1. Safe Patient Handling & Movement (SPH&M) at the VA San Diego Healthcare System Kathleen L. Dunn, MS, RN, CRRN-A, CNS

2. Where we were in 2000  Most patient movement was being done manually.  Some areas had 1 mobile lift, which was rarely used.  Nurse injuries were frequent & costly.  SCI had highest nurse injury rate in the entire hospital.

3. Transfers such as “quad” pivots, 2-person lifts, and 2 person “sheet pulls” were common. Sheet Pull 2-person lift Quad Pivot

4. Where we were in 2000  Traditional body mechanics training was included in orientation and reviewed annually.  Those injured were required to repeat this training.

5. February-April 2001  VASDHS staff attended VISN 8 Safe Patient Handling & Movement Conference.  We saw the light!  Solicited support for program within Nursing Service  Presented to PIC & approved for PIT chartering.

6. Costs of Injuries: FY02 VASDHS  30 nurse injuries associated with patient handling and movement tasks  17 occurred on the Spinal Cord Injury Center resulting in $162,815.53 in charge back (direct) costs.  With indirect costs being 4-10X that of direct, it is estimated that in FY02, the SCI unit had over $650,000.00 in costs related to nurse injuries caused by patient handling and movement.

7. Fall 2001-Summer 2002 Banned manual lifting (2 person lifts & “quad pivots”) on SCI unit. Established SPH&M committee. Collected pre-project baseline data. Planned and held 2 equipment fairs. Trial install of 4 ceiling track lift systems in SCI over 2 months.

8. SCI Patient Room

9. SCI Inpatient Room Single-track ceiling lift for two beds in one room. Auto return to preset height. Battery Charge position Sling hook on bedside cabinet

10. SCI Inpatient Room Patients are issued a sling at admission that stays on their bedside closet hook.

11. Privacy Curtain Modifications Curtains split & Velcroed

12. SCI Clinic

13. SCI clinic exam room

14. SCI Therapy Gym Single-track ceiling lift over P.T. parallel bars. Scales allow measurement of % weight bearing.

15. Use of Ceiling Track Lift for Suspended Gait Training

16. Transverse-track ceiling lift over therapy mat

17. Cost Savings: Phase 1  $150,000 spent for Phase 1 (SCI) ceiling track lift installation in October 2002.  October 2002-March 2003:  Zero (0) SCI nurse injuries related to transfers or lifting.  1 SCI nurse injury related to patient turning.  Estimated costs savings: $600,000 for Phase I pilot

19. June-July 2003  Presentation of Phase 2. proposal to Status of Funds  Approximately $600,000 for equipment approved for Phase 2.

20. October-December 2003  Installation of Phase II  Partial ceiling track lifts on all inpatient units.  New mobile lifts obtained for most areas.  “No-Lift” (SPH&M) Nursing & PCS Services Policy approved.  Staff Education & Training.

21. Develop “Champions” for culture change.  VASDHS – PINs (Preventing Injuries Now facilitators). Includes non-nursing staff as well.  Credible peer leaders.  Ongoing hazard identification.  Train-the-trainers.  Implement algorithms in all units/areas. Strategies PIN

22. Transfer to and from: * Bed to Chair * Chair to Toilet * Chair to Chair or * Car to Chair Does the patient have UE strength ? Ability to bear weight Is the patient cooper ative? Use ceiling lift or portable floor lift with full body sling and at least one care giver. Use full body sling lift and 2 caregivers. Is the patient cooperativ e? Caregiver assistance not needed;Stand by for safety as needed Full Partial Yes No Yes Sample Algorithm

23. Other Examples of Re-Engineering at the VASDHS

24. ICU Ceiling Track Lifts

25. Wall Mounted System in Med-Surg areas

26. Dialysis Ceiling Track Lifts

27. Radiology Ceiling Track Lifts

28. Morgue Lift

29. Where are we now? ALL OF VASDHS – Complete total patient room ceiling track install: Spring 2007. Radiology, MRI, cardiac lab, and Morgue re-engineered. Rarely-used equipment bank (Escort). Increased compliance and skill in use of algorithms.

30. Where are we now?  Before: averaged 40+ injuries a year due to patient handling and movement.  Now: average 20 injuries a year with just partial implementation of the program.  Costs: approx. $950,000 spent on equipment and re-engineering.  Cost Savings: $2.8 million (direct and indirect)

32.  Policy is now applicable to all direct patient care staff (not just nursing staff) as an MCM (3/06).  List of banned manual handling tasks  Universal requirement to use SPH&M techniques and equipment.  Staff, supervisor and administrative responsibilities detailed. Where are we now?

33.  Radiology, Rehab Medicine, and other services represented on Committee, which now reports to Process Improvement Council (PIC).  On-going education & monitoring.  Plans to have input on all patient care equipment purchases from ergonomic stand-point. Where are we now?

34.  VA National Directive mandating SPH&M is expected this summer.  Additional $336,000 received as VACO grant for projects through FY ’08  SPH&M Facility Champion position will be implemented by start of FY ’09. Where are we now?

35. VASDHS Safe Patient Handling & Movement MCM Defines responsibilities at all levels. Applies to all clinical staff. Lists banned patient/equipment handling & movement activities. Defines possible consequences for staff failure to follow this policy & these rules. Contains decision making algorithms.

36. Thank You for Your Attention!