A new era in lift/transfer: the ergonomics expert who helped develop the Beverly Enterprises/OSHA settlement offers guidance toward a new approach - Feature Article

Nursing Homes, May, 2002 by Guy Fragala

After many years of controversy and argument, Beverly Enterprises, Inc., and the Occupational Safety and Health Administration (OSHA) settled an enforcement action that began in May 1991. OSHA had issued citations to five Beverly-owned Pennsylvania nursing homes in response to complaints that workers were suffering back injuries related to lifting and transferring residents. The citations had been issued under OSHA's General Duty Clause, which states that an employer must provide its employees with a workplace free from recognized hazards that cause or are likely to cause serious physical harm.

Beverly contested those citations, and a long legal process ensued. Through 11 years of litigation, the situation took many turns and ran parallel with OSHA's development of an Ergonomic Management Standard.

As an occupational and safety health professional who is very interested in methods to reduce the risk of occupational injuries to healthcare workers, I had closely followed this case. About a year ago I was contacted and told that OSHA and Beverly wanted to try to work toward a settlement agreement and wanted an independent expert on the issues of resident lifting and worker safety to help with the process. I was asked to consider working with both sides on the settlement agreement. As I entered the process, I viewed it as an excellent opportunity for everyone involved to work together constructively, with an eventual "win-win" outcome. Potential outcomes included:

* OSHA achieving success in implementing programs to protect healthcare workers at high risk for occupational injuries.

* Beverly Enterprises implementing a management program that would help reduce occupational injuries to its workforce and, in the process, hopefully, reducing financial burdens and yielding other benefits for the organization.

* Healthcare workers experiencing an improvement in the quality of their work life.

Residents becoming safer and more comfortable through the implementation of new and improved methods of lifting and transferring.

Initially, my hope for these outcomes might have seemed unrealistic. Now that a settlement has been reached, however, I believe the opportunity exists to achieve many of these benefits. I further hope--and it is the reason I am writing this article--that these benefits will disseminate beyond the Beverly organization and result in improvements for the entire healthcare industry.

Much of my role in the settlement process involved helping to structure the lift program's policy and guidelines that have been incorporated into the settlement agreement. A very important part of this guide was the development of "Preferred Methods for Lifting and Transferring Residents." These provide guidance for what are considered to be the best and safest methods to lift or assist residents, based on their dependency level. The intent was, in this manner, to help facilities incorporate methods of transferring into each resident's specific care plan, rather than make it a separate concern. Thus, the method for lifting or assisting is determined by the resident's classification, as obtained from MDS reports using the standard dependency classifications already used in long-term care.

Determining Preferred Procedures for Lift and Transfer

Based on the resident's classification from the MDS reports, specific methods of transferring and lifting will be designated. Different methods might be necessary for different tasks and will be so designated. These designated methods will be clearly recorded and accessible to all staff that perform lifting and transferring tasks and will be included in the resident's care plan. Should a resident's mobility or need for assistance vary throughout the course of a day, or from day to day, this will be noted in the resident's care plan. The care plan shall give the caregiver explicit guidance as to when it is appropriate to employ a different method of lifting or transferring and how to make that determination. The scope of the caregiver's discretion in this matter shall be clearly delineated. Where questions remain, the caregiver shall employ the method of transferring providing the highest level of protection to him/herself and the resident. This information can be communicated through the means of charts or st ickers located on the resident's bed, door and/or wheelchair; at nurses' stations or offices; or through other means determined by the facility. As appropriate, the caregiver will meet with the staff that conducted the initial assessment to provide any information relating to a perceived change in the resident's condition.

Preferred Procedures by Resident Classification

Total dependence, Class 4. All residents classified as total dependence (Class 4) shall be lifted and transferred between beds, chairs, toilets, and bathing and weighing facilities by means of a full-sling mechanical lift device. In some situations another means of transfer might be required, but the first option considered should not involve manual lifting.