Your health is your greatest asset. It’s important that we are at our best so we can share and serve others.

Did you know that using the proper body mechanics during movement can prevent posture problems, as well as reduce stress and enhance your physical capabilities? We often train our patients/clients on accurate body mechanics, but are you taking the time to train yourself?

Dynamic and static posture are important and critical to safely maintain proper alignment during daily tasks.  Dynamic posture impacts how you hold yourself while moving (i.e. walking, running, or bending to pick something up) where static posture influences your core stability when you are not moving.

Being in proper alignment impacts your head, neck, back and pelvis, and your postural control; ideally your spine and hips create the framework to support your movements. Incorrect posture often stems from misalignments in the skeletal system or weakness in the stabilizing muscles. With time, improper posture may cause the muscles to shorten on one side of your body while allowing stretching of the muscle and causing them to become longer on the opposite side. Improper posture affects your joints, ligaments, and muscles and can lead to back and neck pain. 

Workplace incidents related to poor body mechanics can be minimized or avoided. Reduce the risk of musculoskeletal injuries by focusing on healthy postural habits during the day and by continuing to invest in your own wellness. The use of proper body mechanics, stretching, and strengthening exercises can correct the relationship of those joints, ligaments, and muscles while enhancing proper posture. 

Here are some tips on how to maintain that proper positioning.

When you are standing:

• Stand up straight and tall. 
• Keep your feet flat on the floor and shoulder width apart. 
• Do not lock your knees.
• Keep your shoulders down, with your chest out and your back straight.
• Pull in your stomach muscles. 
• Place your weight mostly on the balls of your feet. 
• Keep your head level and arms down at your sides.

When you are lifting, pushing, or pulling:

• Stand with your feet shoulder width apart and have one foot a slightly in front of the other.
• Always keep your back straight.
• Hinge from your hips and knees with your back flat.
• Never bend at your waist.
• While tightening your stomach muscles, lift using only your legs.
• Hold the object close to you at waist level.
• Push objects rather than pull them to avoid further complications.

When you are sitting:

• Sit with your hips touching the back of the chair.
• Keep your back straight, shoulders back, and use extra support behind your lower back. 
• Distribute your weight evenly for both your hips and knees. 
• Keep your feet flat on the floor with your ankles in front of your knees and do not cross your legs.
• Relax your shoulders and do not allow them to round.
• Keep your elbows close to your body.
• Avoid sitting on soft chairs or couches. 
• Change your position often, at least every 30 minutes.
• Adjust your computer screen so the top of the monitor is at eye level.
• If reading paper copies hold them at the same level as your computer screen.
• When looking at your phone, it is important to keep the phone at eye level while not lifting your shoulders because that causes slouching or looking in a downward direction.

Ways to improve your posture:

• Always be mindful of your posture, especially where you are in relation to the object you are viewing. Always keep the object you are viewing at eye level.
• Stay as active as possible. If you are not a fan of strenuous exercise, consider yoga or tai chi. Focus on strengthening your core muscles. 
• Maintain a healthy weight. Excess weight can weaken your core muscles.
• Ensure that workstations are at a comfortable height.  
• Wear proper shoes with low heels, closed backs, and nonslip soles.
• Always ask for help or use a mechanical device to decrease your risk of injury. 
• When sitting for long periods of time, change your position often and consider taking short walks.

Maintaining proper body positioning and mechanics when standing, sitting, or engaged in activities can lead to better health not just in the short term, but as we age. We focus on teaching our seniors how best to hold their bodies, but if we implement that same vigilance with ourselves at younger ages, we can possibly prevent issues down the line.

When alternative interventions are not effective, restraints are devices used to limit the client’s movement to prevent harm to themselves and others in a health care setting.

There are typically three forms of restraints used in a long-term care setting – physical, chemical, and environmental.

Physical restraints are equipment or material attached to the client to restrict voluntary body movement (i.e., arm/leg restraints, hand mitts, lap belts, bed rails, arm trays, wedge cushions, etc.).

Chemical restraints are psychopharmacologic agents used mainly to reduce agitation and violent behavior in clients (i.e., haloperidol and lorazepam).

Environmental restraints restrict the client’s access to all parts of their surroundings to reinforce boundaries, whether it is to items or certain activities.

Risks of Using Restraints

Although restraints are mostly seen as devices used to prevent self-harm and to those around the client, they have the potential to have the opposite effect.

In a long-term care setting, there are many clients diagnosed with neurological disorders, such as dementia, that inhibit proper thought process. Clients with dementia tend to wander and forget limitations. This can increase risk for falls, making fall prevention one of the main reasons for physical restraint use in facilities. Yes, physical restraints have prevented accidents, but they also can be contraindicative according to researchers. Delirium, muscle atrophy, pressure injuries, increased agitation and anxiety, and decreased mobility are a few significant risks of physical restraints. Unfortunately, there have been instances where accidental strangulation and other serious injury has occurred while the client attempted to get out of this form of restraint.

Due to the sedative effect of chemical restraints, clients can become withdrawn, depressed, agitated, hypotensive, and experience dysrhythmias. When given in excess, client’s respirations and heart rate can decelerate drastically resulting in death.

Out of the three forms of restraints commonly used in LTC facilities, environmental restraints can be considered the least risky.  Instead of restricting the client’s ability to move their body, the environment is altered to keep the client safe. For example, locking away items that can be harmful. This doesn’t stop the client from moving about if able but keeps the objects or situations that cause harm away. Although it is the least restrictive, there are still risks associated with environmental restraints. The client could feel a loss in autonomy and dignity, resulting in emotional trauma.  

Alternatives

Here is a list of some alternatives to the restraints discussed above:

• Build trusting relationships with clients.
• Give tools to staff to deescalate incidents where clients are agitated or combative.
• Provide dementia management strategies for all staff.
• Ensure you are staging clients with dementia to establish appropriate interventions and communication approaches.
• Staff units properly to enable timely responses to clients’ needs and supervision.
• Ensure client’s surroundings are free from hazards – clear clutter and clean up spills.
• Work with interdisciplinary team to evaluate and treat mental health concerns appropriately.
• Provide safe area (and equipment if needed) to walk/roll around.
• Consult your therapy team to evaluate client status and changes

Remember: There may be instances where restraint use is inevitable after all other alternatives have failed. However, it should never be used for staff convenience.

If you missed Part 1 of our blog series, you can read the full post here. To recap, only the top 10% of skilled nursing facilities within a state receive a 5-star rating on the 5-Star Quality Rating System, and two-thirds of Functional Pathways’ clients have earned a 4- or 5-Star rating, with over 80% achieving a 4- or 5-Star rating for Quality Measures.

So, how does partnering with Functional Pathways make this kind of success possible?

Functional Pathways’ partnership with our clients leads to outcomes that are above industry standards through a combination of a tactical screening process, utilization of QM and MDS analytical software, and evidenced-based clinical programming. Our processes lead to decreased negative survey outcomes and positive census development data.

Why is this important? Because the Quality Rating System is used not only by consumers, but also by health care insurers and others.

According to the American Health Care Association and the National Center for Assisted Living, the Quality Rating System is used by a number of users in addition to the traditional consumer, like health care insurers, investors, and state regulators. This highlights the importance of a 4- or 5-star rating, because they are used to determine reimbursements, loans, and payments.

A better rating not only means families and patients are more likely to choose your community, but it means your facility is less likely to face penalties and more likely to be successful financially.

CMS is continuing to raise the bar for quality measures, with threshold updates every 6 months. This makes it imperative for every facility to be in a constant state of improvement with their outcomes. Even facilities that currently have a 5-star rating cannot rest on their laurels; they must continue to seek out improvement and not grow stagnant in their operations.

With a strong collaboration between facility and therapy teams, achieving and exceeding those thresholds is not only attainable with Functional Pathways, but also sustainable.

Do you want your facility to exceed expectations and work towards becoming a center of excellence? Click here to schedule an appointment with Functional Pathways today.

Resources:

https://www.ahcancal.org/Survey-Regulatory-Legal/Pages/FiveStar.aspx#:~:text=The%20Five%2DStar%20Quality%20Rating,%2C%20Quality%20Measures%2C%20and%20Staffing.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/brieffivestartug.pdf

Does your therapy provider help drive your Quality Measure Rating to 5-Star success? As the SNF and LTC industry moves away from fee-for-service and embraces value-based care, understanding how to achieve positive outcomes has never been more important. At Functional Pathways, our process of analyzing and improving Quality Measure performance has enhanced the clinical outcomes for our patients and clients.

Our facilities are better than the national averages in many reportable outcomes, and over three-fourths of our partner facilities are rated as 4- or 5-Stars for Quality Measures. Some of our results include:

• 81% of FP clients are 4- or 5-Stars for Quality Measures
• 65% of FP clients are 4- or 5-Star communities
• FP clients as a whole are 19% better than the national average in patient mobility improvement
• FP re-hospitalization average is 10% below national average
• Over 70% of clients have lower than national average for Falls with Major Injury

But what’s so important about being a 4- or 5-Star facility? Let’s take a look at what it means to achieve that designation in part one of this blog series, and part two will explore why FP clients are exceeding expectations.

The 5-Star Quality Rating System was created to compare nursing home quality based on health inspections, quality measures (QMs), and staffing. Health inspection ratings are dependent on the calculation of points extracted from results of nursing home surveys from the past three years, with recent surveys weighing more heavily in the calculation. Those results are used to rank nursing homes within their state, and the top 10% of those nursing homes get 5-star ratings.

Additionally, quality measure ratings are calculated based on a nursing home’s performance in long-stay ADL decline, mobility decline, catheter, high-risk pressure ulcers, physical restraints, urinary tract infections, moderate to severe pain, and short-stay pressure ulcers, and moderate to severe pain- delirium. “ADL decline” and “mobility decline” are ranked against other nursing homes in the state, and the other 8 quality measures are ranked against other nursing homes in the nation, with the top 10% of nursing homes receiving 5 stars.

Only the best facilities receive a 5-star rating, and only very successful facilities are even able to achieve a 4-star rating.

At Functional Pathways, we provide the resources and support necessary to make your community a center of excellence. Two-thirds of our clients rank among the best nursing homes in the nation according to the Quality Rating System, and we can help your community be next.

Schedule an appointment with us today to learn how we can help your facility exceed expectations.

Resources:

https://www.ahcancal.org/Survey-Regulatory-Legal/Pages/FiveStar.aspx#:~:text=The%20Five%2DStar%20Quality%20Rating,%2C%20Quality%20Measures%2C%20and%20Staffing.https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/downloads/brieffivestartug.pdf

Charging stations in airports, bus & train terminals, hotels, and shopping malls.

These are all the places where many people will be charging their electronics. Hackers can insert malware or spyware into your electronics through “dirty charging ports.” Beware that charging your electronics in one of these places with just a USB cord could lead to an empty bank account or much worse. 

The problem with using these charging stations, which are very convenient, is that they can leave your electronics susceptible to a cyber-attack. This is known as “Juice Jacking.” This is where you are plugging your phone or another device into an already compromised power cord, power strip, or charging station, putting your device at risk. 

This is not new. 

Juice jacking has been an issue and warned about by the Federal Communications Commission (FCC) for several years. The FCC explains that your electronic devices can be maliciously attacked while being charged. This maliciousness can lock a device or export your personal data and passwords directly into the hacker’s hands. They can then use this information to access your accounts online or even sell your information to others on the dark web. There have been reports of these criminals intentionally leaving compromised cables at the charging stations already plugged in. So, you think, ah, an extra cord, but every device you plug into with that cord will be compromised. There are also instances where infected cables with malware have been given away as promotional gifts. 

The FBI has previously warned travelers and others about the risk of using hotel wireless networks. Attackers target hotels and are focused on obtaining records of guests, such as their names, personal information, and credit card numbers. 

The draw of the hacker to the hotel environment is that there are many unaffiliated guests, all operating in one area and using the same wireless network. The guests cannot monitor the wireless network security, which leaves them vulnerable. Here the guest is leaving themselves open to hackers monitoring the guest’s internet browsing or even redirecting them to false login pages. Then there is the “evil twin attack,” where the hacker creates a malicious network. This network will be similar to the hotel’s real network name. The guest can then mistakenly connect to the evil twin network instead of the hotel’s, giving the hacker direct access to your computer, tablet, or cellphone. 

When traveling, anytime you are using Wi-Fi or Bluetooth connections and you make a financial transaction by logging into your bank account, even if it is to move money around or use credit cards to purchase items, you are opening yourself up to money being stolen, your credit cards being hacked, or your identity being stolen.  Remember that the convenience of public Wi-Fi can be extremely risky. 

What to do:

• Always carry your charger and USB cord and securely charge your electronic devices using an electrical outlet, not a USB port. 
• Bring your own AC and car charger. 
• Carry a portable charger or external battery. 
• Consider a charging-only cable, which will prevent data from being sent or receiving data while charging. 
• If you have no other option but to plug into a USB port for charging and a prompt appears asking you to select “share data” or “charge only,” always choose “charge only.” 
• Obtain and always use a Virtual Private Network (VPN), which will encrypt all transmissions and will mask your internet connection from hackers. This will make it much harder to compromise your accounts. 
• Check the validity of available Wi-Fi hotspots. If there is more than one hotspot, it appears to be claiming to belong to the organization that you are in, then confirm with the staff to avoid connecting to the imposter. Travel with a MiFi, which is a mobile hotspot bringing you your own portable internet connection. The MiFi, unlike regular internet service, connects to a fixed wireless tower. Ensure you have a strong password assigned to your MiFi.
• Make sure all websites you connect to have the “https” at the beginning of the web address. If they do, then the data you are exchanging will be encrypted.
• Adjust your phone’s settings so it does not automatically connect to nearby Wi-Fi networks, giving you more control of when and where to connect. 
• Always use your device’s data plans to access the internet instead of public access Wi-Fi when transmitting sensitive information if you do not have a hotspot or MiFi available.

Hackers are criminals who attempt to gain unauthorized access to a network or devices. Their intent is to steal sensitive data. This data could be financial or personal information or business secrets. Use all this information here to protect your devices from hackers. It only takes a few extra seconds to use any other means other than hotel Wi-Fi or plug into an electrical outlet instead of using the USB charging station. Ensure that your devices have added layers of security. 

Resources:

“FBI warns against using public USB charging ports.” FBI, April 11, 2023,

https://r.search.yahoo.com/_ylt=AwrFOlmA1UJkPBISeq1XNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZANBREVOR1QyXzEEc2VjA3Ny/RV=2/RE=1682130432/RO=10/RU=https%3a%2f%2fabcnews.go.com%2fPolitics%2ffbi-warns-public-charging-stations%2fstory%3fid%3d98503419/RK=2/RS=NubaN9qrNtvuLofq7gaUr3xDZGU-

“Everything you need to know about MiFI?” allconnect, February 22, 2023,

https://r.search.yahoo.com/_ylt=Awrih7jO2EJkVjISu.BXNyoA;_ylu=Y29sbwNiZjEEcG9zAzEEdnRpZANBREVOR1QyXzEEc2VjA3Nj/RV=2/RE=1682131279/RO=10/RU=https%3a%2f%2fwww.allconnect.com%2fblog%2fwhat-is-mifi%23%3a~%3atext%3dYou%2520use%2520a%2520MiFi%2520device%2520to%2520access%2520the%2cyou%2520would%2520likely%2520benefit%2520from%2520a%2520MiFi%2520device./RK=2/RS=EMRHGAbBs0Bx1dtJBsOf98vIX48-

This week every year, we give recognition and encourage all to learn more about healthcare safety. We need to focus on the safety of our patients because it is estimated that medical harm is the leading cause of death to patients worldwide. 

We must establish a safety culture by maintaining a commitment to safety at all employment levels within organizations.

Some ways we can improve patient safety are:

• The staff must listen to the patient’s needs. Resident care and considerations must come first. Who in this world knows our residents better than they do? No one. 

• The supervisors must know the overall expectations and what their actions should be to promote resident safety in the organization. Do you have an appointed safety champion in each department and patient care area with whom your staff feels comfortable sharing information or asking questions?  

• We as leaders must support the education of safety processes in our facilities with an expectation that all staff will be oriented before working with patients or spending time in their assigned departments regarding the safety processes. 

• Ongoing monthly, quarterly, and annual education plans. Safety policies such as incident notifications and suspected abuse should be reviewed quarterly. Safety issues can escalate over time when the staff is only educated on these policies once a year. Another area of frequent education is detecting changes in conditions. This should be a topic that the directors of nursing address monthly with all nursing staff.

• We must frequently audit the compliance of the staff in all departments with procedures such as hand hygiene and wearing personal protective equipment as needed for different conditions of residents in the facility. We need to study reports that will tell us our monthly infection rates. Know what an acceptable threshold is and maintain that as the expectation. When that expectation is unmet, we have an issue to deal with immediately. All staff should know the expectations and their responsibilities to maintain them.

• Encourage teamwork and good communication—set examples of open communication with the staff. If possible, take a nonpunitive response to mistakes. We should never think a safety issue is due to one employee. Have the plan to educate all if there is one; there is more than likely more.    

• When working on staffing issues, consider consistent assignments. Focus the team on what will give the most staffing stability in the building. It is excellent customer service when the patients and families are comfortable with the person caring for them. Knowing that resident-centered care comes first with each individual caring for them is reassuring.   

• Fully investigate and use root cause analysis to implement appropriate interventions for any identified safety issues. There may be multiple issues identified at the same time. Assigning sub-committees to each problem may assist in obtaining solutions quicker for each case. 

• When a safety issue is identified, we need to inform the QAPI team. We need to set up a process improvement plan (PIP) for each case identified, and here is where we will set up a committee for each issue identified. 

• Frequently audit all safety compliance programs to ensure they run smoothly. If not, we get caught with our pants down. I would much rather find an issue myself than have a surveyor find it, such as setting your eyes on the water temperature logs each month to ensure they are being completed accurately and that something has been done about any temperature out of range. When a surveyor asks to see your facility’s safety logs, don’t let it be the first time you are also looking at it. 

With an estimated 40% of patients experiencing harm and 80% of those harms being preventable, this is a dedicated time for each of us to grow our staff’s awareness of patient safety. 

In my career, I have been through many surveys as the Director of Nursing. Surveyors know that issues are always going to be in every facility; they only want to see what you did to correct the situation. Don’t hide the work you are doing. Be proud of your safety processes, your auditing tools to identify issues, and what you did to correct the problems identified. Once you put a plan in place, continue to audit it regularly to ensure that corrective action is still working. 

It is not usually a process that fails; it is usually the human error of not following the process that causes the issues. Auditing regularly will help you catch human errors before the process crumbles. 

The answer is overexertion. When you push yourself too hard, it involves physical or mental efforts that are beyond your abilities at that moment. 

Three signs of overexertion are some of the most common causes of work-related injuries: dehydration, fatigue, and hypoglycemia (low blood sugar). Let’s look at each of these three top culprits.

Dehydration: Occurs when your body loses more water than you are taking in.  It can happen quickly, and common symptoms include cracked or dry lips, dry eyes, dry mouth, and dark-colored urine. 

• How to avoid: You can take frequent breaks to drink water and avoid sugary sports and energy drinks. 

Fatigue: Occurs when you are pushing your body too hard. The common signs of fatigue are depression, increased blood pressure, dizziness, and irregular breathing. Becoming irritable or irrational, as well as a decrease in your cognitive function, can be due to fatigue. 

• How to avoid: Ensure you are getting enough sleep each night. Sleep is essential because it soothes and restores our bodies after a long day. The lack of sleep consistently over a period can lead to obesity, cardiovascular disease, and diabetes. It can also affect your judgments and mental acuity.   

Hypoglycemia: Occurs when you do not take the time to eat, causing you to have low blood sugar. The common signs of low blood sugar are confusion, nervousness, and fatigue, which can be very dangerous. 

• How to avoid: You can take breaks every 3 to 4 hours to eat regularly during your workday.

Repetitive movements and specific activities are related to overexertion or incorrectly doing an activity or task. It can place undue stress on connective tissues, muscles, bones, and joints, causing an overexertion injury. Sudden, abrupt movements of bending, pushing, climbing, twisting, pulling, throwing, crawling, and reaching can lead to overexertion injuries. Prolonged activities can eventually lead to fatigue, or incorrect technique, such as lifting objects incorrectly, sitting with poor posture, standing in an awkward position, and using the wrong form during exercise. Also, consider the constant use of a computer mouse, or typing or writing. 

Overexertion is the leading cause of injuries such as:

• Muscle sprains
• Muscle strains
• Fractures

You can also develop mental overexertion after focusing for an extended period on cognitive activity. This can make you feel mentally burned out. 

• Avoid mental burnout by taking breaks during many hours of studying or working. 

Some thoughts on how to help your employees to overcome overexertion is by encouraging them to stay physically and emotionally fit and recognize the signs of your staff when they are fatigued or showing signs of hypoglycemia or dehydration. Encourage them to take regular breaks to stay well-hydrated and nourished, avoid overdoing things, and pay attention to their body’s warning signs. Also, encourage employees to exercise, seek relaxation, and prioritize sleep. Educate them by picking a topic each month on how to prevent overexertion. 

Some common ways to avoid overexertion are:

• Warm up your muscles before doing an activity
• Avoid staying in the same position for more than 30 minutes
• Do exercises to keep your joints healthy
• Learn proper techniques and forms for the tasks and exercises you are doing
• Lift heavy objects with your legs, not your back
• Rest after repetitive or strenuous activities
• Try to rest one day out of every seven when exercising
• Gradually increase your physical activities

Overexertion is not a sign of weakness. It is a sign that your body or mind needs much-deserved rest. 

Residents that must spend the holidays in a nursing facility appreciate your decorating efforts of garlands, lights, wreaths, and tinsel. Does your facility have a policy on holiday decorations for both public spaces and the resident’s private rooms? Here is a list of some best practices to follow when decorating for the holidays. 

Flame-Resistant

Artificial Christmas trees and decorative foliage must be labeled flame retardant or resistive. Ensure that your tree is away from heat sources such as a fireplace or heaters. Do not use electric holiday lights on metallic trees. 

Combustible decorations must be flame retardant as well. Limited quantities may be acceptable; however, in more significant amounts, they are not. The National Fire Protection Association Life Safety Code limits the number of combustible materials displayed on interior walls and ceilings to no more than 10%. If more than 10% of the wall or ceiling areas are decorated, over 10% must be documented as flame retardant. The 10% includes photographs and paintings.

No Obstructions

Do not block exits, exit signs, or any fire safety equipment. Areas that include pull stations for fire alarms, fire extinguishers, notification signs for exits, or directions for alarm notifications are also off-limits. 

Do not hang decorations from sprinkler heads. Any object hanging from the ceiling must not be placed closer than 18 inches from a sprinkler head. Many facilities will prohibit hanging decorations from the ceiling.  

Hanging Lights

The Life Safety Code Section 19.7.5.6 does not address holiday lights. However, use light strands that carry the UL label. Remember that your federal and state agencies have electrical and building safety standards. Therefore, do not use extension cords or real flaming candles as part of your holiday decorations. Inspect each electrical ornament or string of lights by observing for cracked or frayed sockets, loose or bare wires, and loose connections.  Once it has passed your observation inspection, plug it in for 15 minutes while observing. If there aren’t any issues, use it, but if they are flickering or will not light up, dispose of it. Do not staple or nail through the electrical wires. Read the packaging and follow the use and care instructions, especially the maximum number of strings that may be linked together. Use automatic timers to turn on and turn off your holiday lights. Avoid overloading electrical outlets. 

Plant Safety

Certain plants specific to the holidays — such as poinsettia, mistletoe, holly, and hemlock — have been known to be toxic. They can have next to no issues or can be seriously harmful. Ensure you research the plants you want to display for potential ingestion hazards.

Guests of Residents

Along with looking at the common areas, don’t forget that families are also decorating the rooms of their loved ones. Train your staff to assist you in safety rounds regularly in identifying unsafe lights, extension cords, clutter on windowsills, and wreaths hung on residents’ doors that may interfere with the opening or closing of the door. Ensure all your staff is educated on your facility’s holiday decorating policy and are assisting you in identifying safety issues with holiday decorations.    

Here is the link to the Life Safety Code requirements from CMS:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/LSC

Here is the link to the Life Safety Code and Health Care Facilities Code (HCFC) from CMS:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/LSC