“Legislation would certainly be strong,” said Keith Wrightson, worker-safety and health advocate for Public Citizen's Congress Watch. In a report called Health Care Workers Unprotected, he looked at evidence from states that have safe patient handling laws. “The results have been overwhelming in the reduction of on-the-job injuries. Regulations work. And OSHA has failed to keep pace with the changes,” he said.
Last June, Rep. John Conyers (D-Mich.) introduced the Nurse and Health Care Worker Protection Act, a bill that would require the U.S. labor secretary to create a standard for safe patient handling and injury prevention to prevent injury to healthcare workers. Health facilities would be required to purchase an adequate number of mechanical lifting devices for their employees to transport and lift patients.
Conyers' proposal gained support from the American Nurses Association, which says only 11 states currently have “safe patient handling” laws. In 2012, the ANA convened experts from numerous disciplines to develop a set of guidelines as a foundation for establishing comprehensive safe patient handling and mobility (SPHM) programs.
But hospitals have to consider the full gamut of needs. “It's more than just about buying equipment,” said ANA spokesman Adam Sachs. “Organizations need to make safe patient handling and a culture of safety a high priority within the organization. It's an investment in higher-quality care and increased safety.”
Many hospitals opt to rent specialized equipment for morbidly obese patients when needed, but safety experts warn that unforeseen complications can arise if the planning isn't thorough. For example, a report from the Pennsylvania Patient Safety Authority looking at whether hospitals in the state were prepared to deal with class III patients documented a case where a rented bariatric bed “repeatedly got stuck in the doorframe and was only able to be dislodged with extreme force by multiple personnel” who were trying to transport a patient to the ICU. The study found that more hospitals in that state opted to rent rather than own bariatric equipment, which may have led to delays in care.
“Based on the information that we learned in Pennsylvania, although most hospitals own bariatric and blood pressure equipment, they may want to consider other items that are essential to patient care,” said Lea Anne Gardner, senior patient safety analyst who authored the report.
When planning for bariatric patients, whether in long-term care or acute-care settings, both the American Nurses Association and ECRI Institute provide lists of items all hospitals should consider, including bariatric beds, total lift systems, wheelchairs in varying widths and depths, stretchers with a 1,000 pound capacity, 42-inch toilets and scales that are wheelchair accessible.
Griffin said many of his clients have considered replacing furniture in waiting rooms, which he said is a reasonable and cost-effective first step. “The furniture choices hospitals and designers make can impact patients' comfort levels before they begin receiving treatment,” he said. “Room equipment and layout can dramatically impact the level of care and efficiency that healthcare providers deliver.”
For now, though, each medical center ultimately has to make its own determination, based on the needs of the community.
“Hospitals need to measure the nature of the risk in their facility by asking questions like 'what is the prevalence of obese patients on any one day' and 'what percentage of the population has a BMI that affects patient care,' ” Gallagher said. “Then you can determine if you need to throw economic resources into this.”
Follow Sabriya Rice on Twitter: @MHsrice