OSHA Issues New Guidelines for Nursing Homes

March 14, 2003 - OSHA Administrator John Henshaw yesterday announced the first in a series of industry-specific guidelines for the prevention of musculoskeletal disorders in the workplace. OSHA's Guidelines for Nursing Homes focuses on practical recommendations for employers to reduce the number and severity of workplace injuries by using methods found to be successful in the nursing home environment.

"Less than a year ago, we announced that we would work with the nursing home industry and workers to develop guidelines to reduce ergonomic-related injuries in their industry," Henshaw said. "I'm pleased to announce that we have completed guidelines that will help the nursing home industry prevent ergonomic injuries to their employees."

The guidelines are divided into five sections: developing a process for protecting workers; identifying problems and implementing solutions for resident lifting and repositioning; identifying problems and implementing solutions for activities other than resident lifting and repositioning; training; and additional sources of information.

OSHA emphasizes that specific measures or guideline implementations may differ from site to site. Still, the agency recommends that all facilities minimize manual lifting of residents in all cases, and eliminate such lifting when feasible. Further, OSHA encourages employers to implement a basic ergonomic process that provides management support while involving workers, identifying problems and implementing solutions, addressing reports of injuries, providing training and evaluating ergonomics efforts.

"Nursing home workers are suffering too many ergonomics-related injuries," Henshaw continued. "But, the experiences of many nursing homes provide a basis for taking action now to better protect these workers. These guidelines reflect best practices for tackling ergonomic problems in this industry."

OSHA announced last April the agency's strategy to reduce ergonomic injuries. The four-pronged approach includes guidelines, enforcement, research, and outreach and assistance. In addition to nursing homes, the agency is preparing industry-specific guidelines for the retail grocery store and poultry processing industries.

OSHA is charged with assuring worker safety and health. Safety and health add value to business, the workplace and life. For more information, visit www.osha.gov.

Below are the details of the new guidelines.

Ergonomics Guidelines for Nursing Homes

Introduction
In April 2002, OSHA issued a comprehensive plan to reduce ergonomic injuries through a combination of industry-targeted guidelines, tough enforcement measures, workplace outreach, advanced research, and dedicated efforts to protect immigrant workers. Secretary of Labor Elaine L. Chao subsequently announced the first industry-specific guidelines to reduce ergonomic-related injuries would be developed for nursing homes. Information for the guidelines came from numerous sources, including existing practices and programs, trade and professional associations, labor organizations, the medical community, individual firms, state OSHA programs, and available scientific information. Arranged into five sections, the guidelines open with a seven-point process to protect workers. The guidelines provide recommendations for nursing home employers to help reduce the number and severity of work-related musculoskeletal disorders (MSDs) in their facilities. MSDs include conditions such as low back pain, sciatica, rotator cuff injuries, epicondylitis, and carpal tunnel syndrome.

Scope
The guidelines are designed specifically for the nursing home industry. However, OSHA hopes that employers with similar work environments, such as assisted living centers, homes for the disabled, homes for the aged, and hospitals will also find the information useful.

A Process for Protecting Workers
OSHA recommends that manual lifting of residents be minimized in all cases and eliminated when feasible. It is also recommended that employers develop a process for systematically addressing ergonomics issues in their facilities and incorporate this process into an overall safety and health program. An effective process will:

Provide Management Support. Employers should develop clear goals, assign responsibilities to designated staff members, provide resources, and ensure responsibilities are fulfilled. A sustained effort is paramount.

Involve Employees. Encourage employees to submit suggestions or concerns; discuss workplace and work methods; participate in training and procedural designs; respond to surveys; and participate in task groups with ergonomics responsibilities.

Identify Problems. Establish systematic methods for identifying ergonomic concerns in the workplace, e.g., analyze information from OSHA injury and illness logs, workers' compensation claims, insurance company reports, etc.

Implement Solutions. Effective solutions usually involve workplace modifications that eliminate hazards. Changes can include the use of equipment, work practices or both. (The guidelines include solution examples in Sections III and IV).

Address Reports of Injuries. Manage work-related MSDs in the same manner and under the same process as any other occupational injury or illness. Like many injuries and illnesses, employers and employees can benefit from early reporting of MSDs. These reports can also help the establishment identify problem areas and evaluate ergonomic efforts.

Provide Training. Provide ergonomics training to nursing assistants and other workers at risk of injury, charge nurses and supervisors, and designated program managers.

Evaluate Ergonomics Efforts. Evaluation and follow-up are central to continuous improvement and long-term success. They help sustain the effort to reduce injuries and illnesses, track whether or not ergonomic solutions are working, identify new problems, and show areas where future improvement is needed.

Identifying Problems for Resident Lifting and Repositioning
An analysis of resident lifting and repositioning tasks involves an assessment of the needs and abilities of the resident involved. The resident assessment should include:

The level of assistance the resident requires

The size and weight of the resident

The ability and willingness of the resident to understand and cooperate, and

Any medical conditions that may influence the choice of methods for lifting or repositioning

The guidelines list a number of protocols designed to help employers with resident assessment and the determination of appropriate methods for transferring and repositioning residents. Some examples include:

The Resident Assessment Instrument published by the Centers for Medicare and Medicaid Services. This information can be accessed at http://www.cms.hhs.gov/medicaid/mds20/.

Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, published by the Patient Safety Center, Veterans Health Administration and the Department of Defense. This information is available at http://www.patientsafetycenter.com

Settlement Agreement between OSHA and Beverly Enterprises entitled "Lift Program Policy and Guide." This information is available at http://www.osha.gov/.

A number of individuals in nursing homes can contribute to resident assessment and the determination of appropriate methods for assisting in transfer or repositioning. Staff nurses, certified nursing assistants, nursing supervisors, physical therapists, physicians, and the resident may all be involved.

Implementing Solutions for Resident Lifting and Repositioning
The guidelines present 22 descriptive examples (with illustrations) of options that a facility can use. Many are simple, common sense modifications to equipment or procedures that do not require a lot of time or resources. The represented categories include: transfer from sitting to standing position; resident lifting; ambulation; lateral transfer; repositioning in a chair; weighing, bathtub and shower activities. Integration of various solutions into the nursing home is a strategic decision that will lead to long-term benefits.

This section also includes questions designed to aid in the selection of equipment as well as the supplier that best meets the needs of an individual nursing home.

Identifying Problems and Implementing Solutions for Activities Other than Resident Lifting and Repositioning
Some reports indicate a number of work-related MSDs occur in activities other than resident lifting. Some activities a nursing home operator may want to review include: bending, lifting food trays above shoulder level or below knee level; waste collection; pushing heavy carts; lifting and carrying while receiving and stocking supplies; laundry removal from washing machines and dryers, etc.

While these tasks do not necessarily present problems in all circumstances, they may present problems in certain cases. The guidelines offer a few examples (again with illustrations) of possible solutions for activities other than resident lifting and repositioning. Examples include: storage and transfer of food, supplies; mobile medical equipment; working with liquids in housekeeping and in kitchens; hand tools; linen carts; handling bags; working in deep sinks; and loading and unloading laundry.

Training
The guidelines describe areas of training for nursing home employees, their supervisors, and program managers responsible for planning the home's ergonomics efforts.

Nursing Assistants and Other Workers at Risk of Injury. Train employees before they lift or reposition residents, and ensure workers understand policies and procedures, how to recognize MSDs and their early indications, and the home's procedures for reporting work-related injuries and illnesses.

Charge Nurses and Supervisors. Charge nurses and supervisors should reinforce the safety program of the facility, and should focus on more detailed issues such as methods for ensuring use of proper work practices; how to respond to injury reports; and how to help other workers implement solutions.

Designated Program Managers. Staff members responsible for managing ergonomics efforts should receive information that will help them identify potential problems through observation, use of checklists, injury data analysis, or other analytical tools; address problems by selecting proper equipment and work practices; and evaluate the effectiveness of ergonomics efforts.

Additional Sources of Information
The guidelines include additional sources (including accessible websites) for those seeking further information about ergonomics and the prevention of work-related MSDs in nursing homes. OSHA also included A Nursing Home Case Study, based on information provided by Wyandot County Nursing Home in Upper Sandusky, Ohio. Wyandot used a process that reflects many of the recommendations in these guidelines to address safety and health concerns.

NOTE: OSHA's Guidelines for Nursing Homes are advisory in nature and informational in content. They are not a new standard or regulation and impose no new legal requirements.