Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Scope and
Application. This Section shall apply to all general acute care hospitals.
EXCEPTION: (1): This Section shall not apply to general
acute care hospitals within the Department of Corrections and Rehabilitation or
the State Department of Developmental Services.
EXCEPTION: (2): This section shall not apply to units
within a general acute care hospital that are separately licensed as a distinct
part under Title 22 Section 70625 and 70627.
NOTE: to subsection (a): This section does not preclude
the application of Section
3203 or other Title 8 safety orders
to patient handling in health care facilities, services and operations not
covered by this section, nor does it preclude the application of other sections
of Title 8, including but not limited to Sections
3203 and
5110, to patient handling in
general acute care hospitals.
(b) Definitions.
"Designated health care worker" means an employee
responsible for performing or assisting in patient handling activities who is
specifically trained to handle patient lifts, repositioning, and transfers
using patient transfer, repositioning, and lifting devices as appropriate for
the specific patient.
"Designated registered nurse" means a registered nurse
who has responsibilities under the Plan required by subsection (c), including,
but not limited to, the responsibilities of a designated health care worker,
preparation of a safe patient handling instruction, the observation and
direction of patient lifts or mobilizations, or the communication of patient
handling information to patients or their authorized representatives.
"Emergency" means unanticipated circumstances that can
be life-threatening or pose a risk of significant injuries to the patient,
staff or public, requiring immediate action.
"Equipment" means a powered or non-powered device that
effectively reduces the forces exerted by or on employees while they perform
patient handling activities, including all accessories necessary for the
operation of the device. Devices and accessories include replaceable and
disposable items.
"General acute care hospital" (GACH) means a hospital,
licensed by the California Department of Public Health as such in accordance
with Title 22, California Code of Regulations.
"Lift team" means designated health care workers
specifically trained to work together to perform patient handling activities
using equipment as appropriate for the specific patient.
"Lifting" means the vertical movement of a patient or
the support of part or all of a patient's body.
"Manual patient handling" means the lifting,
transferring, repositioning, or mobilizing of part or all of a patient's body
done without the assistance of equipment.
"Mobilizing" means the putting into movement, or
assisting in the putting into movement, of part or all of a patient's
body.
"Musculoskeletal injury" means acute injury or
cumulative trauma of the muscles, tendons, ligaments, bursa, peripheral nerves,
joints, bone or blood vessels.
"Patient" means a person who is receiving diagnostic,
therapeutic or preventive health services or who is under observation or
treatment for illness or injury or for care during and after pregnancy.
"Patient care unit" means a unit or department that is
included within a general acute care hospital's license that provides direct
patient care including but not limited to nursing units, diagnostic imaging,
emergency department, or rehabilitation and behavioral health.
"Patient handling" means lifting, transferring,
repositioning or mobilizing of part or all of a patient's body.
"Repositioning" means changing a patient's position on
a bed, gurney, chair or other support surface.
"Safe patient handling policy" means a policy that
requires replacement of manual lifting and transferring of patients with
powered patient transfer devices, lifting devices, and lift teams, as
appropriate for the specific patient and consistent with the employer's safety
policies and the professional judgment and clinical assessment of the
registered nurse.
"Transferring" means moving a patient from one surface
to another (for example from a bed to a gurney).
(c) Patient protection and health care worker
back and musculoskeletal injury prevention plan. As part of the Injury and
Illness Prevention Program (IIPP) required by Section
3203, each hospital covered by this
section shall establish, implement and maintain an effective written patient
protection and health care worker back and musculoskeletal injury prevention
plan (Plan). The Plan shall be maintained and implemented at all times for all
patient care units. The Plan may be incorporated into the IIPP, or may be
maintained as a separate document. The Plan applicable to the unit shall be
available to employees in each patient care unit at all times. The Plan shall
include:
(1) An effective safe patient
handling policy component reflected in professional occupational safety
guidelines for the protection of patients and health care workers in health
care facilities.
NOTE: to subsection (c)(1). Examples of professional
occupational safety guidelines for the protection and care of patients and
health care workers are listed in Appendix A.
(2) The names and/or job titles of the
persons responsible for implementing the Plan.
(3) The methods the hospital will use to
coordinate the implementation of the Plan with other employers whose employees
have work assignments that include being present on patient care units. These
methods shall include how employees will be provided with the awareness
training required by subsection (d)(4), and procedures for investigation and
recording of injuries associated with patient handling. In addition, the
hospital's Plan shall include procedures to ensure that the Plan is implemented
for employees of other employers who are responsible for performing or
assisting in patient handling activities, including the provision of training
required for designated health care workers.
(4) Procedures to ensure that supervisory and
non-supervisory employees comply with the Plan and use specified procedures and
equipment when performing a patient handling activity, in accordance with
Section 3203(a)(2).
(5) Procedures for identifying and evaluating
patient handling hazards, in accordance with Section
3203(a)(4)
including all of the following:
(A) A
procedure to determine the types, quantities and locations for powered patient
handling equipment and other patient handling equipment required for each unit
covered by the Plan. This procedure shall include determining where permanent
and portable equipment should be placed in order to ensure its availability and
accessibility at all times. The equipment needs for each unit shall be
initially evaluated by 11/30/2014 unless an initial evaluation meeting the
requirements of this subsection was conducted after January 1, 2012. GACH
facilities or units that become operational after 11/30/2014 shall have this
procedure conducted prior to the start of patient handling operations in that
facility. The procedures shall include how designated health care workers can
participate in the evaluations.
(B)
Procedures by which the designated registered nurse, as the coordinator of
care, will assess the mobility needs of each patient to determine the
appropriate patient handling procedures based on the nurse's professional
judgment using assessment tools, decision trees, algorithms or other effective
means, and prepare safe patient handling instructions for the patient. The Plan
shall include the means by which health care workers and supervisors licensed
in other disciplines can provide input to the designated registered nurse
regarding the patient mobility assessment.
(C) Evaluation of the need for, use,
availability, accessibility, and effectiveness of patient handling equipment
and procedures. These evaluations shall be conducted:
1. When the Plan is first
established;
2. Whenever the
equipment or conditions change in a manner that may affect safe patient
handling;
3. Whenever the employer
is made aware of a new or previously unrecognized patient handling hazard;
and
4. At least annually for each
unit covered by the Plan.
(6) Procedures for the investigation of
musculoskeletal injuries related to patient handling. To the extent that
relevant information is available, this shall include:
(A) Review of any patient specific risk
factors and the designated registered nurse's safe patient handling
instruction;
(B) Review of whether
the Plan was effectively implemented, including the availability and correct
use of equipment, the availability and use of sufficient staff, and whether the
employees involved had been trained as required by subsection (d);
and
(C) Solicitation from the
injured employee and other staff involved in the incident of their opinions
regarding the cause of the incident, and whether any measure would have
prevented the injury.
(7)
Procedures for correcting hazards related to patient handling, including:
(A) The evaluation and selection of patient
handling equipment, including the involvement of designated registered nurses
and other designated health care workers, and, where utilized, lift team
members;
(B) How sufficient and
appropriate patient handling equipment, selected in accordance with subsections
(c)(5) and (c)(7)(A), will be made available on each unit covered by this
section. This shall include procedures for procurement, inspection,
maintenance, repair, and replacement of appropriate patient handling equipment.
Where equipment is shared between units, these procedures shall also include
the means by which the current location of the equipment can be
determined;
(C) The procedures by
which the designated registered nurse will observe and direct patient lifts and
mobilizations on each patient care unit, in accordance with Labor Code Section
6403.5 and
Title 22, California Code of Regulations, Section 70215;
(D) The procedures by which the designated
registered nurse will communicate the nurse's assessment regarding patient
handling practices to the patient and patient's authorized representatives, in
accordance with Title 22, California Code of Regulations, Section
70215;
(E) The procedures by which
lift teams and/or other designated health care workers will be available to
perform lifts and other patient handling tasks in each patient care unit at all
times in accordance with the Safe Patient Handling Policy. An employee is not
considered to be available if the employee's other assignments prevent the
person from participating in the patient handling tasks within the timeframe
determined to be necessary by the person designated to observe and direct the
patient lifts and mobilizations in accordance with subsection (c)(7)(C) and
(c)(7)(F). Designated health care workers and lift team members shall follow
the safe patient handling policy, including replacement of manual patient
handling with powered patient transfer devices and lifting devices as
appropriate for the specific situation and patient.
(F) The procedures to be followed by
designated health care workers and lift team members in performing patient
handling tasks under normal circumstances, in emergencies, in situations in
which there is no designated registered nurse present, in situations in which
patients are not cooperative with the safe patient handling instruction, and in
those situations in which there is no applicable individual safe patient
handling instruction.
(G)
Procedures for correcting problems found during the review of the
Plan.
(8) Procedures for
communicating with employees regarding safe patient handling matters,
including:
(A) The method by which the
designated registered nurse's safe patient handling instruction for each
patient will be documented and communicated to designated health care workers
and lift team members providing care to that patient;
(B) The means by which employees may
communicate without fear of reprisal their concerns regarding performing a
patient handling activity as instructed, and the means by which concerns and
reported hazards will be investigated and corrected as necessary; and
(C) The means by which designated health care
workers, lift team members, designated registered nurses, and their supervisors
can participate in reviewing the effectiveness of the Plan in their work areas
or departments.
(9)
Procedures for providing training to employees who may be present in patient
care units in accordance with subsection (d).
(10) For facilities or units in existence as
of 10/1/2014, a list of the patient handling equipment identified in (c)(7)(B)
that cannot be implemented by the effective date of the standard shall be made.
For each listed item, this shall include the reason for the delay, and the
schedule by which the equipment will be put into use, and alternative measures
to protect employees until the equipment is put into use. In any event, any
equipment identified shall be put into use no later than one year after
10/1/2014.
(11) Procedures for
reviewing, at least annually, the effectiveness of the Plan in each patient
care unit, which shall include a review of injury data and trends. The Plan
shall include an effective procedure for obtaining the active involvement of
employees in reviewing and updating the Plan with respect to the procedures
performed by employees in their respective work areas or departments.
Deficiencies found during this review shall be corrected, in accordance with
subsection (c)(7) and Section
3203.
(d) Training. The employer shall provide
training to all employees whose work assignments include being present on
patient care units, that effectively addresses the activities they are
reasonably anticipated to perform under the Plan. Training material appropriate
in content and vocabulary to the educational level, literacy, and language of
employees shall be used.
(1) Frequency of
training. Employees shall be trained as follows:
(A) Initial training shall be provided when
the Plan is first established, to all new employees, and to all employees given
new job assignments for which training has not previously been
received;
(B) At least every twelve
months, designated health care workers, lift team members, designated
registered nurses and their supervisors shall also receive refresher
training.
(C) Employers shall
provide additional training when new equipment or work practices are
introduced. The additional training may be limited to addressing the new
equipment or work practices.
(2) Initial training for designated health
care workers, lift team members, designated registered nurses and their
supervisors shall include at least the following elements as applicable to the
employee's assignment:
(A) The areas of body
exposure and types of injuries associated with manual patient handling
activities including risk associated with vertical and lateral movement,
bariatric patients, repositioning and ambulation, and the importance of early
recognition and management.
(B) How
risk factors, such as the patient's ability and willingness to cooperate,
bariatric condition, clinical condition, etc., are assessed and controlled
during patient handling tasks including the following: vertical lifts, lateral
transfer, repositioning, and ambulation.
(C) How to communicate with patients
regarding the use of patient handling procedures and equipment.
(D) The appropriate use of powered and
non-powered equipment to reduce injuries to patients and employees. This shall
include practice using the types and models of equipment that lift team members
and other designated health care workers will be expected to use.
(E) Procedures to be followed in order to
safely perform manual patient handling when necessary.
(F) The importance and process for reporting
concerns regarding equipment availability, condition, storage and
maintenance, and concerns regarding availability of sufficient
staff to perform patient handling activities.
(G) The elements of the employer's Plan and
safe patient handling policy and how the Plan will be made available to
employees.
(H) The right to refuse
to lift, reposition, mobilize, or transfer a patient due to concerns about
patient or worker safety or the lack of trained personnel or equipment, and how
a health care worker can communicate concerns regarding the designated activity
to an appropriate supervisor.
(I)
The role of the designated registered nurse as the coordinator of care, and how
the registered nurse will be responsible for the observation and direction of
patient lifts and mobilization.
(J)
The role of the supervisor to be familiar with the Plan, the safe patient
handling policy, and the patient handling hazards in their unit.
(K) How the employee can request additional
training.
(L) An opportunity for
interactive questions and answers with a person knowledgeable about the Plan
and safe patient handling equipment and procedures.
(M) In addition to the training specified in
subsections (d)(2)(A) through (d)(2)(l), supervisors of
employees covered by the Plan shall also be trained on the hospital's policy
that a health care worker may not be disciplined for refusal to lift,
reposition or transfer a patient due to concerns about patient or worker safety
or the lack of trained designated health care workers or equipment.
(N) In addition to the training specified in
subsections (d)(2)(A) through (d)(2)(L) designated registered nurses who will
assess patients in accordance with subsection (c)(5)(B), shall be trained in
how to assess patients' mobility needs, how to communicate with patients and
their authorized representatives, and how to communicate with supervisors,
designated health care workers, and other health care workers regarding safe
patient handling practices for specific patients.
EXCEPTION: to subsection (d)(2): For employees who have
received initial training in the year preceding the effective date of the
standard, only training on the elements which were not included in the training
need be provided.
(3) Refresher training for designated health
care workers, lift team members, designated registered nurses and supervisors
shall include at least the following elements as applicable to the employee's
assignment:
(A) The use of powered and
non-powered equipment to handle patients safely. This shall include practice
using the types and models of equipment that the lift team members and/or
designated health care workers will be expected to use.
(B) Procedures to be followed in order to
safely perform manual patient handling when necessary. This training shall
include practice in performing tasks involving multiple employees.
(C) A review of the items included in the
initial training.
(D) An
opportunity for interactive questions and answers with a person knowledgeable
about the Plan and safe patient handling equipment and
procedures.
(4) Awareness
Training. Training for employees, other than those identified in subsections
(d)(2) and (d)(3), whose job assignment includes being present on patient care
units, shall address the recognition of the patient interactions that require
the involvement of designated health care workers, or lift teams, how to obtain
that involvement when necessary, and procedures to follow for emergencies
relating to safe patient handling.
(e) Records.
(1) The hospital shall develop and maintain
the following records in accordance with Section
3203(b) as records
of the implementation of the Plan:
(A) Records
of inspections, including hazard identification and evaluation, shall include:
1. records regarding the evaluation,
selection, and placement or installation of patient handling equipment or
devices and the availability of this equipment at all times on each unit
covered by the Plan;
2. records of
initial and periodic inspection of patient handling procedures; and
3. records of investigation of occupational
injuries and illnesses related to safe patient handling.
(B) Training records shall be created and
maintained for a minimum of one year and include the following information:
training dates; contents or a summary of the training sessions; types and
models of equipment practiced during training; names and qualifications of
persons conducting the training; and names and job titles of all persons
attending the training sessions.
(C) All records required by this subsection
shall be made available on request to the Chief of the Division of Occupational
Safety and Health and his or her representatives for examination and
copying.
(D) All records required
by this subsection shall be made available on request to employees and their
representatives for examination and copying in accordance with Section
3204(e)(1) of
these orders.
(E) Records of injury
investigations shall not include "medical Information" as defined by Civil Code
Section
56.05(g).
(F) Records required by Division 1, Chapter
7, Subchapter 1, Occupational Injury or Illness Reports and Records, of these
orders shall be created and maintained in accordance with those
orders.
1. New
section filed 7-31-2014; operative 10-1-2014 (Register 2014, No.
31).
Note: Authority cited: Section
142.3, Labor
Code. Reference: Sections
142.3 and
6403.5, Labor
Code.
