In a
previous blog post, the basic OSHA requirements, or expectations, for prevention of musculoskeletal injuries in long term care (LTC) employees were reviewed. As previously stated, Federal OSHA does not have a specific standard dedicated to preventing sprains and strains—often referred to as "ergonomics" by OSHA. Instead, OSHA regulates ergonomic concerns through the
General Duty Clause, which requires employers to provide a workplace free from recognized hazards that are likely to cause death or serious physical harm to employees. Importantly, individual states have also issued regulations to address safe patient handling and ergonomics. This post highlights certain controls or interventions that OSHA is likely to expect at a LTC facility, identify resources that may be helpful when implementing or updating a safe patient handling program, and list relevant state regulations.
Common Controls
When talking about employee health and safety, "controls" are the precautions or interventions taken by the employer to reduce the likelihood of an injury or illness. As previously discussed, OSHA regards employee safety in terms of a hierarchy of controls, which moves from the most desirable (elimination) to least desirable but still effective (PPE).
When assessing hazards that might contribute to musculoskeletal injuries and identifying the controls that could minimize those injuries, it can be helpful to consider the entire hierarchy, including the following potential controls:
Elimination, Substitution, and Engineering:
The lines between these three levels are blurred, but regardless of what you call it, LTC communities use several strategies to eliminate, substitute, or engineer around patient handling hazards. Initially, LTC communities were built to accommodate wheelchairs and similar resident transportation, reducing the frequency of resident transfers. Moreover, communities typically use a range of assistive devices to reduce or eliminate the amount of lifting done by staff. These devices include mechanical lifts, transfer boards, gait belts, and grab bars.
Administrative:
One of the most significant advantages LTC communities tend to have related to ergonomics is the early implementation of individualized care plans to identify residents who present a hazard to themselves or employees when being lifted or transferred. These care plans are an important hazard assessment tool, but they can also be considered an administrative control used to reduce the occurrence of musculoskeletal injuries.
Work Practice:
How an employee lifts or transfers a resident is a work practice control developed by training on proper lifting techniques, body mechanics, and assistive devices. After an employee is trained, they should be monitored for using proper methods and re-trained or disciplined if they continue to use proper methods.
PPE:
Back braces are typically available to staff to reduce the likelihood of back injuries. If back braces are made available, employees should be informed on how to request a brace and trained on how to use it properly.
Relative State Plan Regulations and Emphasis Programs
While Federal OSHA does not have a specific regulatory standard for safe patient handling, it is important for LTC centers under OSHA approved State Plans to review their state programs for any specific requirements. LTC centers should also be aware of active emphasis programs.
Relative State Requirements:
- California - Has a Repetitive Motion Injuries standard that applies to any job, process, or operation with more than one confirmed recordable injury from repetitive motion.
- Minnesota - Requires a safe patient handling program.
Recent Emphasis Programs
AHCA/NCAL’s OSHA Roadmap resource also contains details on state plans that can be referenced.
Ergonomics and safe patient handling are critical elements to an effective safety program in the LTC sector. While only some LTC centers have specific state requirements to meet, employees and residents of all communities greatly benefit when effective hazard assessments and control measures are implemented.
Resources