Recommendations on Standards for the Design of Medical Diagnostic Equipment for Adults with Disabilities, Advisory Committee Final Report
2.3 Implications of MDE Accessibility for Clinical Staff
Health care personnel face risks of injuries from transferring, positioning, or otherwise physically assisting patients in health care settings. Surgeon Pauline W. Chen, MD, described a failed attempt to transfer a patient onto a fixed height table, capturing the consequences both for the patient and what became the transfer crew – a physician, medical student, several clinical staff, and two security guards (Box 2.3).
Box 2.3
In his 60s, overweight and in a wheelchair, the patient had been seeing doctors and nurses regularly for his diabetes. Only recently had they discovered a pressure sore after someone had finally, as he put it, “wanted to examine at my backside.”
The oversight struck me as unimaginable. Until I watched another doctor try.
My colleague, a strapping man in his 30s, wrapped his arms around the man’s torso to lift him onto the examining table but could hardly budge the patient. A few members of the clinic staff came in to help, each taking a limb. Several minutes later, one of the nurses called for security. Two burly men in dark blue uniforms joined the fray, grunting as they finally extricated the patient from his chair.
A nurse lunged forward to unbuckle the patient’s belt while a medical student began yanking on his sneakers, but with each tug and jerk, the guards’ grip on the patient’s torso loosened. Feeling himself slipping, the patient grabbed at the shirt of one of the guards to break his fall. The guard lost his balance and reached for the wheelchair, but its brake was not engaged. The wheelchair spun, hitting the medical student and nurse and knocking over the other guard as the patient, pants half off and one shoe missing, collapsed back into its seat.
No one was hurt. But when my colleague leaned down to ask the patient how he was, he stopped himself midquestion. Though the patient’s black baseball cap now partly obscured his face, it was clear to all of us what his expression conveyed: utter humiliation.
SOURCE: Chen PW, “Disability and Discrimination at the Doctor’s Office,” New York Times, Doctor and Patient, Health Blogs, May 23, 2013
http://well.blogs.nytimes.com/2013/05/23/disability-and-discrimination-at-the-doctors-office/?hpw
Thousands of health care personnel are injured every year from manually lifting patients, including persons with and without disabilities. Direct-care registered nurses rank tenth among all occupations for developing musculoskeletal disorders.28 Because of back injuries from manually moving patients, 12% of nurses leave the profession every year.29 In 2010, nursing aides, orderlies, and attendants experienced:30
-
An incident rate of 249 cases/10,000 full-time workers for musculoskeletal disorder (MSD) cases with days away from work;
-
27,020 MSD cases with days away from work; and
-
An incident rate of 283 cases/10,000 full-time workers for nonfatal occupational injuries and illnesses involving days away from work.
This high incidence of injuries among clinical staff has heightened attention by government, health care professional, and industry leaders. In 2009, federal legislation was introduced to address this problem: The Nurse and Healthcare Worker Protection Act (H.R 2381). While this legislative effort failed, it is likely that similar legislation will be proposed in future Congressional sessions. Currently, “Safe Patient Handling” (SPH) laws have been enacted in 10 states,31 and Hawaii has passed a SPH resolution. As of June 2013, the American Nurses Association had released National Practice Standards for Safe Patient Handling.32
The National Institute for Occupational Safety and Health (NIOSH), in the CDC, recommends manual lifting of no more than 51 pounds in ideal conditions. In 1994, NIOSH/CDC) released the Application Manual for the Revised NIOSH Lifting Equation,33 which provides an ergonomics assessment tool for calculating the recommended weight limit for two-handed manual-lifting tasks. However, NIOSH excluded assessment of patient-handling tasks from the uses of the revised equation, arguing that such tasks involve too many variables. Nevertheless, the NIOSH Lifting Equation can be used to calculate a recommended weight limit for a limited range of patient-handling tasks in which the patient is cooperative and unlikely to move suddenly during the task. In general, the revised equation yields a recommended 35-pound maximum weight limit for these patient-handling tasks. When the weight to be lifted exceeds 35 pounds, assistive devices should be used.34
As suggested above,25 the availability of these assistive devices is still quite limited especially in doctors’ offices, clinics, and specialists’ offices where many examinations and medical diagnostic tests occur. When assistive devices are not available, clinical staff must manually transfer patients to exam tables and onto diagnostic equipment. Such transfers greatly exceed the 35-lb maximum weight limit and place health care workers at significant risk of injury. However, if equipment is designed such that patients in wheelchairs and scooters can transfer independently or with moderate assistance, the risk of injury to health care workers can be greatly reduced for this task. The use of lifts also can reduce the risk of injury for patients and staff. The risk of injury will also decrease with improved accessibility of medical diagnostic equipment for other individuals with limited mobility, such as the older individuals, pregnant women, and persons with extreme obesity.
Section 2: References
25. Lagu T, Hannon NS, Rothberg MB, et al. Access to subspecialty care for patients with mobility impairment: A survey. Ann Intern Med. 2013;158(6):441-446.
25. Lagu T, Hannon NS, Rothberg MB, et al. Access to subspecialty care for patients with mobility impairment: A survey. Ann Intern Med. 2013;158(6):441-446.
28. Representative John Conyers Jr. (D-MI14). Nurse and health care worker protection act of 2009. 2009;H.R. 2381 (111th).
29. American Nurses Association. AMA leads initiative to develop national safe patient handling standards. multidisciplinary group seeks to establish evidence based guidelines to address deficiency. http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/SafePatient/ANA-Leads-National-Safe-Patient-Handling-Standards.pdf. Accessed May 31, 2013.
30. Bureau of Labor Statistics, U.S. Department of Labor. News release: Nonfatal occupational injuries and illnesses requiring days away from work, 2011. November 8, 2012;USDL-12-2204.
31. American Nurses Association, Nursing World. Saftey patient handling and mobility, health and safety. http://nursingworld.org/handlewithcare. Accessed April 27, 2012.
32. American Nurses Association, Nursing World. Safe patient handling and mobility (SPHM), state legislative agenda. http://nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-SafePatientHandling. Accessed April 27, 2012.
33. Waters TR, Putz-Anderson V, Garg A. Application Manual for the Revised NIOSH Lifting Equation. Pub. No. 94-110 ed. Cincinnati, OH: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Biomedical and Behavioral Science, DHHS (NIOSH); 1994.
34. Waters TR. When is it safe to manually life a patient?. AJN. 2007;107(8):53-58.
User Comments/Questions
Add Comment/Question