Unit-based Hazard Assessment for Safe Patient Handling

Unit-based Hazard Assessment for Safe Patient Handling 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) 558-3928 (813) 558-3990 fax mary.matz@va.gov Unit-Based Hazard Assessment for Safe Patient Handling 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) 558-3928 (813) 558-3990 fax mary.matz@va.gov

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

Ergonomics and Patient Handling

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

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

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. 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.

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

Ergo Injury Triangle Image of Injury as related to posture/force and frequency/duration

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

What Do “Patient Care” Ergonomic Hazards result from? Patient lifting and moving exceed caregivers’ biomechanical limits… What Do Patient Care Ergonomic Hazards Result From? Patient lifting and moving exceed caregivers’ biomechanical limits…

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

What Do “Patient Care” Ergonomic Hazards result from? “Safe” lifting rules don’t apply (Horizontal and vertical lifting) Patients: are asymmetric & bulky can’t be held close to the body have no handles Patient assistance varies What Do “Patient Care” Ergonomic Hazards Result From? “Safe” lifting rules don’t apply (Horizontal and vertical lifting) Patients: are asymmetric & bulky can’t be held close to the body have no handles Patient assistance varies

What Do “Patient Care” Ergonomic Hazards result from? Patient care is unpredictable due to unanticipated patient responses… muscle spasms, combativeness, or resistance Results in… Unexpectedly heavy loads 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. What Do “Patient Care” Ergonomic Hazards Result From? Patient care is unpredictable due to unanticipated patient responses… muscle spasms, combativeness, or resistance Results in… Unexpectedly heavy loads 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.

Simple Biomechanical Model F=ma Simple biomechanical model showing how work equals force times distance d Work = Force x Distance W = F x d

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

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 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

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 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

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 Example 3: Transfer from Chair of Patient 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

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 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

Unit-Based Hazard Assessment for Safe Patient Handling

Unit-based Hazard Assessment for Safe Patient Handling ‘Patient Care’ Practice Settings include… ALL practice settings that move and lift patients NURSING Acute Care Long Term Care Critical Care OR ER SCI Others… NON-NURSING PT Diagnostics Treatment Areas Procedure Areas Morgue Dialysis Others.. Unit-Based Hazard Assessment for Safe Patient Handling ‘Patient Care’ Practice Settings includg… ALL practice settings that move and lift patients NURSING Acute Care Long Term Care Critical Care OR ER SCI Others… NON-NURSING PT Diagnostics Treatment Areas Procedure Areas Morgue Dialysis Others..

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

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

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

I. Prior to Ergo Evaluation 1. Identify High Risk Tasks Collect Staff Perceptions of Unit High-Risk Tasks ‘Tool for Prioritizing High Risk Tasks’ Rank Tasks from 1 to 10 10 = most difficult/highest risk 1 = least difficult/ lowest risk When ranking, consider: Musculoskeletal Stress = Load, Posture, Frequency/Duration Completed by Each Staff member Collectively by Shift Compile by Unit and Shift Prior to Ergo Evaluation Identify High Risk Tasks Collect Staff Perceptions of Unit High-Risk Tasks ‘Tool for Prioritizing High Risk Tasks’ Rank Tasks from 1 to 10 10 = most difficult/highest risk 1 = least difficult/ lowest risk When ranking, consider: Musculoskeletal Stress = Load, Posture, Frequency/Duration Completed by Each Staff member Collectively by Shift Compile by Unit and Shift

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage (Previous slide) 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: To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage (Previous slide)

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

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

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

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

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

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

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

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

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

What’s Wrong with this Picture??

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

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

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

What’s Wrong with this Picture??

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

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

What’s Wrong with this Picture??

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unit-based Hazard Assessments for Safe Patient Handling ‘Patient Care’ Practice Settings include… ALL practice settings that move and lift patients NURSING Acute Care Long Term Care Critical Care OR ER SCI Others… NON-NURSING PT Diagnostics Treatment Areas Procedure Areas Morgue Dialysis Others.. Unit-based Hazard Assessments for Safe Patient Handling ‘Patient Care’ Practice Settings include… ALL practice settings that move and lift patients NURSING Acute Care Long Term Care Critical Care OR ER SCI Others… NON-NURSING PT Diagnostics Treatment Areas Procedure Areas Morgue Dialysis Others..

Thanks