1. Elements of a Successful Patient Handling & Movement Program: Why and How Dana Root, MS, PT, CPE, CSPHP Root.dana@dol.gov 414.297.3315

2. Why? Risks which could potentially cause musculoskeletal injury:Risks which could potentially cause musculoskeletal injury: –Force Lifting own body weight plus patients weightLifting own body weight plus patients weight –Awkward posture Prolonged forward bendingProlonged forward bending TwistingTwisting Holding a positionHolding a position Tight or awkward locationsTight or awkward locations –space restrictions

3. Why? –Repetition Number of transfers per shiftNumber of transfers per shift Number of repositionings per shiftNumber of repositionings per shift Helping other staff with their patientHelping other staff with their patient –Duration Length of shiftLength of shift –overtime Shifts per weekShifts per week Longevity in professionLongevity in profession

4. Why? 1.Transfer from toilet to chair 2.Transfer from chair to toilet 3.Transfer from chair to bed 4.Transfer from bed to chair 5.Transfer from bathtub to chair 6.Weighing patient 7.Lift patient up in bed 8.Reposition patient from side to side in bed 9.Reposition patient in chair 10.Change absorbent pad 11.Make bed with patient in it 12.Undress patient 13.Feed bed ridden patient

5. –The resident/patient is not a box Difficult to keep the load close because the load is a personDifficult to keep the load close because the load is a person There are varied body sizes & shapes and the handles dont always stay putThere are varied body sizes & shapes and the handles dont always stay put End result – more likely to have greater stresses the shoulder & spineEnd result – more likely to have greater stresses the shoulder & spine –NIOSH recommends for most patient lifting tasks: maximum weight limit is 35 pounds under IDEAL lifting conditionsmaximum weight limit is 35 pounds under IDEAL lifting conditions –Using good body mechanics to protect the back is a myth! Why?

6. Why? Healthcare Provider Safety Manual lifting of residents be minimized in all cases and eliminated when feasible

7. The Process: –Evaluate Injury and Illness costs Obtain fundingObtain funding –Establish a lifting committee –Resident/Family notification –Training –Coordination with all staff –Evaluate & select equipment Receive and prep equipmentReceive and prep equipment –Resident assessment –Enforcement –Performance measurement How to Establish a SPH Handling Program?

8. How: The Program For success, required infrastructure MUST be in place prior to implementing SPHM Program http://www.visn8.med.va.gov/patientsafetycenter/ safePtHandling/default.asp http://www.visn8.med.va.gov/patientsafetycenter/ safePtHandling/default.asp

9. RHIR & RHSR for Past Three Years Resident Handling Incident RateResident Handling Incident Rate = # OF RH CASES WITH DAYS AWAY FROM WORK JOB TRANSFER DAYS OR RESTRICTED DAYS x 200,000 Resident Handling Hours worked Resident Handling Severity RateResident Handling Severity Rate = (DAYS AWAY FROM WORK + ON JOB TRANSFER DAYS OR RESTRICTED DAYS) x 200,000 Resident Handling Hours worked MSD days away rate: 9.6 for 2010MSD days away rate: 9.6 for 2010 9

10. The Process: Champions Management commitmentManagement commitment –Quality assurance Competent in equipment usageCompetent in equipment usage Enforcement/discipline of facility policy and proceduresEnforcement/discipline of facility policy and procedures Employee involvementEmployee involvement –The REAL Champions for the process

11. Establish a Lifting CommitteeEstablish a Lifting Committee –Select outgoing CNAs –Meet weekly –Food, fun & praise –Leader Has budget authorityHas budget authority MotivatorMotivator The Process: Champions

12. The Process: Policy & Notification Admission policy statementAdmission policy statement –Resident right issues: use of equipment depending on functional abilities Residents CouncilResidents Council –Notify residents of change Deal with resident refusalsDeal with resident refusals –Notify family of change Introduce new equipment and useIntroduce new equipment and use

13. The Process: Training One-on-one training for each employeeOne-on-one training for each employee Employees competency checked on each piece of equipmentEmployees competency checked on each piece of equipment Competency check signed off by aideCompetency check signed off by aide Not use equipment until competency checkedNot use equipment until competency checked Discipline for not using lift properly or at allDiscipline for not using lift properly or at all

14. The Process: Staff Coordination MaintenanceMaintenance –Preventive maintenance schedule Wheels, etc.Wheels, etc. Battery chargeBattery charge LaundryLaundry –Sling inspection & cleaning –Infection control Rehab staffRehab staff –Need to be trained on use of equipment Lifts require use of residents musclesLifts require use of residents muscles How can use in treatment goalsHow can use in treatment goals

15. The Process: Equipment EvaluateEvaluate –Hold vendor open houses Try out different equipmentTry out different equipment –CNAs test equipment Provide feedbackProvide feedback Consider types of devicesConsider types of devices –Overhead –Floor based total lift –Lateral assist –Sit to stand –Slide sheet Select for resident populationSelect for resident population Facility constraintsFacility constraints

16. Evaluate Type of SlingsEvaluate Type of Slings –Seated –Supine –Standing –Ambulation –Position Support The Process: Equipment

17. Get feedback evaluations from CNAsGet feedback evaluations from CNAs –Equipment –Slings Decision meeting with Lifting CommitteeDecision meeting with Lifting Committee Get budget approval and purchaseGet budget approval and purchase Set date for initiation of programSet date for initiation of program The Process: Equipment

18. Right number of liftsRight number of lifts Appropriate locationsAppropriate locations –Lifts need to be easily available to CNA –With sling –Battery storage The Process: Equipment

19. Copy manufacturer instructions, laminate, and attach to equipmentCopy manufacturer instructions, laminate, and attach to equipment Attach a warning sign that each lift and sling must be checked prior to useAttach a warning sign that each lift and sling must be checked prior to use Develop competency checklist on use of equipmentDevelop competency checklist on use of equipment Who will charge the battery?Who will charge the battery? The Process: Equipment

20. The Process: Resident Assessment Type of equipmentType of equipment –Resident needs –Staff safety Manual lifting of residents be minimized in all cases and eliminated when feasibleManual lifting of residents be minimized in all cases and eliminated when feasible Develop assessment sheetDevelop assessment sheet –Algorithms –MDS ADL self assessmentADL self assessment ADL support providedADL support provided –FIMS CommunicationCommunication

22. Functional Independence Measure (FIM)Functional Independence Measure (FIM) –7 level functional assessment scale of resident's actual performance Evaluates the amount of assistance required to perform basic life activitiesEvaluates the amount of assistance required to perform basic life activities Need for assistance from another person or a deviceNeed for assistance from another person or a device Measures what the resident actually doesMeasures what the resident actually doesIndependent 7Complete Independence 8Modified independence – requires assistive device, ….. Modified Dependence – resident expends 50% or more of the effort 5Supervision (setup) – without physical contact by helper, or applies assistive device 4 Minimal Contact Assistance – resident expends 75% of effort 3 Moderate Assistance – resident expends between 50% to 75% effort 2 Maximal Assistance – resident expends between 25% to 50% of effort 1 Total Assistance – resident expends less that 25% of effort 22 Fresh Eyes: Resident Assessment

23. Floor surfacesFloor surfaces –Ramps –Carpet transitions –Wet Equipment storageEquipment storage Battery chargingBattery charging Size and configuration –Resident room –Bathroom –Shower room –Clutter The Process: Workplace Assessment

24. The Process: Enforcement Policed by Lifting Committee membersPoliced by Lifting Committee members –Empowered to recommend suspensions –# of days suspension Pick suspension days for best use of facility resourcesPick suspension days for best use of facility resources Less impact on employee'sLess impact on employee'spaycheck

25. Resource Guides http://www.visn8.med.va.gov/patientsafetycenter/ safePtHandling/default.asp http://www.visn8.med.va.gov/patientsafetycenter/ safePtHandling/default.asp http://www.cdc.gov/niosh/topics/ergonomics/ http://www.aohp.org/About/ documents/GSBeyond.pdf http://www.aohp.org/About/ documents/GSBeyond.pdf www.osha.gov/SLTCergonomics /index.html www.osha.gov/SLTCergonomics /index.html