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Health Services Research & Development

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New Center of Excellence in Tampa, Florida

Under the leadership of Dr. Audrey Nelson, investigators at the HSR&D/RR&D Center of Excellence (COE) in Tampa, Florida have made significant contributions to both staff and patient safety in VA and in health care across the country.

Over the past 30 years, efforts to reduce work-related musculoskeletal injuries in health care relied on body mechanics classes or training in lifting techniques, both of which have been unsuccessful. At the COE, Dr. Audrey Nelson leads a program of research and research translation in safe patient handling that is now culminating in a $200 million VA-wide implementation program. This program is designed to radically change the way nurses and other direct health care providers move and transfer dependent patients, from manually lifting and pulling to an ergonomics-based program featuring technologies to mechanically move them.

Through studies funded by VA and others, researchers documented that an ergonomics-based program will decrease the number and severity of patient handling injuries, decrease the cost of health care by decreasing workers' compensation costs, and result in increased comfort and dignity for patients.1

Dr. Nelson works with schools of nursing across the country to implement a curriculum for colleges of nursing co-developed with the National Institute for Occupational Health and Safety.2

Researchers at the COE in Tampa have also made strides in the areas of falls prevention and fall-injury prevention. Patient falls are the most frequent adverse event with injury within the VHA and are the leading cause of injury-related deaths among people age 65 and older. Researchers at the COE are addressing gaps in the literature such as the lack of research on falls among patients who use wheelchairs for mobility, fall prevention in impairment-specific populations, and prevention of fall-related injuries. Key research findings in these areas from recently funded studies include the following:

  • People with spinal cord injuries who use wheelchairs have a different fall risk profile compared to other populations. In a prospective epidemiological study, investigators identified six predictors of wheelchair falls: pain in previous two months, alcohol abuse, greater motor function, previous fall, fewer spinal cord injury years, and shorter length of wheelchair. Predictors of injurious falls were: pain in previous two months, greater motor function, previous fall, and inaccessible home entrance. Results are being used to develop a reliable and valid screening instrument, and in the testing of a wheelchair skills training program.
  • Using an innovative probabilistic risk modeling method, researchers identified key high-risk behaviors in VA community living centers that contribute to fall injury risk. These behaviors included staff failure to respond to fall alarms in a timely manner, residents' use of unsafe transfer techniques, and residents' use of wheelchairs that are not properly maintained. Results are being used to develop a staff training program that targets these three at-risk behaviors.

References

  1. Nelson A, et al. Development and Evaluation of a Multifaceted Ergonomics Program to Prevent Injuries Associated with Patient Handling Tasks. International Journal of Nursing Studies 2006, 43(6), 717-33.
  2. Nelson A, et al. Effectiveness of an Evidence-Based Curriculum Module in Nursing Schools Targeting Safe Patient Handling and Movement. International Journal of Nursing Education Scholarship 2007, 4(1).

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