Encompass Health STOP program protects patients and staff while supporting our commitment to delivering exceptional care.
According to the American Nurses Association, approximately 65% of health care workers experience pain from work-related musculoskeletal disorders (MSDs), often caused by lifting, repositioning patients, bearing uneven weight, stretching, standing and bending. These injuries can lead to decreased stamina, long-term health issues and nursing burnout.
What are musculoskeletal disorders?
Musculoskeletal disorders affect muscles, nerves, tendons, joints, cartilage and spinal discs. In health care settings, these conditions can vary in severity and may increase the risk of injury to both patients and staff.
Empowering safer practices with the STOP program
To address these risks, Encompass Health developed the STOP program, an initiative designed to empower health care professionals and prevent injuries by promoting safe practices during patient care and transfers. Through this initiative, participants learn how to set themselves and their patients up for success by following four key steps:
- Stop: Pause to observe your surroundings and assess available materials and support.
- Think: Consider what you need and plan ahead to ensure a safe patient transfer.
- Organize: Gather all necessary equipment before beginning any task.
- Position: Align your body properly to minimize the risk of injury during patient handling.
Loren McDaniel, RN, STOP champion and hospital educator at Encompass Health Rehabilitation Hospital of Greenville, said this program teaches nurses, therapists and other health care professionals the value of advocating for their own safety.
“Nurses perform frequent, recurring transfers at the bedside,” McDaniel said. “That is what the STOP program is designed for. It helps identify the safest and most efficient techniques to use at the bedside to conserve your energy and your patient’s energy.”
By integrating these steps into daily routines, health care professionals can create safer environments for themselves and their patients.
“At Encompass Health, we are more hands-on, lifting patients out of bed, helping them to the restroom and assisting individuals with limited mobility," McDaniel said. “It is important to understand proper body positioning for your safety and longevity.”
What is the STOP program?
The STOP program is divided into two stages, each focused on employee safety and training:
- STOP I teaches employees basic injury prevention techniques.
- STOP II focuses on training employees on safe patient transfer protocols.
Encompass Health regional STOP trainers host boot camps throughout the year, while STOP champions provide ongoing support within hospitals.
“It’s really designed for our employees — to protect them, encourage them and give them the ability to perform safe transfers,” McDaniel said. “It’s a snowball effect. It helps patients with mobility issues and ensures safer transfers. It looks different for everyone, but it’s about supporting our nurses and techs so they can conserve their energy during their shifts.”
McDaniel emphasized the value of formalized training.
“I’ve been a nurse for more than 16 years, and I’ve never had training like this,” she said. “Having a structured approach to patient care helps you make better decisions and provide safer care.”
Participation in the STOP program is mandatory for all clinical staff at Encompass Health rehabilitation hospitals. Building relationships with STOP champions is encouraged, especially when facing complex transfers.
“You’re going to encounter situations that require real-time training,” McDaniel said. “That’s when your STOP champion becomes a vital resource. It’s a way to build and maintain trust with your teams.”
Safe transfers: STOP Light Tool
The STOP Light Tool is the clinician’s visual guide that helps them determine the safest way to transfer a patient.
“Every patient room has a STOP Light Tool, and that’s how clinicians know how to transfer a patient,” McDaniel said. “Therapists, nurses and techs use it to communicate and coordinate transfers. Whether a patient has dependent bed mobility or needs to transfer from a specific side, it’s an interdisciplinary approach to ensure safety — from hospital to home.”
The tool also bridges communication between shifts. For example, the night shift team may encounter more challenging transfers due to patient fatigue or medication effects following therapy earlier in the day. By documenting specific transfer needs, the STOP Light Tool ensures that all team members, regardless of shift, are informed and aligned on the safest approach.
By embracing safe patient handling practices, clinicians not only protect themselves from injury but also enhance the quality of care they provide. As health care continues to evolve, programs like the STOP initiative are essential in fostering a culture of safety, compassion and resilience.
What is dysphagia?
Like aphasia, it can be caused by neurological conditions such as brain injuries and stroke, but it also can stem from muscle disorders, certain cancers and blockages/strictures in the throat.
Depending on the cause, dysphagia can be temporary or long-term.
Conditions commonly associated with dysphagia include:
- Parkinson’s disease and multiple sclerosis
- Neck and throat cancers
- Late-stage Alzheimer’s disease and other dementias
- Cervical neck surgeries
Stages of dysphagia
There are three phases of swallowing that are impacted with dysphagia:
- Oral: This is the process of chewing food and mixing it with saliva to form a bolus in order for it to be moved from the front of the mouth to the back of the mouth. A person with dysphagia in this phase could have trouble breaking down the food enough to properly move it to the back of the mouth to trigger the swallowing reflex. This stage is also where tongue weakness or decreased sensation may impact the ability to clear food from the sides of the mouth causing it to pocket in the cheeks.
- Pharyngeal: This is where the swallowing reflex begins, and pharyngeal muscles push food down the throat to the esophagus. The epiglottis (a cartilage) inverts to protect the airway and sends the bolus towards the esophagus. This is when the upper esophageal sphincter opens to allow food to travel into the esophagus. A person with dysphagia in this phase might feel like the food is “entering the wrong pipe,” Delashaw said, because the muscles in the pharynx and/or larynx are not operating properly to prevent food or liquids from entering the airway.
- Esophageal: This is when the bolus is taken from the upper esophageal sphincter that has opened, allowing it to enter the esophagus. Peristalsis (muscle contractions) carries the bolus from the upper esophagus towards the stomach. In this phase, a person with dysphagia may feel like food is stuck in their throat or chest.
Symptoms of dysphagia
Dysphagia symptoms could include:
- Coughing or choking during or shortly after eating or drinking
- Heartburn or indigestion
- Feeling that food is stuck in the throat or chest
- Painful swallowing
- Regurgitation
- Food sitting in the mouth or being pocketed in the cheeks
- Unexplained weight loss
- Reduced desire to eat
Diagnosing dysphagia
Dysphagia is diagnosed by a healthcare provider. Speech-language pathologists diagnose dysphagia with a comprehensive oral exam and swallowing examination, which should include swallowing tests such as a FEES or MBS exam.
- FEES: FEES stands for fiberoptic endoscopic evaluation of swallowing. This is an exam where a speech-language pathologist inserts a small thin scope with a camera through the nose and allows visualization of the throat, larynx and vocal cords to assess swallow function as you eat and drink certain foods.
- MBS: During a modified barium swallow study, a speech-language pathologist will give you food and liquids covered in a small amount of barium. As you swallow, X-rays are performed to view your swallow in real-time.
Treatment of dysphagia
After a dysphagia diagnosis, a speech-language pathologist can help determine what consistency of food and liquids is safest to eliminate risk of choking or aspiration. They can also provide therapy and exercises to help strengthen the muscles used during the different stages of swallowing.
Treatment should always involve a discussion with the individual to determine their wishes regarding oral intake and development of dysphagia treatment.
“If difficulty is noted in the oral phase, we can design an exercise program to target movement for the muscles used when breaking down the food,” Delashaw said. “Say you had a stroke that impacted lip muscles, and you can’t hold food in your mouth. We’re going to work on increasing the control and strength of the lip muscles, so you do not lose liquids or foods out of the mouth.”
In addition to exercises, Delashaw said neuromuscular electrical stimulation could also be used to increase muscle awareness in the different stages of dysphagia.
In the esophageal stage, your speech-language pathologist could suggest obtaining a referral from your primary care doctor to a gastroenterologist for further evaluation.
Recovery from dysphagia
Depending on the diagnosis and related conditions, dysphagia could improve over time. If swallowing difficulty is related to a neurological condition, inpatient rehabilitation could help develop adaptive techniques and diet plans to meet your needs and quality of life standards.
The multidisciplinary approach in this setting also allows for other symptoms related to your condition to be addressed through intensive therapy. In addition to working with a speech-language pathologist, your therapy team would also include a physical therapist and occupational therapist to address mobility and strength as well as activities of daily living and quality of life.
