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Frontline Training Safe Patient Handling and Mobility Program
INTRODUCTION & PROGRAM DESCRIPTION Version 1.0 Feb 23, 2016 1
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Introductions partners take notes (use index and pens/pencils)
introduce partner to group Questions for partner: Name, job/professional title Brief description of work Where from? Something unique, interesting or recent about partner What color index card did you choose and why?
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Before we get started... Readiness for change survey
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Training Schedule Day 1 Time Day 2 Introductions AM
Patient Risk Profile Program Description PACE Using Equipment Safety Huddles/After Action Review PM After Action Review 4
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Program Description Why is a safe patient handling and mobility program needed? What does an effective safe patient handling and mobility program look like? How is a safe patient handling and mobility program implemented? What is the role of a Peer Champion? 5
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Why have a program? Patient care is improved with safe patient handling programs. Falls Pressure Ulcers Thromboembolism Complications from ⬇ mobility Injuries to staff can be reduced with multi-element safe patient handling programs
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Why not just teach staff how to lift properly?
An average nurse will lift the equivalent of 1.8 tons in 8 hours
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Every 8 hours...
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Program Description
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2. ID Hazards & Assess Risk
Implementation Plan Build Training Capacity Peer Champions 1. ID High Risk Areas 4. Evaluate Leadership and Training 2. ID Hazards & Assess Risk 3. Implement Controls Equipment Build Database of needs 10
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Principles Building capacity Changing culture
Changing Behaviour and Practice Engagement
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Peer Champion Role Trainer Coach Role Model Agent of Change
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Frontline Training Safe Patient Handling and Mobility Program
PACE Pre-mobility Check Version 1.0 Feb 23, 2016 13
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Before We Get Started… Pre-test
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PACE - Why? Discussion Question:
What are some Issues faced by Staff when handling and mobilizing patients? What are potential solutions to these issues?
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PACE – Who? All health care workers involved in moving patients should know and use PACE: Managers/supervisors Nursing Staff (RN, LPN) Support Staff (CCA, Ward Clerk, Porter, Personal Care Worker) Rehab Staff (PT, OT, RA, OTA/PTA, Recreation Therapist) Physicians Others (DI, Environmental Services)
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PACE – What?
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Discussion Small Groups Flip Chart P - Physical
A – Agitation/Aggression C - Communication E - Environment
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P - Physical Turn to their side in bed Sit up Balance
Weight bearing ability while seated Stand up Stability and weight bearing ability while standing
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A - Aggression Five Questions:
Does the patient have clipped or angry speech? Does the patient have a history of agitated/ aggressive behaviour? Is the patient using angry facial expressions (e.g. furrowed brow)? Is the patient refusing to communicate? Is the patient using threats or threatening gestures?
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C- Communication Can be assessed during regular interaction
Pay attention to your patient’s ability to: Answer simple questions (e.g. How are you doing today?) Follow instructions (e.g. Can you bend your knees for me?)
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E - Environment Can play a significant role in the safety of any patient handling and movement task Upon entering the room determine the following: Is there enough space to access the patient including use of necessary equipment? (3 sides of the bed) Is the floor safe to transfer on? (not slippery, dry) Is the mattress surface safe for the patient to perform assessment activities? Is the environment clear of obstacles? Is any necessary equipment present?
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Demonstration Danny 35 year old who just went through an above knee amputation. Prior to his injury he worked as a personal trainer and was very physically fit. He is upset about his amputation but he communicates ok and has been cooperative with his care. He wants to transfer into a wheelchair so his friend can take him out into the hallway. He has not been seen or assessed by rehab staff and he is not aware of his abilities.
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PACE Practice 3 Case Studies 1 patient 1 healthcare worker 1 evaluator
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Frontline Training Safe Patient Handling and Mobility Program
SAFETY HUDDLES AND AFTER ACTION REVIEWS Version 1.0 Feb 23, 2016 25
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Summary Safety Huddle Overview After Action Review Overview
Purpose Structure After Action Review Overview Compare/Contrast Group Discussion Structure and Principles - Safety Huddles Structure and Principles - After Action Review
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Safety Huddles Address concerns with the goal of preventing incidents and near misses Before an adverse event occurs Interprofessional Same time every day 15 minutes Identify action plan to resolve issue/concern
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Safety Huddle Topics Patients at high-risk for falling
Patients who are confused or aggressive Patients who are bariatric Equipment/device issues Environmental concerns Staffing complement 28
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After Action Reviews Immediate assessment of an adverse event
What was expected to happen? What actually occurred? What went well and why? What can be improved and how? Does not replace a formal investigation or root-cause analysis 29
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After Action Review - Features
Informal, open and honest professional discussion Participation by everyone involved in the activity Focus on the results of an event or action Identification of ways to sustain what was done well Development of recommendations 30
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Compare/Contrast Safety Huddles After Action Review Time to complete
15 minutes under 15 minutes Participants Interprofessional team Participants in an “action” When completed Beginning of shift after an “action” Purpose Communicate known hazards and risk learn from an action Blame? No
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Safety Huddle Discussion
List the challenges and drivers to successfully facilitating a safety huddle. What about the structure, format and principles of safety huddles lends them to overcoming the barriers?
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After Action Review Discussion
List the challenges and drivers to successfully facilitating an after action review. What about the structure, format and principles of after action reviews lends them to overcoming the barriers?
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After Action Review – Today so far…
Immediate assessment of an adverse event What was expected to happen? What actually occurred? What went well and why? What can be improved and how? 34
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Frontline Training Safe Patient Handling and Mobility Program
PATIENT RISK PROFILE Version 1.0 Feb 23, 2016 35
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Before We Get Started… Pre-test
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Learning Objectives Understand how to do a Patient Risk Profile:
chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 37
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Learning Objectives Understand how to do a Patient Risk Profile:
chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 38
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Discussion How do you currently decide how much assistance patients require to move/get in/out of bed??
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Patient Risk Profile Determines the minimum amount of assistance required Provides information to help create a Mobility Plan The patient risk profile is used to determine the minimum amount of assistance necessary to transfer a patient safely. It should be integrated into all patient-related processes (e.g. care plans, admitting) in order to determine the risk associated with patient handling and movement tasks. Typically completed by admitting nurse or a consulting physiotherapist or occupational therapist or with input from a variety of health care providers. Specific patient handling and movement tasks are identified, and a plan is documented and implemented to ensure all lifts, transfers, and repositioning activities are performed as safely as possible. It is not necessary to complete the assessment in the order presented, it should be carried out in a logical manner based on assessments and care activities. Always remember to document and communicate results this will help to ensure all lifts, transfers and repositioning activities are performed as safely as possible. 40
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Discussion When should a Patient Risk Profile be completed?
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When should one be completed?
Upon admission Transfer from unit to unit Changes in condition and/or mobility status PACE results are different than Patient Risk Profile 42
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Discussion Who should do the patient risk profile?
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Who? RN LPN Sometimes PT/OT
Not in scope of practice for assistant roles
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Discussion What type of information would you look for in the patient’s chart?
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Review Patient’s Chart
Gain knowledge of current and past medical history Look for: Weight bearing status History of violence Height and weight 46
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Discussion Are there any patient populations that require special consideration or equipment during patient handling and movement?
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Special Considerations
Bariatric needs Orthopedic challenges Cognitive impairments Labour and delivery Once identified, arrange for appropriate equipment or solutions. Section 4 in the Program Guide provides additional information on ensuring safe patient handling and movement is completed with patients in the above populations. Once the patient is identified of requiring special consideration, arrange for the appropriate controls (i.e. equipment) to be put into place. 48
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Special Considerations
Is equipment available? Do you know how to access it?
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Discussion What are some key communication factors that are necessary for safe patient handling and movement? How do communication issues increase the risk of injury during patient handling activities?
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Patient’s Ability to Communicate
Are they able to: Understand and follow directions Articulate intention and needs May occur through verbal and non-verbal channels, or written communication 51
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Patient’s Ability to Communicate
Injury increases during patient handling and movement if patient Does not understand speech Language barrier between HCW and patient Cannot follow simple commands Does not understand non-verbal communication 52
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Discussion What are some quick questions you can ask to give you some understanding of your patient’s cognitive status?
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Patient’s Cognitive Status
Are changes normal for the patient based on their condition or medication May be obtained during chart review. 54
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Discussion How could an increased risk of violence in a patient contribute to an increased risk of injury during patient handling and movement?
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Patient’s History/Risk of Violence
Document and communicate violent behaviour Certain clinical, psychological, and historical variables increase patient’s potential for violence Hallucinations, alcohol or drug use, history of violence etc. May be obtained from chart review
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Discussion What type of information is included in other assessments such as Falls Prevention Assessment or skin integrity assessment at this facility?
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Review Other Assessments
Review existing falls prevention & skin integrity assessments May be obtained from chart review 58
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Discussion What physical movements would be beneficial to observe to help determine the safest way or method for a patient to move?
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Patient’s Physical Abilities
Patient must demonstrate abilities Progresses from supine to sitting to standing to ambulation
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Discussion How would you describe a high risk task?
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Identify High Risk Tasks
Tasks that the patient cannot do independently or with minimal assistance Keep list of high risk tasks up to date 35 lbs safe limit
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Document and Communicate SPHM
Document high risk tasks as well as the appropriate controls 63
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Review of Learning Objectives
Now you understand how to do a Patient Risk Profile: chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 64
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Frontline Training Safe Patient Handling and Mobility Program
USING EQUIPMENT Version 1.0 Feb 23, 2016 65
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Before We Get Started… Pre-test
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Learning Objectives Review various bed features that can assist with patient handling and mobility Know what emergency features are on ceiling and floor lifts Determine appropriate sling selection for tasks/activities Use slings for repositioning, transfer, and holding a limb Use friction reducing devices for repositioning and lateral transfers (maxi slide, breeze sheets, air-assisted lateral transfer device) Demonstrate proper body mechanics and use of gait belt during transfers 67
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Discussion - Patient Bed Features
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Patient Bed Features Operation Scale Chair Function Knee Gatch
Edge of Bed Bed rails Reverse Trendelenburg Bed Height Safe Working Load (SWL) (also equipment)
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Mattresses
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Demonstration - Emergency Procedures
Ceiling Lift When to use Emergency Release Location Procedure After use Portable lift 71
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Emergency Procedures - Ceiling Lift
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Emergency Procedures - Ceiling Lift
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Emergency Procedure - Floor Lift
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Emergency Procedure - Sit-Stand Lift
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Good Body Mechanics Group Discussion:
Describe points related to Good Body Mechanics
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Good Body Mechanics Distribute Station 3 Reference:
Body Mechanics Checklist
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Practical Sessions 4 Stations Station 1 - Selecting Slings
Station 2 - Using Sling lifts Station 3 - Using Friction Reducing Devices Station 4 - Minimal Assist transfers
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Station 1 - Sling Selection
Match the case scenario with the the appropriate sling Universal Repositioning limb Hygenic Long seat/hammock 6 Case Scenarios 79
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Station 2 - Using Sling Lifts
Practice using different slings with a lift Universal Repositioning limb Hygenic Long seat/hammock Turning sling
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Station 3 - Using Friction Reducing Devices
Use different equipment to perform a boost and a lateral transfer BAD Flannel Soaker BETTER Maxi slide Breeze Transfer board Air assisted lateral transfer Compare/Contrast the experience with each device
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Station 4 - Minimal Assist Transfers
Practice bed to chair transfer Use gait belt walker or Sit Stand lift (if available) 82
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Discussion Key Messages Station 1 - Selecting Slings
Station 2 - Using Sling lifts Station 3 - Using Friction Reducing Devices Station 4 - Minimal Assist transfers 83
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Learning Objectives Review various bed features that can assist with patient handling and mobility Know what emergency features are on ceiling and floor lifts Determine appropriate sling selection for tasks/activities Use slings for repositioning, transfer, and holding a limb Use friction reducing devices for repositioning and lateral transfers (maxi slide, breeze sheets, air-assisted lateral transfer device) Demonstrate proper body mechanics and use of gait belt during transfers 84
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