Mining-Related Lower Back Injuries and the Compensation Process: An Injured Worker's Journey.

Background: In Ontario, when an occupational injury occurs in the mining industry, there is often a need to interact with the Workplace Safety and Insurance Board (WSIB). During this process, miners experience economic, social, and mental health-related issues that can affect their overall well-being. This study aimed to determine the impact of a lower back injury and the WSIB claim process experience expressed by some male, underground miners in Sudbury, Ontario, Canada. Methods: A qualitative descriptive study design that utilized in-depth, individual qualitative interviews was conducted. Twelve male participants (underground miners) were interviewed in Sudbury, Ontario. Interviews were transcribed and thematically analyzed. Findings: The results emphasized the need for improved communication, the necessity for resources to be allocated to enhance public discussion about injury prevention, the social and economic burden that miners and their families face, and the power imbalances between injured miners and the companies that were meant to support them. Conclusion/Application to Practice: The findings indicate that several areas require improvement for an injured miner who submits a WSIB claim. Ideally, participants wanted an improved and streamlined process for reporting an injury and for WSIB claim management. These findings suggest that occupational health practices that foster a safe and healthy work environment in the mining industry must be promoted, which will help to guide future policies that enhance support for an injured worker and the WSIB claim process.

Assessment of low back disorders risk based on allowable weight limits for manual lifting in Iran.

In 2011, load limits for manual lifting were adopted in Iran to protect workers from low back injury without prior testing of accuracy with Iranian workers. This investigation examined how accurate the adopted ACGIH TLVs at the allowable limits predict risk for LBP disorders for a group of Iranian workers using biomechanical criteria. Testing took place in the laboratory with participants completing a series of 2-handed lifting tasks as defined in the Iranian Guideline for Manual Lifting. To test accuracy, both compression and shear forces were estimated for fifteen male Iranian workers who completed 25 lift combinations that varied in height and reach with the maximal allowable load. The findings, when compared to a risk threshold of 3400 N compression and 700 N shear, showed above-threshold forces for compression and little-to-no safety margins with repetitive lifting for most lifts at torso height and below. Since Government, employers and workers use these guidelines to decide on work/workplace design; these guidelines require further review and revision based on the anthropometrics of Iranian people.

Moving and handling: reducing risk through assessment.

Manual handling injuries can occur almost anywhere in a healthcare environment, and most staff perform a variety of moving and handling tasks every day. Heavy lifting, awkward posture, and previous or existing injury can increase the risk of musculoskeletal disorders. A healthcare professional's involvement in moving and handling is more widespread than it might appear, and their actions and understanding of techniques, legislation and guidelines have a direct effect on patient care. Every situation that involves the handling, or partial handling, of a person presents varying levels of risk to the patient and the carer. Maintaining a good level of patient mobility and independence is an essential part of care delivery and can reduce the risk of long-term physical and psychological effects. Delivery of care should focus on the individual's capacity, not their incapacity, to ensure that they are treated with dignity and respect.

Saving our backs: safe patient handling and mobility for home care.

Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.

Overhead lift systems reduce back injuries among burn care providers.

Extensive patient handling in burn care provides ample opportunities for staff injury. The objective of this retrospective study was to evaluate frequency of work-related back injury pre- and postinstallation of overhead lifting systems (OLS) in a burn intensive care unit. After receiving institutional review board approval, the Workers Compensation Fund of Utah released deidentified back injury claims filed from the authors' burn center between January 1, 2001 and December 31, 2012. Number of back injuries, cost to workers' compensation, and missed workdays were examined. Three distinct time periods were analyzed based on the timing of installation of OLS in the burn center. Forty-five workers were injured in the burn unit; most were female (76%) nurses (73%), with the majority having lower-back injury (71%). Thirty claims (67%) involved staff with a previous back injury. Median age was 32 years (interquartile range, 22-40) and median term of employment at the burn center before injury was 3.7 years (interquartile range, 1.6-7.7). During the intervention period, rate of staff injuries, number of missed workdays, and total number of paid claims decreased significantly. In the period since installation, only one claim has been filed, which is the lowest number of claims that any individual intensive care unit has reported in the facility. The burn unit installed five OLS at a cost of $7000 per unit. This retrospective review indicated that the installation of OLS on the burn unit was an effective tool for reducing staff injury and associated costs. Back injury was essentially eliminated when five OLS were installed.

Patient handling in the veterans health administration: facilitating change in the health care industry.

OBJECTIVE: To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership. METHODS: Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data. RESULTS: Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors. CONCLUSION: Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

Safe lifting programs at long-term care facilities and their impact on workers' compensation costs.

OBJECTIVE: To determine the utility of a safe lifting program index and a measure of lift inventory to predict workers' compensation claim frequency and costs in long-term care facilities in 23 states. METHODS: Workers' compensation claims and cost data were matched to Center for Medicare and Medicaid Services (CMS)-certified facilities (N = 656). Facility safe lifting program index were derived from interviews with directors of nursing in a subset (N = 271). RESULTS: The higher the safe lift index score, the lower the claims and costs. An increase of one lift per 100 residents is associated with a 5% decrease in claims frequency and an 11% decrease in total costs on average. CONCLUSION: In this national study, we find that a comprehensive safe lift program, endorsed and promoted by directors of nursing, reduces caregiver injury as measured by workers' compensation claims frequency and costs.

Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants.

AIMS: This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties. BACKGROUND: High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants. METHODS: We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data. RESULTS/FINDINGS: The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status. CONCLUSION: Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available.

A better way to perform portable x-rays.

Radiologic technologists at Aurora St. Luke's Medical Center in Milwaukee, WI were experiencing injuries at an alarming rate, resulting in over $200,000 in workers' compensation and lost productivity costs. Lean methodologies were used incorporating the following process: evaluate the current situation, identify areas of opportunity, modify the existing process, substantiate and enumerate improvements, and implement new standard work. A cross-functional team conducted experimental research to test several variables and methods to develop a new ergonomically sound procedure that has essentially eliminated injuries associated with performing portable x-rays.

Assessment of nurses' and therapists' occupational musculoskeletal injuries.

INTRODUCTION: Occupational musculoskeletal injuries are serious issues facing health care professionals and health care facilities in the United States today. PURPOSE: The purpose of the study was to investigate health care worker occupational injury patterns to gain better understanding of the injuries. METHOD: A descriptive study was conducted at a 497-bed hospital to investigate the patterns of occupational injuries of nursing and therapy personnel. A secondary data analysis was conducted on data collected by the occupational health department of a hospital. FINDINGS: Two years of occupational injury reports were analyzed. The evidence showed the overall injury rate between nurses and therapists was similar. Health care professionals ages 50 to 59 were employees injured most frequently. The most injuries occurred between 9:30 a.m. and 11:30 a.m., and Wednesday was the most frequent day of injury. Most employees reported the injury on the day of the injury and did not lose work time from the event. Surgical services department had the most injuries, and back injuries were the most common type of musculoskeletal injury. CONCLUSION: By recognizing the type of injuries, location of injuries, time of injuries, and impact of injuries, nurses can make changes to decrease work-related musculoskeletal injuries and improve work environments.

Use of temporary nurses and nurse and patient safety outcomes in acute care hospital units.

BACKGROUND: To deal with nursing shortages and inadequate hospital nurse staffing, many solutions have been tried, including utilizing temporary nurses. Relatively little attention has been given to use of temporary nurses and its association with both nurse and patients outcomes. PURPOSE: : The purpose of this study is to investigate the association between use of temporary nurses and nurse (needlesticks and back injuries) and patient (patient falls and medication errors) safety outcomes at the nursing unit level. METHODOLOGY/APPROACH: Data came from a large organizational study which investigated the relationship between registered nurse (RN) staffing adequacy, work environments, organizational, and patient outcomes. The sample for this study was 4,954 RNs on 277 nursing units in 142 hospitals. FINDINGS: Nurses working on nursing units with high levels (more than 15%) of external temporary RN hours were more likely to report back injuries than nurses working on nursing units that did not use external temporary RNs. Nurses working on these nursing units also reported greater levels of patient falls compared with those who did not use temporary RNs. This study found that nurses working on nursing units with moderate levels (5-15%) of external temporary RN hours reported fewer medication errors than those without using any external temporary RNs. PRACTICE IMPLICATIONS: Hospitals need to monitor the levels of temporary nurse use and maintain a level of approximately 15% to ensure both nurse and patient safety outcomes. The temporary nurse use to manage nursing shortfall may provide both benefit and harm to nurse and patient safety depending on the level of the use.

Ergonomic assessment of musculoskeletal discomfort of iron workers in highway construction.

OBJECTIVE: The purpose of this study is to ergonomically evaluate the risk of work-related musculoskeletal injuries of the iron workers in highway construction. Two specific job duties are analyzed: (1) tying the vertical, pier support systems, and (2) tying rebar on a horizontal bridge deck. PARTICIPANTS: Eleven right-handed male subjects participated in this study. The eleven rodworkers (5 pier tiers and 6 deck tiers) were recruited from a heavy and highway/bridge building project. METHODS: The ergonomic assessment tools included the BodyMap instrument for measuring potential ergonomic concerns, and a handgrip dynamometer for measuring the maximum voluntary contraction (MVC) and applied grip force of the rebar-tying tasks. RESULTS: This study suggests that there is a significant risk for injury and musculoskeletal disorders among iron workers performing these designated tasks. Findings also show that the ergonomic issues of greatest concern are the discomforts in the lower back and right wrist/hand of the rodworkers. CONCLUSIONS: The ergonomic assessment techniques could assist the early identification of work-related musculoskeletal concerns and help prioritize jobs for intervention in the construction field.

Saving costs, saving health care providers' backs, and creating a safe patient environment.

Back injuries are increasing among health care providers and are related to a multitude of factors, including repetitive tasks related to patient handling, the aging of the nursing workforce, higher patient acuity levels, and an increased prevalence of obesity in patients, as well as limited workspaces in patient rooms. An estimated 12% of nurses leave the profession annually because of back injuries, and more than 52% complain of chronic back pain and injuries. Implemented in response to rising costs of health care providers' injuries, a safe patient handling program resulted in decreased injuries from staff performing work-related duties, and decreased workers' compensation claims, which resulted in significant cost savings and improved patient satisfaction.

[Risk assessment of manual handling of loads: the choice of reference values in light of Leg. 81/2008]. / Valutazione del rischio da movimentazione manuale dei carichi: la scelta dei valori di riferimento alla luce del D.Lgs. 81/2008.

Italian law on safety at work does not clarify specific levels of load for safe manual material handling. For this reason professionals appointed for safety need to define new target range value for the correct application of D.Lgs. 81/2008 law. Authors, discussing about indication of the national laws and international rules, suggest the assumption of a load of 25 and 20 kg as reference values for male and female adult and healthy workers. They also examine the graduation of the acceptable loads in relation to workers' age and the Lifting Index values to be adopted as action limit and exposure limit.

Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes.

BACKGROUND: The rate of lost-time sprains and strains in private nursing homes is over three times the national average, and for back injuries, almost four times the national average. The Ohio Bureau of Workers' Compensation (BWC) has sponsored interventions that were preferentially promoted to nursing homes in 2000-2001, including training, consultation, and grants up to $40,000 for equipment purchases. METHODS: This study evaluated the impact of BWC interventions on back injury claim rates using BWC data on claims, interventions, and employer payroll for all Ohio nursing homes during 1995-2004 using Poisson regression. A subset of nursing homes was analyzed with more detailed data that allowed estimation of the impact of staffing levels and resident acuity on claim rates. Costs of interventions were compared to the associated savings in claim costs. RESULTS: A $500 equipment purchase per nursing home worker was associated with a 21% reduction in back injury rate. Assuming an equipment life of 10 years, this translates to an estimated $768 reduction in claim costs per worker, a present value of $495 with a 5% discount rate applied. Results for training courses were equivocal. Only those receiving below-median hours had a significant 19% reduction in claim rates. Injury rates did not generally decline with consultation independent of equipment purchases, although possible confounding, misclassification, and bias due to non-random management participation clouds interpretation. In nursing homes with available data, resident acuity was modestly associated with back injury risk, and the injury rate increased with resident-to-staff ratio (acting through three terms: RR = 1.50 for each additional resident per staff member; for the ratio alone, RR = 1.32, 95% CI = 1.18-1.48). In these NHs, an expenditure of $908 per resident care worker (equivalent to $500 per employee in the other model) was also associated with a 21% reduction in injury rate. However, with a resident-to-staff ratio greater than 2.0, the same expenditure was associated with a $1,643 reduction in back claim costs over 10 years per employee, a present value of $1,062 with 5% discount rate. CONCLUSIONS: Expenditures for ergonomic equipment in nursing homes by the Ohio BWC were associated with fewer worker injuries and reductions in claim costs that were similar in magnitude to expenditures. Un-estimated benefits and costs also need to be considered in assessing full health and financial impacts.

Effect of a nurse back injury prevention intervention on the rate of injury compensation claims.

PROBLEM: This study evaluated the effect of introducing a No Lifting policy on back injuries to nurses, across an entire health care system. METHODS: Methods included: analysis of the data for all public health agencies in the Australian state of Victoria; compensation data from the Victorian Workcover Authority; data about workforce and program implementation from a retrospective survey of agencies; longitudinal analysis of standardized workers compensation claim rates for back injuries before, during and after the intervention. RESULTS: A statistically significant decline in back injury claim rates during implementation contrasted with no statistically significant trends within the periods before and after the intervention. A statistically significant reduction occurred in mean quarterly standard back injury claim incidence rates per 1,000 equivalent fulltime nursing staff (EFTNS), representing a 24% reduction in standard back injury claims/1000 EFTNS. DISCUSSION: Ergonomics principles encourage changing the work environment to suit the worker. This approach delivered a significant improvement in the immediate term. IMPACT OF INDUSTRY: The substantial decline in back injury rates signifies a major improvement in the safety of a critical aspect of the work environment for nurses.

Estimating investment worthiness of an ergonomic intervention for preventing low back pain from a firm's perspective.

A mathematical model was developed for estimating the net present value (NPV) of the cash flow resulting from an investment in an intervention to prevent occupational low back pain (LBP). It combines biomechanics, epidemiology, and finance to give an integrated tool for a firm to use to estimate the investment worthiness of an intervention based on a biomechanical analysis of working postures and hand loads. The model can be used by an ergonomist to estimate the investment worthiness of a proposed intervention. The analysis would begin with a biomechanical evaluation of the current job design and post-intervention job. Economic factors such as hourly labor cost, overhead, workers' compensation costs of LBP claims, and discount rate are combined with the biomechanical analysis to estimate the investment worthiness of the proposed intervention. While this model is limited to low back pain, the simulation framework could be applied to other musculoskeletal disorders. The model uses Monte Carlo simulation to compute the statistical distribution of NPV, and it uses a discrete event simulation paradigm based on four states: (1) working and no history of lost time due to LBP, (2) working and history of lost time due to LBP, (3) lost time due to LBP, and (4) leave job. Probabilities of transitions are based on an extensive review of the epidemiologic review of the low back pain literature. An example is presented.