Avoiding the Iceberg – Putting MSIP Theory into Practice

January 28, 2015 | News

ArjoHuntleigh-Knowledge-Pressure-Ulcer-Prevention-Therapeutic-Surfaces-Clinical-guidelines-nurses-dicussing-factsIn our last post, The Iceberg Effect, we presented the financial and human argument for reducing workplace injuries, using musculoskeletal injuries (MSIs) as an example. We also highlighted key general principles of successful safety programs. But what does that look like in practice? And more importantly – what is the evidence that this approach actually works? How can an organization avoid its own injury iceberg? The next few installments of this series, Avoiding the Iceberg, will delve into the application of MSI prevention, pulling from the research and framing it in a practical way.

Case Study Spotlight: The Effect of a Transfer, Lifting and Repositioning (TLR) Injury Prevention Program on Musculoskeletal Injury Rates among Direct Care Workers

The Highlights:

  1. A comprehensive safety program can significantly reduce injuries among direct care workers.
  2. Key program features included:
    1. Survey of current equipment needs and investment in equipment upgrades.
    2. Training for all direct care workers on using lift equipment and risk-reduction strategies.
    3. Standardization of mobility assessment procedures and implementation of a notification system to communicate transfer needs at the bedside.
    4. Implementation of a point-of-care risk assessment procedure.
  3. Outcomes:
    1. 8% decrease in all injuries.
    2. 8% decrease in time-loss injuries.
    3. Decrease in claims costs per injury from $3900 to $2200.
    4. Decrease in time off due to injury from 35.9 days to 16.2 days per claim.
  4. Applying research to practice – Currently available tools and resources:
    1. Gap Analysis – Safe Resident Handling Equipment tool, available on p. 50 here
    2. Education support
    3. Assessment support: Mobility Decision Support Tool
    4. Point-of-Care Risk Assessment: Tool and e-training access

The Participants

This study was conducted in three different settings in Saskatchewan: acute care, home care, and long term care. It was staggered over four years (2002 – 2006). Intervention areas were then compared to control areas to assess the program’s impact.

The Initiative

The study’s main focus was the implementation of the TLR Program, a multi-pronged intervention. The program had two main branches: engineering controls and administrative controls.

Engineering controls

Each participating facility underwent an assessment of its current resident transfer equipment. The aim of this portion of the program was to assess where the gaps were in terms of lifts, slings, slider sheets, etc. A total of $200 000 was invested to upgrade participating areas’ equipment.

Administrative controls

ArjoHuntleigh-Patient-Transfer-Solutions-Maxi-500-Transfer-from-bedThree intervention areas were targeted: training, mobility assessments, and communication. For training, all staff involved in resident handling were educated on safe techniques, how to use equipment, and how to use the assessment tools. To aid in assessments, two standardized tools were implemented: the Mobility Assessment Form, and the Patient Handling Algorithm. These tools were used to assess residents’ current status and to facilitate a quick point-of-care check prior to any transfer or repositioning task. Bedside placards were used to display each resident’s current status (e.g. what type of transfer should be performed). Direct care providers then performed point-of-care checks to ensure that the bedside information still matched the resident’s current condition.


Overall, participating areas experienced significant decreases in workplace injuries. Below is a summary:

  • 8% decrease in all injuries.
  • 8% decrease in time-loss injuries.
  • Decrease in direct claims costs per injury from $3900 to $2200.
  • Decrease in time off due to injury from 35.9 days to 16.2 days per claim.

In comparison, the control group experienced a decrease in overall injuries of 9.7%, and an increase in time loss injury rates of 9.5%.

Translating Research into Practice

Taking a multi-pronged approach to reducing MSI injuries due to resident handling tasks is effective at reducing injuries. The key components of this particular program were:

  • Ensuring the right equipment was available
  • Providing staff with training on safe resident handling practices
  • Ensuring mobility assessments are done and recommendations are communicated in a visible way (e.g. at bedside)
  • Teaching staff to conduct bedside risk assessments before each and every resident handling task

There are a number of tools currently available to organizations that can help you address these steps.

Assessing Equipment Needs

The Gap Analysis – Safe Resident Handling Equipment tool, available on p. 50 here provides organizations with a framework to assess their equipment needs.

Training on Safe Resident Handling