Importance of lift teams to nurses

Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety. “I don’t see a differ- ence. I see a world in which everybody is testing. With the federal Drug-Free Workplace [Act], there are few employers who have federal con- tracts who are not testing. You have to wonder – the places that are not testing, are they magnets for people who can’t get a job elsewhere?”

Strong Memorial Hospital in Rochester does not use random drug-testing. But Auerbach, who is an MRO and moderates an MRO listserv, says that random testing can be effective as a deterrent. It should be used with other programs to detect performance problems that could be drug- or alcohol-related and programs to enable employ- ees to come forward and receive treatment and support.

“You do [random testing] in a way that respects the dignity of the individual being tested, most of whom are not going to be drug users,” says Auerbach. “You give everyone an equal opportunity to be tested.”

Random testing is just one part of a broader program that includes treatment, he says. “I fully agree with the need for treating drug use in a med- ical way, in a compassionate way, and offering vol- untary routes to take care of the issue,” Auerbach says. “That is in no way mutually exclusive to the fact that many people don’t come forward. I think it’s very important that you have both [elements].”

Dose tracking catches diverters

At Vanderbilt University, Mary Yarbrough, MD, MPH, director of occupational health and wellness, sees a number of conditions that could affect employee performance, from the declining vision of older workers with presby- opia to depression. She wonders how much attention should be focused on random drug- testing in an atmosphere of limited resources.

“I think the way you identify drug users is by watching their behavior,” she says. “If we have a limited resource, why not put that money into supporting supervisors in their role [of monitor- ing performance].”

Yarbrough also favors treating drug abuse as a medical problem and encouraging physicians, nurses, and others to come forward for counseling and treatment. “If you voluntarily come in and seek help, we will be an advocate for you,” she says. “If you go to treatment and get help, we will treat this, as long as there’s not been any indication that there’s been a problem in the workplace.”

Bill Buchta, MD, MPH, medical director of the Employee Occupational Health Service at the Mayo Clinic in Rochester, MN, also questions the use of resources for random drug-testing. “It fos- ters an environment of distrust and that’s not what we want here at Mayo Clinic,” he says. “I’m sure that not what most people what.”

Tampa (FL) General Hospital uses the AccuDose- Rx medication delivery system (www.mckesson. com) to monitor narcotic use. For example, the tracking database can produce monthly reports indicating how many doses of meperidine 50 mg for injection are given by each nurse compared to other nurses on their unit or in the entire hospital and can track the dosage by the date and time it was removed, explains JoAnn Shea, MSN, ARNP, director of employee health and wellness. The Employee Health Director and the pharmacy nurse liaison review the AccuDose reports via a computer database monthly and identify and investigate discrepancies.

In one case, a nurse in the recovery room was drawing twice as much morphine as other staff — although his charts didn’t show a difference in patient conditions. In another case, an emergency department nurse was taking 100 merpidine a month while co-workers were taking two or three. Those employees were placed in treatment for sub- stance abuse.

Shea estimates that it would cost $20,000 to $30,000 a year to conduct random testing. “Is it really worth it? I’d rather spend that money on promoting health for employees, and spending time identifying the diverters,” she says. ■

Linen lift teams lighten the load Fewer injuries with carts, tugs

Lift teams aren’t just for patient handling. Asthe UC Davis Health System in Sacramento discovered, the same concept can reduce injuries for other workers who must transfer heavy loads.

At UC Davis, environmental services workers were at high risk of musculoskeletal injury. Workers change about 10 tons of soiled linen each day.

Custodians would lift linen bags from patient rooms to carts. Laborers would lift bags from the carts to larger transfer carts and then into another cart, for transport to an outside laundry.

68 HOSPITAL EMPLOYEE HEALTH ® / June 2007

A single custodian might lift 40 or 50 heavy bags of linen in a day. A bag of wet linen could weigh 30 or more pounds. “Every single lift they made was a chance to get injured,” says Janet Ford, PT, MS, a physical therapist and workers compensation biomechanics specialist.

In the 2004-2005 fiscal year, the environmental services department suffered about 50 shoulder and back injuries. Linen closets are small, so the hospital couldn’t just use smaller bags and let them pile up.

To design a new method of handling laundry, Ford shadowed custodians and laborers and investigated options. The result: Linen lift teams that use small carts connected to each other and to a motorized tug. The lift teams use a mechani- cal lift to empty carts into a larger container that is shipped to a nearby laundry.

The new equipment cost about $20,000, esti- mates Sures Chandra, assistant manager of envi- ronmental services and conference services. “The cost of one injury can easily offset that,” he says.

Repetitive lifting was culprit

Ford began her investigation into laundry han- dling with a basic question: What is causing the injuries? Custodians thought the nurses were fill- ing the laundry bags too full, and nurses wanted the laundry removed more promptly. But those issues weren’t the real problem.

The main risk factor was repetitive lifting, she discovered. Pulling and pushing linen-filled carts through the hallways also caused problems.

Even injuries that seemed unrelated to linen may have been connected, Ford suspects. “When you look at your workers’ compensation injuries, sometimes it’s misleading,” she says. “When some- one says they hurt themselves mopping, it may be because they were tired from lifting linen.”

The hospital previously had considered a sys- tem of small, rolling bins in patient rooms or hall- ways, in which nurses would place soiled linens. That would eliminate multiple lifting of laundry bags. But fire codes wouldn’t allow for bins in the hallways.

Ford decided to focus on a well-trained group of employees for laundry lifting, just as the hospital does for patient lifts. The hospital hired six new employees to work as a linen lift team. They work in two-person teams on the day and evening shifts, with one additional person in each team to allow for time off.

“We’ve now taken a large number of employees

out of lifting linen, so we are reducing our expo- sure to risk,” she says.

The hospital could have identified existing employees in environmental services to form the lift team, but the additional staff allowed the cus- todians to spend more time on the floors, says Chandra. “We decided to allow our existing cleaning crew to do additional cleaning on the floors,” he says.

The linen lift crew starts at the loading dock and empty caster carts to the units. There they swap out their carts for one in the soiled linen utility closet and collect linen from each patient room. They make a reverse trip with the loaded caster carts that hook together and maneuvering them with the tug back to the dock. (Caster carts have two large wheels and two small wheels in the front, which make them easy to tip but stable when upright.)

Making a change requires patience and flexibil- ity, Ford cautions. She sought feedback from employees and made changes in the new lift pro- gram when it seemed necessary. For example, the hospital initially considered a stationary mechan- ical lift to empty larger collection carts at the loading dock and decided it wouldn’t work out. A mobile lift worked better.

It may take time for everyone to see the benefits. In fact, in the first year, the number of injuries within the Environmental Services department actually rose, from 46 to 48 — although the severity decreased by 42%. In the first half of the next year, injuries were down by 38% and costs declined an additional 39%.

Equipment alone won’t solve your problems, either, says Chandra. It’s also important to train employees in lifting techniques and body mechan- ics, he says.

“You have to give them good training and plan their routes well so they get sufficient rest,” he says. “That’s the only way you prevent injury.” ■

Taking a LEAP lowers WC costs Fewer CNA injuries with lifts

It’s a common disconnect: An employee at home,healing from an injury, feels increasingly distant from work. As time passes, the chance of that employee returning to work drops. The result: high workers’ compensation costs.

June 2007 / HOSPITAL EMPLOYEE HEALTH ® 69