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  • THE AMERICAN WORKPLACE IS BECOMING SAFER,

  • BUT SERIOUS INJURIES STILL OCCUR

  • IN WORKSITES YOU MIGHT THINK ARE ABSOLUTELY SAFE.

  • NURSING HOMES AND PERSONAL CARE -

  • A FAST GROWING INDUSTRY,

  • AND A KEY PART OF OUR HEALTHCARE SYSTEM.

  • YET, THESE FACILITIES HAVE

  • ONE OF THE HIGHEST WORKER INJURY AND ILLNESS RATES

  • IN THE COUNTRY,

  • SIMILAR TO TRUCKING G,

  • OCCUPA

  • TO BE

  • JUST LOOK AT THE STATISTICS -

  • NURSING HOME WORKERS LOSE TWICE AS MUCH TIME ON THE JOB

  • AS OTHER WORKERS,

  • AND HAVE

  • AN

  • E

  • MORE T

  • TIMES

  • T

  • OVER HALF OF THEIR INJURIES OCCUR WHILE HANDLING RESIDENTS,

  • AND ALMOST HALF INVOLVE THE LOWER BACK.

  • THERE ARE MANY POTENTIAL HAZARDS IN NURSING HOMES:

  • AND

  • M

  • FROM BED TO CHAIRS, SHOWERS, OR OTHER AREAS IN THE NURSING HOME.

  • NURSING HOME WORKERS AREN'T THE ONLY ONES

  • WHO SUFFER FROM STRESS, STRAIN, AND OVEREXERTION.

  • SUCH PROBLEMS ACCOUNT FOR MORE THAN ONE IN FOUR

  • OF ALL ON-THE-JOB INJURIES EACH YEAR.

  • THESE DISORDERS ARE THE SINGLE LARGEST GROUP

  • OF PREVENTABLE JOB INJURIES IN THE UNITED STATES TODAY.

  • BUT WHEN ERGONOMIC PRINCIPALS ARE APPLIED,

  • EVERYONE BENEFITS.

  • SIMPLY PUT, ERGONOMICS MEANS FITTING THE JOB TO THE WORKER,

  • DESIGNING JOBS SO THAT WORKERS CAN AVOID

  • AWKWARD, UNNATURAL POSTURES, AND EXCESSIVE FORCE

  • THAT CAN LEAD TO SERIOUS INJURY AND ILLNESS,

  • SOMETIMES EVEN PAINFUL AND PERMANENT DISABILITIES.

  • OSHA, THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION,

  • HAD A SPECIAL EMPHASIS PROGRAM IN SEVEN STATES

  • TO REDUCE THE THREAT OF INJURIES IN NURSING HOMES.

  • NOW, IN LINE WITH NEW TARGETING PROCEDURES,

  • OSHA IS CONDUCTING INSPECTIONS IN NURSING HOMES NATIONWIDE.

  • EMPLOYERS ARE ENCOURAGED TO CREATE

  • COMPREHENSIVE SAFETY AND HEALTH PROGRAMS

  • TO REDUCE INJURY AND ILLNESS RATES,

  • INCLUDING THOSE ASSOCIATED WITH RESIDENT TRANSFERS.

  • INSPECTION OF A NURSING HOME INVOLVES SPECIAL CONSIDERATIONS.

  • BEFORE GOING ON-SITE, HERE ARE SOME FACTORS TO CONSIDER:

  • THE HEALTHCARE FINANCING ADMINISTRATION,

  • OR HCFA REPORT,

  • SHOULD BE OBTAINED IN ADVANCE

  • TO DETERMINE THE DEPENDENCY LEVEL OF THE RESIDENTS.

  • HELLO, MY NAME IS BRAD BAPTISTE,

  • I'M WITH DEPARTMENT

  • ONCE ON-SITE, THE INSPECTOR SHOULD CONDUCT

  • AN OPENING CONFERENCE AND WALK-AROUND.

  • REMEMBER, THESE INSPECTIONS ARE TAKING PLACE

  • IN THE HOMES OF RESIDENTS.

  • THEIR PRIVACY RIGHTS ARE PROTECTED BY LAW,

  • AND MUST BE RESPECTED DURING WALK-AROUNDS.

  • ANY PHOTOGRAPHY OR VIDEOTAPING OF RESIDENT ACTIVITIES

  • REQUIRES THE RESIDENT'S PERMISSION.

  • NEXT, THE INSPECTOR MUST DETERMINE

  • WHERE INJURIES AND ILLNESSES OCCUR.

  • THIS IS DONE BY STUDYING THE OSHA-200 LOGS,

  • THE OSHA-101 FORMS,

  • OR WORKERS COMP RECORDS DATING BACK THREE TO FIVE YEARS.

  • BY ANALYZING INJURY AND ILLNESS TRENDS OVER TIME,

  • THE INSPECTOR CAN DETECT PATTERNS.

  • COPIES OF ANY REQUIRED WRITTEN PROGRAMS, INSURANCE REPORTS,

  • OR OTHER PREVIOUS AUDITS OF THE FACILITY CAN ALSO HELP.

  • OVERALL INCIDENT RATES

  • AND ERGONOMIC INCIDENT RATES CAN BE CALCULATED.

  • THE SAME CAN BE DONE FOR DIFFERENT DEPARTMENTS,

  • DIFFERENT SHIFTS, AND DIFFERENT WINGS,

  • IN ORDER TO PINPOINT AREAS OF SPECIFIC HAZARDS.

  • BRAD BAPTISTE, A COMPLIANCE OFFICER IN DENVER,

  • HAS CONDUCTED NUMEROUS NURSING HOME INSPECTIONS.

  • YOU WOULD FOCUS YOUR EFFORTS ON THE TWO OR THREE AREAS

  • WHERE YOU'RE HAVING THE HIGHEST INCIDENT RATES.

  • MORE THAN LIKELY IT'S ALWAYS GOING TO BE NURSES AIDES DOING TRANSFERS.

  • THAT'S THE MOST HAZARDOUS OF ALL THE JOBS,

  • AND YOU'LL FIND THAT'S WHERE YOU WANT TO FOCUS YOUR ATTENTION.

  • AS A NORMAL PART OF ALL OUR INSPECTIONS WE DO EMPLOYEE INTERVIEWS.

  • WHAT I'D LIKE TO DO IS AUDIOTAPE OUR CONVERSATION.

  • DO YOU HAVE ANY OBJECTION TO THAT?

  • NO, NONE AT ALL.

  • WHAT YOU NEED TO DO IS INTERVIEW ALL THESE EMPLOYEES

  • WHO HAVE BEEN INJURED, IF POSSIBLE,

  • FIND OUT EXACTLY HOW THEY WERE INJURED,

  • AND THEN DETERMINE THOSE TWO, OR THREE, OR FOUR LIFTS

  • THAT YOU'RE GOING TO WANT TO EVALUATE.

  • THEN YOU'RE GOING TO OBTAIN YOUR VIDEOTAPE

  • IT'S IMPORTANT TO HAVE A REFERENCE OF KNOWN SIZE IN THE PICTURE.

  • YOU WANT HELP UP?

  • YES.

  • >> RESIDENTS ARE ON DIFFERENT SCHEDULES,

  • BUT GENERALLY THEY'RE AWAKENED BETWEEN 7:00 AND 9:00 AM,

  • DRESSED, BATHED, AND HAVE BREAKFAST.

  • THEN THERE ARE MORNING ACTIVITIES, LUNCH,

  • AND FOR SOME, A NAP.

  • OTHERS ENJOY AFTERNOON ACTIVITIES BEFORE DINNER.

  • MANY HAVE AN EVENING ACTIVITY, AS WELL.

  • THE MOST IMPORTANT TIMES ARE DURING RESIDENT TRANSFERS.

  • IT'S IMPORTANT TO LOOK AT MORE THAN ONE SHIFT,

  • AND TO PAY SPECIAL ATTENTION

  • TO THE WORK OF THE CERTIFIED NURSES AIDES.

  • >> YOU MIGHT FIND THAT YOU HAVE A SIGNIFICANT NUMBER OF INJURY

  • OR ERGONOMIC INCIDENT RATE DURING THE NIGHT SHIFT,

  • WHEN TYPICALLY YOU'LL FIND A LOWER LEVEL OF STAFFING AT NIGHT.

  • YOU MIGHT FIND THAT THE DAY SHIFT HAS ACCEPTABLE INJURY RATES,

  • BUT THE NIGHT MIGHT BE EXTREMELY HIGH.

  • SO, IT'S IMPORTANT THAT YOU ADJUST YOUR SCHEDULE

  • SO YOU CAN EVALUATE HOW THEY'RE DOING THEIR LIFTS AT VARIOUS TIMES.

  • >> SAFETY AND HEALTH TRAINING IS ALSO IMPORTANT.

  • SOME QUESTIONS TO ASK ARE:

  • HERE ARE SOME OTHER THINGS TO CONSIDER.

  • >> EXPECT A LOT OF TIME BEING SPENT

  • EVALUATING THE DIFFERENT LIFTS, LOOKING AT THE AREAS.

  • THE PLACES ARE LARGE,

  • SO YOU'VE GOT TO LOOK AT EACH DEPARTMENT.

  • NORMALLY THE WALK-AROUND TAKES AT LEAST A HALF A DAY TO A DAY INITIALLY

  • JUST TO GET FAMILIARIZED WITH THE SITE.

  • THE ERGONOMIC INCIDENT RATE EVALUATION FROM THEIR RECORDS

  • COULD TAKE A DAY, OR TWO, OR MORE,

  • SO, A TIP WOULD BE TO EXPECT THAT WHEN YOU GO IN.

  • THESE ARE NOT SIMPLE CUT AND DRY INSPECTIONS,

  • AND YOU NEED TO BUDGET YOUR TIME WISELY

  • SO YOU CAN FIT IN ALL YOUR INTERVIEWS.

  • >> WHEN EVALUATING PATIENT TRANSFERS,

  • REMEMBER THAT LIFTING ANY HEAVY OBJECT

  • CAN POSE A SERIOUS HAZARD FOR WORKERS,

  • BUT LIFTING A PERSON IS PROBABLY THE MOST DANGEROUS.

  • SOME RESIDENTS MAY BE COMBATIVE,

  • OTHERS MAY HAVE DIMINISHED MOBILITY.

  • MAKING A PROPER LIFT CAN BE VERY DIFFICULT.

  • >> THERE ARE SOME RESIDENTS IN THE NURSING HOME

  • WHO HAVE COMPLETE MOBILITY.

  • THEY CAN DRESS THEMSELVES,

  • THEY CAN GET THEMSELVES OUT OF BED, THEY'RE AMBULATORY.

  • THAT VARIES ALL THE WAY TO THE OTHER END OF THE SPECTRUM

  • WHERE YOU HAVE RESIDENTS

  • WHO ARE ABSOLUTELY UNABLE TO DO ANYTHING WITHOUT ASSISTANCE.

  • THAT ARE MORE THAN LIKELY THE MOST DIFFICULT TO HANDLE,

  • TO TRANSFER THEM FROM THE BED TO A CHAIR,

  • THEY HAVE TO BE TRANSFERRED TO TOILETS,

  • THEY HAVE TO BE TRANSFERRED TO SHOWER AND WHIRLPOOL FACILITIES.

  • THOSE ARE EXTREMELY HAZARDOUS SITUATIONS

  • FOR ANYONE WHO'S LIFTING,

  • WHETHER IT'S A SOLO UNASSISTED LIFT,

  • OR A TWO PERSON UNASSISTED LIFT.

  • THEY PUT A LOT OF STRESS ON PEOPLES SHOULDERS, BACKS, KNEES,

  • AND WE'RE SEEING A NUMBER OF INJURIES IN THESE NURSING HOMES.

  • >> AND THEN, OF COURSE, THERE'S THE RESIDENT TO CONSIDER.

  • IS EXTREMELY PAINFUL TO MANY PEOPLE.

  • THESE PEOPLE HAVE VERY SENSITIVE SKIN,

  • VERY SENSITIVE BONES, OSTEOPOROSIS,

  • THERE ARE REPORTS OF RESIDENTS

  • WHO HAVE LITERALLY HAD THEIR SHOULDERS BROKEN OR DISLOCATED

  • JUST BY PHYSICALLY BEING LIFTED FROM UNDERNEATH THE ARM.

  • >> FORTUNATELY, THERE ARE WAYS TO MINIMIZE RISKS, SUCH AS:

  • THE SIMPLEST ASSIST USED IN NURSING HOMES

  • IS THE TRANSFER BELT.

  • A CERTIFIED NURSES AIDE LOOPS THE BELT BEHIND THE RESIDENT

  • AND HELPS THE PERSON STAND UP.

  • THE BELT HELPS SUPPORT THE RESIDENT

  • WITHOUT STRAINING THE AIDE'S BACK.

  • ONE HAND.

  • OKAY.

  • ALL RIGHT.

  • PUT YOUR HAND RIGHT HERE.

  • YEAH.

  • KEEP YOUR ARMS IN LIKE THIS BY YOUR SIDE.

  • FOR RESIDENTS WHO DO NOT HAVE THE STRENGTH IN THEIR LEGS,