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Better Practice Guidelines2nd Edition

Patient HandlingPatient Handling

ii ThinkSmart Patient Handling Better Practice Guidelines 2nd Edition

Document ControlOccupational Health and Safety Management SystemThink Smart Patient Handling Better Practice Guidelines 2nd EditionIndex No. OHSMS 2-22-1#38Date: March 2010

Copyright The Queensland Government supports and encourages the dissemination and exchange of information. However, copyright protects this material. The State of Queensland has no objection to this material being reproduced, made available online or electronically, provided it is for your personal, non-commercial use or use within your organisation, this material remains unaltered and the State of Queensland (Queensland Health) is recognised as the owner. Inquiries for commercial use or to adapt this material, should be addressed by email to: [email protected] or by mail to: The IP Officer, Office of Health and Medical Research, Queensland Health, GPO Box 48, BRISBANE QLD 4001.

DisclaimerThe materials presented in this publication are distributed by Queensland Health for and on behalf of the Queensland Government and are presented as an information source only. In the text it has not been feasible to avoid individual names of products or manufacturers, because of their common usage. In none of these instances should the appearance of such a name be taken to be a recommendation.

The information is provided solely on the basis that readers will be responsible for making their own assessment of the matters presented. Neither the authors nor the publisher can accept responsibility for any consequences which might result from decisions made upon the basis of the advice given therein.

Need more information• Contact the Queensland Health Healthcare Ergonomics Team: [email protected]

• Visit the Queensland Health Occupational Health and Workplace Safety Unit (OHWSU) intranet site: http://qheps.health.qld.gov.au/safety/

• Contact the Queensland Health Occupational Health and Workplace Safety Unit (OHWSU):GPO Box 48, BRISBANE QLD 4001 Phone (07) 3235 4352

iii

Better Practice Guidelines2nd Edition

Patient HandlingPatient Handling

Think Smart Patient Handling Better Practice Guidelines 2nd Edition

ScopeThe Think Smart Patient Handling Program (Think Smart Program) is intended to provide information to support safe systems of work when moving, transferring or repositioning patients.The Think Smart Program comprises the:

• Think Smart Patient Handling Better Practice Guidelines 2nd edition (better practice guidelines),and the

• Think Smart patient handling training and assessment program (Think Smart training and assessment program).

Information presented in these better practice guidelines and the accompanying training and assessment program is consistent with an evidence-based approach to making patient handling safer for workers and patients.

This revised Think Smart Program provides information to:

• enable the requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21)to be fulfilled

• guide safe workplace practice for the moving and handling of patients. This includes the main issues to be considered and the key steps to take to implement and maintain an effective patient handling program

• assist health service districts (districts)/facilities to contribute to the targets of the Queensland Health Occupational Health and Safety Strategic Plan 2007–2012

• assist legislative compliance with the Workplace Health and Safety Act 1995 and with relevant standards, including the:

– Queensland Manual Tasks Involving the Handling of People Code of Practice (2001)

– National Standard for Manual Tasks (2007) and National Code of Practice for the Preventionof Musculoskeletal Disorders from Performing Manual Tasks at Work (2007).

The Think Smart Program is not intended to be prescriptive but rather to outline a process to follow when establishing and maintaining a safer patient handling program. It may need to be adapted and modified to address specific workplace requirements.

The handling of patients by therapists for the purposes of providing treatment (i.e. therapeutic handling) is outside the scope of this publication and will be addressed separately. Fundamentals of the Better Practice Guidelines can be utilised to complete risk assessment of therapeutic tasks to ensure the therapist maximises therapeutic benefit for the patient, while minimising the manual handling risk to the worker/s. Performance of these therapeutic patient handling activities requires advanced skills in patient handling and problem solving.

Target audienceThe Think Smart Program is designed for use by managers and supervisors; patient handling coordinators; patient handling trainers; clinical educators; occupational health and safety practitioners (including ergonomic coordinators); direct care workers; and others who may be involved in the review, evaluation and implementation of patient handling activities.

Managers and supervisors have specific roles and responsibilities in relation to the implementation and maintenance of an effective patient handling program. These are presented in Section 1 of these better practice guidelines.

Patient handling refers to any workplace activity where a person or their body part is physically moved, handled, repositioned or supported. Specifically, patient handling tasks are those activities requiring the use of force by a worker to hold, support, reposition or transfer (lift, lower, carry, push, pull or slide) a person.1

iv Think Smart Patient Handling Better Practice Guidelines 2nd Edition

How to use these better practice guidelinesThe key topics covered in these better practice guidelines include:

• Section 1 Planning for a safer patient handling program

• Section 2 Managing risk

• Section 3 Managing risk in specific areas

• Section 4 Individual patient handling risk assessment and management

• Section 5 Building design

• Section 6 Equipment, aids and furniture

• Section 7 Think Smart patient handling training and assessment program.

These better practice guidelines are divided into two parts:

Part A: Requirements and tools Part A summarises the key requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) i.e. the requirements for managing patient handling risks and provides copies of the available tools and worksheets to assist you to fulfil these requirements.

The tools and worksheets in these guidelines are provided as illustrated worked examples. Copies of the blank tools and worksheets for use are available from the QHEPS Occupational Health and Workplace Safety Unit (OHWSU) intranet site at: http://qheps.health.qld.gov.au/safety/

Part B: Resource guidelines Part B provides a more detailed resource that expands on the requirements presented in Part A for each of the key topics and provides more in-depth guidance when managing patient handling risks.

It is recognised that districts/facilities will be at different stages of implementation of a safer patient handling program. The information and tools presented in Part A enable you to review the current status of your safer patient handling program. This may be helpful when considering whether existing patient handling program elements can be modified or improved. If you require additional information, this can be found by referring to Part B of these better practice guidelines.

In addition, these better practice guidelines should be utilised in association with the Think Smart training and assessment program.

References specific to each part have been provided at the end of Part A and B respectively. A bibliography and glossary relating to the entire better practice guideline can be found following Part B.

Patient HandlingBetter Practice Guidelines

2nd Edition

Patient Handling

Requirements and Tools

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3Think Smart Patient Handling Better Practice Guidelines 2nd Edition

Contents

Part A Requirements and Tools

ContentsIntroduction .........................................................................................................................................4

Section 1 Planning for a safer patient handling program ...............................................................5

Appendix 1.1 Statistical analysis guide ..........................................................................9

Appendix 1.2 Patient handling work practices audit .....................................................10

Appendix 1.3 Self-assessment checklist .......................................................................12

Section 2 Managing risk .............................................................................................................. 15

Appendix 2.1 FURAT (Facility/Unit Risk Assessment Tool) ............................................22

Appendix 2.2 Manual task risk management worksheet ..............................................23

Appendix 2.3 Musculoskeletal discomfort survey ........................................................28

Section 3 Managing risk in specific areas ....................................................................................31

Section 4 Individual patient handling risk assessment and management ....................................33

Appendix 4.1 Sample template .....................................................................................42

Section 5 Building design ............................................................................................................45

Section 6 Equipment, aids and furniture ......................................................................................49

Appendix 6.1 Patient handling equipment pre-purchase/hire checklist .......................53

Section 7 Think Smart patient handling training and assessment program .................................59

Appendix 7.1 Training needs analysis: Pre-implementation worker survey ..................66

Appendix 7.2 Training needs analysis: Work area specific training needs and plan .....70

References .........................................................................................................................................75

4 Requirements and Tools

Musculoskeletal disorders (MSD) include any injury or disease of the musculoskeletal system. They can arise in whole or part from undertaking manual tasks in the workplace, at home or during leisure activities, suddenly or over a prolonged period of time. Examples include sprain and strain injuries (back, knee or shoulder strain), bone injuries (fractures), nerve injuries (CTS), soft tissue injuries (abdominal hernia) and back injuries (ruptured disc, sciatica).3

IntroductionPatient handling is recognised as a key hazard exposure for Queensland Health workers. The Think Smart Program provides detailed information about how to establish and maintain a systematic approach to managing patient handling risks. This program will form an integral part of the Queensland Health Occupational Health and Safety (OHS) Management System. Efforts to establish and maintain the patient handling program can and should be fully integrated into the existing health and safety system.

This second edition of the better practice guidelines has been extended and revised in structure and content. This edition has been updated to reflect evidence-based practice and industry standards for managing patient handling risks, as available at the time of writing.

ObjectivesThe stated objectives of implementing the Think Smart Program include:

• develop, implement and use safe systems of work for patient handling(i.e. use a risk management approach to patient handling)

• reduce the incidence and severity of musculoskeletal disorders sustainedby workers performing patient handling tasks

• assist to comply with legislative requirements for workplace health and safetyand best practice standards for patient handling tasks

• contribute to the achievement of national, state and Queensland Health OHS targets.

The potential benefits of implementing the program include:

• improved patient safety and comfort (e.g. contribute to reduced adverse patient eventssuch as pressure areas and patient falls)

• reduced indirect costs of injury to both Queensland Health and to workers (e.g. the uninsured costs, worker wellbeing, retainment of skilled workers)

• raised worker awareness and utilisation of best practice strategies for managingpatient handling risks

• enhanced worker efficiency and productivity

• improved worker morale, comfort and satisfaction at work

• contributions to the achievement of other associated OHS performance indicators established by Queensland Health

• promotion of Queensland Health as an industry leader and employer of choice.

Guiding principlesThe Think Smart Program promotes processes to ensure risks associated with patient handling are systematically identified, assessed and eliminated or controlled. This approach is based on the No Lift principles which are supported by the Royal College of Nursing, United Kingdom2

and Australian Nursing Federation.

5

Planning for a safer patient handling programSection 1

OverviewEvidence-based practice, as well as international, national and local experience supports the use of a systematic approach when preventing or minimising injuries related to patient handling tasks. The traditional approach of providing training in patient handling techniques as the main control measure has shown little, or no long-term impact on working practices and injury rates. Multifaceted patient handling programs (i.e. programs that incorporate a number of strategies and key elements) and are based on risk management processes are more likely to be successful in reducing the risks and injuries related to patient handling activities.4,5

Relevant legislation and Queensland Health policies

This section will provide information about the key principles and elements of a safer patient handling program.

You should refer to Part B, Section 1 of this better practice guideline for detailed information about these principles and elements, including examples of roles and responsibilities for each.

•Queensland Workplace Health and Safety Act 1995

•Queensland Manual Tasks Code of Practice (2000)

•Queensland Manual Tasks Involving the Handling of People Code of Practice (2001)

•National Standard for Manual Tasks (2007)

•National Code of Practice for the Prevention of Musculoskeletal Disorders from Performing Manual Tasks at Work (2007)

•Queensland Health Patient Handling Tasks Implementation Standard (OHSMS 2-22#21)

•Queensland Health Occupational Health and Safety Management System Implementation Standard (OHSMS 1-24#21)

•Queensland Health Occupational Health and Safety and Injury Management Accountabilities and Responsibilities Implementation Standard (OHSMS 1-5#21)

•Queensland Health Occupational Health and Safety Consultation and Communication Arrangements Implementation Standard (OHSMS 1-3#21)

Summary of the tools in this section (worked examples)

Tools Description/purpose Appendix No.

Statistical analysis guide

An overview of information that may be collated and analysed to assist with planning and evaluating the patient handling program.

1.1

Patient handling work practices audit

Internal audits undertaken periodically in a ward/unit to evaluate compliance with patient handling training and assessment, patient handling assessments and plans, and patient handling equipment procedures.

1.2

Self-assessment checklist

Used to assess the current status of the district/facility patient handling program. Can be used during planning as part of the initial review of the patient handling program, and as part of an annual system review (e.g. prior to undertaking a more formal audit).

1.3


Key personnelEstablishing and maintaining an effective patient handling program requires a multidisciplinary approach, with commitment and support from a number of key stakeholders.

Managers and supervisors have specific roles and responsibilities and are integral to the ongoing success of the patient handling program.

Facilities should identify a patient handling coordinator to assist with the overall implementation and maintenance of the safer patient handling program. The coordinator can be any classification of worker, as long as they have necessary knowledge and understanding of the requirements of the patient handling program, good communication and problem solving skills, and the ability to work in a team environment.

The roles and responsibilities of key personnel should be identified and established and should be specific to the district/facility.

Principles and key elements of a safer patient handling programPreventing injuries related to patient handling tasks does not have to be difficult or complex. A framework for establishing and maintaining a safer patient handling program is presented in this section (refer to Diagram 1.1). This is based on the suggested framework for occupational health and safety management systems, as detailed in AS/NZ 4804.6 Therefore, it is consistent with the requirements for an effective health and safety program.

The safer patient handling framework incorporates five essential principles, with key elements () identified for each principle. Effective communication and consultation are essential at all stages to achieve continuous improvement in the patient handling program.

The Workplace Health and Safety Act 1995 sets out requirements for consultation between employers and workers to ensure health and safety.7 Effective consultation draws on the knowledge, experience and ideas of workers and encourages their participation and input to improve the systems in place at their workplace.

Diagram 1.1 Framework of a safer patient handling program

Planning

Continual improvement

Measurement and monitoring – check controls effective

Implementation – assessing and controlling risk

Commitment and policy

Review and improve – improvement plan

7

Section 1Planning for a safer patient handling program


Principle 1: Commitment and policyThis principle requires the organisation to define its policy on the management of patient handling risk and to ensure commitment to this policy. The key elements are:

establish management commitment

initial review of the existing patient handling program

patient handling policy and procedures.

The Self-assessment checklist (refer to Appendix 1.3) can be used to assess the current status of your district/facility patient handling program. This will help you determine where you have capacity and areas you may need to build on.

It may also be beneficial to undertake a statistical analysis as part of the initial review (refer to Appendix 1.1) to establish benchmarks and to identify trends and priorities.

Principle 2: PlanningThe initial review of the district/facility’s patient handling program informs the planning phase for establishing and maintaining the safer patient handling program. This stage involves developing a plan for managing patient handling risks and improving overall performance. Planning should occur in consultation with the relevant work areas. The plan should incorporate:

documented methodologies and processes for risk management

legislative requirements for patient handling

objectives, targets and measures to evaluate performance

identification of resources required

allocation of resources and responsibilities for the specific activities.

Everyone has a part to play in ensuring their own health and safety and the health and safety of others at the workplace. For example, this includes managers, supervisors, workers, patients, visitors, designers, manufacturers and suppliers. Workplace health and safety obligations for individuals in their various roles are specified in the Workplace Health and Safety Act 1995.

Implementing new and modified patient handling programs will require changes to many work practices. General principles for managing change should be considered when implementing a safer patient handling program.

Principle 3: Implementation – assessing and controlling riskThis stage involves implementing risk management procedures and activities to ensure patient handling risks are systematically identified, assessed, analysed and controlled. The key elements are:

risk identification, assessment and analysis

risk control.

For effective implementation, the district/facility needs to develop the capabilities and support mechanisms necessary to fulfil the requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) and to achieve the objectives and targets.


Principle 4: Measurement and monitoring – check controls are effectiveThis stage requires measuring, monitoring and evaluating the performance of the patient handling program at the district/facility/work unit level, and taking preventative and corrective actions. The key elements for this stage are:

review of the effectiveness of controls:– post-implementation– ongoing compliance monitoring

investigation of patient handling incidents.

Compliance monitoring activities should be undertaken to evaluate the effectiveness of the patient handling program. These include:

• statistical analysis of incident and injury data (refer to Appendix 1.1)

• review of the patient handling program to verify it is operating effectively. This may involve:

– periodic internal audits, e.g. completion of quarterly patient handling work practice audits (refer to Appendix 1.2)

– a more comprehensive annual review to verify performance against the key principles of the safer patient handling program, and to evaluate and measure against objectives and targets. This may be completed internally or by an external audit arrangement. Prior to undertaking the formal audit, it can be useful to complete the Self-assessment checklist (refer to Appendix 1.3) to assess the current status of the patient handling program.

The investigation of patient handling incidents also provides the opportunity to review the effectiveness of existing controls. Recommendations are made for corrective actions to prevent a re-occurrence of the same or similar incidents.

Principle 5: Review and improve – improvement plan The findings and recommendations arising from the audits and reviews are documented and reported to senior management. Senior management should seek evidence that the recommendations have been implemented according to the timeframes specified.

A continual improvement process should be applied to the patient handling program to achieve overall improvement in performance. An improvement plan is developed that details future activities for continuous improvement of the patient handling program.

The key elements for this stage are:

review of the patient handling program

continual improvement.

9



Statistical analysis involves organising and summarising the available patient handling incident data, identifying patterns and trends, and applying statistical techniques. The following is a guide to information that may be collated and analysed to assist with evaluating the patient handling program. The suggestions provided are not exhaustive but intended to be a guide only.

Examples of data sources include:

• Incident Management System (IMS)

• WorkCover data (i.e. workers compensation data)

• human resource records.

Examples of how data can be organised and trends identified:

Information Example

Type of incident Near miss, serious bodily injury, work caused injury, work caused illness etc.

Injury details • Day of week; month; time of day• Location where incident occurred• Body part affected (e.g. neck; shoulder; lower back etc)• Injury classification (e.g. joint/ligament/muscle/tendon injury; musculoskeletal

disease; fracture etc)• Action at time of injury (i.e. task involved at the time of incident, for example

rolling a patient)• Mechanism of injury (i.e. how the injury was sustained, for example slip or trip;

tendon/muscular stress)• Agency or prime cause (e.g. manual handling patient; mobile equipment/plant).

Injured worker details

• Employer pay stream (e.g. Operational; Nursing; Professional; Medical; Administration)

• Employer position (e.g. Mortuary Attendant; Registered Nurse; Physiotherapist; Operational Officer etc)

• Employee gender (e.g. male; female)• DOB/age.

Other data Absenteeism, overtime, staff turnover etc.

Examples of statistical analysis that can be applied:

Example Measure Example Measure

Total number of sprain/strain injuries related to patient handling

No. Total number of days lost No.

Proportion of patient handling incidents to overall incidents

% Total number of rehabilitation days No.

Proportion of claims equal or greater than five day duration

% Mean days lost No.

Proportion of claims equal or greater than 60 day duration

% Median days lost No.

Proportion of incidents that progress to WorkCover claims

% Mean cost per claim $

Type of claims (e.g. time lost; medical expense only; record purposes; common law)

% Median cost per claim $

Proportion of claims involving re-occurring injuries

% Total costs $

Appendix 1.1

Statistical analysis guide


1 of 2 Think Smart Patient Handling Better Practice Guidelines 2nd Edition


This form can be photocopied if you require additional space to document more information.

How to use this tool

Purpose These periodic internal audits can form part of the ongoing compliance monitoring of the patient handling program within a ward/unit and will assist with completion of the annual evaluation of it. This audit is used to evaluate compliance with:

• patient handling training and assessment (e.g. patient handling training and assessments for the worker undertaking the taskare up to date and records maintained; techniques being used by workers are consistent with training)

• patient handling assessments and plans (e.g. completion of plans; worker compliance with the plans)

• patient handling equipment procedures (e.g. equipment is being stored and maintained appropriately).

This audit is not intended to be used to monitor the performance of individual workers.

How often to complete Completed quarterly (i.e. every three months).

Responsibility to complete Ward/Unit Manager (or delegate).

Record to be kept On the ward/unit.

Instructions 1. Choose four patients at random (patient names are not required). Choose patients with different levels of function and care

(e.g. dependent, needing assistance, supervision only).

2. Circle whether the shift is an early, late or night shift. Where possible, assess at least one patient from each of the different shifts.

3. Review each of the patient’s individual patient handling assessments and plans, and ensure they are complete and up to date (i.e. in accordance with local recording requirements).

4. For the chosen patients, observe all aspects of patient handling (i.e. on-bed and off-bed transfers and mobility) at varying times during the shift:a. observe the patient is moved according to the individual patient handling assessment and plan and the results

of the pre-activity screeningb. observe whether the technique used is consistent with trainingc. ensure the equipment being used has been maintained in good working order, is clean and stored appropriately

d. check whether or not the worker/s completing the patient handling activity have up to date training and assessment records.

5. Record whether the criteria has been met () or not met (). For any criteria that have not been met, briefly describe the non-compliance issue and actions required to address the issue.

6. Report any issues of non-compliance to the unit manager.

7. Ensure the form has been signed and dated once actions have been completed. File the form on the ward/unit, in accordance with local procedures.

Access a copy of the actual tool here.

Appendix 1.2 (Sample only. Note: this is not a comprehensive worked example)


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2 of 2 Think Smart Patient Handling Better Practice Guidelines 2nd Edition


This form can be photocopied if you require additional space to document more information.

Patient number (insert number, i.e. 1, 2, 3 or 4): Shift: early / late / night (please circle)

Level of function: Date:

Criteria or Description of non-compliance

Action required Action completed

(date)

Patient handling plan present and current.

Screening completed, environment and patient prepared, equipment checked to be in good working order.

Patient moved according to plan and results of screening.

Technique consistent with principles of safe patient handling.

Equipment cleaned and stored appropriately after use.

Training and assessment records complete/up to date for this worker.

Completed by: Position title:(name)

Signature: Date:

Approved by: Position title:(name)

Signature: Date:

Instructions• Copy and complete this record four times

• Choose four patients at random, of varying levels of function

• Assess compliance with each criterion for each patient

• Briefly describe the non-compliance identified and actions required to address

• Sign and date when the actions have been completed. 01

Dependent

The plan instructs patient to be assisted with on-bed transfers using 2 slide sheets: patient was moved up the bed using 1 slide sheet only.

Purchase additional slide sheets to ensure 2 slide sheets are always available.

Inform staff of the new slide sheet purchases and remind them at the next team meeting to always use 2 slide sheets where indicated on the patient handling plan.

30/6/09

Technique of transferring patient not consistent with training provided when moving patient up the bed, workers did not use enough weight transfer, were using high forces through the arms and were twisting at the end.

Annual patient handling assessment is due in one month.

Hayley Good

David Tree

Registered Nurse

Nurse Unit Manager

22/06/09

24/06/09

Task specific training for moving the patient up/down the bed. Problem solve with workers to determine any acceptable variations to use for this transfer. Review the principles of inserting and using slide sheets and safe patient handling postures.

Worker to complete annual assessment by 22 July 09.

22 June 09



Patient handling work practices audit continued…


1 of 3 Think Smart Patient Handling Better Practice Guidelines 2nd EditionThis form can be photocopied if you require additional space to document more information.


Part A

Ward/unit: Date completed:

Assessment completed by: Position title:

Principle 1: Commitment and policy

Key element Activity Rating scale (please circle)

1.1 Management commitment

a. Senior management has clearly stated their commitment to the patient handling program. 1 2 3 4

b. Adequate resources have been allocated to support the patient handling program. 1 2 3 4

c. Responsibilities and accountabilities for patient handling have been established. 1 2 3 4

d. A patient handling coordinator has been appointed for the district/facility. 1 2 3 4

1.2 Initial review

a. A review of the current patient handling program has been completed (i.e. self-assessment). 1 2 3 4

1.3 Policy and procedures

a. Requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) have been identified.

1 2 3 4

b. District/facility/unit specific procedures for patient handling have been developed and communicated to workers.

1 2 3 4

Principle 2: Planning

2.1 Risk management

a. Methods and processes have been developed and communicated to workers for identifying, assessing, analysing and controlling patient handling risks.

1 2 3 4

2.2 Objectives, targets and measures

a. Objectives, targets and measures for the patient handling program have been established. 1 2 3 4

2.3 Legislative requirements

a. Managers, supervisors and workers understand the legal requirements to address patient handling risks.

1 2 3 4

b. Processes have been established to ensure communication and consultation with workers. 1 2 3 4

2.4 Resource requirements

a. Current capability for undertaking patient handling risk management activities has been identified and issues addressed.

1 2 3 4

b. Current data sources have been reviewed to assist planning processes. 1 2 3 4

c. Resource requirements (e.g. for equipment, training etc) have been established. 1 2 3 4

d. A plan has been developed for the patient handling program, which incorporates objectives and targets, defined roles and responsibilities, allocated resources, risk management processes, legislative requirements, and planned regular reviews etc.

1 2 3 4

This Self-assessment checklist can be used to assess the current status of your district/facility patient handling program. The simple checklist is organised to enable you to assess performance against each of the key principles of a safer patient handling program. This will help you determine where you have capacity and areas where your district/facility may need to build on.

For each of the recommended activities, record whether you believe this requirement has been met/implemented by circling the relevant number on the rating scale.

Rating scale1 = No, not implemented/met 3 = Yes, partially/sometimes met

2 = In discussion/development 4 = Yes, fully implemented/always met

Forestville Hospital

David Potts/Janet Flower

5/03/09

Patient Handling Coordinator/ OHS Practitioner

00

0

0

0

00

00

000

000




13




Principle 3: Implementation

Key element Activity Rating scale (please circle)

3.1 Risk identification, assessment and analysis

a. Individual patient handling assessments (and plans where relevant) are completed for all patients on admission, and are regularly reviewed and updated according to work place procedures.

1 2 3 4

b. Facility risk assessments (using the FURAT) are completed and/or reviewed at least annually. 1 2 3 4

c. Mechanisms exist and are promoted to enable workers to report patient handling issues and hazards.

1 2 3 4

3.2 Risk control

a. Control plans are completed to manage risks effectively. 1 2 3 4

b. A variety of risk control options are identified and considered, including:

– elimination 1 2 3 4

– design/re-design of the work environment 1 2 3 4

– design/re-design of the work procedures 1 2 3 4

– use of mechanical lifting equipment and patient handling equipment and aids 1 2 3 4

– individual patient handling assessment and control 1 2 3 4

– use of safe patient handling techniques 1 2 3 4

– training and assessment. 1 2 3 4

c. Controls are implemented according to the control plan. 1 2 3 4

Principle 4: Measure and monitor

4.1 Review effectiveness of controls

a. Implemented controls are reviewed and monitored to check their effectiveness. 1 2 3 4

b. Activities are undertaken for ongoing compliance monitoring to review the effectiveness of the patient handling program:

– statistical analysis completed 1 2 3 4

– patient handling compliance records are done quarterly 1 2 3 4

– self-assessment checklist is completed 1 2 3 4

– annual review/audit of the patient handling program is completed. 1 2 3 4

c. The results of evaluations are communicated to workers and senior management. 1 2 3 4

4.2 Incident investigations

a. Patient handling incidents are investigated and corrective actions taken and communicated to workers.

1 2 3 4

Principle 5: Review and improve

5.1 Review of the patient handling program

a. The patient handling program is operating effectively:

– stated objectives and targets are met 1 2 3 4

– requirements of the Patient Handling Tasks Implementation Standard(OHSMS 2–22#21) have been met.

1 2 3 4

b. Management review of the patient handling program takes place at least annually. 1 2 3 4

5.2 Continual improvement

a. An annual improvement plan is developed in consultation with and communicated to workers. 1 2 3 4

b. Resources are committed for continued support of the patient handling program. 1 2 3 4

c. Areas of success and/or in need of corrective action are identified and communicated to workers.

1 2 3 4

Self-assessment checklist Part A0

00

0000

000

00

0000000

00

0000



Self-assessment checklist continued…



Self-assessment action plan

Part B

Completed by: Position title:(name)

Signature: Date:

Approved by: Position title:(name)

Signature: Date:

Rati

ng s

cale

1: N

o, n

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plem

ente

d/m

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Key element (insert number)

Activity (insert letter)

Comments/recommendations Action completed (date)

Rati

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2: I

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/dev

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Rati

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3: Y

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omet

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met Key element

(insert number)Activity

(insert letter)Comments/recommendations Action

completed (date)

Transfer the corresponding number and letter for the key elements and activities that rated either a 1, 2 or 3 in the Self-assessment checklist Part A into the corresponding column to form an action plan for addressing these areas.

David Potts & Janet Flower

Jim Tree

Patient Handling Coordinator ; OHS Practitioner

08/03/09

10/03/09

District OHS Manager

Rati

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1: N

o, n

ot im

plem

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d/m

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Key element (insert number)



1.2 a First time self-assessment has been completed. No further action required.

4.1 b Define positive performance indicators and lag indicators to be analysed each quarter.

Rati

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/dev

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1.1 cEstablish responsibilities and accountabilities for patient handling at all levels and document in position descriptions and district procedures.

2.2 aFormally define objectives and targets of the patient handling tasks program for Forestville Hospital. Link with 4.1b.

2.4 dDevelop a plan for the hospital patient handling program and communicate to relevant workgroups (link in with 1.1c and 2.2a).

Rati

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3: Y

es, p

artia

lly/s

omet

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met Key element

(insert number)Activity

(insert letter)Comments/recommendations Action

completed (date)

1.1 a & b Focus on maintaining. No further action required until close out of actions for 1.1c and 1.3b.

1.3 aDevelop gap analysis based on identified requirements of the Patient Handling Tasks Implementation Standard OHSMS 2-22#21.

2.1 aFURAT to be reviewed annually. Patient handling hazards to be identified and assessed during the monthly unit WHS inspections (as per the inspection schedule).

2.3 aFocus on maintaining. No further action required until close out of actions for 2.2a, 2.3b, 2.4a, 2.4c, and 2.4d.

2.4 aFocus on maintaining. Continue with existing training strategies with managers, supervisors, workers and OHS for patient handling risk management.

cDocument resource requirements for training (e.g. facility, equipment) and timeframes based on analysis of data sources, risk assessments etc.



Self-assessment action plan

15

This section will provide specific information about the steps required to achieve improved compliance and performance, when managing

OHS risk associated with patient handling activities.You should refer to Part B, Section 2 of this better practice guideline for detailed information about how to manage patient handling risk.

You should refer to Section 4 of this better practice guideline for specific information about managing risk associated with patient handling activities, using individual

patient handling assessment and management.

OverviewRisk management is most effective when used systematically and proactively (before an incident or near miss). For example when planning:

• new facilities and refurbishments

• equipment procurement

• service delivery models or work practices and procedures

• staffing and shift changes.

Risk management is also applied reactively (after a near miss or incident), which facilitates thorough investigation of the problems and prevention of further injury by taking corrective action.

Relevant legislation and Queensland Health policies

Managing riskSection 2

• Queensland Health Integrated Risk Management Policy (13355)

• Queensland Health Occupational Health and Safety Risk Management Implementation Standard (OHSMS 1-13#21)

• Queensland Health Patient Handling Tasks Implementation Standard (OHSMS 2-22#21)

• Queensland Health Patient Handling Tasks Risk Assessment Work Practice Directive (OHSMS 2-65#38)




Facility unit risk assessment tool (FURAT)

This is the mandatory tool to support patient handling risk management at facility/unit level within Queensland Health.

The FURAT is reviewed at least annually and brings relevant information together, in one process, including:

• patient profile

• equipment

• environment

• staffing

• training

• patient handling and other care tasks performed.

The tool enables work areas to easily conduct and record patient handling risk management at facility/unit level.

Refer to Work Practice Directive Patient Handling Tasks Risk Assessment (OHSMS 2-65#38) and the FURAT User Guide, for more information about this tool.

Worked examples of the FURAT can be found in the FURAT User Guide.

A full copy of the FURAT User Guide and the work practice directive is available at http://qheps.health.qld.gov.au/safety/

2.1

Manual task risk management worksheet

This tool has been designed to support risk management of a single manual (including patient handling) task. This can be of assistance when:

• assessing a complex or work area specific task identified through the FURAT or other means e.g. workers assisting birthing, undertaking surgical procedures

• conducting an assessment of a patient handling task in response to an incident or near miss

• changes to the task, equipment or work area are planned.

2.2

Musculoskeletal discomfort survey

This tool has been designed to assist in the identification of musculoskeletal discomfort in workers and the tasks related to the discomfort, through self report.

2.3

17

Section 2Managing risk


ResponsibilitiesDistricts should decide how they will manage risk associated with patient handling activities, to fulfil their legislative and policy obligations.

Ultimately, it is the responsibility of senior management to plan and direct how patient handling risk management will occur, document the arrangements and ensure activities occur as intended.

Workers will be given specific responsibility for patient handling risk management activities, appropriate to their position within the organisation. This approach ensures a coordinated way of discharging responsibility. Further, districts can make arrangements suit the nature of their operations, existing management systems and available resources.

Districts are to demonstrate that responsibilities for patient handling risk management are clear and delegated activities have been completed.

ProcessThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) states that managing risk associated with patient handling activities requires systematically identifying those risk factors that lead to musculoskeletal disorders.

To accomplish this, the following OHS risk management process must be applied to direct patient care areas.

The diagram below summarises the five step process for managing OHS risk in Queensland Health.

Diagram 2.1

OHS risk management process

Step 1: Identify the hazards

Step 4: Implement the agreed control measures Step 3: Decide appropriate

additional controls

Step 5: Monitor andreview the effectiveness

of the controls

Consultation should be carried out at each step

of this process

Step 2: Assess the risk with existing controls

v

Consultation during the processConsultation should be carried out during each step of the OHS risk management process.

Workers should be engaged in the process of risk management through meaningful and effective consultation. The statutory requirements of the Workplace Health and Safety Act 1995, part 7, Workplace consultative arrangements must be adhered to.

Consultation is discussed in detail in Section 1.


Step 1: Identify the hazardThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) states that hazard identification must be conducted at the facility and individual patient level.

Hazard identification is a continuous process which must be undertaken:

• now, if not undertaken before

• when changes are planned in the workplace, such as altered work practices, tasks, equipment or environment

• when there is evidence of potential injury to workers

• after an incident or near miss

• at least annually at facility level and as otherwise specified where the level of risk indicates a need.

Refer to Part B, Section 2 of this guideline for detailed information about how to achieve effective hazard identification.

The FURAT has been designed to facilitate hazard identification at facility/unit level, at specified intervals.

The Manual task risk management worksheet has been designed to be used following hazard identification of a single patient handling task.

The Musculoskeletal discomfort survey has been designed to assist with hazard identification through worker self report of discomfort and difficulties with tasks.

Remember that hazard identification is an ongoing process. Therefore, as well as using the FURAT at specified intervals, ongoing hazard identification is required.

Hazardous patient handling tasks are likely to be prevalent in patient care areas. Tasks should be prioritised for risk assessment, where it is not possible to carry out the assessment at the time of identification. Tasks are given a priority for assessment and a timeframe and responsibility allocated.

In order for a manual task to pose a risk of injury a direct risk factor must be present:

• force e.g. high, jerky, sudden

• posture e.g. awkward, sustained

• time e.g. prolonged, repetitive.

Direct risks factors will be examined in more detail during step 2, assessing the risk with existing controls.

Step 2: Assess the risk with existing controlsThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) states that any identified hazardous patient handling task must be assessed to determine whether the task poses a risk of musculoskeletal disorders and the source of the risk.

Assessing patient handling hazards must be undertaken using a team approach.

The FURAT has been designed to incorporate risk assessment of the hazards identified at facility or unit level.

The Manual task risk management worksheet has been designed to incorporate risk assessment of a single patient handling task.

19



The aim of the risk assessment is to:

1. determine the likelihood of the patient handling task causing musculoskeletal disorders in workers, and

2. the likely severity of those musculoskeletal disorders, should they occur.

Risk assessment involves two components:

1. analysing the risk factors that are known to cause injury (direct risk factors)

2. identifying the source/s of the direct risk factors (contributory risk factors).

Diagram 2.2 below illustrates the interaction of direct and contributory risk factors for manual tasks.

Diagram 2.2 Direct and contributory risk factors – manual tasks (including patient handling)

Contributory risk factors

Individual or team factors

Task factors

Workplace factors

Work organisational

factors

Nature/characteristics of the hazard

Posture

Time

Direct risk factors

Force

Direct risk factors (posture, force and time)There is a risk of musculoskeletal disorder when a patient handling task involves:

• repetitive or sustained postures, movements or forces and/or

• long duration and/or

• high force.

Refer to Part B, Section 2 of this guideline for more information about how to assess direct risk factors.


Contributory risk factorsDetermine the source of direct risk by analysing contributory risk factors. The contributory risk factors are those which are known to either cause or contribute to the level of risk including:

• workplace factors (including work area design/layout; tools and equipment; work environment)

• nature or characteristics of the hazard (including the nature/characteristics of the person or items being handled)

• task factors (including work practices; job design; methods of work)

• work organisational factors (e.g. staffing levels; workloads; workplace culture)

• individual or team factors (e.g. skills and experience; worker age).

Refer to Part B, Section 2 of this better practice guideline for detailed information about howto assess contributory risk factors and examples.

Step 3: Decide appropriate additional controlsThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) states that once it has been assessed that a risk of injury exists, control measures must be implemented to eliminate the risk, or if this is not practicable, to minimise the risk to the lowest level that is reasonably practicable.

The FURAT has been designed to incorporate risk control of the hazards identified at facility/unit level.

The Manual task risk management worksheet has been designed to incorporate risk control of a single patient handling task.

The purpose of risk control is to alter the source of the risk (contributory risk factors). Effective risk control results in elimination or minimisation of exposure to direct risk factors during patient handling tasks. As a result, the risk that workers who perform the patient handling task/s will sustain a musculoskeletal disorder is eliminated or minimised.

Risk control is to be carried out according to the hierarchy of risk control. Queensland Health Work Practice Directive Hierarchy of Controls (OHSMS 1-18#21) details a standardised description and definition of the hierarchy of controls. The generally accepted hierarchy of controls is as follows:

1. eliminate the hazard

2. substitute the hazard

3. redesign the hazard/isolate the hazard (engineering)

4. administrative controls

5. personal protective equipment (PPE).

The hierarchy highlights the use of the most effective controls and combinations for workplace hazards. Less effective controls (such as administrative and PPE) are only used when it is not reasonably practicable to use controls further up the hierarchy, or as a secondary control to support the primary controls.

Refer to Part B, Section 2 of this better practice guideline for more information about how to apply the hierarchy of control to patient handling activities, with examples provided. Not all items in the hierarchy are applicable to patient handling activities, e.g. PPE.

Refer to Part B, Section 2 of this better practice guideline for more detailed guidance about designing and selecting risk controls, including:

• elimination

• design/alter the work area/environment

• design/alter the task/job

• design/alter furnishings/fixtures

• provide appropriate mechanical and nonmechanical aids

• safe work procedures

• patient handling training and awareness

• patient risk assessment, education and assistance.

21



Step 4: Implement the agreed control measuresThe FURAT has been designed to specify the means to implement risk control at facility/unit level.

The Manual task risk management worksheet has been designed to specify the means of risk control of a single patient handling task.

Implementation is to be:

• defined in accountability and responsibility

• consultative

• to a timeframe

• communicated

• documented.

The person responsible must have the necessary capacity and authority to facilitate implementation of the agreed controls.

Step 5: Monitor and review the effectiveness of the controlsThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) states that monitoring and review of the controls should be completed on an ongoing basis to ensure:

• the controls have been implemented

• they continue to eliminate or minimise the risk of musculoskeletal disorders as far as reasonably practicable

• they do not result in new hazardous patient handling tasks.

The FURAT has been designed to monitor and review the risk control of the hazards identified at facility/unit level. The FURAT is to be reviewed at least annually.

The Manual task risk management worksheet has been designed to incorporate monitoring and review of risk control of a single patient handling task. Complete the evaluation column of the risk control worksheet.

How to evaluate risk controls1. Check the risk control plan to see if all the planned actions have been completed.

2. Make sure the risk controls are working as expected and are being used properly and when needed.

3. Decide whether the risk factors have been eliminated or controlled as intended.

4. Make sure the changes have not caused another problem or risk.

5. Conduct a further risk assessment if the task or environment has changed.

6. Complete the evaluation columns of the risk control plan as a record.

DocumentationThe FURAT has been designed to document patient handling risk management at facility/unit level.

The Manual task risk management worksheet has been designed to document risk management of a single patient handling task.

Keep records about identification, assessment, control and monitoring activities. Documentation assists with:

• demonstrating the necessary steps have been undertaken to fulfil statutory and organisational obligations to provide safe systems of work for patient handling

• monitoring and planning to keep track of what has been and needs to be done

• continuity when personnel change

• recording previous changes, the rationale for which may be questioned in later years.

All documentation should be kept accessible in the local work areas for as long as it remains relevant. A copy is provided to the local OHS Unit. Escalation or summarised information about patient handling risks is to be recorded in the accountability area risk register (QHRisk).


1 of

1

Janu

ary

2009

Ver

sion

2 –

App

rove

d fo

r Rel

ease

Th

ink

Smar

t Pat

ient

Han

dlin

g B

ette

r Pra

ctic

e G

uide

lines

2nd

Edi

tion

Faci

lity/

unit

risk

ass

essm

ent t

ool (

FUR

AT)

Occ

upat

iona

l Hea

lth a

nd W

orkp

lace

Saf

ety

Uni

t (H

ealth

care

Erg

onom

ics)

O

HSM

S 2-

65-1

#38

Purp

ose

of th

e FU

RAT

:•

The

tool

ena

bles

wor

k ar

eas

to e

asily

con

duct

and

reco

rd p

atie

nt h

andl

ing

risk

man

agem

ent a

t fac

ility

/uni

t lev

el in

acc

orda

nce

w

ith

the

man

dato

ry re

quire

men

ts o

f the

Que

ensl

and

Hea

lth O

ccup

atio

nal H

ealth

and

Saf

ety

Man

agem

ent S

yste

m, P

atie

nt H

andl

ing

Task

s Ri

sk A

sses

smen

t Wor

k Pr

actic

e D

irect

ive

(OH

SMS

2-65

#38)

and

the

Pati

ent H

andl

ing

Task

s Im

plem

enta

tion

Sta

ndar

d (O

HS

MS

2-2

2#21

).

• To

ens

ure

a co

nsis

tent

app

licat

ion

of p

atie

nt h

andl

ing

faci

lity/

unit

risk

ass

essm

ent m

etho

dolo

gy a

cros

s Q

ueen

slan

d H

ealth

.

• Th

e FU

RAT

is th

e m

anda

tory

tool

to s

uppo

rt p

atie

nt h

andl

ing

risk

man

agem

ent a

t fac

ility

/uni

t lev

el w

ithi

n Q

ueen

slan

d H

ealth

.

Who

is re

spon

sibl

e fo

r com

plet

ing

the

FUR

AT?

• Th

e FU

RAT

sho

uld

be c

ompl

eted

by

the

rele

vant

faci

lity/

unit

man

ager

, in

colla

bora

tion

wit

h ot

her k

ey p

erso

nnel

incl

udin

g: th

e lo

cal

patie

nt h

andl

ing

co-c

oord

inat

or, l

ead

and

war

d/un

it pa

tient

han

dlin

g tr

aine

r/s,

occ

upat

iona

l hea

lth a

nd s

afet

y (O

HS)

pra

ctit

ione

rs

(inc

ludi

ng th

e di

stri

ct/i

nter

-dis

tric

t erg

onom

ic c

oord

inat

or) a

nd O

HS

repr

esen

tati

ves.

• Th

e di

stri

ct O

HS

man

ager

(or d

eleg

ate)

is re

spon

sibl

e fo

r ass

istin

g, p

rom

otin

g an

d ed

ucat

ing

man

ager

s in

the

use

of th

e FU

RAT

.

Doc

umen

tati

on a

nd c

omm

unic

atio

n re

quir

emen

ts:

• Th

e fin

ding

s an

d re

com

men

datio

ns fr

om th

e FU

RAT

sho

uld

be c

olla

ted

by O

HS

and/

or d

ivis

iona

l rep

rese

ntat

ives

and

repo

rted

th

roug

h di

stri

ct O

HS

com

mit

tee

stru

ctur

es fo

r the

att

entio

n of

resp

onsi

ble

offic

ers.

For e

xam

ple:

–

a co

py o

f the

con

trol

pla

n m

ay b

e fo

rwar

ded

to d

ivis

iona

l or d

istr

ict O

HS

com

mit

tees

–

findi

ngs/

plan

s/ou

tcom

es m

ay b

e do

cum

ente

d in

the

min

utes

from

uni

t/w

ard/

depa

rtm

ent m

eetin

gs

–

file

a co

py lo

cally

at t

he fa

cilit

y/un

it an

d ce

ntra

lly a

t the

OH

S U

nit.

How

oft

en a

re fa

cilit

y/un

it ri

sk a

sses

smen

ts c

ompl

eted

?•

The

FUR

AT m

ust b

e re

view

ed a

nnua

lly, o

r fol

low

ing

a si

gnifi

cant

inci

dent

or c

hang

e in

the

oper

atio

nal e

nviro

nmen

t or a

ctiv

itie

s,

whi

chev

er is

soo

ner

• Th

e FU

RAT

mus

t be

fully

re-a

sses

sed

at le

ast e

very

thre

e (3

) yea

rs.

Doc

umen

t con

trol

:•

Occ

upat

iona

l Hea

lth a

nd S

afet

y M

anag

emen

t Sys

tem

: Doc

umen

t Ind

ex N

o. O

HSM

S 2-

65-1

#38

• Ve

rsio

n 2

– Ja

nuar

y 20

09

Revi

ew: J

anua

ry 2

012

Wor

ked

exam

ples

of t

he F

UR

AT s

ectio

ns c

an b

e fo

und

in th

e FU

RAT

Use

r Gui

de, l

ocat

ed a

t htt

p://

qhep

s.he

alth

.qld

.gov

.au/

safe

ty/


Access a copy of the FURAT User Guide here.

Appendix 2.1

FURAT (Facility/Unit Risk Assessment Tool)

http://qheps.health.qld.gov.au/safety/

http://qheps.health.qld.gov.au/safety/



Des

crib

e th

e m

anua

l tas

k an

d as

sess

men

t as

sum

ptio

ns (e

.g. s

hift

typ

e; a

vera

ge

pati

ent p

rofil

e an

d ab

iliti

es; i

tem

ch

arac

teri

stic

s; e

nvir

onm

enta

l con

diti

ons;

w

orkl

oad

):

Nam

e an

d ti

tle

of p

erso

n/s

com

plet

ing

asse

ssm

ent:

Dat

e of

ass

essm

ent:

Nam

e an

d ti

tle

of p

erso

n/s

cons

ulte

d du

ring

ass

essm

ent:

Loca

tion

of t

ask:

Prio

rity

for a

sses

smen

t (l

ow, m

ediu

m, h

igh)

:

Reas

on fo

r ass

essm

ent:

If th

e m

anua

l tas

k is

com

plex

, bre

ak it

into

sub

-tas

ks. O

nly

do th

is if

it w

ill m

ake

the

asse

ssm

ent p

roce

ss e

asie

r. If

ther

e is

onl

y on

e m

ain

task

, the

task

bec

omes

sub

-tas

k 1.

Li

st s

ub-t

asks

in th

e ta

ble

belo

w. F

or e

ach

sub

-tas

k, p

lace

a ti

ck in

the

colu

mn

that

is th

e be

st e

stim

ate

of th

e ta

sk fr

eque

ncy,

in a

vera

ge c

ondi

tions

.

Sub

-tas

k

No.

Sub

-tas

k na

me

and

desc

ript

ion

Perc

enta

ge o

f typ

ical

wor

k da

y/sh

ift

spen

t doi

ng th

e ta

sk/s

ub-t

ask

Cons

tant

67–1

00%

Freq

uent

34–

66%

Occ

asio

nal

8–3

3%Ra

re0

–7%

1. 2. 3. 4. 5.

Des

crib

e th

e m

anua

l tas

k an

d as

sess

men

t as

sum

ptio

ns (e

.g. s

hift

typ

e; a

vera

ge

pati

ent p

rofil

e an

d ab

iliti

es; i

tem

ch

arac

teri

stic

s; e

nvir

onm

enta

l con

diti

ons;

w

orkl

oad

):

Bar

iatr

ic p

atie

nt a

dmit

ted

to w

ard

2A

with

recu

rren

t uri

nary

trac

t inf

ectio

ns a

nd le

g ul

cers

.

Patie

nt p

rofil

e: 6

0yo

fem

ale,

hei

ght=

155c

m, w

eigh

t=21

0kg

; ver

y oe

dem

atou

s le

gs w

ith p

oor s

kin

inte

grit

y. P

atie

nt is

com

mun

icat

ive

and

follo

ws

inst

ruct

ions

; pat

ient

usu

ally

m

obili

ses

with

a w

alki

ng fr

ame

but h

as a

his

tory

of r

ecen

t fal

ls a

t hom

e.

At t

he ti

me

of th

is a

dmis

sion

, the

hos

pita

l did

not

hav

e a

larg

e pa

tient

man

agem

ent p

lan:

the

hosp

ital h

ad o

nly

limite

d la

rge

patie

nt e

quip

men

t and

no

desi

gnat

ed b

aria

tric

pa

tient

room

s. S

taff

had

not

rece

ived

any

spe

cific

trai

ning

in p

atie

nt h

andl

ing

for b

aria

tric

pat

ient

s. P

atie

nt a

dmit

ted

to a

2-b

ed s

hare

d ro

om.

Man

ual t

ask

risk

ass

essm

ent c

ompl

eted

for t

he a

ctiv

ity

of a

ssis

ting

a ba

riat

ric

patie

nt in

/out

of b

ed (i

n pr

epar

atio

n fo

r sho

wer

/hyg

iene

on

a m

obile

sho

wer

cha

ir p

ositi

oned

be

side

the

bed

).

Nam

e an

d ti

tle

of p

erso

n/s

com

plet

ing

asse

ssm

ent:

P B

lack

(OH

S Pr

actit

ione

r), R

Bro

wne

(NU

M)

Dat

e of

ass

essm

ent:

1st –

8th

June

20

09

Nam

e an

d ti

tle

of p

erso

n/s

cons

ulte

d du

ring

ass

essm

ent:

B T

rain

er (

War

d/U

nit T

rain

er)

B T

all (

Nur

se)

Loca

tion

of t

ask:

War

d 2

A (a

cute

med

ical

): 2

-bed

bay

adj

acen

t to

nurs

es s

tatio

n

Prio

rity

for a

sses

smen

t (l

ow, m

ediu

m, h

igh)

:H

igh

Reas

on fo

r ass

essm

ent:

Dur

ing

the

first

wee

k of

the

patie

nt’s

adm

issi

on, 4

wor

kers

sub

mit

ted

inci

dent

repo

rts

asso

ciat

ed w

ith p

rovi

ding

car

e to

this

pat

ient

. One

of t

hese

resu

lted

in

a w

orke

r req

uiri

ng >

4 da

ys o

ff w

ork

with

a b

ack

inju

ry: w

orke

r had

exp

erie

nced

a tw

inge

in th

eir l

ower

bac

k af

ter a

ssis

ting

to li

ft p

atie

nt’s

legs

into

bed

.

If th

e m

anua

l tas

k is

com

plex

, bre

ak it

into

sub

-tas

ks. O

nly

do th

is if

it w

ill m

ake

the

asse

ssm

ent p

roce

ss e

asie

r. If

ther

e is

onl

y on

e m

ain

task

, the

task

bec

omes

sub

-tas

k 1.

Li

st s

ub-t

asks

in th

e ta

ble

belo

w. F

or e

ach

sub

-tas

k, p

lace

a ti

ck in

the

colu

mn

that

is th

e be

st e

stim

ate

of th

e ta

sk fr

eque

ncy,

in a

vera

ge c

ondi

tions

.

Sub

-tas

k

No.

Sub

-tas

k na

me

and

desc

ript

ion

Perc

enta

ge o

f typ

ical

wor

k da

y/sh

ift

spen

t doi

ng th

e ta

sk/s

ub-t

ask

Cons

tant

67–1

00%

Freq

uent

34–

66%

Occ

asio

nal

8–3

3%Ra

re0

–7%

1.A

ssis

ting

patie

nt to

mov

e fr

om ly

ing

to s

ittin

g on

the

edge

of t

he b

ed (

by ra

isin

g th

e ba

ck o

f the

bed

; 3–

4 w

orke

r ass

ist;

ass

ist t

o sl

ide

patie

nt’s

legs

ove

r ed

ge o

f bed

).

2.

Ass

istin

g pa

tient

to m

ove

from

sit

ting

to s

tand

ing

from

bed

(pat

ient

pus

hes

self

into

sta

ndin

g; a

ssis

tanc

e to

pos

ition

wal

king

aid

and

to s

tead

y pa

tient

in

sta

ndin

g).

3.A

ssis

ting

patie

nt to

ste

p ar

ound

and

mov

e on

/off

the

mob

ile s

how

er c

hair.

4.A

ssis

ting

patie

nt b

ack

to b

ed: s

tand

ing

to s

ittin

g on

edg

e of

bed

.

5.A

ssis

ting

to li

ft p

atie

nt’s

legs

bac

k in

to b

ed.

1 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Man

ual t

ask

risk

man

agem

ent w

orks

heet



Manual task risk management worksheet


For e

ach

sub

-tas

k, c

ompl

ete

the

risk

ass

essm

ent b

elow

. Ana

lyse

the

sub

-tas

ks a

nd w

rite

rele

vant

info

rmat

ion

abou

t the

sub

-tas

k re

quire

men

ts a

nd ri

sk fa

ctor

s in

the

cells

bel

ow. L

eave

the

cell

blan

k w

hen

ther

e is

no

rele

vant

info

rmat

ion

to re

cord

. You

sho

uld

refe

r to

the

Thin

k S

mar

t pat

ient

han

dlin

g be

tter

pra

ctic

e gu

idel

ines

, Par

t B, S

ectio

n 2,

man

agin

g pa

tien

t han

dlin

g ri

sk fo

r mor

e in

form

atio

n ab

out r

isk

fact

ors

and

asse

ssm

ent.

Risk

ass

essm

ent

Sub

-tas

k N

o.D

irec

t ris

k fa

ctor

sCo

ntri

buto

ry ri

sk fa

ctor

s

Forc

ePo

stur

eTi

me

Wor

kpla

ce fa

ctor

s (i

ncl.t

ools

and

eq

uipm

ent;

wor

k en

viro

nmen

t; w

ork

ar

ea d

esig

n la

yout

)

Nat

ure/

ch

arac

teri

stic

of

the

haza

rd(i

ncl.

natu

re o

f per

son

or it

ems

bein

g ha

ndle

d)

Task

fact

ors

(inc

l. w

ork

prac

tices

an

d sy

stem

s)

Team

or i

ndiv

idua

l fa

ctor

s(e

.g. s

kills

and

ex

peri

ence

)

Wor

k or

gani

sati

onal

fa

ctor

s (e

.g. w

orkl

oads

; av

aila

ble

reso

urce

s)

For e

ach

sub

-tas

k, c

ompl

ete

the

risk

ass

essm

ent b

elow

. Ana

lyse

the

sub

-tas

ks a

nd w

rite

rele

vant

info

rmat

ion

abou

t the

sub

-tas

k re

quire

men

ts a

nd ri

sk fa

ctor

s in

the

cells

bel

ow. L

eave

the

cell

blan

k w

hen

ther

e is

no

rele

vant

info

rmat

ion

to re

cord

. You

sho

uld

refe

r to

the

Thin

k S

mar

t pat

ient

han

dlin

g be

tter

pra

ctic

e gu

idel

ines

, Par

t B, S

ectio

n 2,

man

agin

g pa

tien

t han

dlin

g ri

sk fo

r mor

e in

form

atio

n ab

out r

isk

fact

ors

and

asse

ssm

ent.

Risk

ass

essm

ent

Sub

-tas

k N

o.D

irec

t ris

k fa

ctor

sCo

ntri

buto

ry ri

sk fa

ctor

s

Forc

ePo

stur

eTi

me

Wor

kpla

ce fa

ctor

s (i

ncl.t

ools

and

eq

uipm

ent;

wor

k en

viro

nmen

t; w

ork

ar

ea d

esig

n la

yout

)

Nat

ure/

ch

arac

teri

stic

of

the

haza

rd(i

ncl.

natu

re o

f per

son

or it

ems

bein

g ha

ndle

d)

Task

fact

ors

(inc

l. w

ork

prac

tices

an

d sy

stem

s)

Team

or i

ndiv

idua

l fa

ctor

s(e

.g. s

kills

and

ex

peri

ence

)

Wor

k or

gani

sati

onal

fa

ctor

s (e

.g. w

orkl

oads

; av

aila

ble

reso

urce

s)

1

Hig

h fo

rces

(sho

ulde

r an

d ba

ck) a

ssis

ting

to

slid

e pa

tient

’s le

gs o

ver

edge

of b

ed.

Sust

aine

d ho

lds

of

heav

y pa

tient

legs

whe

n as

sist

ing

to

mov

e/lo

wer

to fl

oor.

Aw

kwar

d w

orki

ng

post

ures

: for

war

d ov

er-r

each

ing

of

heav

y pa

tient

legs

w

hile

ass

istin

g to

slid

e le

gs o

ver b

ed e

dge;

be

ndin

g to

low

er

patie

nt’s

legs

to fl

oor.

Lim

ited

spac

e be

side

be

d fo

r 2 w

orke

rs to

co

mfo

rtab

ly p

ositi

on

selv

es to

ass

ist w

ith

task

.

Una

ble

to u

se h

oist

to

mov

e pa

tient

from

be

d to

sho

wer

cha

ir a

s th

e on

ly la

rge

patie

nt

hois

t in

the

hosp

ital

(SW

L=23

0kg

) doe

s no

t fit

und

er th

e pa

tient

’s

bed

.

Patie

nt c

hara

cter

istic

s:

wei

ght=

210

kg, e

ach

leg

estim

ated

to w

eigh

ap

prox

. 55k

g, p

atie

nt’s

w

eigh

t dis

trib

utio

n is

la

rgel

y be

low

wai

st

– v

ery

diffi

cult

for

patie

nt to

lift

ow

n le

gs;

patie

nt’s

legs

hav

e po

or s

kin

inte

grit

y an

d ar

e pa

infu

l to

touc

h/m

ove.

Patie

nt d

eman

ding

to

have

a s

how

er d

urin

g th

e m

orni

ng s

hift

: w

orke

rs fe

lt pr

essu

red

to m

eet t

his

requ

est

with

out w

aitin

g fo

r th

e ph

ysio

to c

ome

and

asse

ss o

ptio

ns

fully

. Dec

isio

n m

ade

by n

ursi

ng te

am to

as

sist

pat

ient

ont

o a

show

er c

omm

ode

chai

r for

sho

wer

ing

, an

d to

enl

ist t

he h

elp

of 2

str

ong

mal

e w

ard

sman

.

Initi

al p

atie

nt h

andl

ing

asse

ssm

ent o

f the

pa

tient

did

not

incl

ude

a ph

ysic

al s

cree

n of

pa

tient

abi

litie

s.

Wor

kers

hav

e re

ceiv

ed

no p

rior

trai

ning

in

cari

ng fo

r/ha

ndlin

g

a ba

riat

ric

patie

nt.

Mos

t of t

he n

urse

s

on th

is w

ard

are

aged

ov

er 4

5 ye

ars;

a fe

w

have

pre

-exi

stin

g kn

ee

inju

ries

and

are

una

ble

to p

erfo

rm ta

sks

invo

lvin

g sq

uatt

ing/

knee

ling.

Cari

ng fo

r a b

aria

tric

pa

tient

is v

ery

phys

ical

ly d

eman

ding

on

indi

vidu

al w

orke

rs,

and

reso

urce

inte

nse

for t

he w

ard

(due

to

the

num

ber o

f w

orke

rs n

eedi

ng to

be

allo

cate

d to

ass

ist w

ith

patie

nt c

ares

).

As

a co

nseq

uenc

e of

spe

ndin

g lo

nger

as

sist

ing

the

bari

atri

c pa

tient

, wor

kers

ha

ving

to w

ork

quic

kly

thro

ugh

care

task

s w

ith o

ther

pat

ient

s

on th

e w

ard

.

2 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Man

ual t

ask

risk

man

agem

ent w

orks

heet

Ri

sk c

ontr

ol w

orks

heet



Manual task risk management worksheet continued…



1 O

ccup

atio

nal H

ealt

h an

d W

orkp

lace

Saf

ety

Uni

t (O

HW

SU

). 20

08, ‘

Que

ensl

and

Hea

lth

Wor

k Pr

acti

ce D

irec

tive

: Hie

rarc

hy o

f Con

trol

s’ (O

HS

MS

1-18

#21)

[doc

umen

t on

intr

anet

]. Q

HEP

S: Q

ueen

slan

d H

ealt

h.

Ava

ilabl

e fr

om: h

ttp:

//qh

eps.

heal

th.q

ld.g

ov.a

u/sa

fety

/com

mun

icat

ions

/cir

cula

rs/o

hs_0

8_3

5.pd

f

The

tabl

e be

low

des

crib

es th

e hi

erar

chy

of c

ontr

ol m

easu

res,

wit

h ex

ampl

es a

pplic

able

to m

anua

l tas

ks1 . U

se th

is ta

ble

as a

refe

renc

e w

hen

com

plet

ing

the

Risk

Con

trol

tabl

e.

Effe

ctiv

enes

sH

iera

rchy

No.

Type

of c

ontr

ol m

easu

reEx

ampl

e of

con

trol

mea

sure

s

Mos

t ef

fect

ive

1El

imin

ate

the

haza

rdTh

is is

the

mos

t des

irab

le c

ontr

ol m

easu

re a

s it

cont

rols

the

haza

rd a

t the

sou

rce.

Oth

er c

ontr

ols

shou

ld o

nly

be c

onsi

dere

d if

the

haza

rd c

anno

t be

elim

inat

ed.

• El

imin

ate

the

task

• El

imin

ate

the

dire

ct ri

sk fa

ctor

/s

• El

imin

ate

the

need

for t

he ta

sk to

be

perf

orm

edby

any

per

son.

2S

ubst

itut

e th

e ha

zard

Invo

lves

repl

acin

g th

e ha

zard

ous

mat

eria

l and

/or p

roce

ss w

ith

a le

ss h

azar

dous

alte

rnat

ive.

• N

ot a

pplic

able

to p

atie

nt h

andl

ing

• Su

bsti

tute

pro

duct

sup

plie

d as

a h

eavy

aw

kwar

d lo

ad fo

r pr

oduc

t sup

plie

d in

sm

alle

r, ea

sy-t

o-ha

ndle

pac

kagi

ng.

3Re

desi

gn th

e ha

zard

/iso

late

the

haza

rd (e

ngin

eeri

ng)

Invo

lves

cha

ngin

g th

e ph

ysic

al c

hara

cter

istic

s or

des

ign

of th

e ha

zard

ous

mat

eria

l and

/or p

roce

ss.

This

can

invo

lve

mod

ifyi

ng e

quip

men

t, c

ombi

ning

task

s an

d/or

rear

rang

ing

wor

k pr

oces

ses

or

inte

rrup

ting

the

path

bet

wee

n th

e w

orke

r and

the

haza

rd o

r the

haz

ard

and

the

wor

ker.

• D

esig

n th

e ta

sk/j

ob

• D

esig

n/al

ter t

he w

ork

area

/env

ironm

ent

• D

esig

n/al

ter f

urni

shin

gs/fi

xtur

es

• Pr

ovid

e ap

prop

riat

e m

echa

nica

l and

non

-mec

hani

cal a

ids.

4Ad

min

istr

ativ

e co

ntro

lsCo

ntro

l exp

osur

e to

haz

ards

thro

ugh

use

of p

olic

ies,

pro

cedu

res,

sig

ns a

nd/o

r tra

inin

g.•

Saf

e w

ork

proc

edur

es

• Ta

sk/e

quip

men

t spe

cific

trai

ning

• M

aint

enan

ce o

f equ

ipm

ent

• Co

mpl

ianc

e m

onito

ring

• W

ear a

ppro

pria

te c

loth

ing

and

foot

wea

r.

Leas

t ef

fect

ive

5Pe

rson

al p

rote

ctiv

e eq

uipm

ent

Use

of e

quip

men

t, c

loth

ing

and/

or s

ubst

ance

s de

sign

ed to

cre

ate

a pr

otec

tive

bar

rier

bet

wee

n

the

wor

ker a

nd th

e ha

zard

.

• N

ot a

pplic

able

to p

atie

nt h

andl

ing

• A

nti v

ibra

tion

glov

es.

3 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Man

ual t

ask

risk

man

agem

ent w

orks

heet

Ri

sk c

ontr

ol w

orks

heet





Use

the

hier

arch

y of

con

trol

s as

a re

fere

nce

whe

n co

mpl

etin

g th

is ri

sk c

ontr

ol ta

ble.

Wri

te e

xist

ing

cont

rols

and

all

cont

rols

you

will

con

side

r in

the

tabl

e.

This

will

hel

p yo

u de

cide

whi

ch c

ontr

ols

to tr

ial a

nd im

plem

ent i

n th

e w

orkp

lace

. Wri

te c

omm

ents

suc

h as

why

a c

ontr

ol is

not

reas

onab

ly p

ract

icab

le in

the

spac

e pr

ovid

ed.

Whe

n th

e di

rect

risk

fact

ors

cann

ot b

e el

imin

ated

(hie

rarc

hy n

umbe

r 1) i

t is

very

com

mon

to c

ontr

ol th

e ri

sk u

sing

a c

ombi

natio

n of

con

trol

s of

oth

er ty

pes

(hie

rarc

hy n

umbe

rs 2

, 3 o

r 4)

to c

hang

e th

e co

ntri

buto

ry ri

sk fa

ctor

s, w

hich

then

min

imis

e th

e di

rect

risk

fact

ors.

Risk

con

trol

S

ub-t

ask

No.

Cont

rols

alr

eady

in p

lace

Hie

rarc

hy

No.

Oth

er c

ontr

ols

to b

e co

nsid

ered

Hie

rarc

hy

No.

Com

men

ts

Use

the

hier

arch

y of

con

trol

s as

a re

fere

nce

whe

n co

mpl

etin

g th

is ri

sk c

ontr

ol ta

ble.

Wri

te e

xist

ing

cont

rols

and

all

cont

rols

you

will

con

side

r in

the

tabl

e.

This

will

hel

p yo

u de

cide

whi

ch c

ontr

ols

to tr

ial a

nd im

plem

ent i

n th

e w

orkp

lace

. Wri

te c

omm

ents

suc

h as

why

a c

ontr

ol is

not

reas

onab

ly p

ract

icab

le in

the

spac

e pr

ovid

ed.

Whe

n th

e di

rect

risk

fact

ors

cann

ot b

e el

imin

ated

(hie

rarc

hy n

umbe

r 1) i

t is

very

com

mon

to c

ontr

ol th

e ri

sk u

sing

a c

ombi

natio

n of

con

trol

s of

oth

er ty

pes

(hie

rarc

hy n

umbe

rs 2

, 3 o

r 4)

to c

hang

e th

e co

ntri

buto

ry ri

sk fa

ctor

s, w

hich

then

min

imis

e th

e di

rect

risk

fact

ors.

Risk

con

trol

S

ub-t

ask

No.

Cont

rols

alr

eady

in p

lace

Hie

rarc

hy

No.

Oth

er c

ontr

ols

to b

e co

nsid

ered

Hie

rarc

hy

No.

Com

men

ts

1–5

Elec

tric

bed

(hi

-lo,

bar

iatr

ic b

ed).

1. E

limin

ate

the

task

of m

anua

lly li

ftin

g pa

tient

’s le

gs in

/out

bed

by:

• in

the

long

term

, pur

chas

e of

an

adju

stab

le b

aria

tric

str

etch

er c

hair

• in

the

shor

t ter

m, p

atie

nt to

be

care

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Musculoskeletal discomfort survey1

Occupational Health and Workplace Safety Unit (Healthcare Ergonomics)The purpose of this survey is to gather information about work related musculoskeletal discomfort. This includes information about how common it is, what body areas are most affected, what work tasks might be related to it and how much the problem affects you. This information can then be used to target your work area’s problematic tasks for improvement. You do not have to put your name on the survey. If you do, the person who is conducting the survey might contact you to get more information, if they need it.

Date completed:

Work area details

Hospital facility: Ward/department/unit:

Worker details

Name (optional): Position title:

Usual hours worked per week: Shift worker: Yes No

Length of time in this position and work area: Length of time in your occupation:

Musculoskeletal is a technical term that brings together parts of the body like muscles, joints, cartilage, tendons, ligaments, nerves and bones.

Discomfort means symptoms like pain, ache, swelling, heat, tiredness, pins and needles, or numbness.

1. Have you had pain or discomfort during the past 12 months that you feel is work related?

Yes. Please continue. No. Your survey is completed, please return it.

2. If Yes, please rate the level of discomfort for each body part shown in the diagram below. Rate your level of discomfort over the last month by writing a number between or including 0 and 10 using the following scale:

1050

the worst discomfort ever experiencedno discomfort

______/10 Neck

______/10 Left shoulder

______/10 Left elbow/forearm

______/10 Left wrist/hand

______/10 Left hip/thigh/buttock

______/10 Left knee

______/10 Left ankle

Upper back ______/10

Right shoulder ______/10

Right elbow/forearm ______/10

Lower back ______/10

Right wrist/hand ______/10

Right hip/thigh/buttock ______/10

Right knee ______/10

Right ankle ______/10

1 Adapted from Occupational Health and Safety Council of Ontario (OHSCO). Resource Manual for the Musculoskeletal Disorders (MSD) Prevention Guideline for Ontario Part. [document on internet] Toronto, Ontario: OHSCO; 2008. Available from http://www.wsib.on.ca/wsib/wsibsite.nsf/public/PreventMSD

21/06/09

Forestville Hospital

Jane Bark Enrolled Nurse

36

4 years 8 years

Ward 3A

4

4

0

0

0

2

0

4

4

0

7

0

0

4

0




29




3. What do you consider to be your main area of discomfort?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

4. Do you consider your discomfort to be a problem? (e.g. you consider that it impacts on your work or home life activities and/or your general wellbeing)

Yes No

5. Have you received treatment from a health care practitioner for your discomfort in the last 12 months? (e.g. doctor, physiotherapist, chiropractor)

Yes No

6. Have you taken time off in the past 12 months because of your discomfort? (e.g. holidays, sick leave, workers compensation)

Yes No

7. When did you notice your main area of discomfort?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

8. What do you think caused this discomfort?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

9. Have you made changes to your work to reduce your discomfort?

Yes No

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

10. What changes in the workplace do you think would help to reduce your discomfort?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________


Thank you for your time and participation. The results of this survey will be collated and de-identified results presented at the staff meeting.

Lower back.

End of the shift and the day following a busy day.

Assisting patients complete transfers (sit to stand from the bed and onto the toilet). I am frequently rostered on to work with the heavier

patients. Awkward postures, rushing movements to get the job done quickly. It feels like we never have enough staff. This is potentially related

to how our work is organised e.g. feedback, allocation of staff to certain areas, discretion over tasks. Lifting weights that are too heavy (such as

overfilled linen bags; boxes of supplies). Long standing periods on feet.

• team review of the work procedures used for transferring patients in our ward.

• more access to the standing hoist which we have to share between our floor at present.

• increase the number of staff rostered to assist in patient handling tasks.

• review of bed allocations so that the heavier/dependent patients are shared more between staff.

• review job design for team.

I actively encourage the patient to assist where possible with the transfer. I have also modified my shoes to increase comfort.



Musculoskeletal discomfort survey continued…


31

Managing risk in specific areasSection 3

This section will provide information about managing risk in specific areas.You should refer to Part B, Section 3 of this better practice guideline for detailed information about the

identification of patient handling risks and potential control solutions for a variety of specific areas.

OverviewSome work areas and services have unique patient handling risk factors (e.g. removing unconscious patients from a vehicle in the emergency department or inserting x-ray cassettes under patients in radiology). The risk management approach described in Section 2 is still used to identify, assess and control the patient handling risks.

Relevant legislation and Queensland Health policies• Queensland Health Integrated Risk

Management Policy (13355)




ResponsibilitiesManagers should decide how they will manage the specific work area risks associated with patient handling activities in their specific area. This includes consulting with workers when identifying unique patient handling risk factors, undertaking appropriate risk assessment and developing, implementing, reviewing and monitoring risk controls.

The risk management processManagers should review the most recent FURAT. The FURAT is very useful when identifying and recording patient handling activities, patient profiles and environments contributing to hazardous patient handling tasks within a specific work area or service.

Managers should use available sources of work area specific guidance when assessing risk and deciding how to eliminate or control risk. Consultation and collaboration with similar areas in other districts/states is also a useful way to gather information about controls for your work area.

Available information to support the processInformation sheets have been developed for specific areas to assist with the identification of patient handling risks and potential control solutions.

Information sheets are available for the following specific areas:

• aged care • emergency departments

• bariatric patients • emergency situations

• critical care • mental health

• community • mortuary/deceased patients

• diagnostic imaging • paediatrics.

Use this information when developing and evaluating risk controls for these areas using the risk management process described in Section 2.

Where do I find more information?a. The information sheets for the specific areas identified above are located in Part B.

b. You should refer to the existing better practice guidelines for manual handling risks and controls for the:• maternity environment• perioperative environment.

(available from: http://qheps.health.qld.gov.au/safety/)

c. The handling of patients by therapists for the purposes of providing treatment (i.e. therapeutic handling) requires risk assessment of all tasks to ensure the therapist maximises therapeutic benefit for the patient, while minimising the manual handling risk to the worker/s. Performance of these therapeutic patient handling activities requires advanced skills in patient handling and problem solving. This topic is outside the scope of this publication and will be addressed separately.

33

Individual patient handling risk assessment and management

Section 4



Template for district patient handling assessment arrangements

A template is provided, which may be used at district/facility level, to specify and communicate the local arrangements for patient handling assessment to workers.

4.1

This section will provide guidance about how to assess and manage risk associated with patient handling activities, at individual patient level.

You should refer to Section 2 of this better practice guideline for detailed informationabout how to manage patient handling risk in your facility/unit.

OverviewIndividual patient handling assessment is a process which aims to identify and assess risks associated with handling a particular patient. It is integrated into routine nursing practices as part of the overall patient care assessment and documentation.

When completed, documented and kept up to date, patient handling assessment is a risk control.

The assessment will assist workers to determine the safest and most appropriate techniques for assisting, supporting or transferring that particular patient and ensure that risk is not transferred to other workers or persons.

Individual patient handling risk management (identification, assessment, control, monitoring and review) occurs prior to and during handling activities.

Patient handling assessment is an ongoing process which consists of initial assessment, pre-activity screening and re-assessment.

Patients who are not independent in function, on and/or off the bed, need a patient handling plan.

Relevant legislation and Queensland Health policies• Queensland Health Integrated Risk

Management Policy (13355)




ResponsibilitiesAll districts should decide how they will manage risk associated with patient handling activities at the individual patient level, to fulfil their legislative and policy obligations. Responsibilities for particular activities are then delegated to appropriate workers, depending on the scope of their role.

Individual patient handling risk management processPatient handling assessment and planning requires assessment of the physical and non-physical patient factors and other contributory risk factors (environment, equipment and workers). The control of risk arising from individual patient handling activities is complex. Diagram 4.1 illustrates the means by which risk is controlled during the various stages of an individual patient handling assessment and activity. Part of controlling the risk involves specifying the level of involvement of different categories of workers.

Specify the patient handling assessment arrangementsThe standard arrangements for conducting patient handling assessments in your district, facility/unit, should be specified. Districts should consider the advantages of consistent procedures and documentation for workers who work in multiple units/facilities with the district (e.g. agency workers, students, casuals, allied health practitioners, medical officers).

The procedure should detail:

• workers involved and their responsibilities

• time frames for completing the patient handling assessment

• how to record the patient handling assessment and plan

• where the completed patient handling assessments and plans are located

• criteria and process for reviewing the patient handling assessment and plan

• how information about the patient’s handling needs is communicated to all relevant workers (i.e. all workers involved in direct patient care who may assist with the handling of the patient), and to patients and relatives.

It is recommended this information is documented and incorporated with existing district procedures.

Appendix 4.1 provides a worked example for this purpose.

Assess patient needs/abilitiesAs highlighted earlier, individual patient handling assessment is an ongoing risk management process.

In general, patient handling assessment consists of three components:

1. initial patient handling assessment (documented)

2. pre-activity screening, immediately prior to each patient handling activity (often not documented, unless a variance is evident)

3. re-assessment when the patient’s condition or needs change significantly and/or at regular intervals specified by the work area (documented).

The procedures for each of these components will be briefly discussed following and on Page 40.

You should refer to Part B, Section 4 of this better practice guideline and the Think Smart training and assessment program for more detail about conducting individual patient handling assessment.

Individual patient handling assessment is integrated into routine nursing practices as part of the overall patient care assessment. Specific handling needs of the patient are to be documented in the patient’s notes.

35

Section 4Individual patient handling risk assessment and management


Diagram 4.1

Individual patient handling risk management process

i In this better practice guideline, enrolled nurse’s can contribute to initial patient handling assessments by collating data on the patient’s functional status to assist registered nurses and midwives to interpret and develop the patient handling plan.

In some clinical situations other appropriate health professionals contribute to or complete initial patient handling assessments and plans. This will include persons who, within their scope of professional practice, are designated as able to conduct a patient handling assessment and develop a patient handling plan (e.g. physiotherapists, occupational therapists, medical officers).

Individual patient handling risk management process is complete.

Appropriate person to conduct a re-assessment.

Report adverse event or near miss as required.

Note: Step 1 is usually carried out by a registered nurse or midwife on admissioni.

Note: Step 2 is carried out as above and by other health professionals within their scope of practice.

Yes

NoDid the patient handling activity

proceed safely and according to plan?

Notify the appropriate person to review the assessment and plan

and wait for the outcome of this re-assessment; or

Proceed with an alternative patient handling activity with the lowest

risk to workers, and then notify the appropriate person to review the

assessment and plan.

Step 3: Conduct the patient handling activity• Plan the activity

• Gather equipment and workers

• Allocate tasks

• Prepare the patient, workers, equipment and environment

• Communicate with and educate the patient and workers

• Carry out the patient handling activity

• Complete the activity and ‘make safe’ the patient, environment and equipment

• Document the activity if necessary

• Review the activity.

Yes

NoIs the patient handling activity

according to plan and safe to proceed?

Step 2: When a patient handling activity is required• Review patient handling assessment, plan and current medical information

• Conduct pre-activity screening

• Identify current level of patient function, precautions and contraindications.

Step 1: Initial assessment of patient handling needs/mobility• Plan the assessment

• Conduct initial patient handling assessment

• Interpret the assessment and develop patient handling plan in consultation with the patient and others

• Document assessment and patient handling plan

• Communicate patient handling plan

• Review patient handling plan when required.


7B. Document that the assessment was completed and the outcome in the

patient notes/care plan

7A. Document the assessment and a patient handling plan in the patient

notes/care plan

6A. Interpret the assessment6B. Ensure the patient has suitable

equipment and environment to promote independence

5A. Assess the work area, equipmentand assistance available

5B. Scan the environmentto ensure no risks to independence

are present

4B. The patient is independentwith all on and off-bed tasks

4A. The patient is not independentwith all on and off-bed tasks

3. What is the level of dependency for on-bed and off-bed patient handling

activities?

1. Plan/prepare for the assessment

2. Assess patient handling/mobility needs

Initial patient handling assessmentThe initial patient handling assessment is used to establish the level of ability of the patient and what assistance they require to move both on and off the bed, including the techniques, equipment and staffing required and any other environmental considerations. Initial patient handling assessment is carried out by workers with a scope of practice to change the clinical management of a patient.

The procedure is summarised in Diagram 4.2 and Table 4.1 following.

Diagram 4.2 Initial patient handling assessment procedure

37



For each activity below, refer to the corresponding number in Table 4.1 following for more information about how to perform the activity.

Table 4.1 Explanatory notes: Initial patient handling assessment procedure

Number Explanation of procedure

1 • Review chart/notes

• Gather equipment

• Review related assessment (e.g. physiotherapy assessment, falls risk assessment)

• Prepare environment and self

• Get help if needed.

2 • Subjective assessment (interview patient and relatives)

• Objective assessment:

1. Assess individual risk factors (refer to Table 4.2).2. Functional screening on and off bed (refer to Think Smart training

and assessment program).

3 • Refer to definitions in 4A and 4B below to make the decision.

• Level of dependence may be different depending on the task. Only follow B optionsif independent in all tasks.

4A Supervision neededPatient needs some supervision and/or verbal prompting to ambulate/do the transfer, with or without the use of a self-help aid (e.g. walking stick, bed stick).

Assistance neededPatient can understand, cooperate and is physically able to perform part of the activity (e.g. the patient is able to assist and contribute to the task; one or more workers provide minimal to moderate assistance).

DependentPatient is not able to understand or cooperate, or is unable to physically assist (e.g. the patient is invariably not able to assist and contributes very little or nothing to the task; two or more workers provide maximum assistance, therefore the use of patient handling equipment is essential).

4B IndependentPatient can ambulate/do the transfer on their own with or without the use of a self-help aid.

5A Assess the:

• work area environment (e.g. bedside, toilet, shower, corridor)

• equipment available in the work area

• capability and availability of workers in the work area.

5B • Environmental scan for risks (e.g. wet floors, trip hazards, low lighting, low chair, walking aid incorrect height/poorly maintained).


Number Explanation of procedure

6A • Consult with the multidisciplinary team if the patient’s needs are complex and/ora suitable course of action is unclear (e.g. bariatric patient, significant pressure areas, uncontrolled pain).

• Identify the:

– barriers, abilities and foreseeable problems– level and type of assistance required (supervision needed; assistance needed;

dependent)– patient and worker education required– number of workers and equipment required.

6B Equipment and environment for independence (e.g. adjust the walking aid, bedside chair to the appropriate height, show the patient how to use the electric bed controls, move trip hazards, remove and tag out broken equipment).

7A Specify the:

• level of patient dependence/what activity the patient will perform

• patient handling techniques/equipment to be used for each patient handling activity

• number of workers required

• other issues (e.g. environmental considerations, special instructions, variations).

7B The outcome includes any environment/equipment requirements.

39



Table 4.2 below details the key assessment criteria to be examined during initial patient handling assessment.

Table 4.2 Assessment of individual patient risk factors for patient handling activities

Key assessment criteria Relevance/examples

Diagnosis/significant medical history • Understand the needs of the patient

• Precautions and contraindications

• Medications and interactions.

Patient wishes/expectations • To be explored and discussed.

BMI/body shape and size • Impacts on type of technique and equipment used.

Mobility/falls history • Current and past history

• Has a falls risk assessment been completed?

Physical assessment • Pain levels

• Range of motion

• Strength, tone, sensation

• Balance (sitting, standing, static, dynamic).

Mental status and condition • Level of consciousness

• Cooperation, mood

• Confusion, dementia

• Alcohol and other drugs.

Communication • Language and learning difficulties

• Vision or hearing impairment.

Other characteristics/considerations • Continence

• Dignity and privacy

• Timing of medication

• Variance in function over the course of the day

• Attachments

• Promoting independence

• Cultural and other personal considerations.


Pre-activity screeningThe completion of an initial patient handling assessment does not negate the need for workers to screen a patient prior to any patient handling activity. Pre-activity screening is a measure to control the risk associated with patient handling activities.

Pre-activity screening typically involves:

• review of the patient chart (e.g. check blood pressure)

• talking to the patient to confirm their identity, current needs/condition,cognition and level of cooperation

• functional screening tests relevant to the activity to be performed (e.g. sitting balance, straight leg raise)

• scanning the work environment (e.g. check for trip hazards)

• checking availability and function of equipment to be used(e.g. make sure there are two slide sheets at the bedside)

• checking availability and capability of workers needed to assist in the activity(e.g. make sure the assistant has been trained in the use of the slide board).

You should refer to the Think Smart training and assessment program for detailed information about functional screening tests.

Screening is carried out by the principal worker who is responsible for the patient handling activity. Workers must ensure they carry out screening only when within their scope of practice.

When screening indicates the patient handling activity cannot or should not be carried out in accordance with the patient handling plan, re-assessment may be required. Workers, with a scope of practice that does not include changing the clinical management of a patient, should not proceed and instead refer the problem back to the registered nurse or midwife (or person responsible for doing the patient handling assessment). Where an interim change to the patient handling plan is necessary (for example, due to the absence of the registered nurse or midwife), patient handling activities with the lowest risk to workers are to be used and documented until a re-assessment is completed.

Re-assessmentRe-assessment of a patient’s handling needs should occur when:

• there are changes in the patient’s condition or functional status

• there are changes in the workplace (e.g. procedures, layout, equipment)

• the patient moves to a different ward or service (e.g. attending medical imaging;transferred to another ward where the workplace design and layout may be different)

• there has been a patient handling incident or injury involving the patient

• the local work area procedures specify (e.g. at specified intervals in high risk areas,such as rehabilitation or intensive care unit)

• the patient or their relative requests it.

When there has been a change in the patient’s condition or functional status, the registered nurse/midwife should be notified promptly so re-assessment and documentation can be conducted.

Following re-assessment, the patient handling plan must be updated to reflect changes.

Any alterations to the plan must also be communicated to the relevant workers.

41



DocumentationAt a minimum, the initial patient handling assessment and the outcome is documented in the patient notes. Patient care plans are to be completed according to normal procedure (e.g. the mobility section of the care plan). Not every patient will need a dedicated patient handling plan, for example when the patient is independent.

A patient handling plan is generally required when a patient is not independently mobile, either on or off the bed, or both. The patient handling plan will detail:

• the level of assistance required, including the number of workers required to assist

• the techniques and equipment to be used to safely assist the patient

• any environmental or special considerations.

The patient’s handling plan will be documented:

• within a comprehensive care plan or

• separately, as a patient mobility assessment and plan.

Duplication of documentation is not expected, nor encouraged.

The patient handling plan will be kept at the patient’s bedside so workers involved in the patient’s care can access the information easily. If the patient is moved to another ward or service (e.g. medical imaging), the patient handling plan will be sent with them.

The patient handling assessment and plan should be discussed with the patient so their needs and wishes can be taken into account. Difficulties can be addressed at the time and solutions found. This is also a good time to discuss Queensland Health patient handling policy and procedures, such as the No Lift approach to patient handling.



District patient handling assessment arrangements

Procedure for conducting, documenting and communicating individual patient handling assessments and plans.

Name of district: Date:

Element District arrangements

Responsibilities

Initial patient handling assessment

Recording and location of the initial patient handling assessment and patient handling plan

Communication protocol

Procedure for conducting, documenting and communicating individual patient handling assessments and plans.

Name of district: Date:


Responsibilities Unit manager y oversee worker compliance with the requirements for initial patient handling assessment and patient handling plans (through ongoing supervision and completion of periodic internal work practice audits in the work area)

y manage any non-compliances

y ensure workers have received sufficient training in the initial patient handling assessment and patient handling plan requirements.

Registered nurses/midwives y ensure individual patient handling assessments and plans are completed for all relevant patients

y review individual patient handling plans at commencement of each shift/ward handover

y ensure the patient handling plan is modified when patient independence or mobility status changes, and that any changes are communicated to the relevant staff

y ensure patients/relatives are informed of the requirements of the individual patient handling plan where relevant.

Enrolled nurses y collate data on patient’s functional status

y check the requirements of the patient handling plan prior to assisting, supporting or transferring that patient (by either asking the registered nurse/midwife or by checking the care plan).

Allied health professionals y contribute to the completion of initial patient handling assessment, patient handling plans and/or re-assessment of individual patients, in particular for patients with complex mobility needs

y document and communicate any recommendations to the relevant registered nurse/midwife and other workers involved in the handling of that individual patient.

Other workers (i.e. involved in the handling of patients, including allied health assistants, assistants in nursing, patient support officers etc.) y check the requirements of the patient handling plan prior to assisting, supporting or transferring that patient (by either asking the registered nurse/midwife or by checking the care plan).

Patients and relatives y relatives are to check with nursing staff prior to assisting their relative to move/transfer.

Initial patient handling assessment

To be completed on patient admission to ward or unit, by the registered nurse/midwife allocated to the patient’s care. Assessment to include: y individual patient risk factors (refer to key assessment criteria in table 1 following), and

y physical screening of the patients abilities for on/off-bed mobility.

Patients who are not independent in function, both on and off the bed, need a patient handling plan.

Recording and location of the initial patient handling assessment and patient handling plan

y The initial patient handling assessment and the patient handling plan should be documented in the patient’s care plan, which is located at the foot-end of the patient’s bed

y As a minimum, the patient handling plan should include information on the equipment, staffing, techniques and any environmental considerations for assisting the patient with on/off bed mobility tasks

y All documentation to be placed in medical chart upon patient discharge.

Communication protocol

y At commencement of shift at ward, a handover of the status of the patient handling plan is to be provided

y Allied health professional to be notified either in ward handover (if attended) or instructed to check the patient handling plan prior to commencement of a patient handling activity

y Operational staff to check with the registered nurse/midwife regarding the patient handling plan prior to commencement of a patient handing activity

y The individual patient handling plan (located in the patient’s care plan) is to be sent with the patient when they are moved to another ward or service (e.g. xray).

Wombat health services district 22 June 2009


Sample template

43




District patient handling assessment arrangements

Table 1

Key assessment criteria

Key assessment criteria Relevance/examples

Diagnosis/significant medical history • Understand the needs of the patient

• Precautions and contraindications

• Medications and interactions.

Patient wishes/expectations • To be explored and discussed.

BMI/body shape and size • Impacts on type of technique and equipment used.

Mobility/falls history • Current and past history • Has a falls risk assessment been completed?

Physical assessment • Pain levels

• Range of motion

• Strength, tone, sensation

• Balance (sitting, standing, static, dynamic).

Mental status and condition • Level of consciousness

• Cooperation, mood

• Confusion, dementia

• Alcohol and other drugs.

Communication • Language and learning difficulties • Vision or hearing impairment.

Other characteristics/considerations • Continence• Dignity and privacy• Timing of medication

• Variance in function over the course of the day

• Attachments• Promoting independence• Cultural and other personal considerations.


Criteria for screening and re-assessment

Quality monitoring arrangements

Disputes


Criteria for screening and re-assessment

Initial functional screening of patient abilities as part of the initial patient handling assessment.

Pre-activity screening of the individual patient’s function/mobility needs to be completed prior to undertaking any patient handling task. Screening can include: checking the patient’s chart (e.g. for blood pressure); talking to the patient and gaining consent; doing physical screen tests (e.g. straight leg raise); scanning the environment (e.g. to remove clutter/obstacles); checking the necessary equipment before use; checking availability of staff (e.g. to assist; staff knowledge of how to use equipment).

Screening is carried out by the principal worker who is responsible for the patient handling activity (e.g. this could be the nurse, a physio, a wardsperson etc.). The level of screening that is carried out must be within the workers scope of practice.

If screening identifies that the patient handling activity should not proceed according to the documented patient handling plan: y do not proceed with the activity and refer this back to a registered nurse/midwife to complete a re-assessment on the patient.

Re-assessment must be carried out when: y there are changes in the patient’s condition or functional status (i.e. they may have improved or their abilities have deteriorated)

y there are changes in the workplace (e.g. new equipment)

y the patient moves to a new ward or service (e.g. where the design and layout is different)

y following an incident involving the patient.

The registered nurse/midwife caring for the patient or allied health professionals involved in their care are to monitor the patient’s level of independence and complete re-assessment when required.

Quality monitoring arrangements

y Patient handling work practice audits are completed quarterly by the ward/unit trainer and/or other workers from the ward/unit. These audits determine if the initial patient handling assessment and patient handling plans have been completed, are up to date and are being complied with

y Monitoring of compliance with safe work procedures for patient handling is ongoing and is the responsibility of supervisors and all workers involved in patient handling.

Disputes If confusion or dispute arises in relation to patient handling assessment or plan (including disputes involving the patient and their carers/relatives) the registered nurse/midwife who is responsible for the patient should be contacted. If the problem cannot be resolved the nurse unit manager should be consulted.


Sample template continued…


45

This section provides guidance about applying ergonomic principles during design of new and re-design of existing health care facilities

(building design).

Building design was highlighted as an effective risk control in Section 2, providing a means of eliminating or minimising risk associated

with patient handling activities.

The advice contained in this document about building design applies to risk arising from patient handling activities. The scope of this advice

does not extend to all OHS risks, nor all patient safety risks. However, there is some cross over of ergonomic principles into these

other areas of risk. Therefore, in some cases it may be appropriate to apply this advice to other situations.

You should refer to Part B, Section 5 of this better practice guideline for more detailed information about building design to eliminate or reduce patient handling risk.

OverviewThere are many potential benefits to controlling risk arising from patient handling activities through building design including:

• effective risk control (eliminate or redesign the source of risk)

• improved worker safety (e.g. reduced incidence of musculoskeletal discomfort)

• improved patient care, independence or function and recovery (e.g. design facilitates function)

• improved productivity and efficiency (e.g. design out double handling, design to accommodate the best equipment, intuitive design/consistency between similar work areas, improved work flows)

• improved worker and patient satisfaction (e.g. reduced worker absenteeism, increased patient comfort and satisfaction)

• cost benefit (e.g. eliminating the source of the risk means that there are no recurrent costs for risk control such as training, supervision, lost productivity).

Relevant legislation and Queensland Health policiesThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that ergonomic principles be considered when planning for new facilities or modifying existing facilities to ensure the safe handling and movement of patients.

Building designSection 5


ResponsibilitiesIn general, employers have primary control over new acquisitions, building design or other changes in their workplace. Therefore, they are in a position to ensure standards are met for health and safety.8 Employers are to consult with employees about changes to the workplace and do soas early as possible.9

Designers of buildings used as places of work, where manual tasks are performed, have a duty to eliminate hazards or if this is not reasonably practicable, to minimise the risk at the source.10

Designers, facility planners, managers and workers must share information and work together to successfully achieve improved building design for patient handling activities.

ProcessThe following activities will assist facility planners and ward/unit managers to incorporate ergonomic principles relevant to patient handling activities, during building design

1. Brief the designer about patient handling requirements early in the planning phase.

2. Review the most recent FURAT

– review the existing FURAT when planning refurbishment or a new building for an existingward/unit/facility, or

– conduct a table top FURAT for a proposed ward/unit which does not currently exist.

3. Consult with key stakeholders including direct care staff.

4. Learn from past experiences (e.g. post-occupancy evaluation).

5. Refer to available better practice guidelines about design for safer patient handling

The following better practice guidelines and resources are some examples that may assist when improving building design for safer patient handling activities:

– A Guide to Designing Workplaces for Safer Handling of People 3rd edition 2007 www.worksafe.vic.gov.au

– Australian Health Facility Guidelines www.healthfacilityguidelines.com.au– Arjo Guidebook for Architects and Planners; order form available from

www.arjo.com or local supplier.

6. Seek the advice of an ergonomics practitioner, when necessary.

These activities are described in more detail in Part B, Section 5 of these better practice guidelines.

47

Section 5Building design


Elimination/control of patient handling risk through building designThe range of specific ways that risk associated with patient handling activities can be eliminated and controlled through building design is almost infinite. It is important that risk is eliminated and controlled appropriately for each individual situation. This is achieved by systemically applying a risk management approach during building design, as outlined in Section 2 and previously. However, there are some key areas to consider in most cases.

In practical terms, there are five priority areas to consider during building design, which usually have potential to improve the safety, effectiveness and efficiency of patient handling activities. These are described and examples of solutions provided in Table 5.1 following.

Table 5.1 Priority areas for risk control – building design for safer patient handling

Priority area Functional requirement Example of solution

Systems of work/ work organisation

The design accommodates the safe systems of work and work organisation specified for optimal patient handling.

There are a sufficient number of bathrooms able to accommodate the mobile bath trolleys in the orthopaedic ward to cater for peak demand.

Space, layout and working heights

The design in key areas where patient handling activities are conducted (e.g. bedrooms, bathrooms, corridors) enables and encourages the use of safe patient handling techniques and equipment.

The bedroom is of sufficient size to provide clear areas around beds so:

• workers can adopt a safe working posture to carry out patient handling activities

• patient handling equipment can be placed in position when needed.

Building structure Design the building structure to meet the functional requirements of patient handling activities and equipment.

• Ensure corridors and doors are wide enough and free of obstructions to enable patients, with workers and/or equipment, to move along the route and pass each other.

• Ensure the ceiling meets the structural specifications to install a ceiling hoist.

Patient independence Design patient care areas to accommodate the needs of, and to maximise function and recovery of, the patients.

Handrails and grab rails are provided to assist patients to move independently, but must be placed carefully so they don’t obstruct patient handling activities or the movement of equipment.

Equipment storage Provide sufficient storage close to where patient handling activities are undertaken, so that equipment is convenient to use and easy to put away after use.

Multiple recessed mobile equipment bays in ward corridors.

You should refer to Section 6 of this better practice guideline for information about patient handling equipment. Generally, building design and equipment considerations are closely related and should be considered together.


49

Equipment, aids and furnitureSection 6



Patient handling equipment pre-purchase/ hire checklist

This tool is designed to assist managers in determining whether the equipment proposed for purchase/hire is compatible with the work environment, practices and patient needs within the facility/work area.

6.1

This section will provide information about equipment, aids and furniture (equipment) associated with patient handling activities

at the facility/unit level.You should refer to Part B, Section 6 of this better practice guideline for detailed information

about patient handling equipment.

OverviewMechanical patient handling equipment (e.g. hoists, electric beds), non-mechanical aids (e.g. bed ladder rope, slide sheets) and furniture (e.g. height adjustable patient chairs) can assist in the control of patient handling risks.11

Patient handling equipment is a vital part of implementing safer patient handling practices. However, it is important to understand that patient handling equipment which requires physical effort to be applied by workers does not eliminate all risk of musculoskeletal disorders (e.g. using a slide sheet). In contrast, patient handling aids which result in patient independence can eliminate the need for the worker to apply physical effort (e.g. a monkey bar over the bed). Fully mechanical equipment, such as electric beds, can in some cases eliminate the need for a worker to apply physical effort (e.g. sit the patient up by pressing the button on the handset).

Relevant legislation and Queensland Health policies• National Code of Practice for Prevention of

Musculoskeletal Disorders at Work (2007)

• Queensland Plant Code of Practice (2005)



Individual patient equipment requirements The individual patient handling assessment will assist workers to determine the most suitable equipment to use in each situation with a particular patient. The item of equipment that is required depends on:

• the patient’s diagnosis

• level of dependence

• the type of patient handling activities to be completed.

Individual patient handling assessment and management was discussed in detail in Section 4 and will not be covered in this section. You should refer back to Section 4 for details.

Facility/unit patient equipment requirements This section will provide specific information about equipment, aids and furniture associated with patient handling activities at the facility/unit level.

ResponsibilitiesDistricts should ensure the roles and responsibilities of those involved in the identification, evaluation and purchase equipment are clearly defined. Line managers and supervisors have a general obligation to check for musculoskeletal disorder risks that may arise from manual tasks (e.g. using a hoist) before purchasing materials, plant, fixtures, equipment or handling aids.12 This includes an obligation to consult with employees and their health and safety representatives when planning to alter or select new equipment.

Districts and their employees need to be aware that by modifying patient handling equipment (e.g. changing the size of the castors on a mobile hoist), the obligations of a designer and manufacturer of plant are then taken on.13

Legislative requirementsManaging risks associated with patient handling equipment requires compliance with:

1. Workplace Health and Safety Act 1995

2. National Code of Practice for Prevention of Musculoskeletal Disorders from PerformingManual Tasks at Work 2007.

51

Section 6Equipment, aids and furniture


ProcessThe diagram following outlines a process for managing the identification, evaluation, purchase, implementation and review of equipment requirements within facilities/units.

Diagram 6.1 A process for managing patient handling equipment in facilities/units

Evaluate implementation of equipment

Equipment maintenance and infection control

procedures and training

Implement equipment in the facility/unit

Review/identify equipment requirements

Trial/evaluation and purchase of equipment

Step 1: Review/identify patient handling equipment requirementsMost areas where patient handling activities are performed probably already have patient handling equipment. The following steps should be followed:

a. identify the current patient handling equipment inventory and the condition of the equipment

b. consult with the workers to establish their needs and concerns related to equipment

c. review any other information sources, such as business plans, incident reports, risk assessments, manufacturers’ instructions (use and maintenance) and maintenance records or contracts.

The FURAT will help managers with a large portion of these activities.

Managers should review their completed FURAT when reviewing facility/unit equipment needs.

Step 2: Trial/evaluation and purchase of patient handling equipmentThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that priorto patient handling equipment purchase:

• compatibility with the work environment, practices and patient needs be considered

• consultation, trial and formal assessment with relevant workers is completed.

What degree of evaluation is required?The extent of the equipment trial and formal assessment necessary depends on the type of equipment in question and what is already known about the equipment.


Managers should be satisfied that they have gathered sufficient information in order to make an informed decision about purchase, in consultation with workers, patients and other technical experts e.g. patient safety, infection control and engineering. Evidence of equipment trial and evaluation can also be required and supports the business case when making a submission for funding outside the work area.

Step 3: Implementation of patient handling equipment in the facility/unitPrior to the patient handling equipment arriving (where possible):

• develop an implementation plan

• set a review date for post-implementation evaluation

• educate workers

• set up maintenance and cleaning or laundering procedures.

Step 4: Equipment maintenance and infection controlThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that mechanical lifting equipment and patient handling aids are maintained in good working order via a structured preventative program, and in accordance with manufacturers’ specifications.

All equipment is to be cleaned or laundered according to infection control standards and the manufacturers’ instructions. Work areas should have documented procedures for the laundering and cleaning of patient handling equipment and aids.

The FURAT can be used as a patient handling equipment inventory, for quick reference when planning maintenance programs. Alternately, a work area may choose to use a separate patient handling equipment register detailing the equipment stored on the ward and, maintenance and cleaning procedures.

Step 5: Evaluation of patient handling equipment post-implementationIdentify whether the implementation of the equipment has achieved the desired goals. Address any outstanding issues related to implementation and provide feedback to management and workers on the process and outcome.

What information should be recorded and where should it be kept?Copies of records of maintenance undertaken are to be kept in the work area which owns the equipment. Record on the work area FURAT where these records are kept.

The completed Patient handling equipment pre-purchase/hire checklist should also be keptin the work area.

Examplea. If equipment is fairly basic in function, is an accepted risk control for the patient handling

activity or has been trialed in a similar environment with a similar patient population it may not be necessary to undertake a formal evaluation, provided that consultation with workers and patients has occurred. Documentation of the decision regarding the purchase or hire, giving reasons for the decision should be kept by the work area.

b. If equipment is expensive, it must be compatible with existing equipment or the work environment becomes unique. In this case it may be necessary to undertake a formal evaluation of the suitability of the equipment prior to purchase/hire. The patient handling equipment pre-purchase/hire checklist (refer to Appendix 6.1) has been developed to assist with this process.

53




Patient handling equipment pre-purchase/hire checklist

Part A

Purpose of checklist 1. To assist managers in determining whether the equipment proposed for purchase/hire is compatible with the work environment,

practices and patient needs within the facility or work area.

2. To determine the method and extent of on-site trial of equipment and document results.

Facility/Work Area: Name of person assessing the equipment:

Equipment type (make and model):

Supplier:

Contact name: Number:

Reason for purchasing:

The purpose and expected method of use of the equipment:

Criteria Response Details/comments

Supplier

Expected life span of equipment 5yrs 10yrs >10yrs

What is the warranty duration? 1yr 5yrs Other (please provide details)

Is an instruction manual provided? Yes No N/A

Are arrangements available for regular service/maintenance? Yes No N/A

Is replacement equipment available while equipment is being serviced? Yes No N/A

Are parts and service readily available for on-site maintenance? Yes No N/A

Are parts readily available in Australia? Yes No N/A

Does the equipment meet the relevant standards? If yes which one/s?

Yes No N/A

Is there an SOA for this type of equipment? Yes No

If yes, is this item listed on the SOA? Yes No

If no, seek advice from Health Services Purchasing and Logistics Branch.

Ward 3A David Tree

Mobile hoist (Happy Helper 350)

John’s mechanical hoist company

John Happy 3333 5555

Increase in proportion of dependent patients admitted to the ward. 30% of patients were dependent in 2006 whilst

Transferring patients bed to chair/commode/wheelchair.

50% of patients were noted as dependent in 2008/09. The ward is required to borrow a heavy duty hoist from another ward in the event of a

bariatric patient being admitted which has also increased in frequency.

AS ISO 10535-2002. Hoists for the transfer of disabled persons – requirements and test methods.



Patient handling equipment pre-purchase/hire checklist



Patient handling equipment pre-purchase/hire checklist Part A


Risk assessment

Are supporting documents provided? Yes No N/A

Is a risk assessment provided? Yes No N/A

Does the supplier provide documented information, education and training in:

• safe use of equipment• infection control and• maintenance? Yes No N/A

What is the Therapeutic Goods Administration number?

Compatibility of attachments

Are existing components (e.g. battery packs and chargers, wheels) able to be used with this equipment? Yes No N/A

List approved attachments:

Adaptability

Does the equipment control risks associated with more than one patient handling activity? Yes No N/A

Will the manufacturer modify/ adapt the equipment for site use? Yes No N/A

Will building modification be required to use the equipment? Yes No N/A

Is it feasible? Yes No N/A

Safety features

Does this equipment have the following safety features?

• guarding Yes No N/A

• emergency stop Yes No N/A

• manual back-up Yes No N/A

• brakes Yes No N/A

• warning devices Yes No N/A

• controls-lockout Yes No N/A

• low flammability Yes No N/A

Are there appropriate labels, e.g. safe working loads (SWL), manufacturer’s details? Yes No N/A

Aust.3252222

Battery pack by the same supplier.

A range of transfers including bed to bed/chair/wheelchair/commode and floor to bed/chair if required.

One door into the bathroom may need to be widened to enable access.

Funding for building modification not currently available. Alternative bathrooms can be accessed with hoist.



Patient handling equipment pre-purchase/hire checklist continued…

55




Patient handling equipment pre-purchase/hire checklist Part A


Other

Are there any limitations on use as specified by the manufacturer, e.g. SWL; functions? Yes No N/A

Does the equipment include all accessories required for use? Yes No N/A

Is there a range of sizes for clinical use? Yes No N/A List sizes available:

Cost

What cost is involved with the purchase/hire of this equipment?

• hire costs

• capital expenditure

• recurrent expenditure

• other foreseeable, e.g. battery or handset replacement

What are the potential cost-benefits of this purchase/hire?

Trial

Has the equipment been trialled in another work area/facility/district? Yes No N/A

What was the outcome of this trial?

Is an onsite equipment trial recommended? For example:

• equipment has not been trialled previously

• to determine acceptability to workers and patients

• to determine useability within the specific work environment.

Yes. Complete Part B of this checklist.

No. Document recommendations below. You do not need to complete Part B of this checklist.

Final recommendations

Included sling sizes: large, XL, XXL

Approximately $4150 purchase cost.

Trialled by ward 6A.

Hoist was easy to operate, fitted with work area design layout, easy to manoeuvre around ward.

Increase efficiency of transfers and limit time to access hoist outside of ward 3A.

The hoist provides a suitable control to effectively transfer bariatric patients reducing exposure to risk factors for staff and patients.






Patient handling equipment pre-purchase/hire checklist Part B


Patient and worker safety

Are any of the following safety factors a concern for the patient or the worker?

• electrical Yes No

• design (e.g. stability) Yes No

• flammability Yes No

• noise Yes No

• trapping points Yes No

• crushing Yes No

• shearing Yes No

• push and pull force values Yes No

Does the equipment enable the patient to be more independent? Yes No

Does the equipment enable the worker to safely move and handle the patient? Yes No

Equipment design

Is the equipment effective (does it do what it is designed to do)? Yes No

Is the equipment compatible with existing equipment and the work environment, e.g. does the new mobile hoist fit under the existing beds? Yes No

Does the equipment have any of the following design features:

• rounded edges Yes No

• compact Yes No

• light weight Yes No

• controls easily visibleand accessible Yes No

• can it be used in thespace available Yes No

Incorrect use of hoist may expose the patient to trapping points.

The hoist is unable to pass through one doorway (bathroom 2). Doorway will require modification or can use alternate bathrooms.

Heavy duty hoist – is heavy to move especially with patient in.

Mostly yes, apart from bathroom 2.




57




Patient handling equipment pre-purchase/hire checklist Part B

Work environment

Is there space to store this equipment? Yes No

Is this equipment able to be transported and manoeuvred easily? Yes No

What are the special requirements for cleaning and maintenance? Can these requirements be achieved? Yes No

Consultation

What were the methods of consultation undertaken with workers and patients?

Please specify:

What were the results of the consultation process?

Please specify:

List other key stakeholders relevant to the equipment (e.g. patient safety, infection control, engineering):

What were the methods of consultation undertaken with the stakeholders?

Please specify:

What were the results of the consultation process?

Please specify:

Final recommendations

– Initial training and demonstration of hoist by supplier

– Workers satisfied with hoist and noted the hoist is a good patient handling aid to assist with heavier/bariatric patients

– Discussion of hoist at handover promoting use for a range of transfers (based on suitability to the situation)

– Feedback form located at nurses station. Staff indicated date of use, type of transfer, patient feedback and comments

– Structured verbal feedback gained from patients following use of hoist (documented on feedback form).

– Unable to manoeuvre hoist through narrow doorway bathroom 2

– Positive report from patients

– Workers would like further discussion/feedback on appropriate methods to insert/remove sling.

District patient safety officer; maintenance department.

Written communication with district patient safety officer to check no prior incidents involving this item of equipment

and no patient safety concerns. Discussions held with workshop manager regarding available maintenance services.

Nil concerns identified by patient safety. Maintenance workshop able to provide preventative maintenance on hoist

and will arrange for supplier to perform maintenance as specified by manufacturer.

Finalise business case to propose purchase of hoist. Investigate options to assist with funding for hoist.

Store room requires reorganisation to accommodate hoist.

Short, level distances only as intended.

Regular service including maintenance of castors.





59

Think Smart patient handling training and assessment program

Section 7



Patient handling training needs analysis: pre-implementation worker survey

This tool will assist in identifying patient handling training and assessment needs for individual workers. The information is collated by the patient handling ward/unit trainer and will help inform the work area specific training and assessment plans.

7.1

Patient handling training needs analysis: work area specific training needs and plan

The tool will assist in identifying patient handling information, training and assessment requirements for a specific facility/unit.

7.2

This section will provide specific information about training and assessment requirements associated with patient handling activities.You should refer to Part B, Section 7 of this better practice guideline for detailed information

about patient handling training and assessment.

The Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that all workers directly and indirectly involved in patient handling must be provided with adequate information,

training and supervision.

OverviewTraining and assessment helps to ensure employees have the appropriate skills and knowledge to perform their work safely. While training and instruction is important for providing information it is not an effective control measure when used as a sole or primary means of controlling patient handling risks. You should refer to Section 2 for information about selecting appropriate risk controls.

Think Smart training and assessment programThe objectives of the Think Smart training and assessment program are to:

• educate managers, supervisors and employees (including, where appropriate, contractors, temporary workers, agency workers, volunteers and trainees) in risk management principles for patient handling

• teach the principles and safe work procedures for patient handling techniques and patient handling equipment

• assist employees to understand the complex nature of patient handling and the many risk factors involved within their scope of practice. The intent is to train and assess direct care workers in the principles and safe work procedures for the handling and movement of patients. For application of the safe work procedures for the care of individual patients, refer to Section 4.

Relevant legislation and Queensland Health policies• Queensland Workplace Health and Safety Act

1995

• National Code of Practice for the Preventionof Musculoskeletal Disorders from Performing Manual Tasks at Work (2007)



ResponsibilitiesDistricts should ensure the roles and responsibilities of those involved in the establishment and maintenance of the patient handling training and assessment program are clearly defined.

Ultimately, it is the responsibility of senior management to plan and direct how patient handling training and assessment will occur, document the arrangements and ensure that activities occur as intended.

Workers will be given specific responsibility for patient handling training and assessment, appropriate to their position within the district/facility. A guide to suggested roles and responsibilities of key personnel involved in patient handling training and assessment is provided in Part B, Section 7.

Key elementsPatient handling training and assessment is an on-going process to build and maintain worker skills and knowledge. One-off training will not be successful in changing work practices to adopt safer patient handling procedures. The key elements to establish and maintain an effective patient handling training and assessment program are described below.

Element 1: Senior management commitmentIncluding support for the program and a system for ensuring ongoing patient handling training and/or assessment.

Element 2: Policy and proceduresThese detail how the training and assessment requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) are being met.

Element 3: Allocation of resourcesTo develop, implement and deliver the patient handling training and assessment program in accordance with policies and procedures.

Element 4: Appropriately trained staffTo implement the above procedures e.g. patient handling coordinator, line mangers, patient handling lead trainers, patient handling ward/unit trainers.

Element 5: System of audit and reviewTo monitor the application of safer patient handling practices in the workplace. Managers must realise the importance of monitoring practice in the workplace and be prepared to manage the performance of workers if they do not practice safely.

Formal review of work practices should be undertaken using the Patient handling work practices audit described in Section 1. Also, attendance at training and completion of assessment should be monitored as this identifies gaps and improvements needed.

Element 6: Training needs analysis and documentation of trainingThere should also be a system for recording the training needs analysis as well as patient handling training and assessment attendance and content.

61

Section 7Think Smart patient handling training and assessment program


What is a training needs analysis (TNA)?The Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that training and assessment is based on a training needs analysis and should be specific to the worker’s role and the tasks they perform.

Training needs analysis is a process to determine the content, timing and model of delivery to meet the needs of an individual worker, a work area and the organisation.

As a minimum, the training needs analysis for a work area needs to take into consideration the patient handling tasks typically performed in that work area.

A more detailed training needs analysis will consider additional information such as incident/injury data, worker self rating and the frequency that specific patient handling tasks are performed. The tools provided in Appendix 7.1 and 7.2 can be used to assist. Individual workers complete the Pre-implementation worker survey (refer to Appendix 7.1). This information is then collated to complete the Work area training needs analysis and training plan (refer to Appendix 7.2).

Training and assessment program requirementsThe Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) specifies minimum content requirements training and awareness in patient handling tasks for workers (including managers, trainers, direct and indirect care workers). For more detail refer to Part B, Section 7. A summary of the training and assessment requirements for direct care workers is outlined below and in diagram 7.1 following.

Direct care workersAs a minimum requirement, training for all workers directly involved in patient handling tasks must incorporate the following elements:

• legislative requirements

• risk management process and injury prevention

• individual patient handling assessment

• preferred patient handling techniques including the safe use of equipment and patient handling aids, and any techniques and considerations for patient handling in emergency situations

• local procedures for the patient handling program including incident/hazard reporting

• maintenance, laundering and storage of equipment.

These elements are to be completed within six weeks of commencement. Thereafter, training is to be specific to individual need and based on a training needs analysis, as outlined previously. Subsequent training may address any or all of the elements listed previously or additional work area specific elements.

The practical component of training should include practice in an actual work situation or simulated work situation and incorporate performance assessment.

Patient handling is a practical skill and it is necessary to practice these skills under supervision, in much the same way that a person learns to drive a car, as skill develops over time and with practice.14 Use of newly acquired skills also needs to be supported by experienced resource people within the work area, such as the patient handling ward/unit trainer.

Assessment should test the worker’s understanding and application of the education or training undertaken. Without demonstration of knowledge and learned skills, education and training cannot be considered successful.

All workers directly involved in patient handling tasks must be formally assessed as competent in safe patient handling work procedures specific to their work area:

• within six weeks of commencement and

• on an annual basis.


Target audience

Training and assessment programs

Prevention and management of musculoskeletal disorders (MSD)

Patient handling

Introduction to the prevention and management of MSD

Applicable to all Queensland Health workers

If yes, patient handling training and assessment

is applicable

If no, patient handling training and assessment is not applicable.

Patient handling fundamentals (Orientation)

M E 6

M E 6

Generic patient handling techniques/equipment

M P 6

6

12

24

KeyVariancesMandatory

E-learning

Practical/on the job

Based on training needs analysis

Recommended

Time frameWithin 6 weeks of commencement

Every 12 months

Every 24 months

Are workers responsible for direct patient care?

Patient handling task specific training Initial (induction) Ongoing (as required)

6

Patient handling assessment Initial (induction) Annual

M P

TNA

M P

TNA

6

Diagram 7.1 Think Smart training and assessment requirements for direct care workers

12

M

E

P

TNA

*

63



Training and assessment modelThe patient handling training and assessment model describes the method of program delivery and the people involved.

The Think Smart training and assessment program is based on a decentralised model of training and assessment (refer to Diagram 7.2).

A decentralised model disperses knowledge and skills to local level, allowing patient handling training and assessment to be specific to the workers role and the tasks they perform.

Diagram 7.2 Think Smart training and assessment model

Worker Worker Worker Worker

Patient handling ward/unit trainer

Patient handling ward/unit trainer

Patient handling lead trainer/s

Healthcare ergonomics consultant or delegate

Queensland Health recommends a ratio of one patient handling lead trainer to every 30–40 patient handling ward/unit trainers and one patient handling ward/unit trainer to every 10 direct care workers.

Where possible, patient handling training and assessment programs should aim to integrate with existing worker development programs, ward/unit in-services and annual training and assessment programs.

If a patient handling training and assessment program or model other than the Think Smart training and assessment program is used, it must fulfil the requirements of the Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) and incorporate all the minimum elements of the training and assessment program detailed in this better practice guideline.

Who conducts training and assessment?The Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that training and assessment is provided by a competent person. In order that training is of a consistent standard, a person must have the knowledge and skills to implement the Think Smart training and assessment program before undertaking to train others. Individuals undertaking patient handling lead trainer and patient handling ward/unit trainer roles must be competent and meet the specifications detailed in Part B, Section 7 of this better practice guideline.

Patient handling lead trainer/sPatient handling lead trainers are formally assessed by the state wide healthcare ergonomics consultant or delegate. They are assessed as competent in safe patient handling work procedures and their ability to deliver training and assessment programs to patient handling ward/unit trainers:

• following completion of the initial patient handling lead trainer certification and

• every two years.


It is recommended that the role and responsibilities of the Patient Handling Lead Trainer be designated to a suitable clinical professional (e.g. clinical educator or experienced registered nurse/midwife or allied health professional), specific to the district/ facility and in accordance with local requirements. The role may be supported by other staff (e.g. OHS practitioners, enrolled nurse) who have been assessed as competent to deliver the relevant patient handling training and assessment components appropriate to their position, skills and qualifications.

Patient handling ward/unit trainersPatient handling ward/unit trainers are formally assessed by a current patient handling lead trainer as competent in safe patient handling work procedures and their ability to deliver training and assessment to direct care workers:

• following completion of the patient handling ward/unit trainer course and

• annually.

It is recommended that the role and responsibilities of the Patient Handling Ward/Unit Trainer be designated to relevant workers who have been assessed as competent in all aspects of this role that are appropriate to their position, skills and qualifications, and may include a registered nurse, midwife, enrolled nurse, allied health professional, allied health assistant, operational service worker or OHS practitioner.

The diagram following outlines the training and assessment requirements within the Think Smart training and assessment program for trainers.

Diagram 7.3 Think Smart training and assessment requirements

Questions Train the trainer programs

Patient handling For workers seeking certification

as patient handling trainers

1. Does your facility require patient handling trainers to train direct care workers?

If yes, train the trainer program is applicable

If yes, the train the trainer program is

applicable

If no, continue to maintain program

If no, continue to maintain the patient handing training and

assessment

Ward/Unit trainer course

Lead trainer course

Ward/Unit trainer re-assessment

Lead trainer re-assessment

2. Does your facility require patient handling trainers to train ward/unit trainers?

Ward/Unit trainer refresher

Lead trainer refresher training and recertification

12

24

12

12

6

12

24

KeyTime frameWithin 6 weeks of commencement

Every 12 months

Every 24 months

65



Monitor and review

Session evaluationEvaluation of individual training and assessment sessions should be performed at the completion of training. This evaluates the training, materials, venue, content and method of delivery.

This session evaluation is undertaken by the person conducting the training and assessment sessions.

Overall training and assessment programOverall monitoring of the training and assessment program should include:

• examination of whether the program continues to meet the requirements of thePatient Handling Tasks Implementation Standard (OHSMS 2-22#21)

• the number of workers trained and assessed

• survey of trainers and workers

• review of training needs analysis.

This program monitoring is undertaken by the designated person at a district/facility level e.g. patient handling coordinator, lead patient handling trainer.

What information should be recorded and where should it be kept?The Patient Handling Tasks Implementation Standard (OHSMS 2-22#21) requires that training and assessment records are appropriately documented to ensure a structured system for tracking workers’ assessment and annual refresher training.

As a minimum requirement, training and assessment records must be kept and should include:

• names and signatures of trainer and trainee

• date and place of training

• duration

• content

• handouts

• full or partial participation

• refusal or inability to attend

• equipment and aids used

• assessment.

Local training records are not sufficient and a system of centralised record keeping is required for patient handling training and assessment at a district/facility level.

A documented training needs analysis should accompany training and assessment records to demonstrate the training and assessment has been tailored to the individual work area.


1 of

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Pre-implementation worker survey



2 of

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Pre-implementation worker survey continued…


3 of

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Minus 1 – task number is 5-15

Minus 1 – you have not been trained in this task within the past 12 months and task is constant or frequent

Minus 1 – if injury or discomfort has occurred within the past 12 months related to this task (refer to discomfort survey if completed).

Training needs matrix score

Constantly: 67–100% shift

Frequently: 34–66% shift

Occasionally: 8–33% shift

Rarely: 0–7% shift

High: Can do task confidently

Medium: Capable but hesitant

Low: Unsure and require help

1.

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4.

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5.

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No

Yes

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–1=

6.

Sit t

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it Y

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es N

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=7.

Ch

air t

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=8.

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bed

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hair)

Yes

No

Yes

No

–1=

The

follo

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ng y

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rain

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s. T

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ble

lists

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mon

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Fo

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sk w

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the

tabl

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aini

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eeds

mat

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Training Needs Matrix

Sel

f rat

ing

Frequency

Hig

hM

ediu

mLo

w

Cons

tant

ly6

54

Freq

uent

ly6

54

Occ

asio

nally

76

5

Rare

ly7

65

Pati

ent h

andl

ing

task

Freq

uenc

yS

elf r

atin

gIn

cide

nt/i

njur

y hi

stor

yTr

aini

ng/a

sses

smen

tTr

aini

ng n

eeds

mat

rix

scor

e ca

lcul

atio

ns

Iden

tify

the

freq

uenc

y w

ith

whi

ch y

ou

unde

rtak

e ea

ch m

ovin

g an

d ha

ndlin

g ta

sk w

ith

pati

ents

who

requ

ire

assi

stan

ce o

r are

tota

lly d

epen

dent

.

<Ind

icat

e by

tick

ing

the

box>

How

con

fiden

t are

you

in y

our a

bilit

y to

und

erta

ke th

ese

task

s/us

e th

e eq

uipm

ent?

<Ind

icat

e by

tick

ing

the

box>

Dur

ing

the

last

12

mon

ths,

I h

ave

expe

rien

ced

disc

omfo

rt/i

njur

y as

soci

ated

wit

h pe

rfor

min

g th

is ta

sk?

<tic

k>

I hav

e be

en tr

aine

d

in th

is ta

sk in

the

past

12

mon

ths?

<tic

k>













1.

Sitt

ing

up/l

ying

dow

n in

bed

(r

aisi

ng/l

ower

ing

the

back

of

the

bed

)

Y

es N

o Y

es N

o6

6

2.

Mov

ing

up/d

own

the

bed

Yes

No

Yes

No

66

3.

Rolli

ng (i

.e. t

empo

rary

pos

itio

n ch

ange

in b

ed e

.g. t

o in

sert

a

slid

e sh

eet;

che

ck a

wou

nd)

Yes

No

Yes

No

77

4.

Turn

ing/

repo

sitio

ning

in b

ed

(i.e

. per

man

ent p

osit

ion

chan

ge

e.g.

for p

ress

ure

relie

f)

Y

es N

o Y

es N

o7

7

5.

Lyin

g to

sit

ting

on s

ide

of b

ed

and

reve

rse

Yes

No

Yes

No

6–1

4

6.

Sit t

o st

and

to s

it

Y

es N

o Y

es N

o5

–13

7.

Chai

r to

chai

r/be

d/to

ilet

Yes

No

Yes

No

5–1

3

8.

Bed

to b

ed/t

rolle

y; b

ed to

re

clin

ing

adju

stab

le s

tret

cher

ch

air (

e.g.

Reg

ency

cha

ir)

Y

es N

o Y

es N

o6

5






4 of

4

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)Pr

e-im

plem

enta

tion

wor

ker s

urve

y (c

ontin

ued

)

Pati

ent h

andl

ing

task

Freq

uenc

yS

elf r

atin

gIn

cide

nt/i

njur

y hi

stor

yTr

aini

ng/a

sses

smen

tTr

aini

ng n

eeds

mat

rix

scor

e ca

lcul

atio

ns

Iden

tify

the

freq

uenc

y w

ith

whi

ch y

ou

unde

rtak

e ea

ch m

ovin

g an

d ha

ndlin

g ta

sk w

ith

pati

ents

who

requ

ire

assi

stan

ce o

r are

tota

lly d

epen

dent

.

<Ind

icat

e by

tick

ing

the

box>

How

con

fiden

t are

you

in y

our a

bilit

y to

und

erta

ke th

ese

task

s/us

e th

e eq

uipm

ent?

<Ind

icat

e by

tick

ing

the

box>

Dur

ing

the

last

12

mon

ths,

I h

ave

expe

rien

ced

disc

omfo

rt/i

njur

y as

soci

ated

wit

h pe

rfor

min

g th

is ta

sk?

<tic

k>

I hav

e be

en tr

aine

d

in th

is ta

sk in

the

past

12

mon

ths?

<tic

k>













9.

In/o

ut o

f bat

h (n

on-e

mer

genc

y) Y

es N

o Y

es N

o–1

=10

. Re

posi

tion

in c

hair

Yes

No

Yes

No

–1=

11.

In/o

ut o

f the

car

(non

-em

erge

ncy)

Yes

No

Yes

No

–1=

12.

Wal

king

a p

atie

nt Y

es N

o Y

es N

o–1

=13

. M

ove

pers

on o

ff fl

oor

(non

-em

erge

ncy

situ

atio

n) Y

es N

o Y

es N

o–1

=

14.

Init

ial p

atie

nt h

andl

ing

asse

ssm

ent

Yes

No

Yes

No

–1=

15.

Pre-

acti

vity

scr

eeni

ng Y

es N

o Y

es N

o–1

=16

. O

ther

(ple

ase

spec

ify)

Yes

No

Yes

No

=

Com

men

ts:

Cong

ratu

latio

ns –

you

hav

e no

w c

ompl

eted

the

Pre-

impl

emen

tatio

n w

orke

r sur

vey!

Ple

ase

retu

rn th

is fo

rm to

:

Training Needs Matrix

Sel

f rat

ing

Frequency

Hig

hM

ediu

mLo

w

Cons

tant

ly6

54

Freq

uent

ly6

54

Occ

asio

nally

76

5

Rare

ly7

65

Pati

ent h

andl

ing

task

Freq

uenc

yS

elf r

atin

gIn

cide

nt/i

njur

y hi

stor

yTr

aini

ng/a

sses

smen

tTr

aini

ng n

eeds

mat

rix

scor

e ca

lcul

atio

ns

Iden

tify

the

freq

uenc

y w

ith

whi

ch y

ou

unde

rtak

e ea

ch m

ovin

g an

d ha

ndlin

g ta

sk w

ith

pati

ents

who

requ

ire

assi

stan

ce o

r are

tota

lly d

epen

dent

.

<Ind

icat

e by

tick

ing

the

box>

How

con

fiden

t are

you

in y

our a

bilit

y to

und

erta

ke th

ese

task

s/us

e th

e eq

uipm

ent?

<Ind

icat

e by

tick

ing

the

box>

Dur

ing

the

last

12

mon

ths,

I h

ave

expe

rien

ced

disc

omfo

rt/i

njur

y as

soci

ated

wit

h pe

rfor

min

g th

is ta

sk?

<tic

k>

I hav

e be

en tr

aine

d

in th

is ta

sk in

the

past

12

mon

ths?

<tic

k>













9.

In/o

ut o

f bat

h (n

on-e

mer

genc

y) Y

es N

o Y

es N

on/

a

10.

Repo

sitio

n in

cha

ir

Y

es N

o Y

es N

o5

–1–1

2

11.

In/o

ut o

f the

car

(non

-em

erge

ncy)

Yes

No

Yes

No

n/a

12.

Wal

king

a p

atie

nt

Y

es N

o Y

es N

o7

6

13.

Mov

e pe

rson

off

floo

r (n

on-e

mer

genc

y si

tuat

ion)

Yes

No

Yes

No

54

14.

Init

ial p

atie

nt h

andl

ing

asse

ssm

ent

Yes

No

Yes

No

6–1

4

15.

Pre-

acti

vity

scr

eeni

ng

Y

es N

o Y

es N

o6

–14

16.

Oth

er (p

leas

e sp

ecif

y) Y

es N

o Y

es N

on/

a

Com

men

ts:

Hea

ther

Lea

f (Em

ail:h

eath

er_l

eaf@

heat

lh.q

ld.g

ov.a

u)

I hav

e no

t yet

bee

n tr

aine

d in

how

to u

se th

e ne

w h

oist

so

I wou

ld li

ke t

rain

ing

in th

is.





1 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)

Wor

k ar

ea s

peci

fic tr

aini

ng n

eeds

and

pla

n

How

to u

se th

is to

ol

Purp

ose

This

tool

will

ass

ist i

n id

entif

ying

the

patie

nt h

andl

ing

(PH

) tra

inin

g an

d as

sess

men

t nee

ds fo

r a s

peci

fic w

ork

area

.

How

to c

ompl

ete

Com

pile

info

rmat

ion

gath

ered

from

the

Pre-

impl

emen

tatio

n w

orke

r sur

veys

(e.g

. sam

ple

grou

p) a

nd a

ny o

ther

rele

vant

info

rmat

ion

sour

ces

(e.g

. the

FU

RAT

; Pat

ient

han

dlin

g w

ork

prac

tices

aud

its)

to

com

plet

e th

is to

ol. T

he p

erso

n co

mpl

etin

g th

is w

ork

area

trai

ning

nee

ds a

naly

sis

shou

ld a

pply

judg

men

t and

thei

r kno

wle

dge

of th

e lo

cal w

ork

area

. Con

side

r the

last

12

mon

ths

and

the

typi

cal

wor

k co

ndit

ions

and

sit

uatio

ns. T

he fi

ndin

gs o

f thi

s tr

aini

ng n

eeds

ana

lysi

s w

ill b

ecom

e th

e ba

sis

for e

stab

lishi

ng th

e w

ork

area

trai

ning

and

ass

essm

ent p

lan

for t

he y

ear a

head

.

Wor

k ar

ea:

Sou

rces

of i

nfor

mat

ion

used

to c

ompl

ete

this

TN

A

FUR

AT:

Yes

N

oIn

cide

nt re

port

s:

Yes

N

oPH

wor

k pr

actic

e au

dits

: Y

es

No

TNA

Pre-

impl

emen

tatio

n w

orke

r sur

veys

: Y

es

No

If ye

s, n

umbe

r of s

urve

ys c

olle

cted

Com

plet

ed b

y:

Posi

tion

title

:

Dat

e co

mpl

eted

:

Revi

ew d

ate:

Sta

ffing

pro

file

(ple

ase

inse

rt n

umbe

r)

Num

ber o

f wor

kers

Aver

age

num

ber o

f yea

rs e

xper

ienc

e in

pat

ient

han

dlin

g (w

orke

rs)

Repo

rted

ove

rall

turn

over

per

yea

r (ap

prox

. %)

Num

ber o

f wor

kers

wit

h fu

nctio

nal l

imit

atio

nsRe

port

ed o

vera

ll ab

sent

eeis

m p

er y

ear

Wor

ker a

cces

s to

hea

lth p

rofe

ssio

nal/

s w

ith

expe

rtis

e in

pat

ient

han

dlin

g in

my

wor

k ar

ea?

Yes

N

oPl

ease

spe

cify

:

Occ

upat

ion

(ple

ase

inse

rt n

umbe

r)N

atur

e of

em

ploy

men

t (pl

ease

inse

rt n

umbe

r)

Regi

ster

ed n

urse

Ass

ista

nt in

nur

sing

Stud

ent

Perm

anen

t ful

l-tim

eTe

mpo

rary

full-

time

Cas

ual

Alli

ed h

ealth

pro

fess

iona

l En

rolle

d nu

rse

Med

ical

offi

cer

Perm

anen

t par

t-tim

eTe

mpo

rary

par

t-tim

e

Age

ncy

Ope

ratio

nal

Oth

er (p

leas

e sp

ecif

y):

Oth

er (p

leas

e sp

ecif

y):

How

to u

se th

is to

ol

Purp

ose

This

tool

will

ass

ist i

n id

entif

ying

the

patie

nt h

andl

ing

(PH

) tra

inin

g an

d as

sess

men

t nee

ds fo

r a s

peci

fic w

ork

area

.

How

to c

ompl

ete

Com

pile

info

rmat

ion

gath

ered

from

the

Pre-

impl

emen

tatio

n w

orke

r sur

veys

(e.g

. sam

ple

grou

p) a

nd a

ny o

ther

rele

vant

info

rmat

ion

sour

ces

(e.g

. the

FU

RAT

; Pat

ient

han

dlin

g w

ork

prac

tices

aud

its)

to

com

plet

e th

is to

ol. T

he p

erso

n co

mpl

etin

g th

is w

ork

area

trai

ning

nee

ds a

naly

sis

shou

ld a

pply

judg

men

t and

thei

r kno

wle

dge

of th

e lo

cal w

ork

area

. Con

side

r the

last

12

mon

ths

and

the

typi

cal

wor

k co

ndit

ions

and

sit

uatio

ns. T

he fi

ndin

gs o

f thi

s tr

aini

ng n

eeds

ana

lysi

s w

ill b

ecom

e th

e ba

sis

for e

stab

lishi

ng th

e w

ork

area

trai

ning

and

ass

essm

ent p

lan

for t

he y

ear a

head

.

Wor

k ar

ea:

Sou

rces

of i

nfor

mat

ion

used

to c

ompl

ete

this

TN

A

FUR

AT:

Yes

N

oIn

cide

nt re

port

s:

Yes

N

oPH

wor

k pr

actic

e au

dits

: Y

es

No

TNA

Pre-

impl

emen

tatio

n w

orke

r sur

veys

: Y

es

No

If ye

s, n

umbe

r of s

urve

ys c

olle

cted

Com

plet

ed b

y:

Posi

tion

title

:

Dat

e co

mpl

eted

:

Revi

ew d

ate:

Sta

ffing

pro

file

(ple

ase

inse

rt n

umbe

r)

48N

umbe

r of w

orke

rs3

Aver

age

num

ber o

f yea

rs e

xper

ienc

e in

pat

ient

han

dlin

g (w

orke

rs)

25%

Repo

rted

ove

rall

turn

over

per

yea

r (ap

prox

. %)

1N

umbe

r of w

orke

rs w

ith

func

tiona

l lim

itat

ions

55

days

Repo

rted

ove

rall

abse

ntee

ism

per

yea

r

Wor

ker a

cces

s to

hea

lth p

rofe

ssio

nal/

s w

ith

expe

rtis

e in

pat

ient

han

dlin

g in

my

wor

k ar

ea?

Yes

N

oPl

ease

spe

cify

:

Occ

upat

ion

(ple

ase

inse

rt n

umbe

r)N

atur

e of

em

ploy

men

t (pl

ease

inse

rt n

umbe

r)

25Re

gist

ered

nur

se5

Ass

ista

nt in

nur

sing

0St

uden

t 32

Perm

anen

t ful

l-tim

e2

Tem

pora

ry fu

ll-tim

e1

Cas

ual

4A

llied

hea

lth p

rofe

ssio

nal

10En

rolle

d nu

rse

1M

edic

al o

ffice

r10

Perm

anen

t par

t-tim

e0

Tem

pora

ry p

art-

time

3

Age

ncy

3O

pera

tiona

l O

ther

(ple

ase

spec

ify)

: O

ther

(ple

ase

spec

ify)

:

War

d 3A

, For

estv

ille

Hos

pita

l, M

etro

Nor

th H

ealth

Ser

vice

Dis

tric

t

6

Hea

ther

Lea

f

08/0

6/09

08/0

6/10

Regi

ster

ed N

urse

(W

UT)

Sue

Bra

nch

(Phy

siot

hera

pist

); H

eath

er L

eaf (

WU

T)



Training needs analysis



2 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)W

ork

area

spe

cific

trai

ning

nee

ds a

nd p

lan

(con

tinue

d)

Wor

ker i

njur

y hi

stor

y

Ana

lysi

s of

pat

ient

han

dlin

g in

cide

nt s

tatis

tics:

Ana

lysi

s of

mus

culo

skel

etal

dis

com

fort

sur

vey

(opt

iona

l, ad

visa

ble

in h

igh

risk

or p

robl

emat

ic a

reas

):

Pati

ent h

andl

ing

trai

ning

Ratio

of w

ard/

unit

patie

nt h

andl

ing

trai

ners

to w

orke

rs (r

ecom

men

d ap

prox

. 1:1

0):

Has

pat

ient

han

dlin

g tr

aini

ng a

nd a

sses

smen

t bee

n pr

ovid

ed in

acc

orda

nce

wit

h th

e Pa

tient

Han

dlin

g Ta

sks

Impl

emen

tatio

n St

anda

rd (O

HW

S2-2

2#21

)?

Y

es

No

Plea

se s

peci

fy:

Ana

lysi

s of

the

stat

us o

f tra

inin

g co

mpl

eted

by

wor

kers

in th

is w

ork

area

(i.e

. for

MSD

pre

vent

ion

and

orie

ntat

ion

trai

ning

):

Ana

lysi

s of

the

stat

us o

f wor

ker a

nnua

l pat

ient

han

dlin

g as

sess

men

ts fo

r thi

s w

ork

area

:

Wor

k or

gani

sati

on (p

leas

e in

sert

num

ber)

Num

ber o

f wor

kers

rost

ered

on

mor

ning

shi

ftN

umbe

r of w

orke

rs ro

ster

ed o

n af

tern

oon

shif

tN

umbe

r of w

orke

rs ro

ster

ed o

n ni

ght s

hift

Prop

ortio

n of

pat

ient

han

dlin

g w

orkl

oad

in

the

mor

ning

shi

ft (a

ppro

x. %

)Pr

opor

tion

of p

atie

nt h

andl

ing

wor

kloa

d

in th

e af

tern

oon

shif

t (ap

prox

. %)

Prop

ortio

n of

pat

ient

han

dlin

g w

orkl

oad

in

the

nigh

t shi

ft (a

ppro

x. %

)

Wor

ker a

cces

s to

sup

port

wor

kers

to a

ssis

t wit

h pa

tient

han

dlin

g ta

sks?

Yes

N

oPl

ease

spe

cify

:

Wor

k or

gani

sati

on (p

leas

e in

sert

num

ber)

20N

umbe

r of w

orke

rs ro

ster

ed o

n m

orni

ng s

hift

20N

umbe

r of w

orke

rs ro

ster

ed o

n af

tern

oon

shif

t8

Num

ber o

f wor

kers

rost

ered

on

nigh

t shi

ft

50%

Prop

ortio

n of

pat

ient

han

dlin

g w

orkl

oad

in

the

mor

ning

shi

ft (a

ppro

x. %

)30

%Pr

opor

tion

of p

atie

nt h

andl

ing

wor

kloa

d

in th

e af

tern

oon

shif

t (ap

prox

. %)

20%

Prop

ortio

n of

pat

ient

han

dlin

g w

orkl

oad

in

the

nigh

t shi

ft (a

ppro

x. %

)

Wor

ker a

cces

s to

sup

port

wor

kers

to a

ssis

t wit

h pa

tient

han

dlin

g ta

sks?

Yes

N

oPl

ease

spe

cify

:

App

roxi

mat

ely

20%

of w

orke

rs s

urve

yed

have

not

yet

don

e th

eir

gene

ric

1:24

The

maj

orit

y of

wor

kers

sur

veye

d (8

5%)

are

up to

dat

e w

ith th

eir

annu

al p

atie

nt h

andl

ing

asse

ssm

ents

.

10 r

epor

ted

patie

nt h

andl

ing

inci

dent

s in

the

past

yea

r fo

r th

e fa

cilit

y. 1

rep

orte

d pa

tient

han

dlin

g in

cide

nt fo

r w

ard

3A (d

id r

esul

t in

a W

orkC

over

cla

im fo

r a

shou

lder

inju

ry a

nd 4

day

s of

f wor

k).

Mus

culo

skel

etal

dis

com

fort

sur

veys

wer

e gi

ven

to a

ll w

orke

rs o

n th

e w

ard

, with

app

roxi

mat

ely

60%

of

thes

e re

turn

ed.

prev

entio

n an

d m

anag

emen

t of M

SD t

rain

ing

mod

ule

(e-l

earn

ing/

on-l

ine

trai

ning

). A

ll w

orke

rs h

ave

com

plet

ed th

e m

anda

tory

pat

ient

han

dlin

g or

ient

atio

n tr

aini

ng o

n co

mm

ence

men

t.

Gen

eral

ly th

ere

is s

omeo

ne to

cal

l on

to a

ssis

t with

pat

ient

han

dlin

g ta

sks.



Training needs analysis continued…


3 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)

Wor

k ar

ea s

peci

fic tr

aini

ng n

eeds

and

pla

n (c

ontin

ued

)

Pati

ent h

andl

ing

task

Ana

lysi

s of

wor

ker d

isco

mfo

rt/i

njur

y hi

stor

y (a

s pr

ovid

ed o

n th

e TN

A w

orke

r sur

veys

/ m

uscu

losk

elet

al d

isco

mfo

rt s

urve

ys)

Ana

lysi

s of

wor

ker s

elf r

ated

trai

ning

ne

ed (a

s pr

ovid

ed o

n th

e TN

A w

orke

r su

rvey

s)

Prio

rity

of t

rain

ing

Mos

tly

1, 2

& 3

= H

igh

prio

rity

: rec

omm

end

face

to

face

ski

ll re

fres

her t

rain

ing

in th

e ne

xt m

onth

; inc

lude

as

ann

ual a

sses

smen

t tas

k.

Mos

tly

4 &

5 =

Med

ium

pri

orit

y: re

com

men

d in

form

w

orke

rs o

f Saf

e W

ork

Proc

edur

e in

sho

rt te

rm; f

ace

to

face

ski

ll re

fres

her t

rain

ing

wit

hin

12 m

onth

s;

may

incl

ude

as a

nnua

l ass

essm

ent t

ask.

Mos

tly

6 &

7 =

Low

pri

orit

y: re

com

men

d m

onito

r an

d ad

dres

s as

reso

urce

s al

low

.

<For

eac

h ta

sk, r

ecor

d he

re th

e nu

mbe

r of

wor

kers

allo

cate

d ea

ch T

rain

ing

Nee

ds

Mat

rix

scor

e (1

–7),

as id

entifi

ed o

n th

e w

orke

r sur

veys

>

<For

eac

h ta

sk, c

onsi

der fi

ndin

gs o

f thi

s an

alys

is

and

appl

y ju

dgem

ent t

o de

term

ine

trai

ning

pri

oriti

es.

Tick

the

rele

vant

col

umn

for e

ach

task

>

12

34

56

7H

igh

Med

ium

Low

1.

Sitt

ing

up; l

ying

dow

n in

bed

(r

aisi

ng o

r low

erin

g th

e ba

ck

of th

e be

d)

2.

Mov

ing

up o

r dow

n th

e be

d

3.

Rolli

ng (i

.e. t

empo

rary

pos

itio

n ch

ange

in b

ed e

.g. t

o in

sert

a

slid

e sh

eet;

che

ck a

wou

nd)

4.

Turn

ing

or re

posi

tioni

ng in

bed

(i

.e. p

erm

anen

t pos

itio

n ch

ange

e.

g. fo

r pre

ssur

e re

lief)

5.

Lyin

g to

sit

ting

on s

ide

of b

ed

and

reve

rse

6.

Sit t

o st

and

to s

it

7.

Chai

r to

chai

r/be

d/to

ilet

8.

Bed

to b

ed/t

rolle

y; b

ed to

re

clin

ing

adju

stab

le s

tret

cher

ch

air (

e.g.

Reg

ency

cha

ir)

Pati

ent h

andl

ing

task

Ana

lysi

s of

wor

ker d

isco

mfo

rt/i

njur

y hi

stor

y (a

s pr

ovid

ed o

n th

e TN

A w

orke

r sur

veys

/

mus

culo

skel

etal

dis

com

fort

sur

veys

)

Ana

lysi

s of

wor

ker s

elf r

ated

trai

ning

ne

ed (a

s pr

ovid

ed o

n th

e TN

A w

orke

r su

rvey

s)

Prio

rity

of t

rain

ing

Mos

tly

1, 2

& 3

= H

igh

prio

rity

: rec

omm

end

face

to

face

ski

ll re

fres

her t

rain

ing

in th

e ne

xt m

onth

; inc

lude

as

ann

ual a

sses

smen

t tas

k.

Mos

tly

4 &

5 =

Med

ium

pri

orit

y: re

com

men

d in

form

w

orke

rs o

f Saf

e W

ork

Proc

edur

e in

sho

rt te

rm; f

ace

to

face

ski

ll re

fres

her t

rain

ing

wit

hin

12 m

onth

s;

may

incl

ude

as a

nnua

l ass

essm

ent t

ask.

Mos

tly

6 &

7 =

Low

pri

orit

y: re

com

men

d m

onito

r an

d ad

dres

s as

reso

urce

s al

low

.

<For

eac

h ta

sk, r

ecor

d he

re th

e nu

mbe

r of

wor

kers

allo

cate

d ea

ch T

rain

ing

Nee

ds

Mat

rix

scor

e (1

–7),

as id

entifi

ed o

n th

e w

orke

r sur

veys

>

<For

eac

h ta

sk, c

onsi

der fi

ndin

gs o

f thi

s an

alys

is

and

appl

y ju

dgem

ent t

o de

term

ine

trai

ning

pri

oriti

es.

Tick

the

rele

vant

col

umn

for e

ach

task

>

12

34

56

7H

igh

Med

ium

Low

1.

Sitt

ing

up; l

ying

dow

n in

bed

(r

aisi

ng o

r low

erin

g th

e ba

ck

of th

e be

d)

14

1

2.

Mov

ing

up o

r dow

n th

e be

d

11

4

3.

Rolli

ng (i

.e. t

empo

rary

pos

itio

n ch

ange

in b

ed e

.g. t

o in

sert

a

slid

e sh

eet;

che

ck a

wou

nd)

13

2

4.

Turn

ing

or re

posi

tioni

ng in

bed

(i

.e. p

erm

anen

t pos

itio

n ch

ange

e.

g. fo

r pre

ssur

e re

lief)

13

2

5.

Lyin

g to

sit

ting

on s

ide

of b

ed

and

reve

rse

13

11

6.

Sit t

o st

and

to s

itA

few

wor

kers

exp

erie

nced

pai

n/di

scom

fort

from

ass

istin

g w

ith s

it to

sta

nd t

rans

fers

, es

peci

ally

with

hea

vier

pat

ient

s an

d w

hen

in th

e sm

all n

arro

w to

ilets

.1

41

7.

Chai

r to

chai

r/be

d/to

ilet

A nu

rse

inju

red

her

shou

lder

whe

n as

sist

ing

to h

oist

a p

atie

nt fr

om c

hair

bac

k to

be

d –

bel

ieve

d to

be

rela

ted

to d

iffic

ulty

inse

rtin

g th

e sl

ing

unde

r th

e pa

tient

. Re

sulte

d in

4 d

ays

off w

ork.

14

1

8.

Bed

to b

ed/t

rolle

y; b

ed to

re

clin

ing

adju

stab

le s

tret

cher

ch

air (

e.g.

Reg

ency

cha

ir)1

13

1






4 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)

Wor

k ar

ea s

peci

fic tr

aini

ng n

eeds

and

pla

n (c

ontin

ued

)

Pati

ent h

andl

ing

task

Ana

lysi

s of

wor

ker d

isco

mfo

rt/i

njur

y hi

stor

y (a

s pr

ovid

ed o

n th

e TN

A w

orke

r sur

veys

/ m

uscu

losk

elet

al d

isco

mfo

rt s

urve

ys)

Ana

lysi

s of

wor

ker s

elf r

ated

trai

ning

ne

ed (a

s pr

ovid

ed o

n th

e TN

A w

orke

r su

rvey

s)

Prio

rity

of t

rain

ing

Mos

tly

1, 2

& 3

= H

igh

prio

rity

: rec

omm

end

face

to

face

ski

ll re

fres

her t

rain

ing

in th

e ne

xt m

onth

; inc

lude

as

ann

ual a

sses

smen

t tas

k.

Mos

tly

4 &

5 =

Med

ium

pri

orit

y: re

com

men

d in

form

w

orke

rs o

f Saf

e W

ork

Proc

edur

e in

sho

rt te

rm; f

ace

to

face

ski

ll re

fres

her t

rain

ing

wit

hin

12 m

onth

s;

may

incl

ude

as a

nnua

l ass

essm

ent t

ask.

Mos

tly

6 &

7 =

Low

pri

orit

y: re

com

men

d m

onito

r an

d ad

dres

s as

reso

urce

s al

low

.

<For

eac

h ta

sk, r

ecor

d he

re th

e nu

mbe

r of

wor

kers

allo

cate

d ea

ch T

rain

ing

Nee

ds

Mat

rix

scor

e (1

–7),

as id

entifi

ed o

n th

e w

orke

r sur

veys

>

<For

eac

h ta

sk, c

onsi

der fi

ndin

gs o

f thi

s an

alys

is

and

appl

y ju

dgem

ent t

o de

term

ine

trai

ning

pri

oriti

es.

Tick

the

rele

vant

col

umn

for e

ach

task

>

12

34

56

7H

igh

Med

ium

Low

9.

In o

r out

of b

ath

(n

on-e

mer

genc

y)

10.

Repo

sitio

n in

cha

ir

11.

In o

r out

of t

he c

ar

(non

-em

erge

ncy)

12.

Wal

king

a p

atie

nt

13.

Mov

e pe

rson

off

floo

r (n

on-e

mer

genc

y si

tuat

ion)

14.

Init

ial p

atie

nt h

andl

ing

asse

ssm

ent

15.

Pre-

acti

vity

scr

eeni

ng

16.

Oth

er (p

leas

e sp

ecif

y)

Pati

ent h

andl

ing

task

Ana

lysi

s of

wor

ker d

isco

mfo

rt/i

njur

y hi

stor

y (a

s pr

ovid

ed o

n th

e TN

A w

orke

r sur

veys

/ m

uscu

losk

elet

al d

isco

mfo

rt s

urve

ys)

Ana

lysi

s of

wor

ker s

elf r

ated

trai

ning

ne

ed (a

s pr

ovid

ed o

n th

e TN

A w

orke

r su

rvey

s)

Prio

rity

of t

rain

ing

Mos

tly

1, 2

& 3

= H

igh

prio

rity

: rec

omm

end

face

to

face

ski

ll re

fres

her t

rain

ing

in th

e ne

xt m

onth

; inc

lude

as

ann

ual a

sses

smen

t tas

k.

Mos

tly

4 &

5 =

Med

ium

pri

orit

y: re

com

men

d in

form

w

orke

rs o

f Saf

e W

ork

Proc

edur

e in

sho

rt te

rm; f

ace

to

face

ski

ll re

fres

her t

rain

ing

wit

hin

12 m

onth

s;

may

incl

ude

as a

nnua

l ass

essm

ent t

ask.

Mos

tly

6 &

7 =

Low

pri

orit

y: re

com

men

d m

onito

r an

d ad

dres

s as

reso

urce

s al

low

.

<For

eac

h ta

sk, r

ecor

d he

re th

e nu

mbe

r of

wor

kers

allo

cate

d ea

ch T

rain

ing

Nee

ds

Mat

rix

scor

e (1

–7),

as id

entifi

ed o

n th

e w

orke

r sur

veys

>

<For

eac

h ta

sk, c

onsi

der fi

ndin

gs o

f thi

s an

alys

is

and

appl

y ju

dgem

ent t

o de

term

ine

trai

ning

pri

oriti

es.

Tick

the

rele

vant

col

umn

for e

ach

task

>

12

34

56

7H

igh

Med

ium

Low

9.

In o

r out

of b

ath

(n

on-e

mer

genc

y)

n/a

10.

Repo

sitio

n in

cha

ir A

few

wor

kers

exp

erie

nced

pai

n/di

scom

fort

from

ass

istin

g pa

tient

s to

rep

ositi

on

in th

e lo

w c

hair

s on

the

war

d.

31

11

11.

In o

r out

of t

he c

ar

(non

-em

erge

ncy)

n/a

12.

Wal

king

a p

atie

nt

13

2

13.

Mov

e pe

rson

off

floo

r (n

on-e

mer

genc

y si

tuat

ion)

11

31

14.

Init

ial p

atie

nt h

andl

ing

asse

ssm

ent

11

31

15.

Pre-

acti

vity

scr

eeni

ng

11

31

16.

Oth

er (p

leas

e sp

ecif

y)





5 of

5

Thin

k Sm

art P

atie

nt H

andl

ing

Bet

ter P

ract

ice

Gui

delin

es 2

nd E

diti

onTh

is fo

rm c

an b

e ph

otoc

opie

d if

you

requ

ire

addi

tiona

l spa

ce to

doc

umen

t mor

e in

form

atio

n.

Patie

nt h

andl

ing

trai

ning

nee

ds a

naly

sis

(TN

A)

Wor

k ar

ea s

peci

fic tr

aini

ng n

eeds

and

pla

n (c

ontin

ued

)

Com

men

ts:

Nex

t ste

p: d

evel

op a

wor

k ar

ea tr

aini

ng a

nd a

sses

smen

t pla

nU

se th

e in

form

atio

n th

at h

as n

ow b

een

colla

ted

and

anal

ysed

to d

evel

op a

trai

ning

and

ass

essm

ent p

lan

for t

his

wor

k ar

ea fo

r the

yea

r ahe

ad. F

urth

er in

form

atio

n on

dev

elop

ing

a w

ork

area

tr

aini

ng a

nd a

sses

smen

t pla

n ca

n be

foun

d in

the

acco

mpa

nyin

g Th

ink

Smar

t pat

ient

han

dlin

g tr

aini

ng a

nd a

sses

smen

t pro

gram

. Inf

orm

atio

n th

at m

ay b

e do

cum

ente

d in

the

trai

ning

and

as

sess

men

t pla

n in

clud

es:

• a

prio

ritis

ed li

st o

f pat

ient

han

dlin

g ta

sks

to b

e in

clud

ed in

the

wor

k ar

ea tr

aini

ng a

nd a

sses

smen

t pla

n fo

r the

nex

t 12

mon

ths

• a

trai

ning

cal

enda

r for

pat

ient

han

dlin

g tr

aini

ng a

nd a

nnua

l ass

essm

ents

• sp

ecifi

c de

tails

for t

he p

ropo

sed

trai

ning

/ass

essm

ent s

essi

ons;

e.g

. the

pro

pose

d m

etho

d of

del

iver

y fo

r the

trai

ning

/ass

essm

ent;

whe

re th

e tr

aini

ng/a

sses

smen

t will

be

cond

ucte

d;

the

num

ber o

f wor

kers

to a

tten

d ea

ch s

essi

on; d

etai

ls o

f who

will

del

iver

the

trai

ning

/ass

essm

ent;

the

dura

tion

of th

e tr

aini

ng/a

sses

smen

t ses

sion

s; e

quip

men

t req

uire

d fo

r the

trai

ning

/as

sess

men

t ses

sion

etc

.

Man

y w

orke

rs d

escr

ibed

gen

eral

ised

dis

com

fort

from

per

form

ing

all p

atie

nt h

andl

ing

task

s (n

o sp

ecifi

c pr

oble

mat

ic ta

sks

iden

tified

).





References1. Occupational Health and Workplace Safety Unit (OHWSU). 2008, ‘Queensland Health

Implementation Standard for Patient Handling Tasks Version 3’ (OHSMS 2-22#21) [document on intranet]. QHEPS: Queensland Health. Available from: http://qheps.health.qld.gov.au/safety/safety_topics/standards/ohsms_2_22_21.pdf

2. Royal College of Nursing (RCN). 1996, Code of Practice for Patient Handling. London: RCN.

3. Adapted from Occupational Health and Workplace Safety Unit (OHWSU). 2008, ‘Queensland Health Implementation Standard for Patient Handling Tasks Version 3’ (OHSMS 2-22#21) [document on intranet]. QHEPS: Queensland Health. Available from: http://qheps.health.qld.gov.au/safety/safety_topics/standards/ohsms_2_22_21.pdf

4. Nelson, A., Baptiste, A. 2006, ‘Evidence-Based Practices for Safe Patient Handling and Movement’. Orthopaedic Nursing. vol.25, no.6, pp. 366-379.

5. Hignett, S. 2003, ‘Intervention strategies to reduce musculoskeletal injuries associated with handling patients: A systematic review’. Occupational and Environmental Medicine, vol.60, no.9, e.6. [online] Available from: http://oem.bmj.com/cgi/reprint/60/9/e6

6. Council of Standards Australia. 2001, ‘Occupational health and safety management systems - general guidelines on principles, systems and supporting techniques’. AS/NZS 4804. Standards Australia/Standards New Zealand, Sydney/Wellington.

7. Queensland Government. 1995, ‘Consultative Requirements: Part 7’, Workplace Health and Safety Act 1995. Brisbane.

8. Workplace Health and Safety Queensland. 2001, Manual Tasks Involving the Handling of People Code of Practice. Brisbane: Queensland Government Department of Employment and Industrial Relations.

9. Australian Safety and Compensation Council. 2007, National Code of Practice for the Prevention of Musculoskeletal Disorders from Performing Manual Tasks at Work [document on internet]. Available from: http://www.ascc.gov.au/NR/rdonlyres/65298783-6262-4D0D-A41D-13296040703D/0/ASCC_ManualTasks_COP.pdf

10. Australian Safety and Compensation Council. 2007, National Code of Practice for the Prevention of Musculoskeletal Disorders from Performing Manual Tasks at Work [document on internet]. Available from: http://www.ascc.gov.au/NR/rdonlyres/65298783-6262-4D0D-A41D-13296040703D/0/ASCC_ManualTasks_COP.pdf

11. Workplace Health and Safety Queensland. 2001, Manual Tasks Involving the Handling of People Code of Practice. Brisbane: Queensland Government Department of Industrial Relations.

12. Queensland Government. 1995, Workplace Health and Safety Act 1995. Brisbane.

13. Queensland Government. 2005, Plant Code of Practice: Plant [document on internet]. Available from: http://www.deir.qld.gov.au/workplace/resources/pdfs/plant_code2005.pdf

14. Proctor, R.W., Dutta, A. 1995, Skill Acquisition and Human Performance. London: Sage.

References

http://qheps.health.qld.gov.au/safety/safety_topics/standards/ohsms_2_22_21.pdf

http://qheps.health.qld.gov.au/safety/safety_topics/standards/ohsms_2_22_21.pdf

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