Safe Patient Handling Part 1 w/ Lauren Caulfield

It is serious work, physically demanding, and can put nurses, caregivers, and their patients at risk of serious injury. Assisting and moving patients happens hundreds if not thousands of times a day in each care facility or home depending on its size and capacity. No matter if you are recovering from day surgery or in hospice, This close quarters caregiving is essential to the recovery path for any patient. And it’s these movements that are putting caregivers and their patients at risk.  This is Peter Koch, host of the MEMIC Safety Experts Podcast and in this episode I speak with Lauren Caulfield, Director of the Atlantic Region Loss Control here at MEMIC about the Patient Handling Problem, it’s effect on providers and patients and how the MEMIC Safe Patient Handling Program is helping care facilities reduce the number of provider and patient injuries as well as increase the quality of care delivered.   Peter Koch: Hello, listeners, and welcome to the MEMIC Safety Experts Podcast. I'm your host, Peter Koch. So imagine for just a moment, if you can, that you're walking with your elderly grandmother or grandfather down the hall back to the kitchen table, or you're with a friend recovering from a medical procedure that's left them weakened, somewhat frail, or you're guiding a patient back to their room and then they stumble and fall. What do you do? Well, you go to help them get up because I don't know. That's what I would do. Or you try to help keep them from falling in the first place, because that's just the natural reaction. It's what we do. It could even be a compulsion to help others, especially when their loved ones or if it's your job. And so therein lies the problem that we're going to talk about today. It is the patient handling dilemma. We are compelled sometimes to help people. And when we go [00:01:00] to help them, when we try to lift them up or move them, we put ourselves at risk of injury. And there are statistics out there that show health care workers, that's the number one cause of injury for many health care workers, is patient handling when they try to move a patient either from the floor or across the bed. And it's a big challenge. Well, today, I have the pleasure of speaking with Lauren Caulfield, the director of the Atlantic region. Lost control here at MEMIC. Lauren has extensive experience within the health care industry before coming to MEMIC. We used to work with large accounts, both managing self-insured groups and providing lost control services once an injury has occurred. Lauren has been with MEMIC for more than 15 years, using her expertise to help our MEMIC health care accounts realize that patient handling injuries as a loss leader is a solvable problem. And then helping them to implement workable solutions. So, Lauren, welcome to the [00:02:00] podcast today. Lauren Caulfield: Thank you, Peter. I'm so happy to be here. Peter Koch: Very excited and great to have you on the line here today. So patient handling injuries is a real challenge within the health care world. Talk to me a little bit about the extent of the problem. How pervasive are they really and what's the cost? Lauren Caulfield: Well, as I look at the injuries that come through the door at MEMIC for our health care clients, it's no secret that overexertion injuries are definitely on the rise with our nursing employees. And I think part of that problem is that patients are getting bigger. They are harder to handle for sure. And what's also interesting is the patient acuity is higher. So what I mean by that is people that used to be in the ICU use are now on the med surge units. So if [00:03:00] you take that patient size issue, you take the patient acuity issue and then mix that in with a chronic problem with our health care clients. And that is that they're often short staffed. A lot of nurses are leaving the industry because of different types of overexertion injuries. And it's really a challenge for a lot of our clients. So as we look at that, you know, I was looking the other day at the most recent Bureau of Labor Statistics data. And what I found really interesting is they were looking at the overexertion injuries across all industries. OK. So we look at that rate and that rate for these overexertion injuries is 33 per 10000 full time workers. So I said, okay, let's take a look specifically at [00:04:00] our health care industry and how does that compare? And I was really kind of shocked when I saw really that the rate of overexertion injuries for hospitals being twice that average. Peter Koch: You're kidding. Twice the average? Lauren Caulfield: No, twice say the average. The rate was 68 per ten thousand full time employees. And then we all know that, you know, a lot of times the nursing homes and the long term care folks, they're getting injured at higher rates as well. So I went one step further and that, you know, I found out that it was three times the average or 107 per 10000 full time workers. Peter Koch: And that's for which group within health care? The hundred and seven? Lauren Caulfield: That is for our nursing homes. Peter Koch: For the nursing home. So, yeah, general health care was 68 per 10000 full time workers. And when you looked at nursing home, so like your long term care facilities, there was one hundred [00:05:00] and seven per 10000 workers. Yeah. Yeah. More than three times. Lauren Caulfield: Right. Right. So that's 68 per 10000 worth for your hospitals. So they are twice the average. And then our nursing homes are three times the average. And if you look at the data as well. We all think that, you know, our truckers and our roofers and our construction folks are the most hazardous. But one of the things that comes to light is health care is one of the top high risk industries. As you look at these musculoskeletal disorders, so they're at the height. And we have some statistics internally. And I think people would be surprised to see that one back injury can cost upwards of thirty six thousand dollars. So it's so important with, you know, the industry data that we're getting that we get a solid handle [00:06:00] on that because thirty six thousand dollars is a lot of money for one injury. And the good news is there's so much that we can do to help our clients. Peter Koch: Yeah, no doubt. And it is pretty amazing when you when you think about it, you think about health care being a healthy place. There's a lot of good stuff that's going on there. You don't really think about the musculoskeletal, the potential risk for back injuries and shoulder injuries as you would for your construction or your manufacturing or some of the other more traditionally we consider traditionally physically intensive jobs. So it is fairly staggering that we consider that long term care or long term care facilities are three times the national average. Hospitals are twice the national average for those musculoskeletal injuries. And is it mostly lifting or are there other causes [00:07:00] in there that are increasing that number of those musculoskeletal injuries? Lauren Caulfield: Well, as we look at the types of injuries that our clients are reporting, some of the more challenging transfers that we see generally are toileting are lifting people up off of the floor because the easy part is getting down and trying to, you know, get the patient all set up. But the hard part is actually when you manually lift somebody off of the floor and if you ever step back and really look at the body mechanics that people put themselves in and those awkward postures, it's a nightmare. And you know, that's the reason why so many folks get injured when they're doing those floor recovery type transfers. And then the other thing that we see is a lot of upper extremity injuries from moving patients over their bed. So those turning repositioning type [00:08:00] transfers are really presenting major challenges for our folks. So oftentimes the client will say, well, you know, when somebody gets up off of the floor, we do a proper assessment and then we get five or six people to move them up off the floor. And that's when we, you know, are able to provide some great education for our folks to say the safest transfer from the floor is with the use of the lift equipment, because ultimately what we tell our clients is there's no safe lift from the floor when you do it manually. Peter Koch: So elaborate on that a little bit, because you would think we talk about that in other, you know, not people handling. But in other manual material handling issues where if you have to move something by hand, then maybe have a team lift to be able to do that. And you had mentioned a client might [00:09:00] come in or they have a patient that's on the floor and they'll do an assessment or they'll be in a bed, they'll do an assessment and then they'll get more people to come in and help. So why isn't more people a good solution? Why do you still go back to if you have to move the patient from the floor? The best way to do it is with a mechanical assist. How come more people isn't the solution? Lauren Caulfield: It's not because our bodies were not made to lift this amount of weight. And it's not only the weight, it's actually the awkward postures that we put our employees bodies in every day that's creating the issues. So what's interesting, and I always point this out to my clients go to U.P.S. or some sort of delivery service, and they will tell their customers 70 pounds or 75 pounds is the lifting limit. Right. [00:10:00] So we're making sure that the customer is not putting in more than 70 or 75 pounds into a box because they have deemed that unsafe for their drivers. Well, when I say to my nurses, I'm going to give you ten,.0 Seventy or seventy five pound patients on your workload today. What do you think about that? That's a win win for that. Right. They say, wow, that's an easy day. So it's all in perspective. We're looking at nurses that say, wow. Seventy five pounds. That's just an easy day for us. That's an easy person to lift. But the reality is that it's not. And in fact, if you I'm not sure if you are aware, but there is a gentleman, Dr. Tom Waters, who is with NIOSH and him and several different researchers set out to answer the question, [00:11:00] how much can we safely lift without assistive equipment in some of the factors that they looked at? Is the fact that patients or residents are unpredictable? Right. So sometimes we might to go to move Mrs. Jones and she might get combative or aggressive and bite or hit or swat at the employee. So that was one of the things that we have. The other thing is we're not lifting boxes we're moving patients or residents. And when you're doing that, you can't always get them close enough to your body. Right. So we talk about when we lift boxes, make sure that you're getting that close to your body. Well, that goes out the window when you're moving patients. And then the other things that boxes have are handles. Right. So patients don't have handles. So [00:12:00] what do we do? We typically put a gate belt on them to provide those handles for that caregiver. So through their research, they concluded that 35 five pounds was the maximum acceptable weight for manual patient handling. And that is under ideal conditions. Okay. And many times when you are moving or transferring a patient or resident, you're not under ideal conditions. So as I talked to my customers about that many times, they'll say, oh, we have. Lift equipment, and so we have a program. But in fact, when I go and actually look more closely at their program, here's what we're finding. We're finding that lifts are not being consistently used on the floors. [00:13:00] We're finding that a lot of the nursing staff are still manually lifting and are not using that 35 pound acceptable weight limit as their guide. And I think it's about education and changing the client's mindset and perspective. And that's the reason why MEMIC decided to introduce our safe patient handling program. Peter Koch: Well, that's really that's interesting. So when we think about patient handling as a problem within the health care and because you can't get away from it, you have to manage patients looking at that from. How do you do it safely? You can't take the same structure that you might have in a warehouse or a package delivery service, but you have to look at it with some other factors. I like what you said about the unpredictability, because even if you are able to get a handle [00:14:00] on a patient using a gate belt and you're trying to get close to the patient, it's still the unpredictability what if they move? What if they reach out? What if they strike? What if they are more nervous? What if they pass out and all of a sudden the load changes? That doesn't happen with a package. That doesn't happen with a piano. That doesn't happen with another material that you might be handling. It's a human package that we're trying to care for and then add the human factor of the patient handler. The caregiver themselves, who doesn't want the patient to fall, doesn't want them to go back down. So they're putting themselves at greater risk even for that. So. Boy, it really is all about helping change perspective, because you're right. I've talked to health care accounts before. I don't have many of them, but I've certainly spoken to someone. I've talked to you before about this. And there are patient handling devices everywhere, but [00:15:00] they aren't used as much. We go back to that, the human contact, the human piece. So talk to me some about MEMIC's patient handling program and sort of way it came about. why do we go to such lengths to put this program in place? Lauren Caulfield: Well, I think the biggest reason was that our main goal with our employees is that they leave the building in the same condition that they arrive. And if you look at the data and you look at MEMIC data, patient handling injuries are really the top loss leader and then follow by slips and falls in aggressive or combative residents. So we really felt that it was our duty to work with our clients to come up with a program to address these musculoskeletal injuries that were occurring at alarming rates. And not only that, you [00:16:00] know, we want to make sure we're keeping our employees safe. But at the same time, it's you know, it's all about quality of care for the patient. Peter Koch: That's a really good point to think about this as well. We have to address it from both sides. It is the safety of the worker themselves, but also the quality of care for the patient, which doesn't always think about that. On the other side, we always talk about managing safety, quality and productivity from a safe workplace standpoint and the quality of the product. And we talk about, you know, if I drop this, there's going to be a quality issue if I'm picking up a package or moving material. But that really goes well beyond that. When we start thinking about handling another person, moving another person from point A to point B and helping them. So the quality of care is a key part to this, too. So sounds like the key impetus behind MEMIC creating this program is [00:17:00] obviously reducing the worker injuries, but helping to maintain a high level of care for the patients without putting the worker at risk. Lauren Caulfield: Sure. And I think, you know, when you're talking about families, it's important to get them on board with this concept because, you know, a lot of times families think that Hands-On care, a.k.a. manually lifting their loved one means good quality care. And when you introduce the concept of equipment, they say, oh, no, no, no, no, I don't want I want I don't want that to happen because they fear the equipment. Right. They're looking at they're afraid that you're going to put them in the sling and their loved ones are going to fall out of the sling. But in fact, it's the safest possible way to actually move a patient or resident. Peter Koch: So you're [00:18:00] really you're talking about not only changing the perspective of the worker in the workplace, the nurse, the nurse, case manager, management of the hospital or the long term care facility, but really giving them some tools to help change the perspective of the family, of the patient that they're caring for. That's a really unique concept. Lauren Caulfield: It is. And, you know, one of the important things that many facilities should do is to incorporate that into their welcome package or their admission kit, because when your loved one may come into the facility, the long term care facility, independent and everything's all good. But when that resident declines the families, it's a tough time for the families. It's emotional. They're making emotional decisions. They are feeling [00:19:00] terrible that their mom or dad is no longer able to be independent. So it's good that we introduce the concept and the benefits of a safe patient handling program by use of equipment and reducing that manual lift at the admission phase, because then they can understand the concept and the facility could say, you know what, we're not here yet. But later on down the road, as the you know, your loved one declines. This is what our you know, our strategy is. We want to keep our employees safe and we want to keep our, you know, your mom or dad safe as well. And this research shows this is the best way in order to do that. And not only that, what we have found and we talk about quality of care. We have found that this patient handling program [00:20:00] will actually increase the quality of care for the patient or resident. And let me tell you what I mean by that. First of all, when you're not manually handling somebody, there is a lesser chance that there's going to be skin tears. So the data shows that by using lift equipment and reducing that manual lifting, that it's having a very favorable impact on the rate of skin tears, which is great. Hospitals are also showing that they're having reduced length of stay because with the use of equipment, we have early mobility. We can get patients up sooner with the use of equipment. And it's a win and it's actually a lot. It really enhances the dignity of the patient. So one [00:21:00] of the things that we're finding. I wanted to explore that aggressive behavior topic a little bit more. And what we found is this. If you and I, Pete, transfer our resident today, Peter Koch: OK? Lauren Caulfield: And then tomorrow you go on vacation. And Arielle and I are transferring that same resident. Those two transfers could look very different. Peter Koch: Oh, yeah, sure. Lauren Caulfield: Because we're. Yeah. We're using different people. You might be taller than me. I mean, there's so many different things and components that come into that. So the patient or resident that might have dementia or Alzheimer's. They can't predict what's going to happen because every day it's going to be a little bit different. Makes sense. Peter Koch: It does make sense. Even if even just having two different personalities with a patient with dementia or a patient with cognitive challenges, just two different personalities [00:22:00] from one day to the other could be a very difficult position for that patient just mentally for them to understand what's going on. Not even to mention the physical differences in the lift of how that's going to work. Lauren Caulfield: For sure. And now we introduce the concept of lift equipment. Right. That patient now can anticipate what that lift is going to look like every single day because it's going to be consistent. And as a result, these behaviors are being impacted in a good way. Peter Koch: No kidding. So the aggressive behaviors are being impacted by somewhat of the consistency of the lift process by utilizing the equipment. Lauren Caulfield: For sure. For sure. So, again, as we look at these different things and selling these to our families, it is so important that we're pointing out how this can positively impact. The quality [00:23:00] of care of the loved one. Peter Koch: And that's what it's all about. I mean, having worked in emergency medicine, I mean that the comfort of the patient is always a critical piece. You're trying to manage what crisis they're going through, whether it's mental or it's physical. But the comfort of the patient and making sure that they trust what you're doing is really important. And I think that has to be a key part in your long term care or even in short term care in the hospitals, that making sure that the patient is comfortable and then making sure that the family understands because that's, oh boy. That's a huge part of that. Lauren Caulfield: For sure. And I think once you one of the things that we do is we will put this information into our brochure for the client so that they can put it into their admission kit. We also recommend that they have family nights so that you can [00:24:00] come in and bring in your families and get them in the equipment and, you know, get them comfortable with the equipment. And I think that's really important. And oftentimes when I train during my workshops, I will ask folks, you know, raise your hand if you've never been in a piece of lift equipment before. And it's interesting how many caregivers have not actually trialed the equipment and pretend to be the patient and get in the slings and all of that. And I think that that's critical because if you're going to really appreciate what that resident may be going through, especially a resident that may be scared. Right. Or feel uncomfortable, it's so important that you really put yourself in their position, get in these slings, you know, be transferred with it and all of that, and then you can help sort of put [00:25:00] that patient at ease because you've done it before and you can say with certainty it's going to be OK, this is what's going to happen. You're going to feel like this, you know, that type of thing. I always you know, it's kind of like getting a root canal. I always say to the dentist, OK, before we start, what's going to happen? You know, I need to preview it in my mind. So I think, you know, training is just so critical. And to go one step further. It's you know, sometimes facilities will train by use of video, which is good. it definitely has its advantages. A lot of the vendors will have training videos that you can use, but we always recommend to go one step further. Demonstration and return demonstrations are critical because it's sometimes it's so easy. The vendor comes in or the nurse educator comes in and does all this training. And you sit back and you watch and you say, yep, that looks great. And [00:26:00] this happens a lot with the friction, reducing devices that are used for repositioning and turning at the bedside or on the bed. And, you know, they get all this training. They don't have an opportunity to return demonstrate, and then they go back to the bed. They start using or trying to use the device. And they're like, no, it's not as easy as it looked when the vendor came in and did the training. And they're fumbling with it and they don't know how to use it. They're trying to figure it out. And meanwhile, you know, the resident is starting to complain because you there too long and this keeps taking too long. And what happens? They say this doesn't work. Peter Koch: I'm done. Lauren Caulfield: I don't want to use it. Peter Koch: Going back to my old habits right? Lauren Caulfield:  Yes. And so, so often. And this was, you know, one of the things I mentioned before [00:27:00] is that turning, boosting and repositioning in the bed is a top loss leader nationally as well as at MEMIC. And one of the best solutions to that, are these friction reducing devices. And they are being so underutilized in our facilities. And when we look at that, we say it is important to train, to give ample practice time and to have a competency process, not only for your friction reducing devices, but also for your lift equipment, because that should be annual, because you have to go back and make sure that people feel comfortable. And one of the things that we find that are on the rise is not only the back injuries to our nursing assistants, but also to our RNs. And why is that? Well, it's because RNs typically aren't [00:28:00] involved as much with the patient transfers. But getting back to that problem with people being short staffed. What do you do? You go to the RN and you say, hey, can you help me? And they say, sure. But the last time they used the equipment might have been months ago. And oftentimes people will say, well, we don't really include the RNs on our training because they don't do the transfers. Well, these transfers may be a non-routine task, but anyone that knows about non-routine tasks, those are the people that tend to get injured because they're not as familiar. So when I do observations on the unit, I'll often hear an RN say. Yeah just tell me what I need to do. And they will sort of educate them on the job and the use of that equipment. So as we look at our injuries and where they're happening, when we're doing our trending analysis, it's so important to pull in and look at. And if you're seeing [00:29:00] an increase in RNs being injured due to patient transfers, look at that training program and make sure they're getting training as well. Because I think that's really critical. Peter Koch: Yeah, absolutely. You may definitely miss those individuals that you don't expect because it's not part of their job. Their main job description. But they may very well be doing some of those non routine tasks almost assuredly. And you had mentioned it early on. One of the challenges that is pervasive across all of health care and really actually any industry, but health care specifically is the lack of people, the lack of staff. I don't have enough. we don't have enough nurses. We don't have enough nursing assistance to manage the number of patients that we have in the same way that we used to. So we are using people in different ways because we are short. So if that does happen. So training is pretty key. Let's take a quick break so I can tell you about the patient handling dilemma episodes, [00:30:00] parts two and three coming up over the next few months. We'll be going deeper into the problem of using outdated thinking for patient handling and how good safe patient handling programs can be successful. In future episodes we will address the barriers to implementing a safe patient handling program, as well as talk with different health care teams to find out what has made their safe patient handling program work. Check back to the MEMIC podcast page for updates or subscribe to get notified when the next episode drops. If you're a MEMIC policyholder check out all of our safe patient handling resources on MEMIC's Safety Director Web site at www.MEMICsafety.com. Now let's get back to today's conversation. Lauren, you mentioned a whole lot of different steps and different concepts and different things to do. They all seem to be part of this MEMIC patient handling program. Can you talk [00:31:00] about like what is in the program? So how does the program work? What is it? What does it do? Lauren Caulfield: So for our MEMIC policyholders, we made a commitment that we were going to really provide some good, solid research, evidence based training for our customers and in that our job. I really look at our role as making sure that we are in the forefront. We are going to conferences. We're looking at the latest data in research and all of that and incorporating that into our safe patient handling program. So that is what we did several years ago. We realized that if we are going to have solid outcomes with our clients, we had to really get the right people around the table. So it starts out with what do they say, get the right people on the bus. And that's really what we [00:32:00] did. So we started with hiring RNs, occupational health nurses, physical therapists, OTs people that had been in the industry before. And I think our clients appreciate that because there's nothing better than sitting across the table and talking to somebody that has done the job before. It lends instant credibility with our customers. So when we go and try to help them and make recommendations, they're all ears. Right. Because they say, wow, it's nice to have somebody that understands all of the different nuances that come into play with our customers. So that was the first thing getting the right people. And then we developed a process, so to speak. So when a new client comes on board, I always say you can't make recommendations from a conference room. So we do what we call our transfer resident [00:33:00] transfer observations. And what we're doing is we're rolling up our sleeves. We're spending a couple hours on the nursing units and we're just observing transfers in real time. So we're looking at those floor recovery transfers. We're looking at how are we getting patients or residents out of the bed? How are they bringing them to the toilet? How are they repositioning that resident in the bed as well? We're tying it to those known injury sources that we have researched. So, as I said, we're rolling up our sleeves. And one of the things my directors of nurses always say to us, this is probably one of the most valuable things that you bring to the table. And it's really about reinforcing those positive behaviors that we see that the employees are doing. Are they planning for the lift right [00:34:00] you know? Are they moving things around that need to get out of the way, that are going to come into and be a barrier for them when they're, you know, when they're in the middle of a transfer? Are they using the right sling? Do the residents know what sling to use? Are they the proper size? Are they accessible? We're looking at. Are they manual lifting or are they using the equipment consistently? We look at their communication tools. So Mrs. Jones was just transferred with a sit to stand lift. OK. Let's go back to that modified care plan and let's see what that modified care plan says in terms of the transfer method. Many times, unfortunately, how they're transferring and what the care plan or the modified care plan says do not jive. So that gives us an opportunity to help them not only with tricks of the trade in terms of the transfer, [00:35:00] but also to look at their communication tools, because really that's what it's all about, making sure that our communication tools are updated. And we look at just a variety of things in terms of locking wheelchairs and locking beds. So. And I could go on and on, but I think you get the drift with that. Peter Koch: I just wanted to kind of frame that. So the first step is before the program was put in place was you got the right people at MEMIC. So you pulled in the people that would have the best knowledge. They had experience within not just within healthcare, but people that had experience with handling other people. So your physical therapist, athletic trainers, agronomists to be able to provide information to create the plan. And then instead of just getting to going to a client saying here's a written program. Have fun with it. You start with observing what's going on, on the floor within [00:36:00] the unit itself and seeing what's actually happening. So getting real time information and then comparing that real time information into what's actually supposed to happen, to be able to provide some guidance and some feedback. So that's great. Got the right people getting some good information. Real-Time information that's happening right at the facility itself, comparing it with what's supposed to happen. Once that's done, what's the next step in the program? What do you do next? Lauren Caulfield: Well, the next step is really to help that client take that process and adopt it themselves. So we're all about helping clients put systems in place. So we will ask that either their peer unit leaders, their rehab aides, maybe the nurse managers actually do these types of observations because it provides you with an opportunity to reinforce positive behaviors. But it [00:37:00] also provides you with an opportunity to provide just in time training where you see it's necessary. So from them, we now have a good understanding of what that program looks like. We then provide an onsite, full day safe patient handling workshop. It's nationally accredited. They can get CBUs for this. And what that is, is it's not death by PowerPoint. I can assure you it's more getting all levels of nursing in one room. We start out the workshop and we talk about the challenges that we're seeing and tie that back to the observations that we just did. And then what we do is, you know, certainly there's PowerPoint slides at the beginning to sort of set the foundation and the key concepts for everybody. But from there, once we get that all in hand, we now look at the challenges that we have seen [00:38:00] from the beginning. And everyone participates in that. We go around the room, they ultimately tell us what their challenges are that they see on a day to day basis. And then we have group work. And usually it goes like this. So we assign topics to each of the groups. So it could be change of shift, you know, really assessing that whole process. It could be looking at the patient assessment program, looking at their training programs, because what we see is people have great training programs. But you know what? People don't attend. How do we get them to attend? What is the content? What are the different learning styles that we incorporate into the training. You know, everyone has different learning styles, as we know, some people are visual. Other people can read a manual and learn that way. So really looking at the different learning styles that they have introduced into their training programs, some of the groups are assessing communication, overall [00:39:00] communication with physical therapy or from nurse to nurse or nurse to C.M.A. So basically what they do is they spend the second part of the workshop reviewing and assessing and analyzing these very key topics. And then what they do is come up with recommendations that they present to the class. And what that allows them to do is to have a solid action plan going out of the class, because I don't know about you. I go to a conference, I attend all these great classes, and I get home and I got, you know, a binder so thick and I sit there and I say, oh, my gosh. Now, where do I start? That takes that guesswork out of it. They walk out of that class. They have structured a safe patient handling task force that will work on the different recommendations and concepts and challenges that we identified during the class. And [00:40:00] they setup a time to meet and a schedule and hour lost control. Consultants who are health care specialists will actually attend some of these task force committee meetings and help them not to run the meetings, but just to be there if they get stuck or provide some guidance around that. And that's really a key to the process. So we start out with a patient transfer observations. We help them incorporate that into their program. We provide the full day safe patient handling workshops. We help them with their safe patient handling task force. And through that, we're making sure that key people in the organization are involved in that process. So we tie in the Safe Patient Handling Committee into the Falls Committee. We make sure that we have a quality person on the task force. We make sure there's a nursing representation purchasing [00:41:00] because, you know, certainly there is purchasing of equipment that may be needed. This nurse educator, the rehab staff, all of these key people come together to work on the initiative because safe patient handling programs do not mean you just have equipment. And I think one of the other things that we work really hard with customers on is their system of accountability, because oftentimes you have equipment. And that's the easy part. The hard part is getting people to use the equipment. Peter Koch: And I think that's a key part to think about that accountability. You couldn't get the accountability with having the right people in the room and you couldn't get a system in place without knowing where the challenges are through the observations. And you couldn't do any of that, have it work well without getting the group together to be able to buy in to the solutions [00:42:00] that were created. So this is really it's not a one size fits all solution. There are some guidelines that you're helping them work within, but they're really taking those guidelines and developing a safe patient handling solution that works in their facility that they developed, that you helped facilitate and then will help them maintain that through observations and assistance going forward. Is that a good description of how it works or why it works? Lauren Caulfield: That is a perfect description. And when, you know, clients will always say to us, so, you know, this is a commitment. Absolutely. It's a commitment. But what are we going to get out of it? And in looking at the injury statistics from before they came on board and didn't have this formal approach to afterwards. What we're seeing is an average reduction in the cost of their employee injuries related [00:43:00] to overexertion averaging at about 35 percent reduction in cost, which I think is phenomenal. Peter Koch: That is phenomenal. That's truly phenomenal. It's interesting. I've had the pleasure quite a while ago now, but I've had the pleasure of sitting in part of one of those daylong safe patient handling workshops that you've done. And the dynamic was really interesting. So at the beginning of that workshop, everyone was sitting their arms crossed like it's another training. Can I just get back to my work and using the real world situations that not only you've been through and have seen But also the observations that you've seen on the floor and talking about stories and the impact and then getting people in the audience to talk about their challenges. And it's real. It's so real to them. And all of a sudden the arms start to get un-crossed and they're leaning [00:44:00] in a little bit more. And by the break, by lunchtime, by the time you're getting them to work as a group, everybody or the majority of everyone are leaning into the problem. They're excited about trying to problem solve that. They all know what the challenge is. You've just brought it to an actionable process. And now they're able to take action. And it's something that they can own. And I thought that facilitation process was fantastic. And then the results that you're talking about, if they're able to implement the plan that they're developing to see on average of, you know, with 25 to 35 percent reduction in claims. That's amazing. It's a real testament to the process that you've been putting in place to facilitate safe patient handling across the different health care organizations that we work with. Lauren Caulfield: Sure. You know, it's a great thing to see. And I smile when you're saying, you know, the arms crossed and all of that. [00:45:00] You know, we pull in the patient transfer observations and you come in and you certainly have your book of paper or your clipboard or what have you, because you're going to do observations and make some notes and you meet with the CNAs and, you know, your nursing assistants and they are looking at you like are you the state and oh no, what is she here to do? I'm going to have somebody looking over my shoulder. This is horrible. And we you know, we try to say, you know, we’re the friendly people not the state. We're just looking at what a day in your life looks like so we can make it safer. But they're always skeptical and I get it right. So then, you know, you'll say, OK, well, when you transfer these residents, please come and get me so I can observe the transfer and what happens. They'll say, oh, I forgot. So, you know, and that's OK. And you know what? And then over time, we start observing a few and we're working with them. And then we're saying, you know [00:46:00] what? Let's stop for a second. Maybe. Can we just come in at a different angle with the lift or if we raise the bed a little bit higher? That might be a little bit more helpful for you. So you're not bending over and all of a sudden those same folks that didn't want to be , you know, shadowed are now coming to me saying, hey, can you come down here and look at Mrs. Jones? Because you know what? This is a really challenging transfer. Not only is it challenging because sometimes she tends to drop to the floor or she's resistant, but the other thing is she can be very aggressive. So we go in and we're not only looking at patient transfer techniques, we're looking at the whole, you know, how are we approaching that resident so that they don't become aggressive or at least we're limiting or showing them techniques about positive approaches and all of that. So it all goes hand in hand. And what [00:47:00] we're definitely seeing with our customers is not only are our patient handling injuries going down, but our aggressive behaviors are also going down. So it is definitely a Win-Win. Peter Koch: That's fantastic. I think the thing that I'm finding about this, is it's not just a canned program. It's not a notebook that someone can download from the electronic resources. And then here it is. It's a comprehensive assessment, training, guidance and ongoing feedback loop that you've put together to help address not only the injury itself, but the cause of the injury. And that could be the interaction with the patient to begin with, to help reduce the aggressive behavior or really just the tense behavior of the patient not understanding what's happening, but then the way the patient is moved [00:48:00] as well, and having providing the resources to or not so much the resources, but helping the different clients understand that it's not just a one and done. You can't do this training just once there's a system of observations and continued training and return demonstration that really makes the not just the program work, but the results come out. And that, to me, Lauren, is a key concept that folks need to take away when they start looking at this, because it's a huge problem. We started talking about this as the problem of patient handling or the patient handling dilemma. There are so many facets to it. There is a cost and a quality to it, but it's not just a one cause it's not my battery is not strong enough in my car. That's why it won't start on a cold morning. I replace the battery. I fix it. Done deal. I give the package handler a cart that they can use. Done [00:49:00] deal. It's not a done deal. There's so many facets to this. And the interesting part about the program is it addresses all of those facets. Lauren Caulfield: You are spot on Pete because it is definitely not a cookie cutter approach. Every facility is different. They have different cultures. They have different staffing patterns. Patients change can change every single day depending upon what's going on with them at any given moment. And these changes can be very unexpected. So as we work with customers, it's important to tailor these programs to the different challenges that they have. The culture that they have in really in order to be successful. And it is a collaborative effort. We don't go in and just tell them, oh, gosh, here you go. Here's the laundry list of recommendations and head out. We listen to them and sometimes, you know what? I may make a recommendation then like, no that's not going to work for us because of this. OK. Let's [00:50:00] go back to the drawing board. What will work? And we develop plans that are going to be feasible for our customers. And I think that's really a key. Peter Koch: Yeah, that's a fantastic unit. And it has to happen that way. From my experience, working in different industries, that even though the industry might be the same. Like you work with a restaurant someplace or a construction company someplace. And the stuff that they're doing is the same. But you identify that, well, the culture is different. The clientele is different. The environment is different. How the team works together is different. And if you don't address those things or don't allow those things to be part of the plan and you just give a cookie cutter solution, the solution is bound to fail. As soon as you step away from it, I think that's a really key part, is you want this program to be successful without your involvement. You want this to keep going regardless of who [00:51:00] is there at the meetings or who is there at the at the facility. Lauren Caulfield: Right. And I think that comes from the top. The first thing that we always do is meet with the top management before we roll any program like this out. And we make sure we have the key players around and say, are you ready for this? Some clients have competing priorities. And, you know, we make sure we do it at a time. That makes sense. And once we get that commitment and we roll out what that plan looks like, we typically are going to get some really good commitment and support from the top because it's going to take time and it's going to take resources from the facility in order to make this work. And I throw out something because it's sort of my Bible, if you will, for those that are looking for a great book that will help you to determine and give you a good best practice check and balance on where your program [00:52:00] is and what you need to work on. The American Nurses Association put out a publication called Safe Patient Handling and Mobility Interprofessional National Standards. And it's excellent. I would highly recommend it. And at the bottom, it says across the care continuum. And they basically took all different disciplines across the care continuum to come up with these standards. And I refer to this all the time. And what was really enlightening was as I went through this book and I looked at all the key components that they suggest need to be in place. And I compared it to our workshop and our process. We hit each and every one of these. So I felt that it was a really nice way to evaluate our program and make sure that it was in line with what the industry is telling us the best practices were. So that's [00:53:00] just I wanted to throw that out there for folks that might be interested. Peter Koch: That sounds like a great resource. And we can put a link to that publication within the show notes for this podcast itself. But so. All right. How would a health care facility use that? Could they could they look at that, evaluate their program based on the publication that you just spoke about? And if they're missing different parts and pieces, then how does a company know that they're ready to change their patient handling process? How do they know that  they're, it's time for them to do that? Not just they have a lot of injuries. Great. It's going to happen. But how do they know that they're ready to make a change? Lauren Caulfield: I think it's just looking at their overall program, getting feedback from the staff that do the job on a day in and day out basis. And you can generally tell by walking around what [00:54:00] that culture, what that environment looks like. You know, look at the patient and the injuries that you're seeing. Hopefully not a lot and none, actually. But, you know, are you starting to see an uptick with these areas? Are you starting to see that? We have a lot of holes in the management team. We have a lot of people that have left the company. And there's a great amount of turnover in clients that come to me and say, you know, we just can't keep good people. They're leaving for five cents an hour more and going down the road. One of the things that I offer is you have a great patient handling program. Make that a marketing tool for you when you're looking at recruiting really good employees. Put that in your ads because I don't know about you, but if I had a choice in three different places to work [00:55:00] and two of the places require me to manually lift all day long and put me at risk, and one place has a solid patient handling program that has great devices and equipment to make it safer for my job. which facility do you think I'm going to? Peter Koch: I'm going there. Lauren Caulfield: Absolutely and get that message out when you're advertising. And you know what? For clients that had done that. They are getting people through the door. So there's often many, many different things that come up that you say, you know what, I can't do this anymore like this. It's it behooves us to make some changes to make it safer for our employees and our residents or our patients. And when you do that, I think everyone just wants to keep their employees safe. You know, there's nobody likes to see that somebody had a back injury under their watch. There are solutions out there. Does it take time and energy? [00:56:00] Absolutely. But in the long run, you are going to see a lot of benefits to that. Peter Koch: Yeah, absolutely. And it sounds that the patient handling process, having a good, safe patient handling program can not only be a tool that can be used to well, like you said, pull good people in and keep them there. But it can also be something that if it's not so up to snuff in your particular company or you're looking at some of those lagging indicators like you've got a lot turnover or there are injuries that are happening both on the patient side and the worker side, that if you made some changes to your patient handling program, that could not only reduce the injuries, but it might also be a retention tool for you. And you could keep some of those good workers that you have and they won't go someplace for 10 cents an hour more or five cents an hour or more. Lauren Caulfield: Absolutely. Yes, [00:57:00] absolutely. Peter Koch: Well, hey, Lauren. Jeez, we've been talking here for just about an hour as time just flies and we're right about the end of where we are on the podcast. Is there anything else that you'd like to share with our audience, our listeners today about the safe patient handling program or any parts of it or any challenges? Lauren Caulfield: I just think that I just encourage folks, keep doing what you're doing. Keep looking for continuous improvement. It's so important once you put these programs together and make that investment, it's an investment in your employees and you will get so much back from your employees. I laugh. I have a hospital down in Connecticut and we worked with them on a very formal program. And their program has absolutely just done a whole turnaround. And the medical director I was at a meeting with him the other day and he said, Lauren, you're like the mayor in this [00:58:00] place. Everyone talks about, oh, my gosh, look, what these folks did they came in and it's so awesome to come in, my back doesn't hurt at the end of the day. I don't feel fatigued. I can go home and actually play with my kids and not be exhausted. And I said, you know, it's not what I did. It's what you folks did. You made the commitment and you made this a better place to work. And that's really what it's all about. So I encourage everyone to look at your programs and see what are the good things that you're doing that should be reinforced and keep the momentum going. And then just identify some opportunities for improvement and start working on them one issue at a time. Don't try to do too much and get overwhelmed. Don't try to roll out too much. Make it a very methodical process and you will do just fine. Peter Koch: That's fantastic. That's great advice. And if you're not a MEMIC client, I guess one of the resources that they could use would be that publication you referenced before as [00:59:00] a as a guide. But if they are a MEMIC client and they're thinking, you know, I'm ready to make some changes, how do they how did they find out more about the safe patient handling program that MEMIC has to offer? Lauren Caulfield: The first place to go is call your loss control consultant and they will have all the resources you can talk about a plan that's going to fit your needs and that is the first place to go. I think that they'll be able to provide some great guidance and direction for you. Peter Koch: Fantastic, Lauren. Thank you very much for all the time and sharing your expertise with us today. Lauren, it's been fantastic. I really, truly appreciate you being here today. Lauren Caulfield: Thank you, Peter. I appreciate you having me. It's been a great discussion. Peter Koch: Fantastic. So thanks again for joining us. And thanks to all of our listeners out there who continue to listen to us. And we've been talking with Lauren [01:00:00] Caulfield, the director of the Atlantic region, lost control at MEMIC about safe patient handling and the program that MEMIC has and the challenges that safe patient handling or handling patients safely has for the health care industry. And if you have any questions for Lauren or like to hear more about a particular topic on our podcast, e-mail [email protected]. Also, check out our show notes at MEMIC.com/Podcast, where you can find more links to resources for a deeper dive into this topic. Check out our Web site MEMIC.com/Podcast Where you can find all of our podcasts in an archive. And while you're there, sign up for our Safety Net blog so you never miss any of our articles or safety news updates. And if you haven't done so already, I'd really appreciate it if you took a minute to review us on Stitcher, iTunes or whichever podcast service that you find us on. If you've already done that, I really thank [01:01:00] you. Because it helps us spread the word. Please consider sharing this show with a business associate friend or family member who you think will get something out of it. And as always, thank you for the continued support. And until next time, this is Peter Koch reminding you that listening to the Mimics Safety Experts Podcast is good, but using what you learned is even better.