Presentation on theme: "Safe Patient Handling:"— Presentation transcript:
1 Safe Patient Handling: The Hazards of ImmobilityNearly every health care organization has madesome attempt to introduce safety measures in aneffort to reduce musculoskeletal injuries related tohandling and moving patients. What makes amultifaceted safe patient handling and movementimplementation a challenge is the complexityinvolved in creating this safer work environment. Asuccessful implementation of SPHM will consider thepeople, the technical solutions and critical elementsof program management. In this session you willlearn the lessons of why body mechanics trainingand other efforts fails. More importantly, you willhear what can be done to overcome the hazards oflifting. By knowing the pitfalls, you will be able to leadyour team more effectively and avoid costly setbacksand injuries.Content includes: Pathophysiology and nature of work-related musculoskeletaldisorders, physical demands of lifting tasks, ergonomic risk factors found in thepatient care environment, fallacies of using proper body mechanics when manuallylifting, transferring, moving and repositioning patient, examining workers’compensation loss data, examining the consequences in direct and indirect cost ofmanual handling, trends in healthcare that are driving SPHM national regulation andlegislation, obesity and workforce demographic trends, recognize essential elementsto create sustainable and effective SPHM practices and, solutions and mechanicallifting devices.Prepared by :
2 Learning ObjectivesDiscuss the opportunity for quality improvement using SPHM practicesDiscuss expected positive patient outcomes using SPHM practicesDiscuss the role of SPHM practices in patient care initiativesDiscuss how a mobility assessment is able to meet individualized needs
3 Hospital Acquired Disability Hazards of immobility include:accelerated bone lossdeliriummalnutritionsensory deprivationisolationmusculoskeletal weaknessdecreased cardiopulmonary function
4 Early Mobility Avoid the effects of immobility which include: functional declineincreased morbidityincreased mortalityincreased cost of careincreased length of stayWhat is early mobility?Early mobility is the practice of introducing physical activity early into a patient’s hospitalization to combat the degenerative effects of prolonged hospitalization. This practice was developed originally to address functional decline, increased morbidity and mortality, increasing cost of care and improve length of overall hospital stay to mechanical ventilation in the intensive care setting. This has lead many hospitals to adopt an early mobility program for their Intensive Care Units. We have recently added such a program to Banner Baywood Medical Center as a result of research and progress in medicine.
5 Expected Practice Bed mobility Out of bed mobility Ambulation ToiletingBoosting/repositioning/turningTransfersOthersSince adopting a new system policy in May 2011, these safer procedures should be the expected practice for nearly every interface involving patient handling (i.e., in-bed mobility, limb holding, out-of-bed mobility, ambulation, toileting, boosting/repositioning, turning and transfers, etc.). What is lacking, is not only a general awareness of the problems but also a knowledgeable and skilled clinical specialist with time dedicated to focus on this project.
6 Benefits Comfort, safety and dignity for patient Accelerated patient mobility, independence and rehabilitationFall preventionImproved skin integrityPositive patient outcomesReduced hospital associated disabilitySafe patient handling and movement (SPHM) improves safety for patients, and leads to improved quality of patient care. Specific clinical benefits include: (1) increased patient comfort, satisfaction and dignity; (2) accelerated patient mobility, independence, and rehabilitation; (3) fall prevention; and (4) improved skin integrity. Additional positive patient outcomes are expected in efforts to reduce hospital associated disability.
7 Example: Clinical Application Certification in hip facture managementHigh volume of hip fracturesOrthopedic focusTarget populationKey metricsED to OR < 24 hours< Hospital-acquired conditions< LOS< ReadmissionsPatient mobility focusPT starts POD 1Screen mobilityEfficient and safeDisease-specific certification in hip fracture managementFirst for organizationFirst for Arizona
11 Summary of the Evidence Confirms risks associated with manual patient handlingShows tasks cannot be performed safely manuallyDemonstrates the result of cumulative trauma
12 2007 NIOSH Revision Maximum weight a caregiver should lift = 35 lbs (single leg of 200 lb patient)Lateral transfer guidelines: >157 lbs, use mechanical device or air-assisted device
13 Excessive Biomechanical Force 3400 N DCF Limit1000 N SF LimitType of patient transferDisc compression forces (DCF): one person, two person;shear force (SF): one person, two personMarras et al., 1999
14 Evaluating Risk Factors Lifting heavy, awkward loadsSupporting the patient’s body weightWorking in small and/or tight spacesMaintaining awkward posturesReaching away from the bodyPushing and pulling forcesForceRepetitionAwkward posture
15 Classifying Risk High risk activity High frequency task High probability for injury
16 Risk Assessment and Ergonomic Analysis How many patients are you caring for today?What physical tasks are the most frequent and difficult?How many people are typically needed to accomplish the following patient handling task?
17 Boosting with Draw Sheet Moving up in bed(Photo from Griffin AG, Potter PA: Clinical nursing skills & techniques,ed 17, St. Louis, Mo, 2010, Elsevier Mosby)
18 Stand and Pivot Transfer (Photo from Perry AG, Potter PA: Clinical nursing skills & techniques,ed 7, St. Louis, 2010, Mosby)
19 Slide Board Transfer(Photo from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby)
20 Risk Assessment and Ergonomic Analysis (continued) How do you define the dependency level of your patients?How do you define the mobility level of your patients?How do you make decisions about how to do tasks and how many people are needed to perform them safely?
24 Clinical Application Risk assessment tool for nurses Solutions for “Good, Better, Best, and Avoid”Linkage with clinical outcomesDeveloped and mentored championsIntegration with shared-leadership councils
25 Modified Independence Mobility is Linked with SolutionsTotal lift, rollboards, air-assistive device, slide-sheets or slide-tubesMobility Level 1:Mobility Level 2:Total lift or powered sit-to-stand liftNon-powered stand aid, gait belt, cane, crutches, walker or ambulation equipmentMobility Level 3:Modified IndependenceNo equipment required however, supervision is needed to promote safetyWhat equipment do I need?Once you know your patient’s assessment level you should be able to decide what assisted devices, if any, should be used to ensure safety and promote early mobility.All patient transfers to another departments for exams, procedures, and treatments…The mobility level will be assessed and communicated to you through a variety of mediums sharing the patients abilities and limitations. This information and process will increase the safety and efficiency of our areas as we no longer need to guess our patients ability. This information will be clearly identified and communicated to you.For example:Assessment Level 1: This patient is the highest of acuity; the patient requires the most assistance and may require the use of such safety equipment as: Total lift, roller boards, air-assistive device, slider-Sheets or slide-tubes.Assessment Level 2: This patient is able to sit yet is not able to bear weight. The total lift or powered sit-to-stand lifts should be used.Assessment Level 3: This patient is able bear some weight with assistance or assistive devices. The non-powered stand aid can be used; gait belt, cane, crutches, walker or ambulation equipment should be used.Assessment Level “Modified Independence” This patient is able to walk without assistance yet each patientshould be supervised to promote and ensure safety. This patient is the most independent.Always default to the safest lifting method (total lift) if there is any doubt in the patient’s ability to perform the task.Always default to the safest method (total lift) if there is any doubt in the patient’s ability to perform the task.
27 Equipment Solutions Slider Sheets Roller Board Ambulation Pants Sit-to-StandAmbulation VestHow do we practice Early Mobility?Early Mobility can be from range of motion exercises to supervised ambulation with the expectation of increased activity correlating with increased capabilities. Exercises are identified and specific goals and tools are used to promote growth specific to meet the patient’s needs and ability change while maintaining a safe environment by utilizing Safe Patient Movement and Handling Tools and equipment.Safe Patient Handling Equipment and Movement (SPHM): is available to aid in early mobility by maintaining a safe environment for the patient to maximize work while preventing injury as well as protecting staff injury in the process.Sitting UprightTransfer DeviceConvertible ChairRange of Motion
28 Why Safe Patient Handling? Essential skill set for patient outcomesRethink how we provide careInnovative practicesTechnology and equipmentClinical tools, protocols and proceduresWork design changesResults—better, safer and more reliablePatient handling and movement activities are essential job functions in healthcare, but what makes for the safe handling and movement of our patients. In plain words, safe patient handling means rethinking how we provide care to patients in ways that are innovative, linking best practices in clinical care with clinical practices. This program rests on scientific evidence implementing: (1) technology and equipment; (2) clinical tools, protocols and procedures; and (3) work design change to provide better, safer and more reliable care to patients.
29 Bariatric Considerations Provide rooms with overhead/ceiling-mounted liftsEvaluate weight capacity of lift systemPropose minimum room dimensionsMeasure bathroom door widthMeasure shower stall widthEvaluate shower bench weight capacity
30 Bariatric Considerations (continued) Evaluate toilet weight capacityfloor mounted toiletwall mounted toilettoilet jack installationConsider proximity to nurses’ station
31 Create a Bariatric Suite Bariatric bed with pressure reducing mattressExtended capacity patient lift(s)Extended capacity wheelchairExtended capacity and extra wide walkerExtended capacity shower chair or shower stretcherExtended capacity standing aids
32 Create a Bariatric Suite (continued) Extended capacity floor-based toiletExtended capacity bedside commodeBariatric patient reclinerBariatric size friction reducing devices (air-assisted and/or slide sheets or tube sheets)Bariatric rollboardOptimal space in room and bathroomDoors that are wide enough for egress
33 Results of a Pilot Program Program milestone metricsWorkers’ compensation datafrequencyseveritytask specificity
36 Pilot Project Lost Duty Days (2010–2012) Prepared by :
37 Pilot Project (2007–2009 vs. 2010–2012) 54% Decrease 65% Decrease
38 Implementation Success Dedicate an SPHM coordinatorEncourage interdisciplinary involvementPartner with facility leadershipIntegrate with system initiatives and projectsCreate opportunities to share the need and shape vision
39 Safe Patient Handling and Movement Safe for staff and patients:process driven (continuous improvement)evidence-basedbehavior based:assessment and critical thinkingcompetent selection of proper equipmentproficient execution of tasktool for achieving objectives
40 If you have questions or would like a copy of this presentation, please contact: Merl Miller, MS, ATC, CIE Ashton Tiffany, LLC (602)