Preventing Injuries Through Safe Patient Handling & Mobility Programs

Injuries caused by manual patient lifting, transferring, and repositioning extend far beyond healthcare staff. While these injuries devastate the patient care workforce, they also pose a direct threat to the patients that caregivers must transfer. So, what can you do to minimize these risks within your organization?

According to research cited by Dr. Susan Gallagher, the author of the American Nurse Association (ANA) Implementation Guide to the Safe Patient Handling and Mobility Interprofessional National Standards (2013), a 49% reduction in patient falls was found at facilities where healthcare providers were trained to utilize safety-based approaches and proper equipment when moving patients.

This statistic flies in the face of a long-standing belief amongst many that patient handling and mobility programs disproportionately benefit employee safety. Reoccurring training programs centered around Safe Patient Handling and Mobility (SPHM) have been found to have far-reaching benefits in not only patient and employee safety but also staff retention. Unfortunately, more often than not organizations do not have formal programs or fail to recognize the correlation that SPHM has in overall safety, reducing liability, and increasing their bottom line.

The Claim: How Transfers Can Become Incidents

Consider a recent medical malpractice incident involving a 76-year-old female who reported to the emergency department for evaluation of weakness after fainting and falling at home. Her physical examination by the emergency room physician documented no physical injuries and noted her weight at 280lbs. The complaint alleged that while she was under observation, it became necessary to move her to a different room. An LPN arrived at the patient’s room to assist her from the bed to a wheelchair to facilitate the transfer.

During the transfer of the patient from the bed to the wheelchair, the patient alleged that her foot and/or leg became caught under the bed resulting in a fracture to her right femur.

The initial investigation into the allegations revealed no documentation in the patient’s medical record of any patient transfer injury or event. There was no incident or occurrence report found to have been completed. No member of the nursing staff recalled any detail of the event or injury happening.

Due to these circumstances, the medical review panel met and concluded that the facility staff had breached the standard of care. The basis for their opinion included that the LPN should not have attempted to transfer the patient alone without an assistive device given the patient’s multiple medical conditions and body mass. A failure to follow the facility’s policy related to patient transfer also contributed to the panel’s conclusion.

Additionally, they believed that given her negative physical exam upon arrival to the Emergency Department, it was straightforward to determine that the patient’s femur was fractured during the transfer process.

Due to the findings of the panel and the lack of any evidence to defend the case, a settlement was reached between the patient, the facility, and the Patient’s Compensation Fund.

Reducing Risks: SPHM Trained Staff Can Be Proactive Against Red Flags

In this case, the care planning and assessment of the patient should have begun upon arrival at the unit. Although this patient had negative assessment findings in the emergency department, a fall at home was the reason for this visit. The nursing staff should have taken this vital piece of information as a red flag and considered it during the admission process, as part of any risk assessment they conducted.

Safe patient handling and mobility (SPHM) programs are beneficial in preventing falls and other similar hospital-acquired injuries. However, it is important to remember that SPHM programs should be associated with policies to support the program as well as adequate training for staff members. Providing training upon hire and annually regarding the program and policies and requiring competency demonstrations will ensure that each staff member understands the mobility tools and equipment. These techniques allow healthcare workers to operate proactively while providing patient-centered care throughout each shift.

The concept of delivering “patient-centered care” to support the culture of safety is explained by the Institute of Medicine (IOM) as care that is individualized to a patient’s preferences, needs, and values by involving the patient in care decisions. Assessment and technology decisions related to handling and mobility should then be incorporated into the plan of care. This care planning begins upon admission.

Best Practices: Preventing Injuries and Fostering a Culture of Safety

Some best practices to consider in preventing falls and injuries include:

• Incorporate a mobility assessment into every patient assessment:
  • Evidence-based tools exist such as the “Timed-Get Up and Go” and the “Bedside Mobility Assessment” (BMAT). Both are easy to use and help healthcare staff determine mobility requirements, including types of equipment that should be used to assist the patient with mobility. These assessments should be completed upon admission, during shift changes, and upon changes in the level of care or condition. Leadership within the healthcare staff should communicate information from the tool to the entire healthcare team that is caring for the patient in a variety of ways. Consider including hand-off communications on whiteboards or other communication methods that the team shares.
• Incorporate a fall assessment:
  • A fall risk assessment is different from a mobility assessment. Organizations should be using an evidence-based tool for assessing the patient’s potential for falls as well as a mobility assessment. A history of falls should be considered or included when using the fall assessment. If a patient has a history of falls, they are much more likely to fall again. In this case, the risk was exceedingly high since a fall is what necessitated the visit to the emergency department.
• Documentation of adverse events:
  • Lack of documentation of the event, no occurrence report, and the caregiver failing to follow organizational policies by attempting a transfer alone were all breaches in the standard of care. Contrary to myths, adverse events should be documented in the medical record and an occurrence report should be completed to alert the Risk Manager. Each organization should have an occurrence reporting policy in place explaining to staff members how to submit an occurrence report and when it is expected to be submitted.

As for the documentation of the event, it happened therefore it should be documented. However, care should be taken to document only the facts of the event. No opinions or assumptions of what happened should be entered. No admissions of a caregiver or organizational liability should be documented. Staff should remember the mnemonic FACT when documenting adverse events: Factual, Accurate, Complete, and Timely. Healthcare staff often require training specific to the documentation of occurrences to help them better understand factual documentation of these types of events.

Need More Resources?

Please view our toolkits on Safe Patient Handling, Safe Lifting, and Fall Prevention to access best practices that will reduce your risks.

Looking to create a new SPHM program or optimize your current program? Join our SPHM initiative. Contact Stacie Jenkins, Vice President of Patient Safety and Risk, at 225.368.3823 or staciejenkins@lhatrustfunds.com to learn more.

About the Authors

Jamie Lamb
Director of Claims Operations, LHA Trust Funds

Jamie Lamb began her career in claims in 1997. Her experience includes handling multi-line claims in the areas of general liability, medical malpractice, automobile liability, commercial and personal property, excess and umbrella policies, and professional liability. Her experience comes as a former Manager and Litigation Specialist for the American National family of companies. She has been highly involved in the education and training of both internal and external customers her entire career. Ms. Lamb attended both Evangel University in Springfield, Missouri, and Loyola University in New Orleans.

Stacie Jenkins, RN, MSN, CPSO
Vice President of Patient Safety and Risk, LHA Trust Funds

Stacie Jenkins is a registered nurse with a master’s degree in nursing informatics. She has more than 20 years of experience in healthcare, working in patient care and quality/performance improvement positions. As the Vice President of Patient Safety & Risk at LHA Trust Funds, she works closely with hospital administrators, risk managers, and nursing staff to improve patient safety and establish best practices. She conducts on-site assessments and gives presentations designed to help clients address their patient safety risk management challenges.