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Safe Patient Handling & Movement (SPH&M) at the VA San Diego Healthcare System. Kathleen L. Dunn, MS, RN, CRRN-A, CNS. Where we were in 2000. Most patient movement was being done manually. Some areas had 1 mobile lift, which was rarely used. Nurse injuries were frequent & costly.
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Safe Patient Handling & Movement (SPH&M) at the VA San Diego Healthcare System Kathleen L. Dunn, MS, RN, CRRN-A, CNS
Where we were in 2000 • Most patient movement was being done manually. • Some areas had 1 mobile lift, which was rarely used. • Nurse injuries were frequent & costly. • SCI had highest nurse injury rate in the entire hospital.
Transfers such as “quad” pivots, 2-person lifts, and 2 person “sheet pulls” were common. Quad Pivot Sheet Pull 2-person lift
Where we were in 2000 • Traditional body mechanics training was included in orientation and reviewed annually. • Those injured were required to repeat this training.
February-April 2001 • VASDHS staff attended VISN 8 Safe Patient Handling & Movement Conference. • We saw the light! • Solicited support for program within Nursing Service • Presented to PIC & approved for PIT chartering.
Costs of Injuries: FY02 VASDHS • 30 nurse injuries associated with patient handling and movement tasks • 17 occurred on the Spinal Cord Injury Center resulting in $162,815.53 in charge back (direct) costs. • With indirect costs being 4-10X that of direct, it is estimated that in FY02, the SCI unit had over $650,000.00 in costs related to nurse injuries caused by patient handling and movement.
Fall 2001-Summer 2002 • Banned manual lifting (2 person lifts & “quad pivots”) on SCI unit. • Established SPH&M committee. • Collected pre-project baseline data. • Planned and held 2 equipment fairs. • Trial install of 4 ceiling track lift systems in SCI over 2 months.
Battery Charge position SCI Inpatient RoomSingle-track ceiling lift for two beds in one room. Auto return to preset height. Sling hook on bedside cabinet
SCI Inpatient RoomPatients are issued a sling at admission that stays on their bedside closet hook.
Privacy Curtain Modifications Curtains split & Velcroed
SCI Therapy GymSingle-track ceiling lift over P.T. parallel bars. Scales allow measurement of % weight bearing.
Cost Savings: Phase 1 • $150,000 spent for Phase 1 (SCI) ceiling track lift installation in October 2002. • October 2002-March 2003: • Zero (0) SCI nurse injuries related to transfers or lifting. • 1 SCI nurse injury related to patient turning. • Estimated costs savings: $600,000 for Phase I pilot
June-July 2003 • Presentation of Phase 2. proposal to Status of Funds • Approximately $600,000 for equipment approved for Phase 2.
October-December 2003 • Installation of Phase II • Partial ceiling track lifts on all inpatient units. • New mobile lifts obtained for most areas. • “No-Lift” (SPH&M) Nursing & PCS Services Policy approved. • Staff Education & Training.
Strategies Develop “Champions” for culture change. • VASDHS – PINs (Preventing Injuries Now facilitators). Includes non-nursing staff as well. • Credible peer leaders. • Ongoing hazard identification. • Train-the-trainers. • Implement algorithms in all units/areas. PIN
Sample Algorithm Ability to bear weight Caregiver assistance not needed;Stand by for safety as needed Full Partial Is the patient cooperative? Use ceiling lift or portable floor lift with full body sling and at least one care giver. No Yes Is the patient cooperative? No Use full body sling lift and 2 caregivers. No Yes No Transfer to and from:* Bed to Chair* Chair to Toilet* Chair to Chair or* Car to Chair Does the patient have UE strength?
Where are we now? ALL OF VASDHS – • Complete total patient room ceiling track install: Spring 2007. • Radiology, MRI, cardiac lab, and Morgue re-engineered. • Rarely-used equipment bank (Escort). • Increased compliance and skill in use of algorithms.
Where are we now? • Before: averaged 40+ injuries a year due to patient handling and movement. • Now: average 20 injuries a year with just partial implementation of the program. • Costs: approx. $950,000 spent on equipment and re-engineering. • Cost Savings: $2.8 million (direct and indirect)
Where are we now? • Policy is now applicable to all direct patient care staff (not just nursing staff) as an MCM (3/06). • List of banned manual handling tasks • Universal requirement to use SPH&M techniques and equipment. • Staff, supervisor and administrative responsibilities detailed.
Where are we now? • Radiology, Rehab Medicine, and other services represented on Committee, which now reports to Process Improvement Council (PIC). • On-going education & monitoring. • Plans to have input on all patient care equipment purchases from ergonomic stand-point.
Where are we now? • VA National Directive mandating SPH&M is expected this summer. • Additional $336,000 received as VACO grant for projects through FY ’08 • SPH&M Facility Champion position will be implemented by start of FY ’09.
VASDHS Safe Patient Handling & Movement MCM • Defines responsibilities at all levels. • Applies to all clinical staff. • Lists banned patient/equipment handling & movement activities. • Defines possible consequences for staff failure to follow this policy & these rules. • Contains decision making algorithms.
