Article Text

Use of mechanical patient lifts decreased musculoskeletal symptoms and injuries among health care workers
1. J Li1,
2. L Wolf2,
3. B Evanoff1
1. 1Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
2. 2BJC Health Care, St Louis, Missouri, USA
1. Correspondence to:  Dr Bradley A Evanoff  Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8005, St Louis, MO 63110, USA; bevanoffim.wustl.edu

Abstract

Objective: To evaluate the effectiveness of mechanical patient lifts in reducing musculoskeletal symptoms, injuries, lost workday injuries, and workers’ compensation costs in workers at a community hospital.

Design: Pre-post intervention study.

Setting: Three nursing units of a small community hospital.

Patients or subjects: Nursing personnel.

Interventions: Mechanical patient lifts were made available and nursing staff trained in their use between August 2000 and January 2001.

Lift counters and compliance surveys

Lift counter data showed that the stand-up lifts were used the nursing staff, though at less than a desired frequency. Our study team estimated that each stand-up lift should have been used at least 3–4 times per day. Lift counter data showed that each stand-up lift was used an average of 1.1 times per day during the first three months of the intervention; usage fell in the second three months to an average of 0.4 times per day. The stand-up lift shared by the medicine/surgery unit and the intensive care unit was used several-fold more frequently than the stand-up lift in the subacute care unit, possibly because the first lift was being shared by two units, and because patients in the subacute care unit were less incapacitated. On the lift compliance surveys, nursing personnel reported using the lifts occasionally, and reported a number of reasons for not using them, including the increased time required to use the devices and the lack of perceived need to use a mechanical lifting device for many transfers.

DISCUSSION

We observed beneficial changes in a variety of outcomes after an intervention consisting of deployment of mechanical patient lifts and training in their use. Changes included improvements in musculoskeletal comfort and job satisfaction. Rates of recordable musculoskeletal injuries also decreased substantially post-intervention, as did the lost workday injury rates and workers’ compensation costs. Decreases in crude injury rates and lost day rates were statistically significant; after adjustment for temporal trends, large changes persisted but were not statistically significant.

Musculoskeletal comfort data appeared to be a more sensitive indicator of lift effectiveness in our study than did musculoskeletal injury rates. This may have resulted because symptom data were collected at the end of the intervention period, when usage rates of lifts may have been higher than in subsequent months. Also, injury rate data exclude milder lifting related symptoms and minor injuries that do not meet criteria for reporting under federal statutes, and underreporting of injuries on OSHA logs is a widely recognized problem. Symptom survey data have the advantage of providing information directly from participants, and collecting information on milder symptoms that may eventually result in recordable injuries. The results from this study are similar to those of a recent randomized controlled trial of injury prevention performed in a large acute care hospital in Canada, where nursing staff engaging in minimal strenuous lifting reported statistically significant improvements in musculoskeletal symptoms in comparison with the control group. Injury rates, however, were not significantly reduced, possibly reflecting “the less sensitive nature of this indicator compared to subjective indicators”.23

A unique strength of this study is its setting in a small community hospital. Most other studies of mechanical lifts have been conducted in nursing homes or large acute care hospitals.19,21,23 The community hospital setting of this study provides evidence of mechanical lift effectiveness that is more generalizeable to smaller health care settings. However, this setting led to a limited number of injury cases available for analysis, and made it more difficult to detect statistically meaningful results. Other potential limitations of our study included its pre-post study design and loss to follow up on surveys. Due to the pre-post study design, we cannot be certain that the changes observed on the intervention units resulted from the intervention. To minimize this effect, we controlled for temporal trends in injuries and lost workdays in the hospital as a whole by adjusting injury and lost day injury rates using concurrent data from non-intervention units. For the symptom surveys, staff turnover was a factor for the relatively low survey response rate (59%). Analyses comparing baseline responses of staff that did and did not complete follow up surveys showed that non-responders were more likely to be dissatisfied with their jobs, consistent with the greater possibility that they would leave their jobs. However, non-responders experienced fewer musculoskeletal symptoms compared with staff that responded to the follow up survey. This decreased the possibility that the absence of non-responders affected reporting of symptoms in a favorable manner.

One problem that we encountered during the study is the reluctance of many nursing staff to use mechanical lifts for patient handling tasks, as seen in the lift counter data. According to the monthly compliance surveys, the main reason reported by staff for not using a mechanical patient lift was the lack of perceived need, followed by the lack of time and the lack of maneuvering space. Non-usage and the reasons behind it have been common problems in previous studies involving mechanical patient lifts.10,21 Staff may be especially unlikely to use lifts for patients in isolation, since each use required that parts of the lift be cleaned or laundered. Inexperience in using the lifts and staff turnover presented other deterrents to compliance. Additional training and incentive programs may be needed before nursing personnel consistently use mechanical lifts. Other means of increasing lift use include encouragement by management, such as the adoption of a policy of no manual lifting. Such policies have been successful in reducing injury rates in long term care facilities.24

Key points

• The study evaluated the effectiveness of mechanical patient lifts in reducing the musculoskeletal symptoms and injuries associated with lifting in health care workers.

• The study occurred in a community hospital setting.

• The study showed a decrease in musculoskeletal symptoms, injury rates, and lost day injury rates after implementation of mechanical patient lifts.

• There is a need to develop methods to improve compliance in lift usage to further reduce adverse outcomes.

Despite the low frequency of mechanical lift use and the small size of the study sample, we observed reductions in musculoskeletal symptoms and injury rates. Increased usage of lifts and other aids may result in larger reductions in injury rates. However, changes in work practices and work culture are needed before this technology is fully embraced. Methods of promoting the use of mechanical lifting aids by hospital personnel need to be further developed.

Acknowledgments

The authors wish to acknowledge Ms Barbara Renner, RN, COHN-S, and Mr Kevin Taeckens, whose work was critical to performing the intervention and collecting the data.

View Abstract

Footnotes

• This study was approved by the Institutional Review Board of Washington University School of Medicine.

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