Clinical Settings

Overview of Safe Patient Handling for Clinical Settings

Safe patient handling is the term referring to policies and programs that enable direct healthcare workers to move patients in a way that does not cause strain or injury. Even though previously you may not have considered manual assisting of patients to be a safety hazard, studies have clearly shown the risk for injury to staff and patients. The repetitive manual lifting and moving of patients and residents has been the leading cause of musculoskeletal injuries to healthcare workers for years. In fact, the rate of musculoskeletal disorders among healthcare workers exceeds those of construction, mining and manufacturing. (1) Research done by National Institute for Occupational Safety and Health (NIOSH) has shown that the maximum safe limit for manually moving patients under ideal conditions is only 35 lbs (2). When tasks are performed under less than ideal conditions, such as with when lifting a load to the side of the body, lifting with arms extended, lifting in a confined space, etc., the safe weight limit is even less. In recent years there has been a push for healthcare facilities to adopt safe patient handling practices.

The Occupational Safety and Health Administration (OSHA) recommends that manual lifting and moving of patients be minimized in all cases and eliminated when feasible and that employers should put an effective ergonomics process in place that provides management of the program, involves employees, identifies problems, implements solutions, addresses injuries, provides training and evaluates ergonomic efforts.

To date, Minnesota is only one state with SPH legislation for clinics. There are nine states with SPH legislation that applies to hospital, long term care facilities and outpatient surgery centers. Safe patient handling programs have shown the potential to impact the following:

Patient safety and comfort
Patient satisfaction scores
Employee injuries
Workers compensation costs
10-20% off Workers compensation insurance premiums
Initial investment for purchase of equipment and training costs can be recovered in less than 2-3 years

Equipment and devices designed specifically for patient transfers and movements provide a secure and comfortable process for lifting, transferring or repositioning patients. Selection of patient handling equipment is based upon the patient population and assistive needs of the clinic. The goal is to match the equipment to the patient's ability to assist in his or her own movement.

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ADA/Accessible Law: Is Your Clinic In Compliance?

For the majority of patients, access to care provided by clinics due to physical barriers is a nonissue. However, for the mobility disabled access to medical care can present quite a challenge. Individuals with disabilities are less likely to get routine medical care than people without disabilities. Accessibility is legally required. The Americans with Disabilities Act (ADA) is a federal civil rights law that prohibits discrimination against people with disabilities in everyday activities, including medical services. The law requires that all clinics make their service available in an accessible manner. People with mobility disabilities include those who use wheelchairs, walkers, canes, scooters, crutches or no mobility device at all.

The ADA requires that medical care providers provide individuals with disabilities full and equal access to their facility and services; and reasonable modifications to policies, practices, and procedures when necessary to make those services fully available to individuals with disabilities, unless the modifications would fundamentally alter the nature of the services (1).

The ADA sets requirements for new construction of and alternations to buildings and facilities, including healthcare facilities. The regulations are available at www.ada.gov/reg2.html and www.ada.gov/reg3a.html.

In addition, all buildings, including those built before the ADA went into effect have to comply with the requirements for existing facilities. This includes the elimination of physical barriers where such a removal is readily achievable. If barrier removal is not readily achievable, then the provider must make its services accessible through alternative methods.

Key Rules

In compliance with ADA law it is not acceptable to deny individuals treatment or to require them to bring along someone who can help them at the exam. It is also not acceptable to examine or treat them in a chair if the exam or treatment normally requires an individual to be lying. A clinic should have at least one room that is accessible. More than one is recommended if a clinic has the potential to see two or more individuals with disabilities at the same time. This is because it is generally not acceptable for a patient with a disability to wait longer than other patients because they are waiting for a certain exam room.

It is not lawful for staff to refuse to move patients with disability. It is the responsibility of each clinic to keep their staff safe by providing proper training and equipment for them to use to these individuals. Staff and patients should be protected from injury.

If your clinic happens to lease space to other providers you are responsible for making sure the exam room, waiting room and restrooms are accessible.

Tax Breaks

There are federal tax credits and deductions that are available to private business to offset expenses related to complying with the ADA. These credits and deductions are subject to IRS rules. More information about the Disabled Access Credit can be found at www.irs.gov/pub/irs-pdf/f8826.pdf. More information about the tax deduction can be found at http://www.irs.gov/publications/p535/ch07.html#en_US_publink1000208925. Both the tax deduction and the credit can be taken annually. For example, the disabled tax credit can be used for SPH equipment purchases and the tax deduction can be used for removal of architectural barriers such as ramps, entrances, doorways, etc.

Minnesota SPH Law

The Minnesota Safe Patient Handling for Clinical Settings (statute 182.6554) law took effect July 1, 2010. The law states that by July 1, 2010 all clinical settings that move patients must have developed SPH written plan. This plan must be implemented no later than January 1, 2012. This written plan must include the following:

SPH Policy
Results of the patient handling task risk assessment
Type and quantity of SPH equipment intended to be purchased
Initial and ongoing training plans on the use of the equipment
Processes in place to ensure all new construction and remodeling site planning and design of patient care areas are consistent with SPH equipment and goals
Methods and metrics developed that will regularly evaluate and assess the SPH plan and implemented program

You may wonder if your clinic must comply with this law. If your staff physically assist patients with transfers or helps them move your clinic must comply. Some examples of moving patients include but are not limited to the following: repositioning a patient on exam/treatment table, transferring a patient from a wheelchair, assistance in getting in/out of a vehicle, help on/off exam table. The only sure way to know that this law DOES NOT apply to your clinic would be if ALL of your patients are ambulatory and able to move themselves. Based upon ADA law, it is illegal to refuse to see patients who are disabled or to require patients to bring along someone to help them during their visit. (see ADA/Accessibility law)

Enforcement of SPH for Clinical Settings

The enforcement of the law falls under the jurisdiction of Minnesota Occupational Safety and Health (MN OSHA). If a clinic is found to not be in compliance the first offense will result in a written warning. Subsequent offenses will result in fines.

Ergo-PATH System Services

We provide a variety of services for clinics. If your need is not listed below, please contact us as we will be happy to customize our services to fit your needs.

SPH Packet for Clinics:

This package provides a blueprint for any clinical setting in any state to develop and implement a functional and successful SPH system. We have specifically designed into it all of the needed material for clinics located in Minnesota to meet all of the July 1, 2010 deadline requirements for complying with the Minnesota Safe Patient Handling for Clinical Settings law (MN statute 182.6554). This 87 page package contains all of the necessary information, tools and templates your clinic will need to complete the SPH Written Plan that is specified in the law. The package outlines the nine steps and a total of 13 tools and templates that when completed will result in your clinic’s SPH Plan. To assist you in this process, we have provided completed examples of every tool and template. We have two versions of the packet, one for dental clinics and one for medical (non-dental) clinics.

Customized SPH Written Plan:

One of our experienced consultants will come and work with you and write your plan for you. This is choice commonly made when clinics do not have a safety person and/or the time to devote to researching and writing their own plan. Please contact us if you are interested in this option.

Training:

We provide customized training to your clinic’s medical providers on safe patient handling, SPH/accessible equipment, and assistive techniques to ensure you staff is competent, comfortable and confident in assisting disable patients and in using the equipment. We also provide the necessary competency forms and logs for you to keep track of who has received training.

Consultation:

Our experienced consultants are here to varying levels of assistance depending on your SPH needs.

Questions by phone or email: We are happy to answer your questions for free. We promise to reply to your question within 1 business day. If the answer is not straight forward and requires more research we will let you know and provide you options on the next steps to take.

Onsite Consultation:

SPH Plan Outline: If you desire an outline of each step you need to take to get your clinic in compliance with the ADA and/or SPH legislation an onsite visit from one of our consultants is often the best option. Our consultant will spend time with you and your staff to assess and discuss your clinic’s needs. The result of this visit is a high level outline of what steps you need to take and in what order to take them in order to develop your SPH plan.

SPH System Design and Implementation Plan: This option is best for those clinics who do not have the personnel or time to devote to developing their own plan and/or for those clinics who are large and have either multiple departments and/or locations. One of our consultants will be assigned your clinic for the life of this project. This will involve onsite visit(s) and discussions by phone and email to you and your assigned consultant. He or she will work closely with you and designated staff to ensure the plan includes all of the necessary systems and processes.

FAQ

What “clinics” should implement SPH?

All clinics that provide medical care must comply with ADA law which also includes elements of SPH. The type of clinics in which this would apply are medical, dental (including oral surgeons and orthodontics), rehabilitation (physical and occupational therapy), chiropractic, outpatient medical facilities such as endoscopy and outpatient radiology/imaging facilities.

How was the Minnesota SPH for Clinical Settings law created?

Originally Minnesota passed a SPH law that applied to hospitals, long term care centers and outpatient surgical centers. After that law was passed the MN State Council on Disability assembled a work group to determine if a SPH law was needed for clinic. Members of the work group were from the following groups: MN Stat Council on Disability, Minnesota Medical Association, Minnesota Dental Association, Gillette Lifetime Specialty Healthcare, MN Nurses Association, Park Nicollet Health Services and National Multiple Sclerosis Society, MN chapter. The work group concluded that legislation should be pursued that would require each clinic to develop a plan to ensure the safe handling of patients. The suggested wording of the law was what the legislature passed in 2009.

I don’t know what to include in the written SPH plan. Who can I contact for help?

You may be able to contact your state OSHA office for information and assistance in writing your plan. Ergo-PATH offers two options to help you through this process and ensure that your assessment and decisions are done properly. The one option is the downloadable SPH packet that contains information, examples and templates for you to use to create your own plan. The other option is to have one of our consultants work with you and write your plan for you. This is choice commonly made when clinics do not have a safety person and/or the time to devote to researching and writing their own plan. Please contact us if you are interested in this option.

Can a clinic decide that they won’t see patients who are disabled in order not to comply with SPH?

No. You can’t deny service to a patient whom you would otherwise just because they are disabled. You must examine/treat a patient as you would any patient. In order to do so, you may need to provide an accessible exam table, a lift device or have enough staff trained and available who can assist with this transfer. Keep in mind the last option is not recommended as you would be putting your staff and the patient at risk for injury.

Can a clinic require that a disabled patient must bring someone along to help them during their visit?

No. A patient with a disability may come to an appointment alone just like any other patient. The provider must provide reasonable assistance to enable the person to receive medical care.

Can I tell a patient that I can’t treat her because I don’t have accessible equipment?

No. You can’t deny service to a patient who you would otherwise provide care and treatment.

Is ok to exam/treat a patient who uses a wheelchair because the patient can’t get on the exam table independently?

Generally No. . If the exam normally does require a patient to lie down, then the patient must be transferred to the exam table. Examining a patient in his wheelchair is usually less thorough than the exam table and does not provide the patient equal medical services. If the exam/treat normally does not require that a person lie down then the exam table is not important to the medical care and the patient may remain seated in his chair.

In a clinic with multiple exam rooms, does every room need to have an accessible exam table and sufficient clear floor space next to the exam table?

Probably Not. The clinic must be able to provide their services to individuals with disabilities in an accessible manner. Accessible equipment is usually necessary in order to do so. However, the number of rooms or tables that need to be accessible will depend on the size of clinic, the patient population and other factors. A small clinic may need only one accessible exam room while a large clinic will more than likely need more.

Can my staff refuse to help lift a patient?

Staff should be protected from injury, however that doesn’t justify refusing to provide equal services to those with disabilities. It is highly recommended that the clinic protect its staff and patients by providing accessible equipment and training.

What if my staff don’t know how to help a person with a disability transfer or know what the ADA requires my clinic to do?

In order to provide service safely and in an accessible manner the medical providers will likely need to receive training. Training should include when to and how to use the accessible equipment, how to properly assist with transfers and repositioning, how not to discriminate against people with disabilities, etc. It is also important to remind staff to ask the patient if he needs assistance and what is the best way to help.

What constitutes an accessible exam room?

Accessible route to and through the room
Entry door with adequate clear clearance (minimum 32” opening width with door open to 90 degrees)
Appropriate type and placement of accessible examination equipment (accessible equipment can include lift devices, height adjustable exam tables, etc.)

Adequate clear floor space inside the room for transfers and the use of lift equipment (30” x 48” minimum, adjacent to the exam table to make it possible to do a side transfer. Since some patient can only transfer from one side it is recommended that either the exam room has adequate space on both sides of the exam table or that two accessible exam rooms are mirrored in order to allow patients to transfer from their preferred side)