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1 Unit-based Hazard Assessment for Safe Patient Handling.

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Presentation on theme: "1 Unit-based Hazard Assessment for Safe Patient Handling."— Presentation transcript:

1 1 Unit-based Hazard Assessment for Safe Patient Handling

2 2 Mary Willa Matz, MSPH VHA Patient Care Ergonomics Program Manager/Consultant Occupational Health Science Researcher Industrial Hygienist VISN 8 Patient Safety Center of Inquiry James A. Haley VA Hospital Tampa, Florida (813) (813) fax

3 3 Faculty Disclosure ä Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or devices. ä Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this activity. ä This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label. ä The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.

4 4 Ergonomicsand Patient Handling

5 5 Ergonomics… "Ergonomics is the scientific study of the relation between people and their… n n Occupation n n Equipment n n Environment (Shackel)

6 6 Ergonomics Principles Design for human use Fits the task to the worker People are different People have limitations People age

7 7 An Ergonomic Approach… Provides a step-by-step process to ensure the appropriate technology is in place to reduce musculoskeletal stress & strain…. reducing the risk of injury.

8 8 A Simple Look at an Ergonomic Approach Tasks: ä Identify jobs and job tasks which stress body parts beyond limits ä Develop solutions to change these task demands. Workplace Environment: ä Review the design of the physical work environment to reduce risk, remove barriers, minimize travel, etc. Other Factors: ä Consider other factors that affect work performance, such as lighting, noise, equipment storage & maintenance issues. Implement these changes in the work place.

9 9

10 10 Ergonomic Hazards What are Ergonomic Hazards? ä Musculoskeletal System ä Energy/Forces/Stressors ä Exceed the biomechanical limits of the human body

11 11 What Do Patient Care Ergonomic Hazards result from? Patient lifting and moving exceed caregivers biomechanical limits…

12 12 What Do Patient Care Ergonomic Hazards result from? ä Ergonomic hazards for caregivers include… ä pushing, pulling ä lifting heavy loads ä horizontal & vertical lifting ä lifting light loads for long periods of time ä twisting, bending, reaching ä standing for long periods of time ä awkward postures ä repetitive motions ä others….

13 13 What Do Patient Care Ergonomic Hazards result from? ä Safe lifting rules dont apply (Horizontal and vertical lifting) ä Patients: ä are asymmetric & bulky ä cant be held close to the body ä have no handles ä Patient assistance varies

14 14 What Do Patient Care Ergonomic Hazards result from? Patient care is unpredictable due to unanticipated patient responses… Patient care is unpredictable due to unanticipated patient responses… muscle spasms, combativeness, or resistance muscle spasms, combativeness, or resistance Results in… Results in… Unexpectedly heavy loads Unexpectedly heavy loads Patient Movement Patient Movement When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object. When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object.

15 15 d F=ma Simple Biomechanical Model Work = Force x Distance W = F x d

16 16 Exceeding Biomechanical Capabilities results in… Musculoskeletal impact/stress on… ä Back ä Shoulders ä Neck ä Wrist ä Hand ä Knees ä Other body parts…

17 17 Example 1: Pull up in Geri-Chair Risk Factor: Manual Lifting Body Parts Affected: Back – posture, load/force Shoulder – load/force Elbow – load/force Wrist/hand – load/force Neck – load/force Interventions: Sit to Stand Lifts Ceiling/Floor Full Body Sling Lifts Friction Reducing Devices

18 18 Example 2: Transfer to Stretcher Risk Factor: Manual Lifting Body Parts Affected: Back – posture, load/force Shoulder – load/force Elbow/Wrist/Hand – load/force Neck – load/force Interventions: Ceiling/Floor Full Body Sling Lifts Lateral Transfer Devices (LTD) Friction reducing devices Air Assisted LTD Mechanical LTD

19 19 Example 3: Transfer from Chair of partial weight-bearing patient Risk Factor: Manual Lifting Body Parts Affected: Back – posture, load/force Neck – load/force Shoulder – load/force Elbow – load/force Wrist/hand – load/force Intervention: Sit to Stand Lift

20 20 Example 4: Lateral Transfer Risk Factor: Space Constraints Body Parts Affected: Shoulder – posture/load Elbow – position/load Wrist/hand – position/load Neck – posture/load Back – posture/load Intervention: Ceiling Lift Renovate room

21 21 Unit-Based Hazard Assessment for Safe Patient Handling

22 22 Unit-based Hazard Assessment for Safe Patient Handling Patient Care Practice Settings include… ALL practice settings that move and lift patientsALL practice settings that move and lift patients NON-NURSING PTPT DiagnosticsDiagnostics Treatment AreasTreatment Areas Procedure AreasProcedure Areas MorgueMorgue DialysisDialysis Others..Others..NURSING Acute CareAcute Care Long Term CareLong Term Care Critical CareCritical Care OROR ERER SCISCI Others…Others…

23 23 Unit-Based Hazard Assessment Role ä Drives UNIT recommendations for equipment, policy, and procedures ä Identifies areas in need of improvement that impact safety of work environment & use of equipment ä Storage, maintenance, clutter, etc.

24 24 Unit-Based Hazard Assessment I. Prior to Ergo Evaluation – Data Collection 1. Identify UNIT High Risk Tasks l Staff Perception of High Risk Tasks l Unit Injury data 2. Identify High Risk Units 3. Collect Information on Unit Characteristics/Issues II. During Ergo Evaluation 1. Meet with Mgmt/Staff 2. Conduct Site Visit 3. Meet with Mgmt/Staff III. After Ergo Evaluation 1. Perform Risk Analysis 2. Formulate Recommendations

25 25 Unit-Based Hazard Assessment I. Prior to Ergo Evaluation – Data Collection 1. Identify UNIT High Risk Tasks l Staff Perception of High Risk Tasks l Unit Injury data 2. Identify High Risk Units 3. Collect Information on Unit Characteristics/Issues

26 26 I. Prior to Ergo Evaluation 1. Identify High Risk Tasks Collect Staff Perceptions of Unit High-Risk Tasks Tool for Prioritizing High Risk Tasks Tool for Prioritizing High Risk Tasks ä ä Rank Tasks from 1 to = most difficult/highest risk 1 = least difficult/ lowest risk ä ä When ranking, consider: ä ä Musculoskeletal Stress = Load, Posture, Frequency/Duration ä ä Completed by ä ä Each Staff member ä ä Collectively by Shift ä ä Compile by Unit and Shift

27 27 I. Prior to Ergo Evaluation 1. Identify Unit High Risk Tasks *Be sure to note which source is used on your Injury Log Collect Unit Injury Data

28 28 I. Prior to Ergo Evaluation 2. Identify High Risk Units Beware of using Injury data….

29 29 I. Prior to Ergo Evaluation 2. Identify High Risk Units Directs focus for equipment and policy interventions ä Identification of High Risk Units ä ä Analyze all facility UNIT injury data… ä ä Highest number of patient handling injuries ä ä Most severe patient handling injuries ä ä Lost Time ä ä Modified Duty ä ä High Risk Unit Characteristics ä ä Many dependent patients/residents ä ä Patients are moved in and out of bed often ä ä Many patient transfers

30 30 I. Prior to Ergo Evaluation 3. Collect Pre-Site Visit Unit Data Use Unit Characteristics/Issues Use Unit Characteristics/Issues Tool (Handout A-1) ä ä Space issues ä ä Storage availability ä ä Maintenance/repair issues ä ä Patient population (% dependency*) ä ä Staffing characteristics ä ä Equipment inventory/issues ä Confirms site visit data ä Used for making recommendations

31 31 Unit-Based Hazard Assessment II. During Ergo Evaluation/Site Visit 1. Opening Meeting 2. Site Visit/Walk-through 3. Closing Meeting (optional for unit, required for administration)

32 32 1. Conduct II. During Ergo Evaluation/Site Visit 1. Conduct Opening Meeting l Discuss l Pre-Site Visit Data l Issues of Concern l Include l Staff l Unit/Area Manager l Safety/Risk Management l Facilities Management l Union l Others

33 33 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit During Site Visit Walk-through, interview staff… ä Confirms Pre-Site Visit Unit Data Collected ä Discovers staff attitudes, concerns, ideas, information

34 34 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit During Site Visit Walk-through, observe… ä Equipment ä Availability ä Accessibility ä Use ä Condition ä Storage ä Structural issues that impact use

35 35 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit During Site Visit Walk-through, note… ä Patient room sizes/configurations ä Ceiling Characteristics/AC vents/TVs/Sprinklers ä Showering/bathing facilities & process ä Toileting process ä Safety Design Issues: Thresholds, Doorways ä Storage

36 36 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit During Site Visit Walk-through, document… ä Existing/ordered patient handling equipment ä Occurrence of high risk tasks ä % total dependent & extensive assistance pts ä % partial assistance patients ä Occurrence of bariatric/obese patients ä Room configurations ä # beds on unit/average daily census ä Storage issues ä Equipment/Sling recommendations ä Notes (Sample PCE Templates - Handouts A-2a & A-2b)

37 37 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage Based on… 1. Dependency Level of patient/resident population 2. Room configurations on unit: # of private, semi- private, 3-bed, 4-bed rooms, etc. on unit.

38 38 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage Limitations… 1. Structural integrity of mounting surface (I-beam/ concrete pan) 2. Ceiling fixtures - lights, sprinkler heads, AC vents, etc. 3. Ceiling Height 4. Ceiling configuration/drop ceiling/AC housing 5. ICU Power Columns 6. Others

39 39 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Track Options ä Traverse (x-y or H) ä Straight ä Curved ä U-shaped

40 40 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… 1. Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage: ä Sum average % of ä total dependent patients ä extensive assistance patients/residents

41 41 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… 2. Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit: ä To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage (Previous slide)

42 42 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… ä For units w/ only private patient rooms: ä Average % of Patients Requiring CLs x # patients = # private patient rooms w/ CLs ä For units w/ only semi-private rooms: ä Average % of Patients Requiring CLs x # patients / 2 = # semi-private patient rooms w/ CLs

43 43 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… For units with a mixture of room configurations: ä For cost effectiveness in existing construction, and if appropriate for the unit… ä First begin calculations with ceiling lifts placed in most or all larger wards (3-bed & 4-bed wards) ä Then, as appropriate, place in smaller rooms (private and semi-private)

44 44 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… Example: ä MedSurg Unit ä 30 patients ä 4 private rooms, 10 semi-private rooms, and two 3-bed rooms. ä Approximately 70% of the patients will require use of Ceiling Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients). ä For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in... ä two (2) 3-bed rooms (covering 6 patients) ä seven (7) semi-private rooms (covering 14 patients) ä one (1) private room (covering one patient)

45 45 2. II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit Unit Ceiling Lift System Coverage Practice (Handout A- 3) ä NHCU Unit ä Med/Surg (Tele) Unit ä Med/Surg (Rehab) Unit 1. How many (#) patients/beds should be covered? 2. In what rooms would you place ceiling lifts on this unit? 3. How many ceiling lifts would you purchase/install for this unit?

46 46 3. II. During Ergo Evaluation/Site Visit 3. Conduct UNIT Closing Meeting (optional) l Discuss l Preliminary Findings from Site Visit l Pre-Site Visit Data as related to findings l Priorities in need of immediate remediation l Issues of Concern l Include l Staff l Unit/Area Manager l Safety/Risk Management l Facilities Management l Union l Others

47 47 3. II. During Ergo Evaluation/Site Visit 3. Conduct ADMINISTRATOR Closing Mtg l Discuss l Rationale for Site Visit l Preliminary Findings from Site Visit l Priorities in need of immediate remediation l Issues of Concern l Show photos of equipment recommendations l Include l Staff l Union l Unit/Area Managers l Safety/Risk Management/Employee Health l Facilities Management l CFO/Purchasing l Others

48 48 Unit-Based Hazard Assessment III. After Ergo Evaluation 1. Perform Risk Analysis 2. Generate Recommendations

49 49 1. III. After Ergo Evaluation 1. Perform Risk Analysis Sources of Risk: ä ä You must know the SOURCES of risk in your patient care environment to perform Risk Analyses…

50 50 Sources of Risk Risk Sources: ä Health Care Environment ä Patient ä Patient Handling Tasks Once risks are identified, steps can be taken to protect Staff and Patients!

51 51 Whats Wrong with this Picture??

52 52 Sources of Risk Health Care Environment Risk Factors ä Space limitations ä Small rooms ä Lots of equipment ä Clutter ä Cramped working space ä Poor placement of room furnishings

53 53 Sources of Risk Health Care Environment Risk Factors ä Slip, trip, and fall hazards ä Uneven work surfaces (stretchers, beds, chairs, toilets at different heights) ä Uneven Floor Surfaces (thresholds) ä Narrow Doorways ä Poor bathing area design

54 54 Sources of Risk Health Care Environment Risk Factors ä Broken Equipment ä Inefficient Equipment (non-electric, slow- moving, bed rails) ä Not enough or Inconvenient Storage Space ä Staff who dont help each other or dont communicate

55 55 Whats Wrong with this Picture??

56 56 Sources of Risk Patient Risk Factors ä Weak/unable to help with transfers ä Unpredictable ä Hit or bite ä Resistive Behavior ä Unable to follow simple directions

57 57 Sources of Risk Patient Risk Factors ä Overweight ä Experiencing Pain ä Hearing or vision loss ä No/little communication between staff about Patient or with Patient

58 58 Whats Wrong with this Picture??

59 59 Sources of Risk Patient Handling Tasks Risk Factors ä Reaching and lifting with loads far from the body ä Lifting heavy loads ä Twisting while lifting ä Unexpected changes in load demand during lift ä Reaching ä Long Duration

60 60 Sources of Risk Patient Handling Tasks Risk Factors ä Moving or carrying a load a significant distance ä Awkward Posture ä Pushing/Pulling ä Completing activity with bed at wrong height ä Frequent/repeated lifting & moving

61 61 1. III. After Ergo Evaluation 1. Perform Risk Analysis High Risk Task Identification: ä ä To determine the risk of injury for each unit/patient population, high risk tasks specific to the unit must be identified…

62 62 1. III. After Ergo Evaluation 1. Perform Risk Analysis Identify UNIT high risk tasks by… 1. Analyzing Unit Injury Data 2. Collecting Staff Perception of High Risk Tasks 3. Interviewing Employees

63 63 1. III. After Ergo Evaluation 1. Perform Risk Analysis 1. Analyze Unit Injury Data Determine: ä #1 & 2 Causes of Injuries ä #1 & 2 Activities being performed when staff are injured ä Whats going on? What trends are seen? Injury Incidence Profile (Handout A-4)

64 64 1. III. After Ergo Evaluation 1. Perform Risk Analysis 2. Complete & Collate Staff Responses for Tool for Prioritizing High Risk Tasks (Handout A-5) ä ä Rank Tasks from 1 to 10 10= most difficult/highest risk 1 = least difficult/ lowest risk ä ä When ranking, consider: ä ä Frequency, Duration, & Musculoskeletal Stress ä ä Completed by ä ä Each Staff member ä ä Collectively by Shift ä ä Compile by Unit and Shift

65 65 1. III. After Ergo Evaluation 1. Perform Risk Analysis High Risk Tasks will vary by Clinical Setting….

66 66 High Risk Tasks: Long Term Care ä Repositioning in Bed* ä Making occupied bed* ä Transferring patient from bathtub to chair* ä Transferring patient from wheelchair to bed* ä Transferring patient from wheelchair to toilet* ä Lifting a patient up from the floor* ä Weighing a patient* ä Applying antiembolism stockings ä Bathing a patient in bed* ä Bathing a patient in a shower chair /trolley* ä Undressing/dressing a patient* ä Repositioning patient in dependency chair* ** ä Making an occupied bed* ä Feeding bed-ridden patient ä Changing absorbent pad* * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)

67 67 High Risk Tasks: Critical Care Units ä Transporting patients (Road Trips)** ä Lateral Transfers (bed to stretcher)* *** ä Repositioning patient in bed from side to side* *** ä Vertical Transfers (bed/chair/commode)* ä Lifting patient to the head of the bed* *** ä Making occupied bed* *** ä Applying antiembolism stockings ä Bending/Reaching behind & around for equipment, etc. * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)

68 68 High Risk Tasks: Medical/Surgical Units ä Transfer from bed to chair* ä Transfer from bed to stretcher* *** ä Moving Occupied bed or stretcher** ä Making occupied bed* *** ä Bathing a confused or totally dependent patient ä Lifting a patient up from the floor* ä Weighing a patient* ä Applying antiembolism stockings ä Repositioning in bed* *** ä Making occupied bed* *** ä Extensive dressing changes* * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)

69 69 High Risk Tasks: Operating Room ä Standing long periods of time ä Lifting and holding patients extremities* ä Holding retractors/organs for long periods of time ä Transferring patients on and off operating room tables/beds* *** ä Reaching, lifting and moving equipment ä Repositioning patients on operating room beds* *** ä Reaching for equipment Lifts ** Bed mover or powered bed Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD) *** Lateral transfer aid (FRD)

70 70 High Risk Tasks: Orthopedic Units ä Post-operative Total Hip Replacement Patient ä Patient with a cast/splint on extremity ä Use of Continuous Passive Motion Device (CPM) ä Halo Vest, logrolling for dressing changes ä Holding Extremity for procedure ä Altered Gait Pattern - Platform Walker ä Assembling Traction ä Transfers In/Out a Car ä Transfers of Patients with Pelvic & External Fixators

71 71 High Risk Tasks: Home Settings ä Providing patient care in a bed that is not height adjustable ä Providing care in crowded area, forcing awkward positions ä Toileting and transfer tasks without proper lifting aids ä No assistance for tasks

72 72 High Risk Tasks: Psychiatry ä Restraining a patient ä Escorting a confused or combative patient ä Toileting a confused or combative patient ä Dressing a confused or combative patient ä Picking a patient up from floor ä Bathing/ Showering confused or combative patient ä Bed-related care

73 73 Other High Risk Tasks Lifting heavy linen bags Standing for long periods of time behind med carts Data entry Others…

74 74 Information from Risk Analysis drives formation of Equipment Recommendations… 2. III. After Ergo Evaluation 2. Generate Recommendations

75 75 2. III. After Ergo Evaluation 2. Generate Recommendations Patient Handling Equipment for each unit/area Patient Handling Equipment for each unit/area Storage Storage Design Features Design Features Repair/Maintenance Repair/Maintenance Injury Reporting Injury Reporting Bariatric Programs Bariatric Programs Sample Report - Handout A-7 Equipment Support Structures Equipment Support Structures ä Unit Peer Leaders ä Facility Champions ä Facility Safe Patient Handling Team ä Training ä Knowledge Transfer Mechanisms ä Change Strategies

76 76 Unit-based Hazard Assessments for Safe Patient Handling Patient Care Practice Settings include… ALL practice settings that move and lift patientsALL practice settings that move and lift patients NON-NURSING PTPT DiagnosticsDiagnostics Treatment AreasTreatment Areas Procedure AreasProcedure Areas MorgueMorgue DialysisDialysis Others..Others..NURSING Acute CareAcute Care Long Term CareLong Term Care Critical CareCritical Care OROR ERER SCISCI Others…Others…

77 77


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