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Research Highlight

Implementing HRO: The VHA Safe Patient Handling and Mobility Program

The Veterans Health Administration (VHA) is nationally recognized for leadership in implementing a highly successful, evidence-based Safe Patient Handling and Mobility (SPHM) program. Beginning in 2009, the program was implemented in partnership with local, VISN, and Central Offices. In 2009, 2010, and 2011, VHA funded the national SPHM program with a budget of $208 million. The original evaluation team developed a three-year longitudinal study, and obtained data from VA administrative databases on nursing back injuries and surveys of 141 VA facility champions (collected at baseline and six-month intervals, from October 2008 to June 2011). The data analysis employed multiple regression to test the effect of SPH program elements while controlling for organizational factors. VHA led the nation in SPHM implementation and this is substantiated by 1) peer-reviewed articles that document reduced musculoskeletal injury rates among nurses after adoption of mechanical means to mobilize patients instead of using manual methods;1 2) collaborations and products produced with national partners, including the American Nurses Association and the National Institute for Occupational Safety and Health; 3) citations of VA work by the Joint Commission and others; and 4) national media attention.

Program Evaluation

The results showed that three organizational risk factors – bed days of care, facility complexity level, and baseline injury incidence rate – were significantly associated with injury incidence rate. Five SPHM components significantly predicted a decrease in injury incidence rates: deployment of ceiling lifts and other new technologies, peer leader effectiveness, competency in equipment use, facility coordinator link with safety committee, and peer leader training.1

The VHA SPHM Program continues to enhance staff safety across multiple patient settings (e.g. inpatient acute care, rehabilitation, long term care). SPHM equipment is available for each patient physical activity, such as walking, transferring in and out of beds, stretchers, or chairs, and showering. SPHM technology includes powered mechanical lifts, accessories, and slings, which can be customized for any mobility task. The most recent available data from FY 2009 to FY 2017 demonstrated a 45 percent reduction in all VA nursing staff back injuries.2 Other associated advantages include: avoiding lost work time due to injury, fewer compensation claims, and reduced costs necessitated by staff replacement resulting from injury and absence. Most recently, the VHA SPHM coordinators have created videos using the equipment to prone ventilated patients with COVID-19. These have been disseminated throughout VHA and non-VHA hospitals.

HRO Implementation Strategies

The VHA SPHM program is an example of high reliability organization (HRO) program implementation. The program components represent the day-to-day implementation strategies of an HRO.3 The development of leadership and training for this program is exemplified by unit peer leaders and facility coordinators who continually educate, check competencies with equipment, and problem- solve patient lifting and mobility challenges with all hospital staff involved with patient care. The culture of safety is exemplified by “no-lift” policies, “after action” or “near miss” staff safety huddles, continuous ergonomic unit assessments, and marketing. Data on staff injuries is monitored and informs coordinators which units may need further education or equipment. Patient falls and injuries that are impacted by equipment use are also monitored by unit peer leaders. Finally, implementing effective interventions is demonstrated by daily use of SPHM equipment.

The most important implementation tool for the SPHM program is the network of coordinators, national program directors, and national SPHM advisory group members. This network has face-to-face training conferences and monthly national and Veterans Integrated Service Network meetings. The network assures the sustainability and success of the program by gathering and disseminating information on equipment, how to integrate the program into building plans, and most importantly, how to assimilate new coordinators into the program.

Currently, the Nursing Innovations Center of Evaluation is developing a Mobility Screening and Solutions Tool to expand the SPHM program to include all clinical care providers who are responsible for safely moving and transferring patients across multiple settings. This tool will quickly assess a patient’s mobility and align possible equipment to use in a specific task. The newest focus of SPHM is on patient outcomes. The VISN 8 Patient Safety Center of Inquiry (PSCI) has many ongoing SPHM projects, including studies to examine how the equipment is used in Veterans’ rehabilitation, how to best utilize overhead and sling technology, how to prevent skin injury, and how to minimize patient and staff injury due to patient falls. Other projects include how SPHM equipment and practices could impact early mobility in ICUs and installing SPHM equipment in Veterans’ homes. This effort would include training family caregivers on how and when to use SPHM equipment and represents an exciting opportunity to transfer what we have learned from inpatient SPHM programs to the home setting. Such a transfer would reduce negative caregiver outcomes while promoting mobility for the patient. Finally, a newly funded research study is underway to develop a measure of Veterans’ experiences of assisted mobility during a hospital admission.

References

1. Powell-Cope, G, et al. “Effects of a National Safe Patient Handling Program on Caregiver Injury Incidence Rates,” Journal of Nursing Administration 2014; 44(10):525-34.
2. Rugs D. Safe Patient Handling and Mobility Analysis. Unpublished raw data 2017.
3. Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of High Reliability Organization Principles. Washington (DC): Department of Veterans Affairs (US); 2019 May.