Nursing home OHS – a 2001 interview with Kathleen Rockefeller

The last time I spoke with Kathleen Rockefeller was in 2001 on the eve of her speaking at a conference organised by the Ergonomics Society of Australia.  At that time Kathleen was a physical therapist and ergonomist within the Washington State Department of Labour & Industries.  Her latest profile says that she is now in Florida (via Chicago) as an Assistant Professor at the School of Physical Therapy & Rehabilitation Sciences at University of South Florida.

Rockefeller interview 2001_Page_1Kathleen’s career may have progressed (as probably has her tan) but the hazards and control solutions that we discussed in 2001, sadly remain relevant.  I have reproduced some of the interview I conducted with Kathleen in those early days when no-lift policies were radical and  patient-handling equipment was expensive and rare.

SAW: Around the world the no-lift policy is being introduced but why is that policy the most popular risk control measure?

KR: I don’t know where it actually originated or where the term “no-lift” came from. It’s a horrible term because everyone in healthcare knows that it is a little unrealistic. I think some people have been turned off by the name. I prefer to call it “low-lift” or “minimal-lift”.

Looking at the literature and research clearly shows that decreasing the amount of times per day that the human body has to act like a derrick is a good idea. Each episode exposes the body to forces of a magnitude high enough to potentially be injurious. Anyone who has nursed or worked in nursing homes knows that lifting is not the only activity that carries physical risk. There are tasks like leaning over the bed to delivering treatment to changing clothing, repositioning—these activities can be stressful as well. I wish it were simple to say “let’s get rid of the lifting” but it is an important first step.

SAW: In Australia the no-lift push came from the unions in order to push management to get into action on a whole range of manual handling issues.

KR: I’ve heard a rumour over here, and I don’t know how true it is, that the equipment manufacturers began using the term “zero-lift” but I really don’t know.

SAW: Your research shows that financial incentives were used to encourage the purchasing of new equipment. Were the incentives really necessary?

KR: Washington State is unique in the US in that the workers compensation insurance is handling by a State agency. So the insurance is handled by us unless the company meets the requirements for self-insurance. The agency has monitored the data and monitored the trends to try some initiatives with a number of different industries, nursing homes were chosen for a research project. They were hurting financially. A major reason for not buying lifting equipment was financial.

The agency decided to allocate some of their funds to the nursing home industry and to see if offering some of the funds allocated for injury prevention projects would help. The funds weren’t handouts but discounts on the workers’ compensation premium in return for investing in equipment and beginning a manual handling improvement process. The program was designed as a trial project to see what effect this type of incentive might have.

SAW: How applicable is your research to other States, given Washington’s unique processes?

KR: Many recommendations will be applicable as the program wasn’t just on the financial incentives. The study was a state-wide and industry wide look at how nursing homes were doing overall in implementing zero-lift programs. The research has identified the problems of implementing a large-scale intervention and we can all learn from these problems.

SAW: Other than manual handling what are the major OHS risks in nursing homes?

KR: Of course, patient handling has various tasks and the higher risks are certainly the physical transferring but also the repositioning, delivering incontinence care to residents, changing their clothing. The other thing I noticed in the homes while following nursing assistants and doing sampling is the total amount of time they stand or walk. I think that fatigue must be a contributing factor, both local muscle and total-body fatigue. There is very little recovery time. I knew this already but doing the research really emphasised this.

SAW: Did you observe a high stress level? Was resident violence an issue?

KR: Those are certainly issues as well. The issues of staffing and turnover is huge. The turnover for nursing assistants is an industry average of 100% a year and can go much higher. The constant turnover creates turmoil.

An unexpected element was the huge turnover in management personnel. This was striking. When you think of a facility trying to keep stable processes and procedures and the head person leaves within 3 years or even one year— that is a real problem.

I heard a lot from the nursing assistants and through the literature about the importance of knowing the residents. You mentioned potential problems with the residents but if you work with the resident for a while you get to know them and then you may be able to pick up warning signs on behaviour. If you’re a short term agency nurse and you don’t know the residents, it may increase your vulnerability.

SAW: Perhaps the no-lift policy has been introduced due to the throughput of staff rather than dealing with a root cause of the manual handling injuries? Perhaps because no-lift can give immediate results?

KR: Expecting a zero-lift program to have miraculous results in light of these other issues leading to instability is an unreal unrealistic expectation. I think introducing the program and getting it to work as best you can while at the same time, people who can affect change, maybe us baby boomers, need to start screaming very loudly because our parents are next.

Injuries related to manual handling have a number of causes and efforts to decrease these injuries require multi-faceted approaches. The point is well taken because if you are going to expect a zero-lift program in itself to have miraculous results in light of these other issues leading to problems and instability, it is not a realistic expectation.

Kevin Jones

New safety campaign – making the invisible visible

hi res moving cement vwaThe last week of October each year is Safe Work Australia Week.  This theme is enacted in each State with their own resources and events.  WorkSafe Victoria is one of the more active of the state regulators and 2009 seems no different.

On 13 September 2009, WorkSafe Victoria will launch a new campaign of graphic advertisements but what makes these different is the injuries result from “simple” work activities.  They are not in high-risk industries where workers may perform high-risk tasks.  These ads concern the (mis)use of an office chair, lifting a bag from a pallet, not using the stairs, slipping on a wet floor and lifting a person.

hi res office chair vwaThere has always been the challenge of how to generate interest in manual handling injuries as they are internal or invisible, and cumulative.  WorkSafe has done well by illustrating the physical consequences of what many dismiss as “taking a fall”.  In fact, the images that are less confronting than the noise of the bones breaking or the hernia appearing.

WorkSafe’s Executive Director, John Merritt, describes the campaign this way

“There’s no ‘blood on the floor’ or spectacular images on the nightly TV news or in the morning paper, yet the consequences of these injuries are enormous for individuals, their loved ones and their employers.

“For business, the average cost of treating these people through Victoria’s workers compensation system averages $45,000 per claim.

“Individuals lose quality of life and many, the capacity to work for at least a short period, some require surgery or have permanent pain and never fully recover.

“For employers productivity is cut, there may be staff replacement costs, retraining and safety improvements to be made after the event. Industries lose people permanently.

“Identifying and preventing these issues has benefits for all.”

Merritt also provides the statistic that  60% of all reported workplace injuries* – more than 17,000 a year in Victoria – involve manual handling.

The new campaign is graphic but it is hard to see how the total costs – social, personal and business – could have been described better.  Having a worker clutch their lower back and grimace with pain has been seen in campaigns and images repeatedly for decades and a new approach was needed.  Making the invisible visible should help.

Kevin Jones

* Based on Victorian Workers compensation claims where people are off work 10 days or more and / or medical treatment costs in excess of $520.

Man crushed by unstable stack

On 1 September 2009 there were early reports that

“… a man died at Stanhope in northern Victoria when a one-tonne bag of salt fell from a stack and crushed him at a cheese factory.”

Further details were revealed in a media report on 4 September 2009. The media officer for WorkSafe, Michael Birt, discussed the stacking of multiple, one-tonne, bags of salt.

“The improvement notice is requiring them to develop a safer system of work in relation to storing the salt because they can’t stack it three high in these bales which are about a metre tall,” he said.  “It’s symptomatic of what happens in typical cases after this, we look at it and we find the systems need to be further improved.  Our aim is to get safety improvements happening sooner rather than later and if those improvement notices are dealt with promptly everyone’s life moves on.”

WorkSafe informed SafetyAtWorkBlog that the 50-year-old man was at the base of a stack of three bags of salt.  Each bag had been placed in the factory on a pallet, so the stack from the floor was pallet – bag – pallet – bag – pallet – bag.  The bottom bag had leaked and has possibly destabilised the stack.  The stack fell, crushing the man.  There was not racking around the stack.

The bags (similar to the one pictured right) are large bale-type bags with handles.  The bags are used for a variety of contents and are in common use.

There were no witnesses to the man’s death on the Tuesday afternoon.  Gaffer tape was found near the man’s body

WorkSafe has placed a “do not disturb” notice on the fatality site and has formally directed the company to review its bulk handling procedures in the salt store.

WorkSafe Victoria has a range of advice and guidances concerning the bulk handling of raw material, a couple are below.

Kevin Jones

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A study of violence

Australian writer, Jeff Sparrow, recently recently a book that looks at violence and killing , “Killing: A Misadvanture In Violence“.  As part of promoting the book he has been interviewed on several radio shows, the one most relevant to SafetyAtWorkBlog, is the 3CR program, Stick Together, about his book.

Killing_fullcover_NEW.inddSparrow says that he wanted to investigate the “normalisation of killing” and l0oks at occupation which have killing as part of the job.  He analysed the killing of animals through the first-hand experience of kangaroo-shooting and visiting an abattoir.

Sparrow says that the abattoir was very much a factory that deconstructs animals rather than manufacturing items, such as cars.  This will be no revelation to anyone who has read Eric Schlosser’s book, Fast Food Nation, in which he analyses abattoirs, particularly meatpacking, in the context of food production.  Schlosser’s section on the worker safety and compensation processes in the US meat industry is confronting.

They are also possibly more directly relevant to OHS (or heartless capitalism) than Sparrow’s take on abattoirs, although Sparrow does mention how the structure of the workplace “controls the workers”.  This harks back to the dehumanisation of workers for the purpose of productivity where repetition makes the reality of the action of killing or dismemberment, mundane.

In comparison, the roo-shooters have a more detailed understanding of their “craft” because they are working in the wild, where things can go wrong, instead of on the killing floor.

Sparrow also looks at killing that is undertaken in other occupations, such as the defence forces, and workplaces, such as deathrow.  In these contexts Sparrow talks about the industrialisation of the war processes.

Ultimately, from the workplace perspective, Sparrow’s book sounds like an interesting resource for those who study the depersonalisation of the worker, or industrialisation.  For those who work on, or have responsibility for, production lines, this psychological approach to the book may help.

Kevin Jones

A sample chapter of the book is available for download.

Falling under the safety radar

The tricky thing about getting safety right is making sure you are on top of where the dangers are. One danger that seems to be consistently “off the safety radar” for lots of workplaces, particularly small businesses, is falls.

Here’s some key stuff you need to be looking at:

  1. Rule #1 for all safety problems is to try and eliminate the danger first. For fall hazards this means; have you exploited all the available storage space that can be reached from the ground (i.e. without the need to use a ladder)? Lots of places have all the ground level storage space they need, but because of its convenient access that space gets filled with junk. Turfing out the junk to exploit the ground level storage areas is the key thing to do. Ground level storage – good. Elevated storage spaces – not so good.
  2. Step ladders are used a lot to get access to high shelves, and the ordinary type of step ladder is notoriously unstable the further up the ladder you go. If people have to be on the last couple of steps, or worse still, right on top of a step ladder to retrieve stuff from high racking, then you have a serious injury or fatality waiting to happen at your business. (WorkSafe Victoria has reported deaths of workers who have fallen off step ladders.)
  3. Consider reconfiguring your storage racking so that the highest shelves are all the same height so you can use a proper order picking ladder to get access to those high shelves (i.e. ones at 2 metres or above). (WorkSafe has a guide on order picking) Consider getting lower versions of this type of ladder for middle height racks.
  4. Most Australian laws will say you have to do very specific things about stopping falls if workers are working at 2 metres and above. But keep in mind deaths have happened for falls as low as 1 metre, they are more common than you’d think.
  5. Lots of workplaces use mezzanine or above-room spaces to store things. First, see tip #1. If you have to use those spaces make sure a) that the floor of those spaces are safe to walk on; b) have guard rails around the perimeter; and c) that the way to get up to those space is as safe as it can be. It’s not safe to have only one hand free to get up or down a ladder.

Preventing falls is an excellent example of why the common legal duty to first look to eliminate a hazard or risk is a clever thing. I get the sense that lots of people quickly dismiss elimination as a viable option; it shouldn’t be the case. Hard thinking about elimination solutions needs to be first cab off the rank in risk control decisions, particularly when it comes to preventing falls.

Col Finnie

Latest Australian OHS Statistics

Below is an edited summary of the findings from the latest compendium of statistics issued by the Australian Safety & Compensation Council.  The stats relate to 2006-07 primarily but with some comparative data from 2000-01 onwards.  The full report is available for download as is a media statement from the Council Chairman, Bill Scales.compendium200607-cover

132 055 serious workers’ compensation claims in 2006-07  = to 14 claims per 1000 employees or 9 claims per million hours worked.

Men accounted for 68% of all serious claims

Incidence rates for male employees almost twice that of females

There were 9 claims per 1000 employees aged 15-19 years, which increased to 17 claims per 1000 employees aged 60-64 years.

“The Manufacturing, Transport and storage, Agriculture, forestry and fishing, and Construction industries had incidence rates substantially above the national rate of 14 claims per 1000 employees.”

The occupational group with the highest incidence rate of serious claims was Labourers and related workers (39 claims per 1000 employees).

Transport workers and some others had the second highest rate with 29 claims per 1000 employees.

The majority (73%) of the serious claims involved injury or poisoning (95 910 claims)

The remaining 27% (36 145 claims) were disease related.

The most common injury (41%of all serious claims leading to a serious claim was Sprains and strains of joints and adjacent muscles.

Fractures and Open wounds (8% of all serious claims )not involving traumatic amputation were the next most common injuries

The most common diseases were:

  • Disorders of muscle, tendons and other soft tissues (7% of all serious claims),
  • Dorsopathies – disorders of spinal vertebrae (6%), and
  • Mental disorders (5%).

23% of all serious claims involved the Back. Hand (13%), Shoulder (9%) and Knee (9%).

Manual handling mechanisms (Body stressing) were the cause of 41% of all serious claims, with: 

  • lifting objects (18%)
  • handling objects (15%)

The most common mechanism was Falls on the same level (13%).

Non-powered handtools, appliances and equipment represented 26% of all serious claims.

Over the period 2000-01 to 2005-06, the number of serious claims decreased 6% from 144 740 claims to 136 575.

“The Agriculture, forestry and fishing industry recorded the highest time lost from work of 4.6 working weeks in 2005-06 but due to the lower salaries in this industry, it recorded one of the lowest median payment amounts ($5100 in 2005-06 compared to the all claims median of $6100).  The highest median payments were recorded in the Mining industry ($10 400 in 2005-06).”

Compensated Fatalities

Preliminary data show that in 2006-07 there were 236 compensated fatalities = an incidence rate of 2.5 fatalities per 100 000 employees.

Of the fatalities, 91% were male employees.

Over the period from 2000-01 and 2005-06, the number of fatalities fell 21%.

Industry

The Construction industry recorded the highest number of fatalities (50).

Transport and storage industry = 45 fatalities (of which 31 were in Road freight transport).

Mechanism of injury or disease

A third of the fatalities (81) were due to Vehicle accident

33 deaths due to Long term contact with chemicals or substances,

19 due to Being hit by moving objects and

18 due to Being hit by falling objects.

Draft guidance on musculoskeletal injuries in mining

Any inquiry into musculoskeletal disorders (MSD) in any industry is of great interest to OHS professionals as MSD are the bane of the profession.

The New South Wales Dept of Primary Industries (DPI) is requesting public comment on a new MSD guidance for the mining and extractive industries.  Below is some text from the media release

Industry comment is being sought by the Musculoskeletal Disorders (MSD) Working Party on the guidance document The Management of Musculoskeletal Disorders in the Mining and Extractives Industry.

The benefits of the guide are that it;
• Facilitates sites taking planned preventative measures;
• Uses the capacities that already exist and;
• Provides effective tools for sites to use.

Comments are welcome on the guidance through the DPI website by close of business 27 March 2009.

Kevin Jones

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