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COEH CE -Alan: Hello everybody and welcome. COEH CE -Alan: We'll get started here at the top of the hour. COEH CE -Alan: Okay, it is 12 O'clock Pacific Standard Time. So let's get started. Welcome. Thanks for joining us today. COEH CE -Alan: My name is Alan bar here at CH Northern California, and on behalf of denial supported education and research centers throughout the country. COEH CE -Alan: We're pleased to present another installment of the 2020 ERC ergonomics Webinar Series offering free monthly webinars on various topics on human factors and economics. COEH CE -Alan: This collaborative effort on behalf of each ERC continuing education program aspires to provide access to current research supported through nyasha ERC programs. COEH CE -Alan: Thank you again for joining us today. If you log in today with your registration email you receive a link to the recording and an evaluation form that will qualify for a certificate of completion worth one continuing education contact our COEH CE -Alan: Quick note that we do have another ERC webinar coming up on a ton. Sorry, November 18 at noon pacific time and the title is emerging technologies, the future of ergonomics. This is in partnership with North Carolina. Oh sh ERC COEH CE -Alan: For today's webinar you will be muted during the presentation but if you'd like to ask a question and we certainly encourage you to do so, please enter it into the online Q AMP a box. COEH CE -Alan: Rather than the chat. It's a little easier for us to keep track of. And we'll save some time at the end of the presentation to address your questions. COEH CE -Alan: Today's webinar will be recorded and made available with past webinars on the CH Northern California YouTube channel. Please take a moment to like and subscribe to our channel to help us continue to grow. COEH CE -Alan: Today's webinar is titled Minnesota safe patient handling act policy, practice and research and it's presented by Brenda cheetah and Christina rosebush COEH CE -Alan: In partnership with Midwest center for occupational health and safety ERC as well as the Minnesota Department of Labor and industry. COEH CE -Alan: And other topics. This webinar will provide a history of the Minnesota say patient handling act a law designed to protect healthcare workers from injuries caused by lifting and transporting patients and we're lucky enough to have two speakers today. COEH CE -Alan: This bracket cheetah and Dr. Christina rosebush COEH CE -Alan: Brenda is and they're gonna missed and industrial hi Janice for Minnesota has a Minnesota OSHA's consulting group workplace safety consultation. COEH CE -Alan: She's a certified professional economist and has an MS pH and industrial hygiene and. Prior to working for the Minnesota Department of Labor. COEH CE -Alan: She was a private consultant and industrial hygiene and ergonomics Becca has also worked as a health compliance officer and senior member of the economics team for OSHA compliance with the North Carolina Department of Labor. COEH CE -Alan: And also with us is Dr. Christina rose bush not rose bush is a recent graduate of the occupational health services research and policy program and a postdoctoral fellow at the University of Minnesota. COEH CE -Alan: And. Her research focuses on the health and safety of direct care workers in long term care settings. COEH CE -Alan: Prior to coming to the University of Minnesota Christina work as an environmental epidemiologist at the Minnesota Department of Health and project manager for the Minneapolis VA evidence synthesis program. COEH CE -Alan: With that it is my pleasure to hand the mic over to Dr. Most, most Thank you so much for the introduction. Allen and thanks to everyone for joining us today. One moment, I'm having trouble forwarding my slides. Christina Rosebush: Here we go, a little bit of a delay there Brett and I are happy to be here to discuss Minnesota safe patient handling work with all of you. Christina Rosebush: Just to lay out a brief agenda record. We'll start by sharing the background of the law. Christina Rosebush: And talk about support that our state programs currently offer health care facilities as they develop and maintain their safe patient handling programs. Christina Rosebush: Then I'll share the results of a policy evaluation that we conducted at the University of Minnesota and Department of Labor and industry using workers compensation data. Christina Rosebush: This evaluation was focused on the effectiveness of the lot in nursing homes. Specifically, we'll wrap up with our thoughts on where safe patient handling policy, practice and research are headed and then we'll open up the floor for discussion. Christina Rosebush: This work was supported in part by a pilot project grant from our Midwest center for occupational health and safety ERC Christina Rosebush: I wanted to share a quick story out of North Carolina set the stage for our work today, this case is courtesy of the NPR feature injured nurses that came out several years ago and is really amazing. If you have a chance to check it out and fall Christina Rosebush: In 2008 Terry cothren had been working at Mission Hospital as a nurse for 20 years and was considered one of their most reliable employees. Christina Rosebush: She was injured on her 45th birthday. While manually transferring a C section patient from a gurney to a bad and in her words that instantaneously felt like hot tar was going down her spine. Christina Rosebush: Terry reported that injury and return to work. She was re entered twice lifting patients. The following week Christina Rosebush: The hospital argued that her back injury was caused at home, lifting a dinner casserole out of the oven. They rejected her workers compensation claim and terminated her position. Christina Rosebush: Though Terry was eventually compensated in court. She can't return to nursing and has lost that part of her identity as a caregiver. Christina Rosebush: stories like these have inspired nurses associations to call for laws to help prevent injuries caused by lifting transferring and repositioning patients. Christina Rosebush: Minnesota is one of 12 states have passed a safe patient handling law between 2005 and 2015 Christina Rosebush: The American Nurses Association, which has a very large presence in hospitals was responsible for much of the advocacy behind these laws so hospitals were really the initial focus Christina Rosebush: The states and blue shown here requires safe patient handling programs and hospitals, the States in orange require programs and hospitals, nursing homes and some other healthcare settings and Becca will share more details about Minnesota Minnesota is lot with you now. Breca Tschida: Thank you. Breca Tschida: So there are two safe patient handling statutes in Minnesota. There is one of you to 6553 and 22 6554 for most of this talk, we're going to be talking about 182 6553 Breca Tschida: And it was really the first one enacted in Minnesota. It wasn't active in 2007 and it covered licensed health care facilities. These were defined as hot Breca Tschida: Little outpatient surgical centers and nursing homes. The statute was phased in over time with sites required to have a written program. Breca Tschida: A fake patient handling committee and a facility hazard assessment by July 1 of 2008 by January 1 of 2011 the sites were expected to have a full program in place, including equipment, such that minimized manual lifting Breca Tschida: Next slide please. Christina Rosebush: Sorry, I'm getting a delay here. Breca Tschida: That's okay. There we go. Breca Tschida: Thank you. Breca Tschida: So you can see sites had time to phase in a safe patient handling program. They weren't expected to have all of their equipment in place until 2011 Breca Tschida: They had different dates for phasing in Breca Tschida: In 2013 we did amend the statute, such that the definitions of a healthcare facility were defined by next code, rather than by licensing. Breca Tschida: OSHA defines industry by makes codes, rather than how they are licensed. And so we had trouble when we went into facilities, trying to argue with them about how they were licensed versus how OSHA tends to define them. Breca Tschida: We also looked at adding assisted living facilities to the covered facilities, but because of the arrangement, the landlord tenant agreement that was in place. Breca Tschida: And the type of relationship that that presented, we couldn't add them as a covered facility. So we do know that there were risks associated with those types of facilities, but they weren't included under the statute. Breca Tschida: Next slide please. Breca Tschida: There are many types of safe patient handling equipment that a site can use anything, including a non powered sit to stand a powered sit to stand ceiling lifts floor based lifts friction reducing devices and bathing systems are are great for using to reduce patient handling issues. Breca Tschida: Next slide please. Breca Tschida: So focusing on that particular statute for hospitals and nursing homes and surgical outpatient surgical centers. Breca Tschida: The statute required that each site have a written program a safe patient handling committee conduct periodic training and have a written hazard assessment. Breca Tschida: And the written program had to contain specific elements they had to have an assessment of the hazards at the site, they had to detail how they were going to be purchasing Breca Tschida: Safe patient handling equipment. There had to be training on the equipment. There had to be information on what the site would do if there was a modification to the site or construction to the site and it required a periodic evaluation as well. Breca Tschida: Next slide please. Breca Tschida: Each site was required to have a safe patient handling committee, it could be an existing committee or it could be a newly formed committee, it has to be at least 50% non managerial direct care staff and if there was union representation. The workers. Breca Tschida: On the committee would be selected by the Union, they Breca Tschida: Distribution of the members of the committee, sometimes presents the challenges for sites they often try and try to use a safety committee to fulfill this committee requirement, but it usually fails to meet the committee makeup so that's been a challenge for sites. Breca Tschida: Next slide please. Breca Tschida: If anyone's familiar with how OSHA writes their standard standards. Breca Tschida: The word shall is pretty important. It basically means do everything as written, and really don't have a lot of room to try to free freelance on it so Breca Tschida: The requirements of the safe patient handling committee were that they had to make recommendations on the training. Breca Tschida: On the use of the equipment they had to do an annual evaluation of the safe patient handling program at the site and how the site was progressing towards goals established in the handling policy. Breca Tschida: They had to recommend procedures to make sure that remodeling a patient carriers accommodated safe patient handling equipment. Breca Tschida: And then they had to complete a hazard assessment that included how patient handling tasks were being conducted types of nursing units. Breca Tschida: What the population was the physical environment of the where the care is being provided. Breca Tschida: Where their problem and solution areas. I mean, I'm sorry, where their problems and solutions. What were the areas of highest risk for lifting injuries and then recommend a mechanism to track and analyze those injury trends. Breca Tschida: Next slide please. Breca Tschida: So I came on with workplace safety consultation in 2009. So the standard had already been enacted, and was in the process of Breca Tschida: Being pushed out to share to stakeholders. So I had the fortunate opportunity to travel the state of Minnesota in January. Breca Tschida: To educate stakeholders about the statute, what it meant what it was going to be requiring them to do in Minnesota. There are seven economic regions. So I got to travel to each one of those during that winter period. Breca Tschida: In addition to that, I've do basically on site visits. I'm a field person, so I will go out and visit sites at their request. Breca Tschida: I do training sessions. We've developed alliances with various sites on safe patient handling and developing resources for that I have to work groups that Breca Tschida: I basically facilitate maintaining the website. I also developed the sample programs for the requirements for the written programs, as you can imagine people looked at it and did it many different ways. So having templates available was helpful. Breca Tschida: And then we planned to conferences and I support Minnesota OSHA enforcement with their maintenance of the directive. Breca Tschida: Minnesota also has grants for safe patient handling equipment. We've done a research and statistics study Breca Tschida: One of the work groups that I work with and have for about 11 years is the facilitated hospital group and initially what wait for hospitals in Minnesota to connect and share ideas about safe patient handling. Breca Tschida: We've SINCE EXPANDED TO AN EMAIL group and extended the group to I think every hospital group in Minnesota. Breca Tschida: We hold a quarterly meetings, both in person and virtually to discuss challenging areas with a patient handling and I've worked with Christie on this project. So Christie. I'm going to turn it back over to you. Christina Rosebush: Perfect, thank you so much. Becca. Christina Rosebush: So getting back to the background of our research project. These are data from the Bureau of Labor Statistics survey of occupational injuries and illnesses and this chart shows all recordable injuries and illnesses in us and Minnesota and nursing homes and hospitals. Christina Rosebush: It's notable that injury and illness rates are higher in nursing homes and hospitals but declining over time in both settings. Christina Rosebush: However, the rate in Minnesota nursing homes was still quite elevated in 2017 when we started this research. So that was really some of the inspiration behind this project. Christina Rosebush: So why are injury rates elevated in nursing homes overall patients are higher acuity or higher need so patient handling happens more frequently. Christina Rosebush: It's a challenging environment for lifting and transferring think of tight patient rooms and bathrooms as well as daily schedules. Most patients must be transferred to a dining room within a short window of time three times a day, for example. Christina Rosebush: Finally, direct care staff and nursing homes are mostly nursing assistants these workers receive low compensation and few benefits and have high levels of responsibility at work and at home. Christina Rosebush: They are disproportionately women racial and ethnic minorities and single mothers and they are not empowered to participate in workplace safety culture on the job. Christina Rosebush: CNS have some of the highest musculoskeletal disorder rates of any occupation as these data from the 2017 so a show that their rate of MST is is up there with firefighters empties and Boston transit drivers. Christina Rosebush: There's very limited literature evaluating safe patient handing laws, particularly peer reviewed literature and the focus is again on hospitals. Christina Rosebush: In the five years a hospital specific law was rolled out in Washington State. There was a larger decline in musculoskeletal injuries and hospitals compared to nursing homes, which were not subject to the law. Christina Rosebush: And survey surveys Washington healthcare workers reported improvements in knowledge of safe patient handling policies equipment and say patient handling training relative to workers who were surveyed in Idaho State that did not have a law. Christina Rosebush: In California hospital workers nurses specifically reported similar improvements on a series of surveys Christina Rosebush: They reported that musculoskeletal symptoms declined over four years, but did not report changes in prevalence of work related injury. Christina Rosebush: Because these evaluations of state laws are so li ited, we can look to the literature on voluntarily implemented safe patient handling programs for more guidance. Christina Rosebush: As a whole results are promising for nursing homes workers compensation claims and costs have declined following implementation of safe patient handling programs. However, these studies are generally quite small and use pre, post designs without external competitors. Christina Rosebush: So with that in mind, the goal of this evaluation was to look at trends and patient handling injuries in Minnesota nursing homes before and after the Minnesota safe patient handling Act was enacted. Christina Rosebush: First by assessing changes in indemnity claim rates over time hypothesizing that the claimant would decline from pre law to post implementation. Christina Rosebush: And then assessing whether changes in injury rates over time, buried by facility level Stephen characteristics, namely worker retention and staff hours per resident day Christina Rosebush: And we hypothesize that nursing homes with high staffing and high staff retention would experience greater reductions in their claims over time compared to other nursing homes. Christina Rosebush: We compile from three sources. The first was the brown long term care focus database. This is a national data set that includes mostly Medicare and Medicaid or CMS data. Christina Rosebush: For many measures, it's more useful than CMS as Nursing Home Compare because it isn't limited to those CMS quality measures. Christina Rosebush: And it's also publicly available already cleaned and standardized across states. So we pulled the majority of individual nursing home characteristics that you'll see in our models shortly from this data source. Christina Rosebush: Next we pull data from our state nursing home report card. Christina Rosebush: These data are designed to inform nursing home choice for Minnesota residents and their families data or from reports that Medicaid certified nursing homes submit annually to the state in Minnesota or Medicaid program is the medical assistance program. Christina Rosebush: We use estimates of worker retention annual retention and number of workers, which we used as our rate denominator for each facility from the source. Christina Rosebush: And the report card is publicly available, but we we put in a separate data request for more granular data. Christina Rosebush: The nursing home report card is maintained by the Department of Human Services in Minnesota. Christina Rosebush: Finally, our injury and illness data come from the state workers compensation database. And these are the only data we use that are not publicly available by law. Christina Rosebush: For each claim we have injury source nature event and body part injured and each claim is pre coded by department of labor and industry staff. Christina Rosebush: Using the occupational injury and illness classification system so we relied on these four fields to determine musculoskeletal disorders and patient handling injuries. Christina Rosebush: In Minnesota only indemnity claims are captured in our workers compensation database. So these last time claims involved payments for wage loss or permanent disability. Christina Rosebush: They also include settlements which stem from disagreements about the circumstances or severity of an injury often between employee and employer. Christina Rosebush: The database does not capture claims that only results in payments for medical treatment. Christina Rosebush: And I shouldn't mention that depending on the year this is between 70 and 80% of claims. So we're, we're really only capturing the tip of the iceberg. Here we've got between 20 and 30% of claims and therefore they're the most severe claims, reflecting the most severe injuries. Christina Rosebush: Here are the elements that went into our model. We were primarily interested in how time period staff retention and staff hours per resident day impacted injury claim. Christina Rosebush: If you think back to the timeline slide that Becca shared we looked at time period categorically to reflect the way that the law was rolled out. So we had a pre law period implementation and to post law periods, conveniently, they were all three year periods. Christina Rosebush: We included a variety of facility level covariance, mostly from that brown long term care focus data based on a directed a cyclic graph. Christina Rosebush: And we looked at several injury outcomes. We were most interested in comparing time trends in patient handling and non patient handling entries Christina Rosebush: And using those weeks codes that I mentioned patient handling injuries were all injuries, for which the injury source was patient resident or clients and non patient handling injuries or everything else. So pretty cut and dry definition. Christina Rosebush: Just briefly on our methods we first looked at trends and staffing and facility characteristics over time. And then we use negative binomial regression models to estimate on adjusted and adjusted indemnity claim rates by time period. Christina Rosebush: Finally, we used interaction terms to see if the relationship between time and injury buried by levels of worker retention or staff hours per resident day Christina Rosebush: This slide is a little busy. My apologies. But this is just our descriptive table the highlighted variables show changes over time. Christina Rosebush: So we look at the slide moving left to right, we're moving from pre law to the post law period. Christina Rosebush: And we see that facility level staff retention decreased staff hours per day increased and average resident acuity increased Christina Rosebush: The majority of nursing homes across time retained less than 75% of their workers each year. And that's actually better than estimates from studies of other regions, we know that nursing assistants in particular have incredibly high rates of turnover often exceeding 100% per year. Christina Rosebush: Here are time trends from our unadjusted models. We saw declines over time in total indemnity claims and that was really driven by patient handling claims non patient handling claims were steady over time, there was no statistically significant change. Christina Rosebush: I should note that musculoskeletal disorders and patient handling injury is shown here are not mutually exclusive. So this is just showing that the grand majority of total MST is we're in fact patient handling injuries. Christina Rosebush: Here's a look at our patient handling claim for categories by time period because we use those weeks codes to define them. Christina Rosebush: The broad category captures all injuries attributable to patient resident or client. If we look just at MST. We see a significant decline over time. Christina Rosebush: The next most common category of these injuries was violence and injuries attributable to resident violence did not change over time. Christina Rosebush: The other category is unfortunately a little bit of a grab bag. So that's significant difference by time period does not tell us much without diving more into the data. Christina Rosebush: And here the adjusted results for non patient handling claim over time. Slips, Trips and Falls had a significant uptick in our 2008 to 2000 times 10 time period. Christina Rosebush: And that other category also showed some significant movement. Christina Rosebush: amnesties did not change over time for these non patient handling injuries. Christina Rosebush: Finally, when we looked at body part. The difference between patient handling and non patient handling claims was most striking for back injuries. Christina Rosebush: Across time back injuries were 57% of the patient handling claims and only 26% of the non patient handling claims and you can see the clear difference in turn trend over time. Excuse me. Christina Rosebush: Here are the results from our models. The second column shows results for patient handling claims the third column shows results for non patient handling claims. Christina Rosebush: Controlling for facility characteristics patient handling claims were 25% lower in the second post implementation period and 38% lower in the second post implementation period compared to pre law. Christina Rosebush: We also saw a 20% decline in non patient handling claims in the second post implementation period only Christina Rosebush: Our interaction terms between time and our to staffing variables. We're not statistically significant. So those were dropped from final model so that we could interpret the main effects. Christina Rosebush: However, we did see some interesting made effects with retention facilities with over 75% worker retention. Christina Rosebush: Across time had a 17% lower patient handling injury rate compared to facilities with less than 65% annual retention and that was not a pattern that we saw in non patient handling injuries. Christina Rosebush: facilities in the Minneapolis, St. Paul metro hospital affiliated facilities and for profits also had lower patient handling injury rates and metro and hospital affiliated facilities had lower non patient handling injury rates as well. Christina Rosebush: But in summary we saw greater decline and patient handling entries compared to non patient handling entries in the years after the Minnesota State patient handling Act was passed. Christina Rosebush: The association between the law and patient handling claims was not modified by staffing levels or staff retention but facilities with certain characteristics had elevated claim rates overall Christina Rosebush: At the state level mechanisms to support the floor already in place and several of those were discussed by Brenda Christina Rosebush: There's the Grants Program and the men OSHA consultation program that she runs and these programs can use these results to target groups of nursing homes with elevated claim rates to address patient handling injury disparities across our state. Christina Rosebush: We also looked at individual facilities and we found that 45% of them did not show a decline and injury rate over time. So we do have quite a bit of room to improve in Minnesota. Christina Rosebush: So why do we think that some groups of nursing homes. They'll have elevated patient handling injury rates. Christina Rosebush: Worker safety is not always prioritized and nursing homes and late have many competing goals and requirements. Christina Rosebush: There's a tension between safety and rehabilitation goals rehabilitation staff are working to maximize residents functional independence and an over reliance on patient handling equipment is often perceived as a hindrance to that goal. Christina Rosebush: Reinforcing that is the traditional a CMS reimbursement model which is based on resident function progress and outcomes. And then they are all of the state and federal quality regulations which inform public facing nursing home ratings. So those are really high priority. Christina Rosebush: addressing all of this while maintaining profitability or sustainability is no minor feet and is particularly challenging for nursing homes with limited resources. Christina Rosebush: I also want to mention again that unique power dynamics in nursing homes patient care plans, which include equipment directives when and how to use patient handling equipment. Christina Rosebush: Are maintained and updated by nurses and executed by CNS. So there's this disconnect between the workers who know the residents, day to day function best and the workers who are maintaining the care plan. Christina Rosebush: We code about faculty at the university and Department of Labor to disseminate our results to stakeholders, our stakeholder groups include nursing home owners and managers direct care workers safety advocates and local and state legislators. Christina Rosebush: These will be distributed through the state safe patient handling website and directly through the mail and hopefully someday in the future we'll have some in person presentations as well to share these with workers. Christina Rosebush: With all of us in mind what we see happening with safe patient handling policy, practice and research going forward. Christina Rosebush: The bulk of state laws were passed before 2010 and federal proposals in 2013 and 2015 we're not successful. Christina Rosebush: If our strategy is to pursue new legislation, we need to shine a spotlight on ergonomics in the context of total worker health, making the connection with worker safety issues that are really holding the public's attention today like personal protective equipment and staffing concerns. Christina Rosebush: Alternatively, or in addition we could put our energy into supporting healthcare facilities that already have programs. Christina Rosebush: Several studies of nursing homes and states without laws have shown got most do already have a safe patient handling and program in place voluntarily. So the question may be, how can we make sure that those existing programs are successful. Christina Rosebush: Perhaps with more equipment grants and free trainings by enhancing safe patient handling requirements in direct care worker curricula for providing workers compensation insurance incentives for facilities that demonstrate successful programs consistently. Christina Rosebush: Finally, we should be comparing CMS requirements to safe patient handling goals to identify areas where safe patient handling is potentially being dis incentivized Christina Rosebush: Regarding practice at the state level, we can build on efforts to identify best in class programs and share their strategies with other nursing homes. Christina Rosebush: A great example of this from one of records safe patient handling work groups is a nursing home that holds all of their committee meetings on the floor, instead of in a conference room so ergonomics issues are identified in real time and discussed as they occur. Christina Rosebush: We can work to extend the reach of safe patient handling support beyond major metropolitan areas. Christina Rosebush: in states like Minnesota. Much of the support is offered to facilities via in person trainings and meetings this shift that we've had to virtual work environments and workflows opens up new opportunities to develop online trainings and support for more world facilities. Christina Rosebush: Better enforcement is needed in Minnesota, only about 30 citations for unsafe patient handling have been issued under the law since 2007 Christina Rosebush: We need to more clearly defined manual handling and how to reduce it and her written standards so that nursing home staff and oceans factors are like can easily identify it. Christina Rosebush: And we should also disseminate methods for nursing home staff to easily estimate the amount of patient. Wait, they're moving staff may self regulate better if it's clear. They are performing a manual handling task and moving a lot of weight. Christina Rosebush: Finally, thinking about research or promising workers compensation data sources at the state and national levels that may enable more comparison of patient handling entry trends. Christina Rosebush: For example, the National Council and compensation insurance already collects claims data on STS and we have a similar ensures association in Minnesota, as do many other states. These data could be leveraged to compare entry experiences and states within without a patient handling laws. Christina Rosebush: There are of course limitations. The requirements of safe patient handling laws vary quite a bit state to state, as do workers compensation systems and the work of our enforcement agencies. Christina Rosebush: Nonetheless, this is one of the most standardized national data sources that we could use for project. Christina Rosebush: Locally, we could also think about leveraging OSHA injury and illness logs to track less severe injuries. Christina Rosebush: As I mentioned, we know our work comp data is only capturing a sliver of the experienced injuries. Christina Rosebush: The challenge with using OSHA logs, is that employers are not required to submit their full logs to a government agency so obtaining the logs requires quite a bit of coordination and cooperation from employers. Christina Rosebush: The Department of Labor in industry has done some small pilot studies collecting these data. Christina Rosebush: And it was certainly a challenge the response rate to the request was fairly low and we would guess that more motivated facilities are submitting their logs. So they might not be an accurate representation of what's happening with entries throughout the states. Christina Rosebush: Finally, building on the findings from our evaluation, we should explore the association between worker retention and patient handling injuries more Christina Rosebush: Is retention impacting patient handling practice directly because more experienced workers are more familiar with safety policies on their residents. Christina Rosebush: Or our retention injury rate. Both are a reflection of the work environment that is nursing homes with a healthy work environment, both retain their workers and have effective, safe patient handling programs. Christina Rosebush: Here are some resources if you learn more about the work that we presented today. Christina Rosebush: Amen. OSHA safe patient handling website includes the resources, Becca discussed, including sample safe patient handling programs and materials from our state safe patient and handling conference. Christina Rosebush: And there are two publications related to the evaluation I presented today. The first discusses time trends and injuries and the second focuses on differences in injury rates by occupational group. Christina Rosebush: And finally, feel free to reach out directly if you'd like to talk more or interested in collaborating on future research. Christina Rosebush: Thank you so much for listening. I think we actually wrapped a little early so we have several, several minutes for questions and discussion. COEH CE -Alan: That's fantastic. Thank you so much. Christina, and thank you, bracket, that was an excellent presentation breakout ask you to unmute your mic and then we can take some questions here. And I do have a few for you. COEH CE -Alan: I'll start at the top, I'm going to read these verbatim. So you I think Breck and Christina also have access to these if you'd like to read it, you may COEH CE -Alan: For states that do not specifically legislative type safe patient handling programs does OSHA simply reference general duty claws and look to industry best practices as a means to encourage the development of SP ah programs. Breca Tschida: So I'll take that one. Christy yes that is generally how it works. So if, if there are Breca Tschida: States that don't have specific legislation, the general duty statute does apply would be used and for a period of time actually Region five OSHA Breca Tschida: Of Wisconsin had a physical therapist that was doing compliance work, and I believe she actually had over the course of the same time of our safe patient handling statute going into effect. Breca Tschida: I think she had four citations that were issued to nursing homes and other facilities for safe patient handling violations. So definitely the faith patient handling could be cited under the general duty if it wasn't specifically covered item in that state. COEH CE -Alan: Great. Does the Minnesota s pH legislation prescribe building construction requirements to support safe patient handling, or does it reference another standard or guideline. Christina Rosebush: It only requires that Christina Rosebush: Basically Breca Tschida: Yeah, go ahead. It'll Christina Rosebush: Buyers that construction must be considered. That's a patient handling must be considered for building construction. I don't believe that there are references to to more specific guidance is that correct Breca Tschida: Yeah, and there is a guidance document out there for the design of Breca Tschida: healthcare facilities to basically accommodate faith patient handling and a lot of the sites and I am drawing a blank on what that document is read it right at the time and I can find it, but it was something that I would share with sites. Breca Tschida: On how to develop their how to how to work with their facilities to basically reduce things that would be problematic. Breca Tschida: Such as the transition into the shower or possibly transition from the room or things like carpeting. And so I'm going to find that document on my hard drive, but Breca Tschida: It wasn't wasn't specifically detailed in the statute, it would be part of the hazard assessment. So if you were evaluating your facility. Breca Tschida: And you realize that people having trouble moving the lift around in the room, whether it was carpeted or there were some kind of transition in their or their records. Breca Tschida: Sometimes even just having two people in one room were problematic or the residents, if there were clothes on the floor things, those things would be identified as challenges to save patient handling and as part of the hazard assessment could be addressed that way. COEH CE -Alan: Okay, a couple of questions, sort of combined here. Does the legislation differentiate between hands on training versus theory based training and COEH CE -Alan: For set for instance where the demonstration for ceiling lift use qualify that a worker would be sufficiently competent for safe us. And a related question is COEH CE -Alan: Are there any findings on which method training method is more effective hands on versus learning modules or frequency training, etc. Breca Tschida: So the statute does not specify the training methods. So it is not specifically required to do hands on training, but in my years of work with the hospitals here. Breca Tschida: I can tell you that they have gone to a lot of them, and a lot of also the the nursing homes when they do their Breca Tschida: initial training for staff do hands on and then there is a lot of return on training for insurance of competencies, although that's not required in the statute. Breca Tschida: But we do know that that increases the effectiveness of employee retention on the use of equipment. Breca Tschida: Particularly in places where employees may not use the equipment on the day to day basis in the nursing home, the use of equipment is pretty much almost hourly i mean they're using it so much. Breca Tschida: They're just moving boom boom boom and using equipment so they have a little a pretty good retention on what they're supposed to be doing it just tends to be when someone's new and uncomfortable with a piece of equipment. So I think I covered all the items. Christina Rosebush: And I'm not aware of literature that directly compare is more theory based training two Christina Rosebush: hands on training though participants certainly jump in if you are aware of it. What I've seen is generally pre, post studies of one specific training that is either theory based or hands on, or a hybrid rather than a direct comparison of the two modalities. COEH CE -Alan: Okay, I'm working. Were any. Were there any identified successful strategies to combat the high worker turnover outside of focusing retention of COEH CE -Alan: Retention sorry outside of focusing retention and increasing training frequencies. For instance, the idea of pure coaches or training managers, supervisors. Christina Rosebush: It's not something that we looked at in this study that we're certainly interested in it for future research. It would need more of a mixed methods approach. Christina Rosebush: Though anecdotally record you have anything to to share on Breca Tschida: On those strategies. Yeah, I was just Breca Tschida: I was just thinking that I don't see peer coaches as often in the skilled care environment as I do in the hospital environment. And maybe that is just Breca Tschida: How the system systematically set it up pretty much in the skilled care I'm seeing teams of two individuals that work together to manage a certain number of residents and not, I don't see Breca Tschida: Any peer coaching happening, unless it's like an initial training or something like that. But I see the peer coaching far more in the hospital environment than I do in the nursing home. COEH CE -Alan: Okay, great. Thank you. And how could the COEH CE -Alan: Standard be improved in your estimation Breca Tschida: Oh, there's lots of ways. Number one. Breca Tschida: Um, well, it, it did it really kind of Breca Tschida: REALLY FOCUSES ON A written program and I'm training and you know that you have to have a committee, but it never really comes right out and demands that you know you reduce manual lifting Breca Tschida: Other than you evaluate your program and look at it so it it does have that as as part of a topic, but it's really Breca Tschida: Some of the language in it. It was written, not by people that that typically write Breca Tschida: Legislation or write statutes. So, you know, enforcing it as an OSHA person and it's written by someone who's outside the language is a little bit different. Breca Tschida: And we like to be very OSHA language is very Val shout do this spell shout do that. So there's a there's a lot of language in there that is a little bit different than Breca Tschida: An OSHA person like to see Christina Rosebush: And some of the elements like developing a mechanism to to track the program over time. Christina Rosebush: And ensuring the program is effective, just don't have the language to be something that could be checked by an inspector. Christina Rosebush: Let me know if I'm wrong. Breca Tschida: But I don't think that Christina Rosebush: Tracking you know your exam of Christina Rosebush: Injuries and you're right actually checked. Breca Tschida: Well, and it's something that I figured out, but, you know, and I do the training for the new compliance officers. Breca Tschida: But it's you know it's a method of, like, okay, now you need to evaluate your injuries at your site and you need to use your OSHA recordkeeping Breca Tschida: But it's not something that they're necessarily familiar with in a way that somebody who does safety and health at a manufacturing site might be accustomed to doing Breca Tschida: In a healthcare facility, they're not looking at incident rates in the quite the same way in comparison to like evaluating a program. So it's just a little bit of a shift on on mindset on that. So there is a way to evaluate it, but it is not obvious immediately. COEH CE -Alan: Okay, thank you. Are you planning on writing up your work for publication. Christina Rosebush: We have two publications on the the work that I presented today and we also did a small study using workers compensation data from a single ensure Christina Rosebush: That compared nursing homes, hospitals and other health care settings. So there's probably a third publication pending based on that work, but for the state study that we presented today. The two publications on that final slide are the ones COEH CE -Alan: Right. Can you briefly discuss barriers to broader adoption. Breca Tschida: Um, broader adoption outside of Minnesota or broader adoption. COEH CE -Alan: Oh, absolutely. Yeah. Breca Tschida: Okay, well, you know, different states have different Breca Tschida: Things they focus on and different levels like Minnesota state plans date. We're one of 26 Breca Tschida: So we have to be at least as effective as the federal as federal OSHA does, but we can also enact our own statute standards and rules and so Breca Tschida: That that helps to be able to do those kinds of things. If it's a federally run state. If it's covered by federal ocean does not have a state plan. Breca Tschida: They're going to have, you know, have to have a federal standard for it. So those are some of the limitations that depends on the political climate in the state. Breca Tschida: You know, if there's a lot of enactment of standards, you know, there's some states that have we saw that there were 12 states that have safe patient handling. Breca Tschida: statutes and rules at the state level. So you can see that they are states that are pretty aggressive in terms of enacting standards for Safety and Health, more so than other states. COEH CE -Alan: Okay, excellent. Let's move on. COEH CE -Alan: Question, would you wager a guess at the mechanisms by which the legislation may be reducing patient handling injuries. Is it equipment purchases equipment usage changing procedures, all of the above. Christina Rosebush: I Breca Tschida: Oh wow, okay. Christina Rosebush: I would say equipment purchases is probably a large piece of it, especially for some of these smaller facilities that may have had really limited equipment or been relying on things like gate belts and slip sheets before Christina Rosebush: The monetary support was available from the state. What do you think, Becca. Breca Tschida: Yeah, I think it's just me going around and talking to people. Now I'm just kidding. Breca Tschida: There's Breca Tschida: I mean, I talk people into things right. No. Breca Tschida: No, I think it having the equipment and understanding that they can use that grant to purchase equipment there been a lot of say patient handling equipment that's been purchased through that grant Breca Tschida: And and lots of things from you know ceiling tracks and ceiling lifts and bathing systems, you know, a lot of stuff and also then experience was experimenting with the equipment and going, oh wait, this really, this does something we can use this Christina Rosebush: And that actually makes me think the previous question that someone asked about what could be improved in the language of the statute. Christina Rosebush: I think the statute says that each facility must have adequate equipment and being more prescriptive as to what adequate mean how much equipment per head in in each type of facility. I think would be helpful addition to the law. Breca Tschida: Sorry to backtrack there. Yeah. And some of that wasn't really ya know that some of that information. Wasn't it was pretty early on when that was being developed as to how many, you know, based on what type of Breca Tschida: You know tasks, you're doing so. Yeah, definitely. Having a good distribution and understanding what that looks like in terms of equipment. COEH CE -Alan: Some of these excellent questions are come from Canada Canadian hospital are gone. I missed and Breca Tschida: Oh, nice. COEH CE -Alan: And and that person would just like you to know that this was particularly enlightening to hear specific legislation to support us pH and that you're trailblazers and thanking you for your, for your valuable efforts. So I thought that was noteworthy just an attack. Breca Tschida: Well, thank you. That's very, very kind. COEH CE -Alan: I'm glad I'm glad you finished early so that we could have a time for this discussion, because this is very interesting component COEH CE -Alan: Here's another one for you, other than the composition of the SP H committee itself. Is there anything else that is looked at during inspection is to determine if the committee's are functioning as they were intended to Breca Tschida: Yes, so I'm like I said I'm a field person. So I go out and do the inspections and I do the majority of the safe patient handling ones. Breca Tschida: So I will look at the makeup of the committee, I will look at the activities that the committee has been conducting I look at their hazard assessment. Breca Tschida: I will also talk with them. I'll basically take their OSHA 300 log and break down all the injuries. Breca Tschida: Based on whether it is safe patient handling related or possibly interaction with residents. Breca Tschida: So I will show them where their numbers breakdown and then we basically see where they're trending over a three year period, based on those logs, whether they are staying the same, or whether the incident. Breca Tschida: Is whether the rate is going up, whether they are functioning healthfully and then I'll talk to the members of the committee, and I'll talk to employees. Breca Tschida: actually developed a whole document for this because sites were having so much difficulty. Breca Tschida: With their committees, because of the turnover every time a new person came in. It was like they were reinventing the committee so Breca Tschida: I worked with one of my work groups on say patient handling to develop a calendar of activities. It's m re fun than, you know, just your regular calendar is the safe patient handling committee calendar. Breca Tschida: And it had three years of activities that you could, you know, got that. Breca Tschida: Three years of activities that you could use for your committee so that if there was a turnover. When someone left you wouldn't lose all of your progress as a site. Breca Tschida: And so it would have fun things like analyze where your trends are and look at your numbers for the year. And then also go look at your equipment to inspect it. Breca Tschida: A lot of times sites really struggle with this because they really don't have time. Breca Tschida: For so much committee activity. So we really have to think about how to have that committee functioning where they're not just sitting in a room. Breca Tschida: And it's a large committee, it tends to have to be a smaller streamlined very active community, who's going out into Breca Tschida: The, the staff, the workers and asking them, and inquiring about how safe patient handling is going and what barriers there are and can they get equipment and what's happening. Breca Tschida: So we really have to think differently about how that committee functions. And that's something that I talked with sites about to Breca Tschida: And I do train the compliance staff, the new compliance have to look at this and then I also help with compliance staff who are evaluating it as well. So it's a learning curve for everybody to try to Breca Tschida: Work with the statute and, you know, we get better at it. The longer we have it because we understand how to use it better. COEH CE -Alan: That's great. Here's a related sort of follow up to that. Do you have any suggestions or recommendations on improving cooperation between safety committees and patient handling committees. Breca Tschida: So that's an interesting question. Um, oftentimes what I find works is that the safe patient handling committee is a subset or a subgroup of the safety committee and that they are bringing back information to that safety committee. Breca Tschida: Since the safety committee tends to be a larger committee and they tend to have sort of traditional meetings. So if you have Breca Tschida: Interested parties and and really at a facility. It just takes one very interested person to basically get a couple other people interested Breca Tschida: And to get that information and start collecting it and then share it with the safety committee to look at ways of improving it, but not necessarily operating in the same way as the safety committee does COEH CE -Alan: Okay, great. I think I have one more question for you and that's COEH CE -Alan: Do you think that COEH CE -Alan: gaining access to 100% of claims data versus the current 30% of claims data would be a game changer, or does the 30% that you've currently evaluated really reflect all the meaningful trends and is compelling enough without that other 70 odd percent Christina Rosebush: I would say it's compelling enough to make me want to dig into the rest Christina Rosebush: Of the data. One concern that we have is, are we not making progress and preventing injuries all together instead. Are they are they getting less severe so is the equipment helping, but are we still having employees injured. Well, lifting and transferring patients. Christina Rosebush: But just via a different mechanism. So we think of like those sit to stand lifts. Christina Rosebush: Involve a lot more shoulder action from workers as they're they're helping push patients up. So I do think it would be a game changer to compare trends in these more severe last time injuries to less severe medical only injuries and then comparing both of those to the soy data. COEH CE -Alan: Excellent. And how do you go about getting your hands on that. Christina Rosebush: In Minnesota we have to work with individual insurance companies. Christina Rosebush: And so it's not representative of the whole state, it's just kind of a snapshot of the enrollees with that company, but it does give us access when we form partnerships with them to to the full spectrum of work comp data. Christina Rosebush: I believe in other states the state systems do include all claims. So it would be interesting for those states to take a look at that more severe versus the less severe injuries. COEH CE -Alan: Well, that's great. I think go but some one more just popped up. COEH CE -Alan: Would you be kind enough to put up the last slide with the resources briefly. For. Thank you. COEH CE -Alan: And we'll leave that slide up for now and I'll have some closing remarks here quickly. COEH CE -Alan: You may learn more and register for our upcoming webinars at CH berkeley.edu and you can also subscribe to our YouTube channel where you can find recordings of previous webinars and other events. COEH CE -Alan: And as a reminder, you if you log in today with your registration email you'll receive a link to the evaluation form that will qualify for a certificate of completion. COEH CE -Alan: Worth one continuing education hour. And when I end the webinar, it will hang up on everybody. So I just like take a moment to say thank you very much to our presenters. COEH CE -Alan: Wonderful job and very enlightening, as was mentioned before, and allow your presenters to say goodbye as well. Thank you for joining us. Christina Rosebush: Yes, thank you so much. We really appreciate your time today and hope to hear from some of you in the future. Breca Tschida: Definitely. Thank you so much. COEH CE -Alan: Okay, good job, everybody. See you next time, bye bye bye