Feature Article 7

Analysis of Ergonomic-Related Injuries in Nursing Homes: A Case Study

By Charles W. McGlothlin, Jr., Ph.D., P.E. and Ashley B. Streetman

Author Biographies

Charles W. McGlothlin, Jr., Ph.D., P.E.
Program Director & Assistant Professor
Occupational Safety & Health
School of Health Sciences
Oakland University
Rochester, MI

Charles W. McGlothlin, Jr. is Assistant Professor and Program Director of the Occupational Safety and Health Program at Oakland University in Rochester, Michigan. He has work as an engineer, operations manager, and safety educator for over 40 years. Professor McGlothlin received BS and MS degrees in Mining Engineering from West Virginia University and his Ph.D. in Education and Human Resource Studies at Colorado State University. He has served as the corporate officer responsible for operations and environmental, health, and safety compliance at mining operations for Bethlehem Steel in Pennsylvania, Atlantic Richfield and Kaiser Coal corporations in Utah, and KN Energy in Colorado. In addition, he has worked as a Registered Professional Engineer in Pennsylvania, Utah, and Colorado and continues to work as a safety and health consultant domestically and internationally.

Dr. McGlothlin is a professional member of the American Society of Safety Engineers and a member of the National Safety Management Society, the Midwest Cooperative Education and Internship Association, and the National Safety Council. He serves on the ASSE Education Standards Committee and the Executive Committee of the ABET Applied Science Accreditation Commission. In 2006 Dr. McGlothlin was recognized as the ASSE Educator of the Year.

Ashley B. Streetman
Occupational Safety & Health Student
Oakland University, Rochester, Michigan

Ashley B. Streetman is a senior in the Occupational Safety and Health B.S. degree program at Oakland University in Rochester, Michigan. She has a 3.28 overall GPA and is recipient of a 2007-2008 OU School of Health Sciences Undergraduate Research Grant that is supporting her current research into ergonomically-related injuries in nursing homes/extended care facilities. Ashley also was awarded a DaimlerChrysler Diversity Scholarship and a Michigan Safety Conference Scholarship in 2007. She is currently the OU ASSE Student Section Vice President and will begin her senior internship experience this fall with the Chrysler Group.

Abstract

An analysis to identify ergonomic-related risk factors that are resulting in excess injuries to nursing home staff and residents and determine the impact of engineering controls designed to minimize manual transfers of residents. The research study hypothesis is that engineering controls designed to minimize or eliminate manual transfers of residents in extended are facilities will result in a significant reduction of injuries to nursing home staff and residents.

Introduction
1.  Problem

One of the most prevalent and costly safety and health problems in the modern workplace is work-related musculoskeletal disorders (NIOSH 2006).  According to the International Journal of Nursing Studies (Nelson et al., 2006), nurses have one of the highest rates of musculoskeletal injury of any profession over the last 30 years.  Caregivers in nursing homes and extended care facilities are among the nations highest in number when it comes to suffering ergonomic-related musculoskeletal injuries.  These injures primarily occur to nursing aides as a result of lifting and handling nursing home residents.

The Bureau of Labor Statistics recently reported that musculoskeletal disorders were the most common type of nonfatal injury or illness reported by nearly 800,000 nursing, psychiatric and home health aides from 1995 to 2004.  In 2004, 54 % of workplace injuries and illnesses in this group involved musculoskeletal disorders which the U.S. Department of Labor defines as an injury or disorder of the muscles, nerves, tendons, joints, cartilage or spinal discs.  These types of disorders are related to events such as bodily reaction, overexertion, and repetitive motion and do not include injuries caused by slips, trips and falls or similar accidents.  The most common event resulting in musculoskeletal related injury is the manual transfer of a nursing home resident from one position or location to another.

The National Safety Council, OSHA, and NIOSH have all published on this subject matter in 2006 recognizing this national safety problem in nursing homes and extended care facilities.  According to the American Nurses Association (2003), the occurrence of musculoskeletal injuries may have a profoundly discouraging effect on the current nursing shortage in light of an aging nursing workforce and waning numbers of professional entrants.  If the current situation is troublesome, what does the future hold as the baby boomers find the need for nursing home/extended care?  Because of this rapidly expanding elderly population in the U.S., employment for nursing aides and orderlies is projected to increase by 25% between 2002 and 2012.  This growth will add an estimated 343,000 jobs in nursing home/extended care facilities (Bureau of Labor Statistics, 2007).

In 2004, nursing home and residential care facilities experienced 206,000 nonfatal occupational injuries suffered by caregivers.  These facilities experienced a total recordable case rate of 9.7 and cases with days away from work, job transfer, or restriction (DART) rate of 5.8 in 2004.  In 2005, Michigan nursing home and residential care facilities total recordable case rate was 20.6 and the DART rate was 14.9 (Bureau of Labor Statistics, 2007).  OSHA targeted over 4,000 of America’s most hazardous worksites for unannounced comprehensive inspections in 2006 based on their Site Specific Targeting Program which allows OSHA to direct resources to industries and workplaces with the highest injury and illness rates.  Nursing homes and residential care facilities were included on the agency’s primary list for inspection as a result of the high rates of ergonomic-related musculoskeletal injuries (National Safety Council, 2006).

Michigan has a state plan OSHA program and has established a committee to address ergonomic-related injuries in the state’s workplaces.  In light of the well established ergonomic-related injury problem in nursing homes across the nation and in Michigan particularly, the Martha T. Berry Medical Care Facility and the Macomb County Risk Management Department in Macomb County, Michigan established a partnership with Oakland University in Rochester, Michigan to develop an ergonomics program to prevent work-related musculoskeletal disorders and reduce the associated costs at Martha T. Berry.  Martha T. Berry is a 217 bed long-term care facility which is owned and operated by Macomb County.  This project is a joint effort by the above Macomb County groups, the Occupational Safety and Health and the Physical Therapy programs at OU, and an undergraduate researcher in the OSH program at Oakland University.

2. Purpose

The primary purpose of this study is to identify ergonomic-related risk factors that are resulting in excess injuries to nursing home staff and residents and to determine what impact site-specific engineering controls designed to minimize manual transfers of residents might have on these ergonomically-related injuries.  The research study hypothesis is that engineering controls designed to minimize or eliminate manual transfers of residents at the Martha T. Berry Medical Facility will result in a significant reduction of injuries to nursing home staff and residents and will result in a significant reduction in both direct and indirect injury-related costs.

In addition, it is the purpose of this study to develop a nursing home specific risk assessment tool and cost/benefit analytical tool that can be used at other nursing home facilities to identify engineering controls to address ergonomically-related risks and injuries and then facilitate cost justification of those engineering interventions to reduce ergonomically-related injuries in those extended care facilities.  This analytical approach could result in a user friendly management system which could have a major impact on a current nationally recognized ergonomically-related injury problem area.

3. Research Methodology

This research project is designed as a case study of the Martha T. Berry facility using both quantitative and qualitative research methodologies.  The facility is being evaluated based on analysis of injury and illness data, accident reports, workers’ compensation claims, employee turnover, employee interviews and perception surveys, focus groups, and observations of work practices.  Evaluation of work practices will be assessed through the development of a risk assessment tool based on a review of the literature, consultation with loss control experts, and recent publications by NIOSH (2006).

4. Intervention

The intervention in this case study includes development of an ergonomics program consistent with OSHA Ergonomic Guidelines for Nursing Homes (2005).  Although not mandatory, these guidelines are specifically tailored to the needs and injures specific to nursing home and extended care facilities.  OSHA recommends that the manual lifting of residents be minimized in all cases and eliminated when possible.  The programs will be tailored to the specific needs of the Martha T. Berry facility and will follow the OSHA Ergonomic Guidelines for Nursing Homes.  The Martha T. Berry Ergonomics Program will consist of the following elements:

5. Results

From the review of the literature and a visit to one of the nation’s best examples of a no-lift nursing home in Ohio, it is anticipated that the null hypothesis will be rejected in favor of the alternative/research hypothesis stated above.  The Wyandot County Nursing Home in Upper Sandusky Ohio is considered one of the benchmark nursing homes which has moved to a no-lift policy to reduce employee injuries and related costs. The Wyandot facility was featured in OSHA’s Nursing Home Guidelines (2005) as an example of an effective approach to the resident handling problem in nursing homes and used a process that reflects many of the recommendations in the OSHA guidelines.  The Oakland University research team visited this facility to see first-hand how they initiated the project, learn from their experiences, and gain insight into an effective approach at Martha T. Berry facility.

Before Wyandot implemented its ergonomics program, their workers compensation costs averaged almost $140,000 per year and the turnover rate among nursing assistants averaged over 55% annually.  Fifty-two percent of Wyandot’s workers’ compensation claims were a result of ergonomically related injuries and averaged more than $5,000 each.  Before the engineering interventions were in place nursing assistants’ resignations averaged 25 per year.  Since resident handling equipment has been installed and a no-lift policy implemented, nursing aides resignations have dropped to less than five per year.  Only one nurse’s aide resigned last year and the facility has a waiting list for new hires.  Workers’ compensation costs have declined to an average of less than $4,000 per year.  Workers’ comp savings coupled with annual payroll costs savings due to reduced overtime and absenteeism and reduced turnover costs have resulted in Wyandot realizing less than a one year payback on the resident handling equipment investment. 

If, as expected, the study hypothesis is demonstrated to be effective and is accepted at the Martha T. Berry facility, similar injury prevention and cost saving are anticipated as realized at the Wyandot Nursing Home.  In addition, a process for data collection, analyses, and cost/benefit analysis could then be developed and offered to area nursing homes to facilitate cost justification of engineering interventions to reduce ergonomically-related injuries in those extended care facilities. 

Conclusion

Although this case study is not complete, there is considerable optimism by the Martha T. Berry staff, Macomb County Risk Management Department, and Oakland University participants that the Martha T. Berry Medical Care Facility will achieve significant reductions in ergonomically-related musculoskeletal injuries and realize significant associated cost savings. 

References

American Nurses Association, Comment to 29CFR1910 Ergonomics Proposed Rule, submitted by Mary Foley, March 1, 2000 to U.S. Department of Labor – Occupational Safety and Health Administration.

American Nurses Association (2003). Handle with care: The American Nurses Association’s campaign to address work-related musculoskeletal disorders. Available at http://www.nursingworld.org/handlewithcare/brochure.htm.

Bureau of Labor Statistics (2007). Survey of occupational injuries and illnesses, 2003. US Department of Labor. Available at http://www.bls.gov/data/home.htm.

Bureau of Labor Statistics (2007). Highest incidence rates of total nonfatal occupational injury and illness cases, private industry, 2003. Available at http://www.bls.gov/data/home.htm.

Bureau of Labor Statistics (2007). Occupations with the largest job growth, 2002-2012. Available at http://www.bls.gov/emp/emptab4.htm.
Collins JW, Wolf L, Bell J, Ebanoff B (2004). An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Injury Prevention, 10, 206-211.

National Institute for Occupational Safety and Health. (1997). Elements of ergonomics programs. DHHS (NIOSH) Publication No. 97-117. Cincinnati, OH.

National Institute for Occupational Safety and Health. (2006). Safe lifting and movement of nursing home residents. DHHS Publication No. 2001-122. Cincinnati, OH.

National Research Council and Institute of Medicine. (2001). Musculoskeletal disorder and the workplace – low back and upper extremities. National Academy of Sciences. Washington, DC: National Academy Press.

National Safety Council (2006). OSHA outlines 2006 inspection targeting program. OSHA Up to Date, 35, 2.

Nelson N., et.al., (2006) Development and evaluation of a multifaceted ergonomics program to prevent injures associated with patient handling tasks. International Journal of Nursing Studies, 43, 717-733. Available at www.sciencedirect.com.

United States Department of Labor – Occupational Safety and Health Administration. (2005). Guidelines for nursing homes: Ergonomics for the prevention of musculoskeletal disorders. Washington, DC. Available at http://www.osha.gov/ergonomics/guidelines/nursinghome.

United States Department of Labor – Occupational Safety and Health Administration. (2005). OSHA effective ergonomics: Strategy for success: Four pronged comprehensive approach. Washington, DC. Available at http://www.osha.gov/ergonomics/.