Risk Patient Handling

transcript

Patient Care Ergonomics

Remember… Through Ergonomics

• Job can be redesigned• Jobs can be improved to be within

reasonable limits of human capabilities However, ergonomics is not a magical

solution…• To be effective, a well thought out system

of implementation must be developed

Here’s A Successful Solution using Patient

Care Ergonomics…

Successful Solutions

Overview of a Safe Patient Handling & Movement Program

Safe Patient Handling & Movement Program

•Management Support

•Champion•SPHM Team •Program

Elements

•Equipment•Knowledge

Transfer Mechanisms

•Technical Support

For success, required infrastructure MUST be in place prior to implementing SPHM Program

SPHM Champion

CloutMover/Shaker InterestNursing, Therapy, Safety…

Goals Reduce the incidence of

musculoskeletal injuries Reduce the severity of

musculoskeletal injuries Reduce costs from these injuries

Goals Create a safer environment &

improve the quality of life for patients/residents

Encourage reporting of incidents/injuries

Create a Culture of Safety and empower nurses to create safe working environments

SPHM Key Objectives

Reduce # of lost workdays due to patient handling tasks by ___%

Reduce # of light duty days due to patient handling tasks by ___%

Note: Best to NOT measure success by # of reported injuries…

What goals do you want to achieve for yourself, your co-workers,

and your unit?

What specific Program Objectives do you want to attain?

(Complete “A” & “B” of Handout A-1, Developing a Safe Patient Handling & Movement Action

SPHM Program Elements Peer Leaders – BIRNS/Ergo Rangers After Action Review Process Patient Assessment, Care Plan,

Algorithms for Safe Patient Handling & Movement

SPHM Policy Ergonomic & Hazard Assessment of

Patient Care Environment Equipment

Safe Patient Handling & Movement

Program Elements

Back Injury Resource Nurses

Chapter 7

BIRNS Roles & Responsibilities

4. Perform Continual Hazard/Risk Monitoring

Two Levels of Hazard/Risk Evaluations

•Formal Ergonomic Hazard Evaluation – Ch. 3

•Ongoing Workplace Hazard Evaluations• Of the Environment• Of Patients/Residents• Of Patient Handling Tasks

Outcomes for Staff Staff are empowered

•Channel to voice ideas/suggestions•Opportunity to have input in making work environment safer

Increased competence in performing job

Increased sharing of knowledge/best practices

Fosters Culture of Safety

Examples of Problems Identified Lifts not being used on night

shifts. • Why? Batteries were being charged

on night shifts because no back-up batteries.

• Solution: Buy extra battery packs so lifts can be used 24 hours per day.

Safe Patient Handling & Movement

Program Elements

Patient Assessment, Care Plan, & Algorithms for Safe

Patient Handling & Movement Chapter 5

Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling

& Movement

The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling

activities you must perform3. Follow the algorithms to

determine what equipment and # of staff are needed

4. Complete the Care Plan5. File for future use

What Tasks Do the Care Plan & Algorithms Cover?

1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

2. Lateral Transfer To and From: Bed to Stretcher, Trolley

3. Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table

4. Reposition in Bed: Side to Side, Up in Bed5. Reposition in Chair: Wheelchair or

Dependency Chair6. Transfer a Patient Up from the Floor

What Tasks Do the Bariatric Care Plan & Algorithms

Cover?

1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

2. Lateral Transfer To and From: Bed to Stretcher, Trolley

3. Reposition in Bed: Side to Side, Up in Bed 4. Reposition in Chair: Wheelchair or

Dependency Chair5. Tasks Requiring Sustained Holding of Limb/s

or Access to Body Parts6. Transporting (stretcher, w/c, walker)7. Toileting8. Transfer Patient Up from Floor

Patient Assessment & Care Plan – Page 71

Completed on all patients Takes into consideration:

•Patient Characteristics •Patient Handling Task•Equipment

Uses Algorithms

Algorithms - Page 73

Based on Specific Patient Characteristics (from Assessment)

Assists nurses in selecting• Safest Equipment • Safest Patient Handling

Technique Advises # of staff needed

How were these Algorithms Developed?

Developed by a group of nursing experts

Tested with different patient populations in a variety of settings

When Should The Algorithms be Used?

Use the Algorithms for every patient/resident who needs help moving

Remember….• The Algorithms provide general

direction• Caregiver must use their

professional judgment in applying Algorithms

How Do We Lift This Resident?

Let’s assess NH resident: Fred Veteran

80 year old resident of a VA Nursing Home.

Weight: 156 lbs. Height: 5’ 9” Has dementia and a history of falls. Some days he is cooperative. Other days

he is combative and fearful. When he is cooperative, he can bear

weight. Otherwise, he resists standing. He is to be out of bed every day in a chair.

Assessing Fred V.

Take a few minutes and complete a Patient

Handling Care Plan for Fred Veteran.

(Use Handout A-3, Patient Assessment & Care Plan)

Assessing Fred V.

Level of AssistanceDependent

Can the resident bear weight?

No, because the resident is not cooperative

Does resident have upper extremity strength needed to support weight during transfers?

No, because resident is unreliable for using his upper extremity strength

Assessing Fred V.

Resident’s level of cooperation and comprehension

Unpredictable

Weight: 156 lbs. Height: 5’ 9”

Special circumstances?

History of Falls

Finishing Fred V.’s Care Plan

Although the resident can sometimes bear weight, he can be uncooperative.

The “No” answer to “Is the Resident cooperative?” leads you to: “Use full body sling lift and 2 caregivers”

Answer: Use full body sling lift and 2 caregivers

Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling

& Movement

The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling

activities you must perform3. Follow the algorithms to

determine what equipment and # of staff are needed

4. Complete the Care Plan5. File for future use

Step 3. Obtain Pre-Site Visit Data

Remember…Involve as many staff as possible and as much as

possible…

Step 3. Obtain Pre-Site Visit Data

Now… think of one of your high-risk units from your facility and complete a cursory “Unit Data Collection Tool” for that unit.

* Complete Unit Data Collection Tool Profile (Handout A-5)

Step 5. Conduct Site Visit

Site Visit Walk-through• Patient room sizes/configurations• Ceiling Characteristics/AC vents/TVs• Showering/bathing facilities• Toileting process

Site Visit Walk-through• Equipment

•Availability Accessibility•Use Condition•Storage

• Staff attitudes

After Site Visit… Organize data by entering into

Site Visit Summary Data Sheet (p. 34 and Handout A-6)

Use during Risk Analysis in order to make Recommendations

9 Step Ergonomic Workplace Assessment of Nursing

Environments

Step 6. Perform Risk Analysis

Risk Identification/Breakdown High Risk DEPARTMENT/AREA High Risk JOBS (RN, CNA, LPN, etc.)

• Specific TASKS of High Risk Jobs (p. 30)

• Specific ‘ELEMENTS’ of High Risk Job TASKS

What do we need to look at to identify Specific

RISKS of ‘ELEMENTS’ of High Risk Job TASKS?

Element/Task Risk Identification

Task Intensity Task Duration Work Posture General Design of Equipment Space Characteristics Where do you think problem

exists?

Methods to Gather Risk Data General Observation Staff Discussions Staff Questionnaires Review of Medical Data Symptoms Surveys Quantitative Evaluations

Previous Studies Job Consistency

& Fatigue Brainstorming &

Group Activities Job Safety

Analyses

Job Safety Analysis (JSA) Break down job into steps Identify hazards associated

with each step Determine actions necessary to

eliminate or minimize hazards

Job Safety Analysis (JSA)

Let’s try it!!!

See Job Safety Analysis Worksheet (Handout A-7)

Risk Analysis is used to find Risk Factors that may cause injury.

There are three categories of Risk Factors in a Patient Care

Environment...

What do you think they are??

Risk can come from: Patient Handling Tasks Health Care Environment Patient

Once risks are identified, steps can be taken to protect Staff

and Patients!

What Risk Factors are related to the Health Care Environment?

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

Space limitations • Small rooms• Lots of equipment• Clutter• Cramped working space

Poor placement of room furnishings

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

‘The Far Side’ Safety Humor…

What Risk Factors are related to Patients?

Patient Risk Factors Weak/unable to help with

transfers Unpredictable Vision or hearing loss Hit or bite Resistive Behavior Unable to follow simple

directions

Patient Risk Factors Overweight Experiencing Pain Hearing or vision loss No/little communication

between staff about Patient or with Patient

What Risk Factors are found in Patient Handling Tasks?

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

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

Step 7. Formulate Recommendations

Hazard Elimination Scale in sling lift Transfer Bed

Risk Patient Handling

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