Podcast: AliTalks with Mary Grace Hensell, RN, MSN, CNOR on Safe Patient Handling
Podcast: AliTalks with Mary Grace Hensell, RN, MSN, CNOR on Safe Patient Handling
March 30, 2020
Daniel Litwin: Welcome to AliTalks where we sit down with thought leaders to bring new medical product solutions that are leading industry trends, driving best practices, and delivering efficiencies for healthcare professionals everywhere.
Shelby Skrhak: Welcome to AliTalks, an AliMed Podcast. I’m your host, Shelby Skrhak. Today, we’re sitting down with Mary Grace Hensell to discuss safe patient handling for patient safety and nurses. So let’s start off by telling us a little bit about yourself and how you found your way to nursing.
Mary Grace Hensell: Well, thank you. How I find my way to nursing? Well, I’m Mary Grace Hensell and I’ve been a nurse for 39 years, going on 40 years, and started off in Med Search. At that point in time, went to ICU and I’ve been in the operating room for about 33 years and have made this my life’s work and I’ve enjoyed every moment in every aspect of a perioperative nursing.
Shelby Skrhak: Well, of course, safe patient handling is an important topic because it’s really easy to hurt yourself trying to lift a patient or performing repeated actions like bending over a bed. I would even say my own example, I was caretaking for my grandmother for about a year with an already iffy back, and so now I’m heading for back surgery because I didn’t think it was really dangerous enough to put that kind of strain on your body. Do you have new nurses that think like that, that they don’t maybe realize how improper patient handling what that can do to your body, your back, all of those important things?
Mary Grace Hensell: Being in a number of different positions and I’ve been an educator in my career, I’ve been a frontline staff person, I’ve been a circulator, I’ve been a scrub, and you know, now my most recent position has been senior director for perioperative services for NOVO. So when you ask me, do new nurses find that it’s possible to hurt themselves? What I’m going to tell you is I think nursing is really one on the ten top occupations that have musculoskeletal injuries. And when I’ve been teaching new nurses during my career, they really don’t realize that the movement of bending or twisting your back or lifting incorrectly can cause a lifetime injury.
Now we know that hospitals are aware of that, but our new nurses, no, they’re not. And the nature of the beast of being in the operating room is time is money, everybody’s in a hurry, everybody’s in a rush, and quite frankly we have an explosion of technology in the operating room. We’ve got navigation systems, C-arms, towers, and HANA tables, Jackson tables, and everybody’s wanting to have a quicker turn over time, move faster, get that piece of equipment. So nurses, new nurses or even older nurses, may inadvertently be pulling things instead of pushing and really, you know, I’d like to give you like a little story about that at this point in time. I had a nurse and she was actually tenured and trying to push a Jackson table, and there was a divot in the floor, and when she was pushing it, it got stuck in that divot. And of course she went to push it even further and ended up with a shoulder injury and that’s where her injury has, you know, been a part of her life ever since.
So one poor decision or bad decision, if you want to call it that, could actually create that whole lifetime injury for you. We know that nurses nowadays, about 18.3%, it’s been cited in the AORN, are leaving nursing because they feel they’re not safe. So new nurses are coming out and they haven’t experienced it, but shortly afterwards they do experience this.
Shelby Skrhak: It’s much more than just, you know, bend your knees when you lift. You mentioned pushing versus pulling. What are some of those strategies that you’re helping kind of educate fellow nurses and really you want to make sure that the nursing profession is aware of, I guess, starting with those and then also I do want to go into some of the tools that are available as well, but I guess what are those basic best practices first?
Mary Grace Hensell: So some of the strategies out there have been, “Let’s just give education. Let’s do ergonomic training and education.” And I have to be quite frank with you, that’s actually just not quite good enough. I think that’s a start and it’s a very nice start to start teaching nurses not to twist while they’re picking up an item or bending your knees as you put it. It’s not just that. It’s about the pushing, the pulling, how do you do everything. But the AORN has actually put out a guide that’s very nice and what they have cited is that you really bring an assessment team in and take a look at all the potential areas where a patient or a nurse can get hurt, and really taking that due diligence and looking at that and then buying products that can help you do the lifting.
I mean, we have a population in the United States that is obese and so where our patients are getting heavier so really you need to take a look at, you know, particularly in the operating room, you’re under general anesthesia or you’re heavily sedated, you know, we ask you to slide over, but they really can’t move, so it’s dead weight, and it’s dead weight of maybe 400 pounds because currently right now, like I said, the population is obese. I mean, I’ve looked at new nurses who have been trying to lift, to put somebody in a lithotomy position and lifting a leg that that leg is as big as their waist. So how do you lift the leg up in that position? And I really think that you’ve got to take a team to take a look at that, do that deep assessment and deep dive and to find out where the high risk areas are for nurses to get hurt, what are the high risk areas that patients may actually be hurt as well. So it’s not just nurses. And then put those strategies, get those technologies, purchase them, and they will pay for themselves over and over again.
Shelby Skrhak: When you’re out in the field, do you see a lot of the proper and improper lifting techniques? You gave an anecdote about this, but I’d love to hear more about your experience out in the field when you’re talking to nurses that just don’t realize how important safe patient handling is. Is there a kind of you wouldn’t believe a nurse that was trying to do this type of story?
Mary Grace Hensell: Here’s a great story and it’s not just about nurses. I had a resident. We had a large patient, a very obese patient and it was time to move that patient over onto the stretcher. After they had completed the procedure, we moved the patient one time, and since this patient was about 400 pounds and at the time very high BMI, we rolled them on the side of what she thought was when she took that draw sheet that she pulled so hard because she didn’t wait for additional help, lifting help, because sometimes you can’t find that lifting help in the operating room. So she pulled so hard on the patient so they could put a roller board underneath that when she did that she pulled the patient on top of her and off the table.
Shelby Skrhak: Oh my gosh.
Mary Grace Hensell: And I have to be honest with you, she became the next patient. We had to take her to the ED and she broke her ankle and she ended up with plates and screws herself because her ankle was at a right angle. Now thankfully, the patient was fine, but it could have set up for a whole other story. Now if you think about that, that’s an oh-my-gosh moment. You know, I’m trying to help the patient, but I pull so hard that I pull him over top onto myself. And I’m going to give you a real personal story. I also worked with a nurse who was using a cysto table and I’m not at that organization anymore, but I got the phone call from her. And she said, “We’re putting patients in awkward positions. That’s a big fluoro table and I have to place the patient over and lift their legs up and put them in a lithotomy position. But I’m hampered because I have the fluoro piece that comes over top of the patient.” So I’m asking, ‘Is there a better way to move a patient?’ And quite frankly, the administration in that organization said, “It’s really too expensive to get like an AirTAP or to get The Move and those are a couple of technologies out there. So we’d like you to just try to move the patient yourself.” And she said, “I’m going to hurt my back. I feel the pulling in my back. What do I do?” And I said, ‘What you’ve got to do is make a case for why we need that technology and it’s not just about that I’m not getting hurt.
It’s about what is the cost to have you as an employee being out, what is the cost to the patient if you hurt them, what is the cost as to getting that piece of equipment and then you got to do that gap analysis.” But again, I guess if you’d think about that, that’s an oh-my-gosh moment, here we are, trying to tell people to move and to try to be safe. But in the same instance, we’re saying in one breath that it’s too expensive.
I think all of that plays into it. And then lastly, you know, I, myself being an O.R. nurse at one point in time, did a bend and a twist and that ended up in a back injury for me. And I can tell you personally had I thought about that, that movement and not twist it, but somebody called my name and I wanted to be really helpful, it just took that one moment of a bad decision and then you have a lifetime injury. So that’s what I would have to tell people out there. It just takes that one second that I’m being in a hurry and not thinking and that could be a lifetime injury where you have to do stretches. You may end up with surgery. There’s a variety of things. So we really need to work hard at this.
Shelby Skrhak: Well, you’re right, and that’s the frustrating thing about back injuries is that you don’t, I think a lot of us end up taking it for granted. You don’t realize all of these proper lifting methods or you don’t utilize these proper lifting methods until you’re already saddled with some back pain and you’re starting to educate yourself. I mean, that was certainly the case with me. I just kind of took it for granted that, “Well, I know I’m supposed to. This isn’t a great position, but I do what I got to do.” And then once you start learning more about these positions, it’s kind of eye opening. So your anecdotes are spot on of the necessity and importance of this. One thing I want to highlight though, the fact that the administration is saying it’s too expensive, as much as we want to think that that doesn’t happen, how prevalent is that a reason or an excuse for not employing the correct equipment?
Mary Grace Hensell: So unfortunately, I think it’s more prevalent than we would like to think. There’s a lot of myths out there that, you know, lifting equipment is not affordable. It’s not cost-effective. But there’s a lot of studies out there to say differently. I can say to you a number of different organizations that has instituted lifting protocols or no lifting at all. There’s actually organizations say no lifting and they’re using equipment to lift those types, you know, lift our patients. So it’s not really the person lifting, it’s we’re having the equipment lift. So I want to just give you a little bit about that, like Kaleida Health Network. They’re one of the largest healthcare providers in Western New York. They invested $2 million in safe patient handling program in 2004 and realized their return on investment three years later back in 2011 with five hospitals was over $6 million. You know, what administrator would say, “Oh geez! I’m not going to put $2 million out across five hospitals to get $6 million back!” And what I’m saying is you’re going to get it back in keeping your employees there, making sure your patients are safe.
Like the example I gave you, that patient who fell on top of the resident that easily put a broken shoulder. I mean, those things happen on a day to day basis. You know, when you asked me about an oh-my-gosh moment, I even think about another incident where I had a patient on a Jackson table and somebody didn’t take the time to lock the wheels, which was really important. That Jackson table shot out, could have hurt another employee, but the patient fell, and in this particular case there was an injury. They ended up with a broken shoulder. How often? How prevalent is it? I think we’re always looking for ways to do cost-cutting measures, but cost-cutting measures, we could be foolish and really cutting costs, but really costing ourselves more in money all around. And again, I can give you other examples of that, such as Sacred Heart. You know, they saved $305,000 over a two-year period, implementing a no lifting program as well and there are just really tons and tons more out there that have saved money.
Shelby Skrhak: When we start to talk about some of the specific tools that are available to help patient lifting, can you share maybe the most impactful that you’ve seen? I mean, I know that there’s different tools for different situations, but I guess from a best for most everybody, what do you think the absolute key tools are and then what are some of those specialty types of lifting tools that a lot of hospitals may not even realize that this type of lifting technology exists?
Mary Grace Hensell: Some of the, I think, best practice technology out there, there’s a HoverMatt, there’s AirTAP, and I’m using certain brand names, but these devices can move an obese patient actually with just two people, and the technology that they’re looking at is really the same as your air hockey. So with an air hockey, you have that air that’s on top. You can move a patient that easily. There’s another technology out there that’s called “The Move,” and it’s disposable. It’s a little bit better than a slider board, and you can move that patient. You can transfer them. And remember, that’s one of the most repetitive things that we do as nurses is moving patients, you know, laterally, and we’re really at high risk because we’re bending over. We’re leaning over a gurney or a stretcher. And we’re trying to put somebody over onto a bed. Not all nurses are six foot tall. In fact, most are. I’m actually a very short nurse. So when you say that I would need to do a step-up stool and try to lean over and try to pull or to push a patient over, that’s not the best ergonomic way to do that.
So The Move is a great device. There are additionally gait belts that you can get a patient up from a sitting to a standing position. They can help pull. This wraps around the patient and you can pull on that versus leaning over and using your back to try to pull somebody up. So there’s a number of different technologies out there I think that are really best practice. And those are just a couple of them. But you should always be using a roller board or a transfer device to move somebody over. But there really are better technologies as I just stated that can help patients move from one end to the other without hurting and just really getting… let’s just get to lifting team and move that patient because we’re in a hurry. I think that’s the myths out there that if I just get another body because it’s faster, I’ll be able to move that patient and everything will be fine. It’s better to invest into technology.
Shelby Skrhak: So as we start to wrap up this episode, what takeaway do you want to make sure that our audience really gets from this podcast?
Mary Grace Hensell: So I think some of the takeaways is we really need to protect our employees. As administrators, as educators, we need to really start to institute these ergonomic programs and not just think that education is going to be enough because there are plenty of studies out there that say when you’ve just educated, you still get the same injuries. I think nurses face ergonomic problems, patient transfers, prolonged standing, twisting and lifting. They’re lifting trays in the operating room, equipment, they’re moving it. And again, we’re all doing it on high speed and we really need to look at the costs and what that’s going to save us long-term for hospitals. If I can impart one thing to nurses, I would tell you and say if you have to lift and your organization is not helping you with that, there are two things, I would tell you get enough people, think before you lift or when you move because you may end up with a life-long injury where, if you could go back in time, you would change that decision.
I will tell you to, as a nurse, even if you’re a frontline nurse, you can make a case to establish a business case for your facility. If you’re administrator, listen to your nurses, look at the stats. How can you make that case? You can make it by looking at the workmen complaints that are every year, the indirect costs to cover your additional costs with injuries such as temporary health, and the fact that it decreases morale in your institution and then you have call offs and it just puts that extra added burden. So factor in all those costs and then look at the costs it would take for you to buy these technologies because I’m going to tell you, once you make your case, they’ll believe that. You’re going to save the money in the long run. So whether you’re a frontline staff person, speak up, or whether you’re an administrator or an educator, I think you need to take this all. You need to band together and unite to make sure that patients and nurses are safe moving patients and transferring patients. So that’s my takeaway. Be proactive.
Shelby Skrhak: Mary Grace, excellent advice from you today. I really appreciate you joining me on AliTalks.
Mary Grace Hensell: Well, thank you for having me and I really have enjoyed it and I hope that I can help others make a case for transferring safely. Thank you.
Shelby Skrhak: Perfect. And that does it for this episode of AliTalks, an AliMed Podcast. Until next time, I’m Shelby Skrhak.