2 High risk patient care activities ObjectivesErgonomicsRisk factorsHigh risk patient care activitiesConditions that result in high risk environmentsBest solutions for moving and handling patients
3 The Basic Problem Fundamental ergonomics The National Institute of Occupational Safety and Health (NIOSH) research:Under IDEAL CONDITIONS, 90% of males, and 75% of females can safely lift 23 kilograms (~51 pounds), MAXIMUM.Healthcare settings do not provide ideal conditions (straight back, no bending, no twisting, positive grasp, infrequent lifts, etc.)ConclusionOne healthcare worker cannot safely lift an adult patient alone, and positioning tasks that require greater than 23Kg of exertion are also hazardous.
4 What Makes Patients Risky? They are bulky—adults are > 51 poundsNo handles! (Technical term is “coupling” = good grasp)The unpredictable occurrencePossible lack of help from patientPossible consideration of wounds
5 Risks of Job TasksWhat factors contribute to a healthcare worker being hurt during patient positioning?Awkward posturesLifting heavy loadsLength of lifting (supporting the patient over a period of time)ReachingFrequency of positioning tasks
6 OSHA “Regulations” Regarding Patient Positioning OSHA recommends minimizing manual lifting of patients/ residents in all cases and eliminating lifting when possible.
7 Basic Safe Patient-Positioning Process IdentifyCharacteristics of the patient to be positionedType of positioning to be accomplishedIf movement, where the patient is being moved to.Task-related HazardsEnvironment/facility-related hazardsWhat personnel/equipment will be neededHow to move or lift the patient.
8 Possible Risks In Job Environment Slip, trip, and fall hazardsUneven work surfaces (bed to stretcher, chairs, toilets)Space limitations—(i.e. patient fallen in the bathroom)Equipment hazards (respirators, IV pumps etc.)
9 Help unavailable when needed (understaffed facility) Other RisksHelp unavailable when needed (understaffed facility)Patient handling equipment in poor working orderCombative patientsOthers?
10 Assessing the Patient Before Moving Always review the patient care plan before attempting to move the patient.A patient care plan describes a specific patient’s needs, degree of assistance required, special treatments, etc.
11 Can they provide assistance? Can they bear weight? Assessing a PatientNext ask the following questions before moving or transferring the patient.Can they provide assistance?Can they bear weight?Can they cooperate and follow instructions?How big and heavy is the patient?Note patient’s wounds, dressings, and any machinery.
12 Types of Patient Moves and Lifts Lateral transfers: Moving a patient sidewaysRepositioning: Moving a patient up and down or side to side in a bed or chairTransfers involving sitting position: bed to chair, bed to bed, chair to toilet, car to chairFloor: Recovering a patient that has fallen on the floor
13 Why Use Patient Equipment? When a patient weighs too much for safe manual positioningFrequent unassisted lifting and movement of patients causes muscle and joint pain/damage.
14 Patient handling/moving equipment Sling – for patients that are totally dependentLean Stand Assist – for patients that have some lifting abilityCeiling Mounted Lift Device – for patients that are totally dependent
15 Patient Assist Devices Sliding boards (also called back boards)Slip sheet, roller sheet, or draw sheetTrapeze lift attached to bed (mostly used on orthopedic patients)Walking or gait beltShower chairsToilet seat risersAnd many more…
16 Hospital & Nursing Home Systems The following are systems utilized by hospitals to decrease the risk of work-related lifting injuriesColor Coding – color coding of patient’s lift requirements for posting at the patient’s bedside. By looking at the displayed color coding system an employee can know what kind of moving assistance the patient will need
17 Hospital & Nursing Home Systems Segregation of patients based on need. This will ensure that equipment and staff are appropriately assignedStaggered Staffing – Provide additional staff for peak periods. This would usually be during the day shift, patient baths, physical therapy etc.
18 Lifting and Moving Algorithms What are lifting and moving algorithms?They were developed by a group of nursing experts and tested in different patient populationsHow do algorithms help you?They give you a safe process to accomplish the task you are trying to performEnsure that you and the patient will not get hurt during the moveNow lets look at one example of a lifting and moving algorithm…
20 Discussion of Nursing Home mechanical lifting program: ResourcesDiscussion of Nursing Home mechanical lifting program:Full discussion and all algorithms:OSHA’s Ergonomics Guidelines for Nursing Homesguidelines/nursinghome/final_ nh_guidelines.html
21 Basic Lifting Techniques Always remember basic safe lifting techniques while performing dutiesStand as close to the patient as possibleKeep back straightGet a good grip on the patientLift with legs when possible
22 SUMMARYBack injuries are among the most costly and disabling of all injuries.A back injury now could cause pain for a lifetime – it is important to treat the back well.Always use the proper lifting techniques and systems, doing so will allow a healthy back for tomorrow and years to come.