Creating Safer Environments for Long-Term Care Staff and Residents : Page 2 of 2

February 13, 2012

Implementing the Program

Implementing a safe lifting program on the Allerton unit presented several challenges. The resident population, all considered to have special needs, had physical impairments requiring them to wear specialized orthotics and body jackets. The residents were totally dependent on staff for all activities of daily living, including positioning and transfers. The staff caring for these individuals was routinely required to perform many lifting tasks, yet they were initially resistant to the idea of using resident lifting equipment.

To launch the program on the unit, education and training sessions were scheduled. At the initial education program, the concepts of safe lifting were presented to the staff, and a vendor representative demonstrated the new lifting equipment. Afterward, a training schedule was set up and the same vendor representative trained key staff members, who would in turn train other staff.


The implementation of the program had positive results on staff attitudes, as measured by a survey before and after the CASE interventions (Table 2), by the emerging acceptance of the participating staff, and by a reduction in staff injuries. To measure the benefits beyond injury reduction, a preintervention survey was conducted with 24 caregivers, including registered nurses, licensed practical nurses, aides, and other staff members from the Allerton unit. Attitude statements were presented to measure aspects of staff satisfaction and their opinions of the program. The survey tool was administered before the intervention and again approximately 3 months after implementation. The survey asked staff members to respond to statements using a 7-point rating scale (1=strongly disagree to 7=strongly agree). The survey had a 100% response rate.

impact of CASE

When asked if they enjoyed coming to work, postintervention scores increased from 4 (neither agree nor disagree) to 6 (moderately agree). Staff also felt that the program had a positive impact on morale. The preintervention average score indicated that staff slightly disagreed that morale was “better today than it was a year ago,” whereas postintervention they agreed slightly to moderately that morale was “better today than it was a year ago.” Staff also felt that management and supervision were more concerned with their individual safety. Preintervention, staff slightly agreed that management was committed to providing a safe environment, and postintervention, they moderately to strongly agreed that management was committed to providing a safe environment. Preintervention, the staff only slightly agreed that supervisors in their work group were concerned with their safety. Postintervention, they strongly agreed with this statement.

An indication that the methods to lift and transfer dependent residents with new equipment had a positive impact regarding staff attitudes is also reflected in responses to the question, “Residents should be lifted with the mechanical lifting equipment, not manually.” Preintervention, the staff moderately disagreed with this statement, whereas postintervention, they strongly agreed with it. To further reinforce the need to redirect training efforts in LTC, staff attitudes regarding the amount of training provided remained the same before and after the intervention. Preintervention training had involved body mechanics and teaching of proper manual lifting techniques, whereas postintervention training was focused on how to effectively integrate the new lifting equipment into the process of delivering care. Through postintervention training, new and better methods to lift and transfer residents were being taught and implemented as part of the ongoing revision of the training protocols, and time for training was not increased.

As staff became familiar with using new equipment, they learned that use of the lifts did not increase time and actually facilitated lifting and transferring patients. In addition, the use of lifts helped with other activities, such as weighing residents. Using lifts with a built-in weight scale eliminated many manual lifting tasks and simplified the process. Staff also observed that residents felt safer and more secure when being transferred with lifts as observed by smiles, facial expressions of pleasure, and a decrease in rigidity in the residents’ bodies as they were being transferred with lifts. The application of properly chosen slings created a cuddling effect for the residents, which made them feel more comfortable and less anxious during the transfer process.

Beyond improvements to the environment of care, impressive results were demonstrated related to occupational injury experience. A review of the injury experience on the Allerton unit showed that there were four resident handling incidents resulting in 236 lost workdays and 2 restricted workdays before the intervention. Postintervention, there were no reported resident handling injuries to staff over a 12-month period. For the control unit, the injury experience remained close to the same for the preintervention and postintervention periods. Injury experience results are displayed in Table 3.

musculoskeletal injuries

The five-step method described in Table 1 provides for ongoing cycles of continuous improvement. Once a facility has completed its monitoring and evaluation in step five, it moves back to step one and completes a risk assessment of the current situation, striving for continued improvement by reapplying the five-step process. The timeframe is determined by each individual facility to best fit its situation and resources. 


The results of our pilot study are consistent with the evidence-based practice of safe patient handling, demonstrating that occupational injuries can be reduced in a systematic manner. The study also illustrates the key elements for an effective and safe resident-handling program, which includes engaging the commitment of company operations management and senior leadership and involving direct-care staff early in the process to create buy-in. The program was implemented without adding any staff. The facility used internal resources with some outside expert support to help get started. The important outcome is that the program was implemented and has been sustained with internal resources. The ideas presented in this article can help create and maintain effective safe patient-handling programs in LTC facilities as well as in other healthcare settings.


The author reports no relevant financial relationships.



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