OSHA Inspection: BROAD MOUNTAIN NURSING CENTER

Issued

1993-01-11 00:00:00

Abate by

1993-04-14 00:00:00

Penalty

Initial $5000.00 · Current $5000.00

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
employer did not furnish employment and a place of employment which were
free from recognized hazards that were causing or likely to cause death
or serious physical harm to employees in that employees were exposed to
the hazards of lifting patients in an unsafe manner and other strenuous
operations.  This exposure caused, aggravated, or precipitated employee
injuries to the trunk and upper extremities.  This exposure occurred at
the following operation:
a)  Broad Mountain Nursing Center, Nursing Department:
Nursing Assistants (NA); Licensed Practical Nurses
(LPN); and Registered Nurses (RN) while performing
routine patient transfer activities.  The injury
records for 1989, 1990 and 1991 document a pattern
of such injuries.
The following conditions contributed to the existence
of this hazard:
1.  The sheet method of patient transfer exposes
employees to extensive body position and compressive
force stressors.
2.  The majority of residents who are totally
dependent or need extensive help with transfers are
manually lifted from one location to another.
3.  Totally dependent residents are transferred from
geri chairs manually.
4.  Mechanical lifts at the facility are limited in
design and flexibility of usage.
5.  CNA's are not aware of how to use brakes on the
beds.
6.  The manual lift technique of under arm grasp used
at the facility exerts significant compressive forces
on the lower back.
7.  Communication problems seem to exist between CNA's
and the professional nursing and/or administrative
staff with regard to resident capabilities, goals
of rehabilitation, and the CNA's involvement in the
rehabilitation program.
8.  The training program provided for the CNA's for
transferring is not adequate;  for the hoyer lift,
for the gait belt, or for special needs of residents.
9.  There is no established program for retraining
when CNA's return to work after back pain incidents.
10.  Some of the equipment does not allow for
application of ergonomic principles.
AMONG OTHER METHODS, A FEASIBLE AND ACCEPTABLE ABATEMENT METHOD TO CORRECT
THIS HAZARD WOULD BE IMPLEMENTATION OF AN EFFECTIVE PROGRAM FOR DEALING
WITH
RESIDENT TRANSFER.  AT A MINIMUM INCLUDE THE FOLLOWING ELEMENTS IN THE
PROGRAM:
I    Management Commitment
1.  Implement an ergonomics program.  Ensure that the
program includes a clear statement of management's
commitment to effectively deal with the problem of
employee injuries related to resident transfers and
other strenuous activities.  Ensure that the
program is written;  addresses the area of employee
involvement;  and provides a mandatory mechanism
for regular program review and evaluation.
II   Worksite Analysis
1.  Analyze medical, safety and insurance records
including the OSHA-200 log and information compiled
through the medical management program;
2.  Identify those employee jobs that are the most
physically stressful and may be related to employee
injuries;
3.  Conduct detailed ergonomic evaluations of those
tasks which are associated with the highest
frequencies of employee back injuries, such as
resident lifting or laundry handling, including
the identification of specific elements in those
tasks which are capable of being modified through
the use of mechanical lifting devices and aids or
changes in lifting methods, including where
necessary, the use of multiple personnel during
specified lifting tasks.
4.  Conduct periodic workplace surveys to evaluate the
implementation and effectiveness of resident
transfer methods.
III  Hazard Prevention and Control
1.  Ensure that patient chairs and other furniture are
designed to facilitate safe transfer.  For example
select chairs that allow for proper positioning of
employee's feet during a resident transfer and
which are at heights compatible with  other
equipment.
Give consideration to location of controls
and the range of height adjustments for beds.
2.  Assure that assist devices such as hoists, transfer
boards and wheelchairs with arm rests and removable
or swing away foot rests are available in
sufficient
quantity to ensure resident transfers are
performed according to the ergonomic program.  When
selecting a particular type of assist device
include consideration of resident comfort and and
safety, and employee safety and preference.
3.  Develop and implement a maintenance program for
resident moving and lift assist devices.  Ensure
that sufficient back up equipment is available
during periods when primary equipment is out of
service.
4.  Reduce the number of resident transfers to the
maximum extent feasible by use of equipment such
as ramp scales that require no resident transfers
and use of shower chairs that are compatible with
toileting facilities.
5.  Analyze equipment considered for purchase to
determine that it is ergonomically appropriate for
the work settings.
6.  Establish official procedures and guidelines
describing specific step-by-step techniques for
the various routine lifting and patient transfer
tasks performed by nursing department personnel.
7.  Perform baseline assessments of the lifting skills
and abilities of all new hires prior to assignment
to specific patient care areas.
8.  Assure that sufficient number of personnel are
available where multiple employee patient lifting
and transfer is required, and the nursing staff is
fully aware of the policy relating to and not
reluctant to request assistance in multiple
employee
transfer situations.
9.  Assure that the existing policy and criteria
relative to multiple employee lifts is sufficiently
protective, and is being clearly communicated to
the nursing staff, including supervisory personnel
and that staff is following the policies.
IV  Training
1.  Supervisory nurses will be trained to properly
evaluate  the resident transfer techniques
practiced by the nursing staff.
2.  Orientation training for new employees will include
practice and discussion of proper resident transfer.
3.  Mandatory inservice back injury prevention training
for all nursing department employees who may be
involved in lifting and patient transfer tasks.
Training sessions should include at a minmum:
(a)  A review of the back injury prevention
policy.
(b)  A discussion of the general rules of
body mechanics, along with those
musculosketal
disorders which result from
overexertions encountered during lifting
and patient transfer tasks.
(c)  Hands-on demonstrations and performance
of the specific lifting and patient
transfer techniques in the work setting
with specific emphasis on the use and
understanding of mechanical lifting
devices and aids.
(d)  A discussion of the benefits of exercise
in reducing the incidence of work
induced back injuries, including
identification
of sources of information on
specific exercises and available
exercise
programs.
(e)  A review of the procedures to be
followed by employees subsequent to the
occurence of a back injury, along with a
description of the medical and
rehabilitation
services and return-to-work
programs which are available to these
employees.
4.  Refresher training will be provided that includes
practice and discussion of proper resident transfer
techniques.  Employees who miss training sessions
will be provided with equivalent training sessions.
Employees returning to work after time off from a
work related injury will be re-evaluated in
resident
transfer techniques and retrained as necessary.
5.  All employees expected to use lift assist devices
will be trained in the proper use and limitations
of the equipment before they are expected to use
the devices. At least every year each employeee
should demonstrate competence in use of these
devices.
V  Medical Management for Worker Injuries
1.  Implement a medical management program that
addresses the following issues:
(a)  Injury and illness recordkeeping
(b)  Early recognition and reporting of injuries
(c)  Systematic evaluation and referral
(d)  Conservative treatment
(e)  Conservative return to work
(f)  Systematic monitoring
(g)  Adequate staffing and equipment
ABATEMENT NOTE:
Step 1 - Effective administrative protection, including the
establishment of a formal back injury prevention
policy, mandatory in-service training and baseline
assessments of new hires, shall be provided as an
interim protection measure until feasible engineering
and permanent administrative controls can be
implemented which will reduce employee exposure to
nominal risk.
Step 2 - Submit to the Area Director a detailed plan of
abatement
outlining a schedule for the implementation of
engineering and administrative measures to control
employee injury due to manual lifting and employee
transfer tasks.  Engineering controls to reduce
musculoskeletal stresses include, but are not limited
to, task redesign, reduction of lifting frequencies or
weight and use of mechanical lifting devices and aids.
All proposed control measures shall be approved by a
person knowledgeable in the evaluation of workplace
conditions which cause lifting disorders and injuries.
Step 3 - Abatement shall have been completed by the
implementation
of back injury prevention program and upon
verification of the program's effectiveness in reducing
the occurence of musculoskeletal injuries among nursing
department personnel.