Pennsylvania Patient Safety Advisory Implementing a Safe Patient Handling and Movement Program in a Rehabilitation Setting ABSTRACT and transfers. The Veterans Integrated Service Net- Musculoskeletal injuries are a prevalent and costly work 8 Patient Safety Center of Inquiry in Tampa, occupational health problem, particularly in the Florida, funded by the U.S. Department of Veterans healthcare field. The performance of repetitive Affairs (VA), recommends that a weight limit of 35 lb manual lifting tasks over a substantial period of time be used when assessing patient handling tasks.2 This increases the risk. In recent years, many facilities have weight limit is derived from the National Institute for implemented no-lift policies or minimal-lift policies to Occupational Safety and Health’s (NIOSH) revised reduce the risk of injury to patients and nurses associ- lifting equation algorithms to help healthcare workers ated with manual lifting, transferring, repositioning, or know when an assistive device is required. If a patient movement of patients. Several states have passed leg- is dependent and requires the worker to lift more islation requiring hospitals to establish and implement than 35 lb, assistive equipment such as a full mechani- programs on safe patient handling. The American cal lift is recommended. If a patient is able to partially Nurses Association has launched the Handle with assist and will not force staff to lift more than 35 lb, Care campaign, a profession-wide effort to prevent they may be able to use a sit-to-stand assistive device, back and other musculoskeletal injuries. A strong body or they may be able to assist manually if equipment is of research has demonstrated that the use of mechan- not necessary.2 ical lifting equipment, as part of a program promoting A safe patient handling and movement (SPHM) pro- safe patient handling and movement, can significantly gram uses assistive equipment and devices to help reduce musculoskeletal injuries among healthcare decrease the risk of staff injury and improve the safe workers while improving the safe delivery of patient delivery of patient care.3 Assistive equipment and care. Key to improving both patient and staff safety devices, such as lifts, lateral transfer devices, and when implementing a no-lift or minimal-lift policy is to friction-reducing devices, significantly reduce the introduce the policy as part of an overall safe patient risk of musculoskeletal injury to healthcare staff, handling and movement program that includes admin- consequently reducing work-related healthcare costs. istrative support, proper equipment evaluation and Low nurse recruitment and retention rates remain availability, staff and patient education, and defined a serious problem, and nursing shortages are only conformance expectations. (Pa Patient Saf Advis 2009 exacerbated by occupational injuries and residual Dec;6[4]:126-31.) disabilities. A SPHM program communicates organi- zational concern for staff safety, promotes retention, provides an added incentive for recruitment, and may Sharon Saracino, RN, CRRN, Patient Safety Officer reduce costs related to overtime and agency use for Susan Schwartz, BSN, CRRN, Director of Nursing replacing injured workers. Erin Pilch, RN, CRRN, Clinical Nurse Manager A SPHM program affords a safer progression through John Heinz Institute of Rehabilitation Medicine the patient’s care and greater preservation of the patient’s dignity. SPHM equipment and practices Identifying the Need enhance a patient’s ability to assist in movement and allow the patient to progress as confidence, strength, Patient handling tasks, such as manual lifting and and endurance improve. These improvements, in transfers, are high-risk, high-volume occurrences within healthcare facilities that pose significant risk to both personnel and patients. Performing these tasks increases nurses’ risk for work-related musculoskeletal Editor’s Note disorders, which may result in high costs, both finan- cial and emotional. Nursing is among the occupations The topic of patient transfers and the benefit of equipment- assisted transfers is closely tied to preventing patient falls with the highest risk for musculoskeletal injuries and and their associated injuries (as well as injuries to health- disorders. It is estimated that 12% of nurses leave care workers). Falls account for a large number of the reports the profession annually due to back injuries, and as submitted to the Pennsylvania Patient Safety Authority as many as 52% complain of chronic back pain.1 Many one of its nine event type classifications. From June 2004 of these injuries and disorders are directly associated through September 2009, the Authority received 180,458 with the manual handling and movement of patients reports of patient falls, of which 6,908 were reported as Seri- and the frequency with which nurses must perform ous Events (harm to the patient). Nearly 5,850 of the total these tasks. Manual handling also increases the poten- fall reports were associated with problems with patient trans- tial for patient injuries (e.g., musculoskeletal) from fers. The Pennsylvania Patient Safety Authority is pleased to falls or other mishaps. Skin integrity issues related communicate information about the successful implementa- tion of a program to decrease injuries with transfers. to shear and friction increase when patients require moderate or complete assistance with repositioning Page 126 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Vol. 6, No. 4—December 2009 Pennsylvania Patient Safety Advisory turn, promote and encourage patient autonomy, units to reduce the risk of injury to nursing personnel conserve energy, and maximize therapy tolerance and and to conserve patient energy in order to maximize rehabilitation potential. Collectively, these factors therapy participation. The nursing department staff may improve patient satisfaction, positively influence openly supported the move toward developing a patient outcomes, and shorten overall length of stay. SPHM program within the hospital. Development and Implementation The intended patient population for the SPHM pro- The John Heinz Institute of Rehabilitation Medicine gram was identified as patients who are assessed as is one of the foremost providers of rehabilitation in requiring more than moderate assistance from two the United States. Under the supervision of board- staff members, or who are dependent for transfer certified physiatrists, a team of highly qualified and movement tasks. These patients were felt to be professionals provides a broad range of specialized consistent with those patients who would require the services and therapies for inpatients, treating both nurse to lift more than the NIOSH-recommended orthopedic and neurological conditions, with special- 35 lb.2 The initial committee became the source of a ized programs in the areas of brain injury, injured subcommittee, consisting primarily of nursing person- worker recovery, and pediatrics. The organization’s nel, which met on a regular basis to outline a mission 71-bed inpatient rehabilitation facility, which has an statement (see “John Heinz Institute of Rehabilita- 11-day average length of stay, has served the northeast tion Medicine Safe Patient Handling and Movement United States for more than 25 years as part of the Mission Statement”), actively seek out and evaluate Allied Services organization. John Heinz provides equipment, develop policies and competencies, and comprehensive rehabilitation care, including services identify potential risks and benefits. The infection in audiology; clinical and forensic neuropsychology; control nurse was consulted during the evaluation physical, occupational, speech, and recreational thera- and selection of equipment in order to identify and pies; rehabilitation nursing; respiratory therapy; social implement the appropriate infection control mea- services; psychology; and rehabilitation technology. sures for the selected equipment. To further mitigate Patients admitted to the John Heinz Institute may the risk of cross-contamination, the subcommittee require various levels of assistance with tasks and identified the need to purchase enough slings for the mobility, with some needing minimal assistance and lift equipment that each sling could be dedicated to others being completely dependent. a specific patient for the length of the patient’s stay or until the patient’s endurance and transfer status In March 2007, John Heinz’s Susan Schwartz, CRRN, improved. A search of the ECRI Institute Web site director of nursing, and Erin Pilch, CRRN, clinical was conducted by both the patient safety officer and nurse manager, attended the Seventh Annual Safe clinical engineering staff. This search identified no Patient Handling and Movement Conference in Lake alerts related to malfunctions of or injuries from the Buena Vista, Florida, and immediately recognized evaluated or purchased equipment. A search of Joint the benefits of a SPHM program as a proactive safety Commission Sentinel Event Alerts likewise identified improvement within the hospital for both patients no sentinel events related to the use of patient lifting and staff (see “Benefits of a Safe Patient Handling and Movement Program”). At the conference, they had the opportunity to observe available safe han- dling equipment and to speak with leaders in the Benefits of a Safe Patient Handling and field of SPHM. Upon their return, they presented Movement Program their findings and ideas for a SPHM program within ■ The potential for patient injury (e.g., shoul- the hospital to administration, receiving full support. der injuries, skin tears) as a consequence of An interdisciplinary committee consisting of certi- manual handling mishaps (e.g., patient falls) fied rehabilitation registered nurses, physical and is reduced when assistive equipment and occupational therapists, the patient safety officer, devices are used. the infection control nurse, and the risk manager ■ Patients are provided with a safer means was convened to review information, statistics, and to progress through their care, promoting products. Despite the issuance of a white paper by patient autonomy, conserving energy, and the American Physical Therapy Association, Associa- maximizing therapy tolerance. tion of Rehabilitation Nurses, and Veterans Health ■ A reduction occurs in the rates of back injury, Administration supporting the use of safe handling which is the second leading occupational equipment,4 the physical and occupational therapy injury in the United States (back pain is the staff had reservations regarding the implementation most common reason for filing Workers’ of a minimal-lift program and the incorporation Compensation claims). of lifts and transfer devices within the scope of the ■ Organizational concern about staff safety is patient’s therapy. The therapists expressed concern communicated to nursing staff, promoting that deviation from their current practice could retention and providing an added incentive potentiate patients’ dependence on equipment and for recruitment. (Recruiting and retaining nurses is an ongoing problem.) worsen patient outcomes. They did, however, concede the benefit of using the equipment on the nursing Vol. 6, No. 4—December 2009 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Page 127 Pennsylvania Patient Safety Advisory each 21- to 23-patient nursing unit would meet the John Heinz Institute of Rehabilitation hospital’s needs. In total, three full mechanical lifts Medicine Safe Patient Handling and and three sit-to-stand lifts were purchased. To ensure Movement Mission Statement the availability of an adequate number of slings and To eliminate unsafe manual patient lifting prac- belts for individual patient dedication, the hospital tices by creating an environment that promotes also purchased 12 slings in various sizes for the full employee and patient safety utilizing patient mechanical lifts, and 15 belts in various sizes for the handling devices to lift/transfer and reposition sit-to-stand lifts. The subcommittee decided that hav- patients, thereby reducing the risk of injury to both ing one lateral transfer sheet in each patient room patients and healthcare workers, and reducing the would make these items easily available and facilitate facility’s financial burden associated with work- staff compliance with their use. Additionally, lateral related injuries. This is accomplished through transfer sheets were placed in each of the therapy education, training, and the use of state-of-the-art gyms, and a supine lift sling was purchased and stored ergonomics and patient handling technologies. with the backboard near the cardiac crash cart to facilitate safety in emergency situations. A safe patient handling equipment log was developed to enable and transfer devices. (A more recent search of the nursing management to track the use and location of ECRI Institute Web site revealed that ECRI Institute all slings and to prevent their loss (see Figure). The published a paper evaluating ceiling-mounted patient purchases were prepared and presented to hospital lifts in April 2009 and presented a Web conference administration. titled “Implementing a Patient Lift Program That By July 2008, all initially requested equipment had Won’t Hurt Your Staff or Kill Your Budget” in May been purchased and received. In all equipment 2009. This further reinforced for us that SPHM is at purchases, the needs of bariatric patients were con- the forefront of today’s healthcare issues.) sidered. Two of the full mechanical lifts purchased In May 2007, the hospital sponsored a safe handling accommodate up to 500 lb, and the third has a capac- equipment fair, with demonstrations from several ity of 700 lb. All the sit-to-stand lifts accommodate equipment vendors. Frontline nursing staff, clinical patients up to 500 lb. The lateral transfer sheets departments, and representatives from other divisions purchased were bariatric size, with a weight capacity of within the Allied Services organization were invited to 700 lb. Historically, the hospital has seen few patient attend. It was imperative to get feedback from front- admissions beyond this weight range, and it was line staff, since the equipment was intended for use confirmed with the vendors that additional bariatric primarily within their daily practice. Several members equipment could be rented on an as-needed basis. of the interdisciplinary SPHM committee also visited Equipment storage was an issue for our hospital, as the local VA Medical Center to evaluate the equip- it is for many healthcare providers. Equipment that ment in use at that facility. Following the fair, some is not readily available to staff reduces the likelihood equipment was identified as being appropriate for the of compliance in using it. The facility determined John Heinz patient population, and arrangements that storing lifts on each nursing unit would facilitate were made with the vendors for equipment trials. their use. To ensure that the additional equipment in the patient care area would not become an impedi- The hospital’s 71 beds are divided into 3 nursing ment to patient flow in the event of an emergency, an units. No formal ergonomic assessment was com- addition was made to the nursing assignment sheet pleted to identify high-risk units because the acuity to specifically assign a nursing staff member on each level fluctuates from day to day and any of the units unit and each shift to clear the hallways of equipment could be considered high risk at any given time. if such a situation were to arise. The clinical engineer- Before any equipment trials, the vendor trained front- ing department remained involved throughout the line staff in the safe and appropriate use of each item. equipment selection process and remains available to Equipment trials commenced in May 2007, with address damaged or malfunctioning equipment. frontline nursing staff providing written feedback and evaluations on each piece of equipment by means Policies and staff competencies were developed for the of an equipment evaluation form developed by the overall SPHM program, as well as for each individual SPHM committee for this purpose. The SPHM sub- piece of equipment that had been purchased, and staff committee continued to meet to develop policies and training was initiated and evaluated. A nursing depart- review the evaluations of the equipment. Equipment ment policy to direct the overall minimal-lift process trials and rentals continued from July 2007 to March was developed after review of current literature and 2008, with input from the clinical engineering depart- similar policies in use at other healthcare facilities with ment. After evaluating a minimum of three different successful SPHM programs. The policy was presented versions of each piece of equipment, the hospital to and approved by administration via the patient purchased its first full mechanical lift with attendant safety committee and medical executive committee. supplies. For the hospital’s more mobile rehabilita- The policy defines patient-handling-related terms, pro- tion population, the subcommittee determined that vides a process for the assessment of patients who may one full mechanical lift and one sit-to-stand lift for require patient handling equipment, and outlines the Page 128 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Vol. 6, No. 4—December 2009 Pennsylvania Patient Safety Advisory Figure. Log Sheet Example. DATE INITIATED: EQUIPMENT USED FULL MECHANICAL LIFT SHIFT USED: DAYS EVENINGS NIGHTS SLING SIZE: __________________ SLING #: _______________________________ IN ROOM: YES NO Patient Identification CLEANED AFTER USE: YES NO DISCONTINUED DATE: __________________________________________________ RETURNED TO: _______________________________________________________ SIT-TO-STAND LIFT SHIFT USED: DAYS EVENINGS NIGHTS BELT SIZE: ___________________ BELT #: ________________________________ IN ROOM: YES NO CLEANED AFTER USE: YES NO DISCONTINUED DATE: __________________________________________________ RETURNED TO: _______________________________________________________ MS09504 Reprinted with permission from John Heinz Institute of Rehabilitation Medicine, Wilkes-Barre, Pennsylvania. responsibilities of staff and nursing supervisors and Since the SPHM program was formally launched managers in relation to the program. Policies were (September 2008), feedback from both patients and also developed for the use and care of each individual staff has been overwhelmingly positive. piece of equipment based on the manufacturer’s Potential Barriers to Program Implementation instructions, including cleaning between uses with a disinfectant approved by the U.S. Environmental The most significant potential barriers to the imple- Protection Agency. Individual competencies for each mentation of any SPHM program are financial piece of equipment were developed by members constraints. The cost for the initial implementation of the program in our facility was approximately of the SPHM committee and used throughout the $45,000. However, the hospital expects to recoup this training process. The competencies were designed to cost within three years of full implementation of the follow the manufacturer’s instructions for use and program because of a reduction in Workers’ Com- required a return demonstration by each individual pensation expenses. To further mitigate the financial staff member before the equipment could be put into impact, the equipment was identified for purchase use. As part of each competency, staff signed a state- in a prioritized manner, which allowed the initial ment indicating that they understand that the safe outlay to be spread out over a period of time. It is also patient handling and minimal-lift policy is important important to consider that the quantity of equipment for the safety of the patients, their own safety, and purchased must be sufficient to ensure that it is avail- able when needed. Insufficient equipment quantities the safety of their coworkers and that they agree to resulting in wait times discourages staff compliance adhere to the policy. Our hospital promotes a nonpu- with equipment use policies. nitive culture. However, this does not mean that staff who repeatedly or intentionally violate policy and Reluctance to accept change in longstanding pro- procedure will not be held accountable. Staff mem- cesses is another barrier that may be anticipated, as was our experience with the physical and occu- bers found to be noncompliant with the minimal-lift pational therapy departments. While these staff policy are reeducated about the SPHM program and members are still reluctant to fully adopt the SPHM expectations for compliance. The circumstances sur- program in the physical and occupational therapy rounding the event are also reviewed to identify any milieu, in the time since the program was fully potential system factors that may have contributed to implemented in the nursing department, they have the failure to follow policy. exhibited a growing acceptance of the equipment and Vol. 6, No. 4—December 2009 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Page 129 Pennsylvania Patient Safety Advisory have even requested to use the lifts to safely recover patients in a fall or assisted-fall situation. Some staff Communicating Safe Patient Handling may feel that it is more efficient in terms of time to and Movement Needs simply perform manual transfers, as they have always ■ Nursing shift summary documentation revised done. Education regarding the risks of manual han- to include documentation of patient transfer dling and the benefits of a SPHM program to workers status on nursing unit and equipment in use empowers staff and helps them become invested in for patient the program. Involvement of frontline staff in evalua- ■ Space for documentation of equipment in tions and equipment selection is crucial to successful use added to daily status sheet, which is compliance with the program. At John Heinz, front- provided to all clinical departments to com- line nursing staff were provided demonstrations and municate which equipment is in use for education about the use of all equipment selected patient handling on the nursing unit for trial and purchase. The selected equipment ven- ■ Laminated photographs of equipment in use dors trained designated nursing staff to be trainers placed in nursing Kardex for other staff, providing them with responsibility and further investment in the program. Expected benefits were emphasized, including those associ- ated with the reduction of physical workload in results in consistency and continuity of care, prevents patient movement tasks, those from the reduction injury, and promotes positive patient progress. of work-related injuries, and benefits for patients. As the program progressed, we found that our staff Outcomes were not only becoming excited about the program, The SPHM subcommittee continues to explore but also becoming proactive. Based on the unique options for obtaining meaningful measurement data character and diverse requirements of rehabilitation for our SPHM program. Unfortunately, historical data patients, staff involved in the equipment trials began related to employee injury before the development of to identify and assess specialized needs among our the SPHM program was not gathered in a way that patient population. This feedback was communi- facilitates the identification of patient-handling-related cated to the vendors, who, based on suggestions and injuries. To evaluate the initial effectiveness of the demonstrations from our staff, were able to develop program, the number and cost of nursing injuries sus- and manufacture additional adaptations to the belts pected to be related to patient handling tasks before and slings, providing further safety and security for the implementation of the program were compared patients with specific deficits. to the values measured following the initiation of the program. The initial figures are encouraging. From Communication July 1, 2006, to June 30, 2007, 16 nursing injuries Effective communication about transfer status and attributable to patient handling tasks occurred, at equipment needs of individual patients is impera- a total organizational cost of $35,747.* From July tive between members of the rehabilitation team 1, 2007, to June 30, 2008, a time when equipment and between workers from one shift to the next. The was in use (either as part of a trial or after having subcommittee developed new processes and revised been purchased), we saw a decrease to four nursing existing ones to address this need (see “Communicat- injuries attributable to patient handling tasks. One ing Safe Patient Handling and Movement Needs”). additional injury occurred during this period but was Patients’ transfer status had traditionally been not reported until several months later. Including this assessed at the time of admission, with input from the injury, the cost for this period decreased to $13,708. nursing and occupational therapy departments. To Moving forward, we are working to standardize the better define each patient’s assessed transfer status, a data gathered on employee injuries. Additional infor- revision was made to the Interdisciplinary Admission mation has been included on the employee accident Assessment to allow documentation of the transfer reporting forms to identify events related to patient status along with cues to identify patients who should handling tasks and allow evaluation of any injury be considered for patient handling equipment. Upon occurrence to monitor whether the staff member was identification of the patient’s equipment needs, complying with the minimal-lift policy and using the laminated photographs of patient-specific equipment appropriate equipment at the time of the event. The items are placed in the nursing Kardex for commu- risk management department now generates monthly nication between shifts. A revision was also made to reports of employee injury broken out by department the nursing shift summary form to allow documenta- and type, including cost, days missed, and days on tion of the equipment required by the patient, which light duty, that we feel will allow us to gather more may potentially vary from shift to shift based on the patient’s fatigue level. An addition was made to the daily status sheet, which is completed by nursing staff * These costs reflect Workers’ Compensation claims. Costs related to patient injuries were not included in the analysis, but it should and faxed to other clinical departments, to alert them be noted that this could further increase the cost-effectiveness of to the patient’s transfer status and the equipment cur- the SPHM program, additionally justifying the financial outlay for rently in use for safe handling. Good communication the initial equipment. Page 130 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Vol. 6, No. 4—December 2009 Pennsylvania Patient Safety Advisory related costs, and we have received positive feedback Additional Resources from both patients and staff. Staff openness and ■ American Nurses Association. Nationwide administrative support are key to a successful SPHM state legislative agenda, 2008-2009 reports program, but it is just as important to maintain staff [online]. 2009 [cited 2009 Aug 19]. Available interest and program momentum. Our SPHM com- from Internet: http://www.nursingworld.org/ mittee continues to meet periodically. Posters were MainMenuCategories/ANAPoliticalPower/ designed and placed in prominent locations to alert State/StateLegislativeAgenda.aspx. staff, patients, and visitors to the hospital’s SPHM pro- ■ American Nurses Association. Safe patient gram and minimal-lift zones. An information brochure handling [online]. 2009 Jul 17 [cited 2009 was designed for distribution to patients. Patients and Aug 19]. Available from Internet: http://www. families are encouraged to ask questions and learn nursingworld.org/MainMenuCategories/ about the program and the benefits it provides. Lapel ANAPoliticalPower/State/ pins have been ordered to identify the “go to” person StateLegislativeAgenda/SPHM.aspx. on each unit and each shift. As a result, these staff will ■ American Nurses Association. Workplace be further invested in the program, and other staff health and safety. In: Nursing’s legislative members will have a resource person to go to with and regulatory initiatives for the 110th Con- questions or problems. The SPHM committee is also gress. Silver Spring (MD): Department of presently exploring the prospects for an incentive pro- Government Affairs; 2007. gram to encourage continued staff compliance with ■ Nelson A, ed. Safe patient handling and the minimal-lift policy and procedure. movement: a practical guide for healthcare professionals. New York: Springer Publishing Motivated by the American Nurses Association’s Company; 2006. Handle with Care campaign implemented in 2003, ■ Nelson A, Baptiste AS. Evidence-based prac- 9 states have already enacted safe handling legislation, tices for safe patient handling and movement. and 10 more states have introduced legislation so far Online J Issues Nurs 2004 Sep [cited 2009 in 2009 related to the restriction or elimination of Aug 19]. Available from Internet: http://www. manual patient lifting.5 If Pennsylvania introduces leg- nursingworld.org/MainMenuCategories/ islation, we feel we will have favorably positioned our ANAMarketplace/ANAPeriodicals/OJIN/ facility for any regulations that may be forthcoming. TableofContents/Volume92004/No3Sept04/ Regardless, we will have provided both our patients EvidenceBasedPractices.aspx. and our nursing staff with a safer and more ergonomi- ■ Nelson A, Harwood KJ, Tracey CA, et al. cally friendly process. Myths and facts about safe patient handling Notes in rehabilitation. Rehabil Nurs 2008 Jan-Feb; 33(1):10-7. 1. American Nurses Association. ANA supports safe ■ Waters TR. When is it safe to manually lift a patient handling measures in Congress to improve safety of nurses and patients [press release online]. 2009 patient? Am J Nurs 2007 Aug;107(8):53-8. Jun 4 [cited 2009 Aug 19]. Available from Internet: http://www.nursingworld.org/MainMenuCategories/ OccupationalandEnvironmental/occupationalhealth/ handlewithcare/Safe-Patient-Handling-Measures-PR.aspx. meaningful data. We also continue to monitor all patient event reports for any events related to patient 2. Waters TR. When is it safe to manually lift a patient? handling tasks, and we have not noted any increase. Am J Nurs 2007 Aug;107(8):53-8. It is anticipated that these numbers will continue to 3. American Nurses Association. Handle with care decline moving forward with full implementation [brochure online]. 2004 [cited 2009 Sep 28]. Available of the program. from Internet: http://nursingworld.org/ MainMenuCategories/OccupationalandEnvironmental/ Conclusion occupationalhealth/handlewithcare/hwc.aspx. At the John Heinz Institute, the development of our 4. American Physical Therapy Association, Association of SPHM program is part of our comprehensive team- Rehabilitation Nurses, Veterans Health Administration. oriented approach and commitment to quality-driven Strategies to improve patient and health care provider patient care, as evidenced by the implementation of safety in patient handling and movement tasks [white proactive safety initiatives that reduce risk to patients paper]. 2004 Dec 1. and staff, maximize resources, and reduce costs while 5. American Nurses Association. Safe patient handling improving quality of care. In the short time that the [online]. 2009 Sep 1 [cited 2009 Sep 28]. Available from program has been implemented at our facility, we have Internet: http://www.anasafepatienthandling.org/ already seen a decrease in employee injury rates and main-menu/ana-actions/state-legislation.aspx. Vol. 6, No. 4—December 2009 REPRINTED ARTICLE - ©2009 Pennsylvania Patient Safety Authority Page 131 PENNSYLVANIA PATIENT SAFETY ADVISORY This article is reprinted from the Pennsylvania Patient Safety Advisory, Vol. 6, No. 4—December 2009. The Advisory is a publication of the Pennsylvania Patient Safety Authority, produced by ECRI Institute and ISMP under contract to the Authority. Copyright 2009 by the Pennsylvania Patient Safety Authority. This publication may be reprinted and distributed without restriction, provided it is printed or distributed in its entirety and without alteration. Individual articles may be reprinted in their entirety and without alteration provided the source is clearly attributed. This publication is disseminated via e-mail. To subscribe, go to https://www.papsrs.state.pa.us/ Workflow/MailingListAddition.aspx. To see other articles or issues of the Advisory, visit our Web site at http://www.patientsafetyauthority.org. Click on “Patient Safety Advisories” in the left-hand menu bar. THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web An Independent Agency of the Commonwealth of Pennsylvania site at http://www.patientsafetyauthority.org. ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for nearly 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology. The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.