Patient Care Ergonomics
Remember… Through Ergonomics
• Job can be redesigned• Jobs can be improved to be within
reasonable limits of human capabilities However, ergonomics is not a magical
solution…• To be effective, a well thought out system
of implementation must be developed
Here’s A Successful Solution using Patient
Care Ergonomics…
Successful Solutions
Overview of a Safe Patient Handling & Movement Program
Safe Patient Handling & Movement Program
•Management Support
•Champion•SPHM Team •Program
Elements
•Equipment•Knowledge
Transfer Mechanisms
•Technical Support
For success, required infrastructure MUST be in place prior to implementing SPHM Program
SPHM Champion
CloutMover/Shaker InterestNursing, Therapy, Safety…
Safe Patient Handling & Movement Program
Goals Reduce the incidence of
musculoskeletal injuries Reduce the severity of
musculoskeletal injuries Reduce costs from these injuries
Safe Patient Handling & Movement Program
Goals Create a safer environment &
improve the quality of life for patients/residents
Encourage reporting of incidents/injuries
Create a Culture of Safety and empower nurses to create safe working environments
SPHM Key Objectives
Reduce # of lost workdays due to patient handling tasks by ___%
Reduce # of light duty days due to patient handling tasks by ___%
Note: Best to NOT measure success by # of reported injuries…
Safe Patient Handling & Movement Program
What goals do you want to achieve for yourself, your co-workers,
and your unit?
What specific Program Objectives do you want to attain?
(Complete “A” & “B” of Handout A-1, Developing a Safe Patient Handling & Movement Action
Plan)
Safe Patient Handling & Movement Program
SPHM Program Elements Peer Leaders – BIRNS/Ergo Rangers After Action Review Process Patient Assessment, Care Plan,
Algorithms for Safe Patient Handling & Movement
SPHM Policy Ergonomic & Hazard Assessment of
Patient Care Environment Equipment
Safe Patient Handling & Movement
Program Elements
Back Injury Resource Nurses
Chapter 7
BIRNS Roles & Responsibilities
4. Perform Continual Hazard/Risk Monitoring
Two Levels of Hazard/Risk Evaluations
•Formal Ergonomic Hazard Evaluation – Ch. 3
•Ongoing Workplace Hazard Evaluations• Of the Environment• Of Patients/Residents• Of Patient Handling Tasks
Back Injury Resource Nurses
Outcomes for Staff Staff are empowered
•Channel to voice ideas/suggestions•Opportunity to have input in making work environment safer
Increased competence in performing job
Increased sharing of knowledge/best practices
Fosters Culture of Safety
Back Injury Resource Nurses
Examples of Problems Identified Lifts not being used on night
shifts. • Why? Batteries were being charged
on night shifts because no back-up batteries.
• Solution: Buy extra battery packs so lifts can be used 24 hours per day.
Safe Patient Handling & Movement
Program Elements
Patient Assessment, Care Plan, & Algorithms for Safe
Patient Handling & Movement Chapter 5
Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling
& Movement
The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling
activities you must perform3. Follow the algorithms to
determine what equipment and # of staff are needed
4. Complete the Care Plan5. File for future use
What Tasks Do the Care Plan & Algorithms Cover?
1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair
2. Lateral Transfer To and From: Bed to Stretcher, Trolley
3. Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table
4. Reposition in Bed: Side to Side, Up in Bed5. Reposition in Chair: Wheelchair or
Dependency Chair6. Transfer a Patient Up from the Floor
What Tasks Do the Bariatric Care Plan & Algorithms
Cover?
1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair
2. Lateral Transfer To and From: Bed to Stretcher, Trolley
3. Reposition in Bed: Side to Side, Up in Bed 4. Reposition in Chair: Wheelchair or
Dependency Chair5. Tasks Requiring Sustained Holding of Limb/s
or Access to Body Parts6. Transporting (stretcher, w/c, walker)7. Toileting8. Transfer Patient Up from Floor
Patient Assessment & Care Plan – Page 71
Completed on all patients Takes into consideration:
•Patient Characteristics •Patient Handling Task•Equipment
Uses Algorithms
Algorithms - Page 73
Based on Specific Patient Characteristics (from Assessment)
Assists nurses in selecting• Safest Equipment • Safest Patient Handling
Technique Advises # of staff needed
How were these Algorithms Developed?
Developed by a group of nursing experts
Tested with different patient populations in a variety of settings
When Should The Algorithms be Used?
Use the Algorithms for every patient/resident who needs help moving
Remember….• The Algorithms provide general
direction• Caregiver must use their
professional judgment in applying Algorithms
How Do We Lift This Resident?
Let’s assess NH resident: Fred Veteran
80 year old resident of a VA Nursing Home.
Weight: 156 lbs. Height: 5’ 9” Has dementia and a history of falls. Some days he is cooperative. Other days
he is combative and fearful. When he is cooperative, he can bear
weight. Otherwise, he resists standing. He is to be out of bed every day in a chair.
Assessing Fred V.
Take a few minutes and complete a Patient
Handling Care Plan for Fred Veteran.
(Use Handout A-3, Patient Assessment & Care Plan)
Assessing Fred V.
Level of AssistanceDependent
Can the resident bear weight?
No, because the resident is not cooperative
Does resident have upper extremity strength needed to support weight during transfers?
No, because resident is unreliable for using his upper extremity strength
Assessing Fred V.
Resident’s level of cooperation and comprehension
Unpredictable
Weight: 156 lbs. Height: 5’ 9”
Special circumstances?
History of Falls
Finishing Fred V.’s Care Plan
Although the resident can sometimes bear weight, he can be uncooperative.
The “No” answer to “Is the Resident cooperative?” leads you to: “Use full body sling lift and 2 caregivers”
Answer: Use full body sling lift and 2 caregivers
Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling
& Movement
The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling
activities you must perform3. Follow the algorithms to
determine what equipment and # of staff are needed
4. Complete the Care Plan5. File for future use
Step 3. Obtain Pre-Site Visit Data
Remember…Involve as many staff as possible and as much as
possible…
Step 3. Obtain Pre-Site Visit Data
Now… think of one of your high-risk units from your facility and complete a cursory “Unit Data Collection Tool” for that unit.
* Complete Unit Data Collection Tool Profile (Handout A-5)
Step 5. Conduct Site Visit
Site Visit Walk-through• Patient room sizes/configurations• Ceiling Characteristics/AC vents/TVs• Showering/bathing facilities• Toileting process
Step 5. Conduct Site Visit
Site Visit Walk-through• Equipment
•Availability Accessibility•Use Condition•Storage
• Staff attitudes
Step 5. Conduct Site Visit
After Site Visit… Organize data by entering into
Site Visit Summary Data Sheet (p. 34 and Handout A-6)
Use during Risk Analysis in order to make Recommendations
9 Step Ergonomic Workplace Assessment of Nursing
Environments
Step 6. Perform Risk Analysis
Step 6. Perform Risk Analysis
Risk Identification/Breakdown High Risk DEPARTMENT/AREA High Risk JOBS (RN, CNA, LPN, etc.)
• Specific TASKS of High Risk Jobs (p. 30)
• Specific ‘ELEMENTS’ of High Risk Job TASKS
Step 6. Perform Risk Analysis
What do we need to look at to identify Specific
RISKS of ‘ELEMENTS’ of High Risk Job TASKS?
Step 6. Perform Risk Analysis
Element/Task Risk Identification
Task Intensity Task Duration Work Posture General Design of Equipment Space Characteristics Where do you think problem
exists?
Step 6. Perform Risk Analysis
Methods to Gather Risk Data General Observation Staff Discussions Staff Questionnaires Review of Medical Data Symptoms Surveys Quantitative Evaluations
Previous Studies Job Consistency
& Fatigue Brainstorming &
Group Activities Job Safety
Analyses
Step 6. Perform Risk Analysis
Job Safety Analysis (JSA) Break down job into steps Identify hazards associated
with each step Determine actions necessary to
eliminate or minimize hazards
Step 6. Perform Risk Analysis
Job Safety Analysis (JSA)
Let’s try it!!!
See Job Safety Analysis Worksheet (Handout A-7)
Step 6. Perform Risk Analysis
Risk Analysis is used to find Risk Factors that may cause injury.
There are three categories of Risk Factors in a Patient Care
Environment...
What do you think they are??
Step 6. Perform Risk Analysis
Risk can come from: Patient Handling Tasks Health Care Environment Patient
Once risks are identified, steps can be taken to protect Staff
and Patients!
Step 6. Perform Risk Analysis
What Risk Factors are related to the Health Care Environment?
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors
Slip, trip, and fall hazards Uneven work surfaces (stretchers, beds,
chairs, toilets at different heights) Uneven Floor Surfaces (thresholds) Narrow Doorways Poor bathing area design
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors
Space limitations • Small rooms• Lots of equipment• Clutter• Cramped working space
Poor placement of room furnishings
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors
Broken Equipment Inefficient Equipment (non-electric, slow-
moving, bed rails) Not enough or Inconvenient Storage
Space Staff who don’t help each other or don’t
communicate
‘The Far Side’ Safety Humor…
Step 6. Perform Risk Analysis
What Risk Factors are related to Patients?
Step 6. Perform Risk Analysis
Patient Risk Factors Weak/unable to help with
transfers Unpredictable Vision or hearing loss Hit or bite Resistive Behavior Unable to follow simple
directions
Step 6. Perform Risk Analysis
Patient Risk Factors Overweight Experiencing Pain Hearing or vision loss No/little communication
between staff about Patient or with Patient
Step 6. Perform Risk Analysis
What Risk Factors are found in Patient Handling Tasks?
Step 6. Perform Risk Analysis
Patient Handling Tasks Risk Factors Reaching and lifting with loads far
from the body Lifting heavy loads Twisting while lifting Unexpected changes in load
demand during lift Reaching Long Duration
Step 6. Perform Risk Analysis
Patient Handling Tasks Risk Factors Moving or carrying a load
a significant distance Awkward Posture Pushing/Pulling Completing activity with
bed at wrong height Frequent/repeated
lifting & moving
Step 7. Formulate Recommendations
Hazard Elimination Scale in sling lift Transfer Bed
