1. New and Improved VA Algorithms / New SPHM App!
Marie Martin, PhD
Kurk A. Rogers, RN, BSN, CNOR, MBA (CDR, NC, USN [RET])
With information from
Mary W. Matz, MSPH, CPE, CSPHP

2. Objectives
On completion of this training program, participants will be able to:
Describe the rationale, history and evidence behind the VHA Safe Patient Handling algorithms.
Recognize changes made in 2014 to the VHA Safe Patient Handling and Mobility algorithms.
Describe how the VHA SPHM app can be used to help caregivers use VHA SPHM Algorithms and other SPHM resources.

3. Speaker Disclaimers
The speakers and VA do not endorse any specific vendor or manufacturer of SPHM technology.
The speakers have 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.

4. VHA Algorithms: History
Mary Matz, MSPH, CPE, CSPHP
President, Patient Care Ergonomics Solutions, LLC
(813)
Former VHA National Program Manager, Patient Care Ergonomics
VHA Algorithms: History

5. VHA Algorithms: History
Why were the Algorithms developed?
Key SPHM Program Element included in original VA SPHM study ( )
Knowledge Transfer mechanisms were critical
The following patient assessment criteria will assist health care staff in considering critical patient characteristics that affect decisions for selecting the safest equipment and techniques for patient handling and mobility tasks. Health care staff members have often become accustomed to using whatever limited lifting aids are available, rather than carefully matching equipment to specific patient characteristics. It is expected that careful use of assessment and planning tools will improve safety for both patients and caregivers. Patients will receive assistance appropriate for their functional level, assuring safety and comfort. For caregivers, the goals are to decrease the incidence, severity, and costs associated with job-related injuries, as well as decreasing the intensity, duration, and frequency of job-related musculoskeletal pain and discomfort.

6. Creating a Culture of Safety in a Health Care Environment
Management/Leadership Support
Staff Buy-In/Support
Knowledge Transfer Support Structures
Safe Patient Care Environment

7. Knowledge Transfer Mechanisms
Learning After
Accident Review Boards (ARB)
Root Cause Analysis (RCA)
Safety Investigations (OSHA)
Educational Outreach
Best Practices Systems
Epidemiology
After Action Review (AAR)
Human Action
Learning Before
Peer Leaders
Best Practices
Safety Huddle/After Action Review
Failure Mode & Effect Analysis (FMEA)
Algorithms
Michael Hodgson: Thanks. So, what can you say about learning?
Mary Matz: First of all, instead of using the term learning, I like to use the term “knowledge transfer”. This implies a more active role for both the giver and the receiver, and this is important, because knowledge transfer should be a two-way street. Certainly, a front line worker can learn from his supervisor, but very importantly, a supervisor can learn from his or her employees.
In all methods of knowledge transfer, a person learns from the experiences of someone else…. As you can see though, you can transfer knowledge before hand, proactively, in order to attempt to prevent an incident from ever occurring. And, you can also transfer knowledge after one occurs, as a reaction to an incident. Certainly, the former is preferred.
You can also transfer knowledge during an incident. This method has been used very successfully by the military for years and is called an After Action Review Process.
Michael Hodgson: Thanks Mary, now tell us more about After Action Review.
Learning During
Individual Imprinting
Personal Experience

8. VHA Algorithms: History
Role of Patient Assessment, Algorithms, & Care Plan for Safe Patient Handling & Movement
Provided standardized method to determine how to handle, move, and mobilize patients
Ensured patient handling techniques were based on individual patient characteristics/conditions
Written care plan ensured accurate transfer of information
staff to staff
shift to shift

9. VHA Algorithms: History
Patient Assessment
Completed on all patients
Included…
Patient Characteristics
Patient Medical Condition/s
Algorithms
Based on Specific Patient Characteristics (from Assessment)
Assisted caregivers in selecting safest Equipment
Advised # of staff needed

10. Ergonomic Algorithm 1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

11. VHA Algorithms: History
The Assessment, Algorithms, & Care Plan went hand in hand...
Assess the Patient
Use Algorithms to determine equipment and # of staff needed for each high risk task
Complete the Care Plan
File/Save for future use

12. VHA Algorithms: History
Who developed the Algorithms?
Technical Advisory Group (TAG)
Nursing Experts led by Dr. Audrey Nelson
5 healthcare facilities represented – VHA and non-VA
VHA Office of Public Health and Environmental Hazards, VHA Patient Safety Center of Inquiry (Tampa, FL), and VHA Healthcare Analysis and Information Group

13. VHA Algorithms: History
How were these Algorithms Developed?
TAG developed an algorithm for each high risk patient handling task with technology controls
Tested with different patient populations (med/surg, ED, long term care, critical care, OR)
Tested in a variety of healthcare facilities (5 VA and non-VA hospitals/LTC facilities)

14. VHA Algorithms: History
Originally published in March 2001.
Periodic minor revisions to reflect new evidence and best practices.
Content to provide general direction; professional judgment is needed to assure safety of patients and caregivers.
Original were based on scientific and professional information available in March 2001.
They have since been revised periodically to reflect new evidence and best practices.
Content was developed to provide general direction; professional judgment is needed to assure safety of patients and caregivers.

15. VHA Algorithms: 2014 Changes
Marie Martin, Ph.D.
Veterans Health Administration, Occupational Health (10P4Z)
Acting National Program Manager, Patient Care Ergonomics
Industrial Hygienist (Safe Patient Handling and Mobility Facility Coordinator)
VA North Texas Health Care System
(I represent only my own opinions and not those of VA.)
VHA Algorithms: Changes

16. Comprehensive Patient Assessments and Algorithms:
Help you determine the mobility and independence of your patient
Assess their ability to perform certain tasks
Choose the safest patient handling methods and equipment that might be needed to assist the patient.
You can assess your patient’s ability to perform multiple tasks or specific tasks by answering a series of questions
Based on your answers, the assessments’ algorithms will provide you with technology recommendations.

17. When Patient Assessment and Algorithms Should be Used
Use varies by clinical settings
Evaluate on initial admission
Re-evaluate in clinical areas where patients/ residents maintain similar status for periods of time
Re-evaluate monthly
Re-evaluate when status changes/as needed
Ex: long term care or SCI

18. When Patient Assessment and Algorithms Should be Used
Use varies by clinical settings
Care Plan updates not feasible in some clinical settings where status changes quickly
Attach algorithms to lifts for easy access
Post algorithms in patient rooms

19. Why Change the Algorithms and Patient Assessment
Ease of use: unifying standard and Bariatric algorithms
Safety upgrades: clarification to avoid situations with fall risk
Resolution of conflict: number of caregivers in dispute (manufacturer instructions often allow 1 caregiver, but many organizations say 2)
Increased focus on patient mobilization

20. Patient Assessment (changed to include all Algorithm questions)
Weight
Weight Bearing Capability (fully/ partial/ no)
Balance (sitting/ standing/ none)
Can patient raise and advance both feet?
Upper Extremity Strength (fully with both/ fully with one/ insufficient)
Ability to grasp (fully with both/ fully with one/ insufficient)

21. Patient Assessment
Patient’s level of cooperation and comprehension (Cooperative & follows simple instructions/ uncooperative, combative, or unpredictable)
Can patient perform independent lateral transfers (bed/stretcher/table/trolley)?
Can patient reposition independently in bed?
Can patient reposition independently in chair/wheelchair? (yes/no/Partial)

22. Patient Assessment
Can patient assist in lifting extremities and maintaining position?
Can (bariatric) patient assist by providing access to abdominal area?
Can (bariatric) patient assist by providing access to perineal area?

23. Patient Assessment
Fall History: Any Yes answer denotes high risk for falls and need for fall protection
Fall during current admission?
Two or more falls within past year?
Any fall in past year that resulted in an injury?
Is patient worried or concerned about falling?
Is patient at high risk for falls as indicated by fall screening tool? (> 45 on Morse Scale or other scale used?)
None of the above are applicable to this patient.

24. Patient Assessment (questions only for those who have fallen)
For those patients who have fallen, (specific for Fall/Recovery Algorithm): Was patient injured?
Was injury minor?
Can Patient get up without help?
Care Plan records SPHM technology, slings, and sizes.

25. List of 2014 Algorithms
Algorithm 1: Transfer To/From Seated Positions: Bed to Chair, Chair to Chair, Chair to Exam Table
Algorithm 2: Lateral Transfer to/from Supine Positions: Bed, Stretcher, Trolley, Procedure Table
Algorithm 3: Repositioning in Bed
Algorithm 4: Reposition in Chair: Wheelchair, Dependency Chair or Other Chair

26. List of 2014 Algorithms
Algorithm 5: Transport in Bed/ Stretcher/ Wheelchair
Algorithm 6: Toileting
Algorithm 7: Showering and Bathing
Algorithm 8: Floor/Fall Recovery
Algorithm 9: Transfer between Vehicle and Wheelchair, Powered Wheelchair, or Stretcher
Algorithm 10: Ambulation

27. List of 2014 Algorithms
Algorithm 11: Patient Handling Task Requiring Lifting of Extremities
Algorithm 12: Bariatric Patient Handling Task Requiring Access to Abdominal Area
Algorithm 13: Bariatric Patient Handling Task Requiring Access to Perineal Area

54. We Seek More Input!
To provide input into VHA algorithms, please contact Marie Martin:

55. Other Methods Used in VHA
NAON and AORN algorithms (linked from app)
Bay Pines scoring method (0-4)
6 questions, same as original criteria
Add up scores and choose method accordingly
BMAT and related mobility scores
Patient demonstrates current level of mobility – no guessing
Reverse order from Bay Pines
Included in new early and progressive mobility programs

56. Kurk A. Rogers, RN, BSN, CNOR, MBA (CDR, NC, USN [RET])
San Diego, CA
Former Safe Patient Handling and Mobility Facility Coordinator, San Diego VAMC
New VHA SPHM App

57. Safe Patient Handling Mobile Application
Why should you use the SPHM App?
The information in this app offers the current best practices in SPHM at the point of care, to help prevent injury and improve interactions between you and your patients.

58. Safe Patient Handling Mobile Application
Provides evidence-based SPHM techniques to help provide the safest care possible to patients.
Offers a blend of knowledge and tools to prevent injury of both health care professionals and the patients they care for,
Incorporates:
patient assessments
scoring tools
algorithms
equipment guides
videos for training
peer leader activity checklists.

59. Safe Patient Handling Mobile Application
The advice within this app has been compiled by the VA but is intended for both Department of Veterans Affairs (VA) and non-VA care teams
Intended for direct care providers including nurses, physical medicine and rehabilitation (PM&R) specialists and Imaging staff.
Others are welcome to use this app based upon their specific governance approval.
Use of this tool should be considered as guidance and not substituted for professional clinical judgment.

60. VA SPHM App Locations:
Future download page:
Training:
Expected to release for iOS first and for web and Android later

104. Questions?