An interview with Breca Tschida, CPE, Ergonomics Program Coordinator, Workplace Safety Consultation, Minnesota OSHA by Steve Shuman, D.D.S., M.S., Associate Professor, University of Minnesota School of Dentistry, and Chair of the MDA Elderly and Special Needs Adults Committee and Peg Simonson, RDH, B.S., Dental Hygienist and Adjunct Instructor, University of Minnesota School of Dentistry and consultant to the MDA Elderly and Special Needs Adults Committee.
Minnesota enacted Safe Patient Handling legislation in 2009 that established new safety requirements for medical and dental clinics. To assist practices in preparing for implementation of these new regulations and answer some key questions now on the minds of dental practitioners, Dr. Steve Shuman, Chair of the MDA Committee on Elderly and Special Needs Adults, and dental hygienist Peg Simonson, a consultant to this committee, visited the Minnesota Department of Labor and Industry (DLI) offices to interview Breca Tschida, a certified ergonomist from the Minnesota Occupational Safety and Health Administration’s Workplace Safety Consultation.
Q: Why was it necessary to include medical and dental offices in addition to hospitals and nursing homes in Minnesota’s Safe Patient Handling regulations?
A: The health care industry recognizes that manually lifting and transferring individuals with physical limitations due to weight or disability are highrisk activities for both the person being lifted or transferred and the person doing the lifting. Additionally, increasing numbers of individuals with disabilities are expressing concern about the serious limitations in access to basic health care services. Limited physical and programmatic access to health care services for people who move differently or who are unable to move discourages participation in routine preventive care and creates delays at early intervention points that would otherwise be effective and less costly.
In an attempt to address safe patient handling issues, the 2007 legislature directed that “By July 1, 2008, every licensed health care facility in the state shall adopt a written safe patient handling policy establishing the facility’s plan to achieve by January 1, 2011, the goal of minimizing manual lifting of patients by nurses and other direct patient care workers by utilizing safe patient handling equipment.” Medical and dental clinics are not licensed facilities and were not included in this original law, so to address this, legislation was passed that a work group be convened to prepare a report on safe patient handling issues in clinic settings, and the recommendations of this work group were adopted by the legislature into law in 2009.
Q: What are key requirements of the Safe Patient Handling regulation for dental practices, and what are the deadlines?
A: As of July 1, 2010, dental practices were to have a written safe patient handling plan that contains all the elements outlined in the statute. The goal of this plan is to minimize manual lifting by January 1, 2012. This would include having adequate equipment and making provisions for training as needed.
Q: What if dental practices can’t meet these deadlines? Will there be inspections or penalties?
A: Minnesota OSHA schedules inspections with the following priority: imminent danger, fatalities or catastrophes, formal complaints, referrals, follow-up, and programmed routine. Dental clinics are not currently scheduled for routine inspections, and dental offices have not been identified as having high rates of occupational injuries.
Q: What is the easiest way to develop and document that dental offices have a “Safe Patient Handling Program” that meets regulatory requirements?
A sample program template is provided on the Minnesota DLI’s website at: http://www.dli.mn.gov/WSC/SPHlegislation.asp
. This has been designed so dental offices can quickly and easily download and complete the document.
Q: The Minnesota DLI’s Safe Patient Handling Program Template says that practices have to perform a patienthandling hazard assessment and that completed written hazard assessments will be maintained with a master copy of the written safe-patient-handling program. Can you tell us how dental offices should do this?
A: Dental offices should assess their patient population to determine their patients’ needs for moving and repositioning using the hazard assessments that are being finalized by MNOSHA with MDA input and will be posted on the DLI and MDA websites shortly.
Q: The Safe Patient Handling Program Template also says that patients are supposed to be assessed for safe-patient-handling needs before arrival at the office and for relevant activities in care delivery. This information is also supposed to be included in patient records along with safepatient-handling requirements for that individual. How should dental practices go about this?
A: Prior to an individual’s arrival at the practice, information on the patient’s transfer needs should be collected. Information that will help the practice determine a patient’s lifting needs would include whether the patient walks independently, walks but needs assistance (e.g., walker, cane, or escort), needs a wheelchair but transfers independently, needs a wheelchair with one person assistance with transfer, or needs a mechanical lift. We are also working with the MDA to develop a short assessment tool that will help dental practices document this type of information for their patient records.
Q: Can a dental office decide not to see someone because he or she needs assistance in lifting or transferring?
A: Generally no, according to the U.S. Department of Justice’s document “Access To Medical Care For Individuals With Mobility Disabilities.” Because of the provisions of the Americans with Disabilities Act, problems could arise if you deny services to a patient whom you would otherwise serve simply because he or she has a disability. In order to provide care that is comparable to what would normally be provided to others, appropriate and accessible equipment may need to be available, along with enough trained staff to assist the patient to transfer.
Q: How should offices decide what type of Safe Patient Handling equipment they would need to comply with the regulations?
A: Algorithms for the assessment of hazards in lifting or moving patients have been developed by MNOSHA Workplace Safety Consultation in collaboration with the MDA’s Committee on Elderly and Special Needs Adults, and will be available on the Minnesota DLI as well as the MDA’s websites. These algorithms are simple step-by-step flowcharts to help dental practices identify what situations they typically would encounter if their patients require assistance in movement. These algorithms will, in turn, guide offices in determining what type of safe patient handling strategies and equipment will be needed.
Q: The regulations also require appropriate training if practices have patients who require assistance in movement. What type of training is required and where is it available?
A: Physical therapists would also be able to provide training on transfer techniques and appropriate use of some types of safe patient handling equipment such as gait belts or transfer boards. Training on more complex types of equipment, such as mechanical lifts, should be provided to the caregivers, and many safe patient handling equipment companies offer this as a service when purchasing their equipment.
Q: What if a dental office does not have any patients who require special assistance with movement? What type of documentation do they need to comply with the SPH regulations?
A: No formal documentation is required if a dental office does not have any patients who require special assistance with movement. A dental hazard assessment certification can be completed and kept on file. However, reassessment of the patient population should be conducted on a periodic basis to determine if any changes in status have occurred.
Q: Where can dental practices get more information if they need help in implementing the new Safe Patient Handling regulations?
As the Ergonomics Program Coordinator for MNOSHA’s Workplace Safety Consultation, dental practices may contact me directly, or can visit the Safe Patient Handling website at http://www.dli.mn.gov/WSC/SPHlegislation.asp
. We are also working with the MDA to make sure that all of the necessary information, such as the Safe Patient Handling Program template, hazard assessments algorithms, and other resources are posted on the MDA web site. MDA members can also contact MDA’s Elderly and Special Needs Adults Committee via the MDA central office for further information.