roles and responsibilities of management and staff are clear. For larger clinics, it may make sense to form a small SPH committee that is in charge of meeting the law’s requirements so the responsibilities and tasks are spread among a few people versus only one person.
Clinical settings have been added to the Minnesota Safe Patient Handling law. Even though previously dentists may not have considered manual assisting of patients to be a safety hazard, studies have clearly shown the risk for injury to staff and patients. By being the first state to address patient handling in clinics, Minnesota is acknowledging that patient movement can occur in all clinical settings and is demonstrating its desire to ensure staff safety at those previously overlooked facilities. SPH and the SPH law requirements may seem a bit foreign and confusing at first, but hopefully, by reading this article dentists and their staffs have gained the understanding and knowledge they will need to make sure each individual clinic meets the compliance deadline.
2. U.S Bureau of Labor Sta. (2007). Nonfatal occupational injuries and illnesses requiring days away from work. Available from: http://www.bls.gov/news.release/pdf/osh2.pdf
3. Waters, T. R. (2007). When is it safe to manually lift a patient? American Journal of Nursing , 107 (8), 53-58.
*Jill Kelby is president of Ergo-PATH System, LLC, Eden Prairie, Minnesota. Email is firstname.lastname@example.org.