Patient Care Ergonomics

1. 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

2. Here�s A Successful Solution using Patient Care Ergonomics�

3. Successful Solution using Patient Care Ergonomics� VISN 8 Patient Safety Center Research Project: VISN-Wide Deployment of a Back Injury Prevention Program for Nurses: Safe Patient Handling and Movement (2001-2002)

4. Results: Incidence (#) of Injuries

5. Results: Injury Rates* Decreased from 24 to 16.9 Difference was significant at 0.036 level

6. Results: Light Duty Days

7. Results: Lost Work Days

8. Results: Job Satisfaction

9. Successful Solutions

10. Safe Patient Handling & Movement Program Management Support Champion SPHM Team Program Elements Equipment Knowledge Transfer Mechanisms Technical Support

11. SPHM Champion Clout Mover/Shaker Interest Nursing, Therapy, Safety�

12. SPHM Team Responsibilities Implements Program Writes Policy Reviews/Trends Data Ensures incidents/injuries are investigated Facilitates Equipment Purchases

13. SPHM Team Members Nursing Administrator Nursing Staff (CNA, LPN, RN) Nursing Service Safety Rep Peer Leader (BIRN) Risk Manager Resident/Patient Union Nurse Educator Therapy Staff (OT, PT, ST) Purchasing Engineering Employee Health/Safety Others�

14. Safe Patient Handling & Movement Program  Goals Reduce the incidence of musculoskeletal injuries Reduce the severity of musculoskeletal injuries Reduce costs from these injuries

15. 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

16. SPHM Key Objectives Reduce manual transfers by ___% Reduce direct costs by ___% Decrease nursing turnover by __% Decrease musculoskeletal discomfort in nursing staff by ___%

17. 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�

18. 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)

19. 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

20. Safe Patient Handling & MovementProgram Elements Back Injury Resource Nurses Chapter 7

21. Safe Patient Handling & Movement Program BIRNS are the Key to Program Success� Implement Program Continue Program

22. Back Injury Resource Nurses RN, LPN, CNA Informal Leader/ Respected Safety Interest Ergo Experience Not Required Enthusiastic/ Out-going Good Time/ Mgmt Skills

23. Back Injury Resource Nurses Roles/Responsibilities Implement/Continue SPHM Program Act as Resource, Coach, and Team Leader for Peers, NM, Facility Share/Transfer Knowledge Perform Continual Hazard/Risk Monitoring Monitor and Evaluate Program Monitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successesMonitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successes

24. BIRNS Roles & Responsibilities1. Implement/Continue SPHM Program BIRNS activities and involvement depend on what program elements are included in your Program. 

25. BIRNS Roles & Responsibilities2. Act as Resource, Coach, and Team Leader Share expertise in use of Program elements Motivate use of Program elements Listen to Ideas & Concerns Demonstrate Care & Concern for Staff Well-Being Support and promote a �Culture of Safety� Cheer on Safety Successes!!

26. BIRNS Roles & Responsibilities3. Share/Transfer Knowledge BIRNS-BIRNS Within Units, Facilities, Organization� With Others Organizations Monthly Conference Calls Outlook Email Groups National Conferences

27. BIRNS Roles & Responsibilities3. Share/Transfer Knowledge BIRNS-STAFF AAR Meetings On-the-Job Co-workers New Employees Staff Meetings Skills Check-off Training/In-services

28. BIRNS Roles & Responsibilities4. 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

29. BIRNS Roles & Responsibilities5. Monitor and Evaluate Program Assist in Collecting/Analyzing Injury Data Complete Checklists for Safe Use of Lifting Equipment Evaluate Ability to use Algorithms & Complete Care Plan

30. BIRNS Roles & Responsibilities5. Monitor and Evaluate Program Weekly BIRN Process Log (p.89) BIRNS Activity Level BIRNS and Program Status Effectiveness Adherence Support Monitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successesMonitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successes

31. What Helps Make a BIRNS Successful? Personality Natural Leader Positive Outlook Team Player Proactive Cooperation & Support

32. What Helps Make a BIRNS Successful? Cooperation & Support Nurse Manager Nursing Administration Facility Management Facility Safety Champion Engineering & Housekeeping

33. What Helps Make a BIRNS Successful? Management Support TIME to fulfill BIRNS role (especially during implementation phase) Coverage during meeting times, staff in-services & BIRNS training Lighter case-load TIME for Staff to attend In-Services

34. 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 Monitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successesMonitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successes

35. 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. Monitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successesMonitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successes

36. Safe Patient Handling & Movement Program BIRNS are the Key to� Implement SPHM Program Continue SPHM Program

37. Safe Patient Handling & MovementProgram Elements After Action Review ProcessChapter 9

38. After Action Review An After Action Review is for transferring knowledge a team has learned from doing a task in one setting, to the next time that team does the task in different setting. (Dixon, 2000)

39. AAR and Risk Reduction Provides mechanism for whole team to learn from the experiences of one individual Involves front line staff in identifying problems and SOLUTIONS

40. Guidelines for AAR Use Used for injuries AND �near-misses� After an incident has occurred bring staff together to discuss the incident No notes are taken Involve as many staff as possible Hold AAR in location of incident, if possible Non-punitive approach with no fault-finding/blaming

41. Guidelines for AAR Use Keep meetings brief - less than 15 minutes Staff-driven Assign one or two persons to ensure corrective actions are taken At next AAR, follow-up if needed

42. Guidelines for AAR Use The AAR group asks (1) What happened? (2) What was supposed to happen? (3) What accounts for the difference? (4) How could the same outcome be avoided the next time? (5) What is the follow-up plan?

43. Training Staff on AAR Minimal Training required Staff In-service � review purpose, need for trust, benefits, etc. Training Tools Handout A-2, AAR Brochure My AAR slides

44. AAR Case Study A nurse manager of a long term care unit decides to implement after action reviews after she notices an increase in musculoskeletal injuries among the staff.

45. AAR Case Study After hearing an explanation of the process, staff decide to schedule AAR meetings on Monday, Wednesday, and Friday at 11 AM. This time was selected because most of the morning care is completed by 11:00 and it is before lunch time.

46. AAR Case Study During the first meeting, group members ask staff to think about what happened during the morning. Did anything happen (near-miss or injury) that could have put them or their co-workers at risk of injury that everyone could learn from?

47. What Happened? Sue, an LPN, begins. I had to get Mr. Walker up because he was lying in a wet bed.... I was late with my meds and I knew I needed to get to the in-service. Then, I couldn�t find a sling, so I just got him up myself. While I was lifting him I kept thinking� �Don�t� hurt yourself�� I guess I was lucky I didn�t! So.. What happened was that I lifted Mr. Walker without help, without using a lift.

48. What Was Supposed to Happen? Nancy: OK.. So, what should have happened? Sue: I should have found the sling and used the lift, but I was in such a hurry. Nancy: I know� It�s so frustrating to have all of these new lifts but not have the slings where you need them. I know I�ve had trouble finding slings, too. Others discuss their experiences related to the lifts and slings.

49. What Accounts for the Difference? Nancy: Let�s see� What accounts for the difference? Well... The sling wasn�t available. For starters, the sling should have been in the room and on the bed side stand, where we agreed to keep them.

50. What Accounts for the Difference? Ron: You�re right, but there's not always room to put them there� That�s where patients place their things too� Because of that a lot of times I put slings places where �I� can find them when �I� come back in the room, but I guess that makes it hard for you guys to find them when I�m not around�.

51. What Accounts for the Difference? After more discussion, the group decides that the problems of �inaccessible slings� is caused by no good location for the slings in patient rooms.

52. How can the same outcome be avoided the next time?? Nancy: OK� We�re always running around looking for slings. What do you think about placing a sling �hook� in every patient room, right at the door, so you can easily pick the sling up on entering and put it back on leaving? Fred: That�s a good idea! I also think it would help if we had more slings� How many more do you think we need?

53. How can the same outcome be avoided the next time?? Brad: I�ll request a work order to install the hooks and after they�re installed I�ll make sure everyone gets the message on the new procedure. Ron: I�ll add the process to the new employee orientation packet. Fred: I�ll put in a request to order 6 slings.

54. What�s the Follow-up Plan? Sue: Let�s see if I have all of our recommendations� Put in a work order for installation of the hooks, buy more slings, spread the word, and the add process to the unit orientation packet for new employees. Brad: Since this has been a continual problem, let�s see how we�re doing on the sling issue at an AAR in one month.

55. After Action Review Case Study AAR Case Study BIRN noticed friction reducing devices (FRDs) weren�t being used on her Unit Held staff AAR Determined FRD�s too narrow Solution: BIRN contacted manufacturer who made new, wider FRD�s. Outcome: New, wider FRD�s used on Unit Monitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successesMonitoring & Risk Assessment - Complete ONGOING Risk Assessments Assist in collecting Injury Data/Information Complete Checklists for Safe Use of equipment Share Knowledge - Bi-weekly conference calls BIRN Process log Community of Practice web site Resource/Coach etc - Share expertise in use of Program elements Listen to ideas & concerns Demonstrate Care & concern for staff well-being Support & promote a Culture Of Safety Cheer on safety successes

56. AAR Practice Break into groups Think of a problem common to your group Perform an AAR using the AAR questions.

57. Safe Patient Handling & MovementProgram Elements Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling & Movement Chapter 5

58. Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling & Movement The Assessment, Algorithms , & Care Plan go hand in hand... Assess the Patient Determine what handling activities you must perform Follow the algorithms to determine what equipment and # of staff are needed Complete the Care Plan File for future use

59. What Tasks Do the Care Plan & Algorithms Cover? Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair Lateral Transfer To and From: Bed to Stretcher, Trolley Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table Reposition in Bed: Side to Side, Up in Bed Reposition in Chair: Wheelchair or Dependency Chair Transfer a Patient Up from the Floor

60. What Tasks Do the Bariatric Care Plan & Algorithms Cover? Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair Lateral Transfer To and From: Bed to Stretcher, Trolley Reposition in Bed: Side to Side, Up in Bed Reposition in Chair: Wheelchair or Dependency Chair Tasks Requiring Sustained Holding of Limb/s or Access to Body Parts Transporting (stretcher, w/c, walker) Toileting Transfer Patient Up from Floor

61. Patient Assessment & Care Plan � Page 71 Completed on all patients Takes into consideration: Patient Characteristics Patient Handling Task Equipment Uses Algorithms

62. Algorithms - Page 73 Based on Specific Patient Characteristics (from Assessment) Assists nurses in selecting Safest Equipment Safest Patient Handling Technique Advises # of staff needed

63. How were these Algorithms Developed? Developed by a group of nursing experts Tested with different patient populations in a variety of settings

64. 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

65. How Do We Lift This Resident?

66. 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.

67. 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)

68. Assessing Fred V. Level of Assistance Dependent 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

69. Assessing Fred V. Resident�s level of cooperation and comprehension Unpredictable Weight: 156 lbs. Height: 5� 9� Special circumstances? History of Falls

70. 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

71. Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling & Movement The Assessment, Algorithms , & Care Plan go hand in hand... Assess the Patient Determine what handling activities you must perform Follow the algorithms to determine what equipment and # of staff are needed Complete the Care Plan File for future use

72. Algorithms Practice Break into groups Have one person give a clinical description of a recent patient requiring moving/handling Develop a patient handling Care Plan using the assessment tool and algorithms.

73. Safe Patient Handling & MovementProgram Elements Safe Patient Handling & Movement Policy Chapter 6

74. Safe Patient Handling & Movement Policy SPHM Policy Ties all Program Elements Together� Based on UK Policy Implemented in high-risk units Focus on creating a safe workplace for caregivers rather than on punitive action for mistakes

75. Safe Patient Handling & Movement Policy SPHM Policy Ties all Program Elements Together� Says to avoid hazardous Patient handling tasks. If can�t avoid, carefully assess hazard, & if possible, always use Patient handling equipment

76. Safe Patient Handling & Movement Program BUT�. Patient Handling Equipment/Aids MUST be in place first, before implementing a SPHM Program. So, a systematic process is needed to ensure the right equipment is in place�

77. Safe Patient Handling & MovementProgram Elements 9 Step Ergonomic Workplace Assessment of Nursing Environments Chapter 3

78. Patient Care Ergonomic Hazard/Risk Evaluation 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

79. Patient Care Ergonomic Evaluation Process Studies show ergonomic approaches Reduced staff injuries from 20 - 80% Significantly reduced workers compensation costs Reduced lost time due to injuries Bruening, 1996; Empowering Workers, 1993; Fragala, 1993; Fragala, 1995; Fragala, 1996; Fragala & Santamaria, 1997; Logan, 1996; Perrault, 1995; Sacrifical Lamb Stance, 1999; Stensaas, 1992; Villaneuve, 1998; Werner, 1992)

80. Patient Care Ergonomic Evaluation Process Patient Care Ergonomic Evaluation Process 1. Collect Baseline Injury Data 2. Identify High Risk Units 3. Obtain Pre-Site Visit Data 4. Identify High-Risk Tasks 5. Conduct Team Site Visit at each High-Risk Unit 6. Risk Analysis 7. Formulate Recommendations 8. Implement Recommendations (Involve End Users) 9. Monitor Results/Evaluate Program/Continuously Improve Safety

81. Step 1. Collect Baseline Injury Data

82. Step 1. Collect Baseline Injury Data Cause: Patient Handling Tasks Target Population/s: Nursing Staff (Radiology, Therapy Staff � PT,OT,ST, Others?) Type: Strains/Sprains (Struck, Fall..?) (Best to include all types of injuries, then analyze those of interest.) Duration: Minimum of 1 year of data

83. Step 1. Collect Baseline Injury Data Collect by Unit (will also use later during risk analysis) Sources: Risk Manager/Safety/Human Resources Facility Injury Logs/Statistics, Unit Records, OSHA 200/300 Logs Patient Care Incident/Injury Profile Note which source is used on your Injury Log

84. Step 2. Identify High-Risk Units What units have the Most Patient handling injuries/ incidents? Most severe injuries/incidents? (by lost time or modified duty days) Highest concentration of staff on modified duty?

85. Step 2. Identify High-Risk Units Common Characteristics: High proportion of dependent patients/residents High frequency of patients/residents getting in & out of bed High frequency of transfers from one surface to another, e.g. w/c to toilet or bed

86. Step 4. Identify High-Risk Tasks �Tool for Prioritizing High Risk Tasks� � p. 30 Rank Tasks from 1 to 10 1 = highest risk 10 = lowest risk When ranking, consider: Frequency & Musculoskeletal Stress Delete Tasks not usually performed on Unit Completed by Each Staff member Collectively by Shift

87. Step 4. Identify High-Risk Tasks High Risk Task Ranking Exercise Think of a high-risk unit. Complete Tools for Prioritizing High-Risk Patient Handling Tasks (Complete Handout A-4, Prioritizing High Risk Tasks)

88. Step 4. Identify High-Risk Tasks Let�s compare high risk tasks identified by you and others� If there were differences� Why?? What factors play a role in ranking tasks?

89. Step 4. Identify High-Risk Tasks High Risk Task Ranking UNIT Exercise 1. Have staff complete 2. Compare their perceptions to yours 3. Compare their and your perceptions to Baseline Injury data

90. 3. Obtain Pre-Site Visit Data on High-Risk Units Use �Pre site Visit Unit Profile� � p. 24 Space issues Storage availability Maintenance/repair issues Patient population Staffing characteristics Equipment inventory/issues Will use when performing site visit and for making recommendations

91. Step 3. Obtain Pre-Site Visit Data Remember� Involve as many staff as possible and as much as possible�

92. 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)

93. Step 5. Conduct Site Visit Site Visit Walk-through Patient room sizes/configurations Ceiling Characteristics/AC vents/TVs Showering/bathing facilities Toileting process

94. Step 5. Conduct Site Visit Site Visit Walk-through Equipment Availability Accessibility Use Condition Storage Staff attitudes

95. 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

96. 9 Step Ergonomic Workplace Assessment of Nursing Environments Step 6. Perform Risk Analysis

97. 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

98. Step 6. Perform Risk Analysis What do we need to look at to identify Specific RISKS of �ELEMENTS� of High Risk Job TASKS?

99. 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?

100. 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

101. 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

102. Step 6. Perform Risk Analysis Job Safety Analysis (JSA) Let�s try it!!! See Job Safety Analysis Worksheet (Handout A-7)

103. 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??

104. 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!

105. Step 6. Perform Risk Analysis What Risk Factors are related to the Health Care Environment?

106. 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

107. 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

108. 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

110. Step 6. Perform Risk Analysis What Risk Factors are related to Patients?

111. 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

112. 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

113. Step 6. Perform Risk Analysis What Risk Factors are found in Patient Handling Tasks?

114. 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

115. 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

116. Step 6. Perform Risk Analysis Now, it�s time to tie� Patient Handling Task Risks Health Care Environment Risks Patient Risks to Site Visit Data This will show us what to consider in making recommendations.

117. Step 6. Perform Risk Analysis Risk Analysis includes review of� Unit Baseline Injury Data Patient Care Incident/Injury Profile (p. 21) Pre-Site Visit Data Pre-Site Visit Unit Profile (p. 24) High-Risk Tasks Tool for Prioritizing High-Risk Patient Handling Tasks (p. 30)

118. Step 6. Perform Risk Analysis Risk Analysis includes review of� Site Visit Information Site Visit Summary Data Sheet (p. 34) Observations & Additional Information from Site Visit

119. Step 6. Perform Risk Analysis Analyzing Unit Baseline Injury Data Will provide direction when making ergonomic recommendations Determine: #1 & 2 Causes of Injuries #1 & 2 Activities being performed when staff are injured What�s going on? What trends are seen?

120. Step 6. Perform Risk Analysis Analyzing Unit Baseline Injury Data Activity Let�s try it� Use Injury Incidence Profile (Handout A-8) 1. For the NHCU, what are the: #1 & 2 Causes of injuries? #1 & 2 Activities involved in the injuries? 2. What trends do you see?

121. Step 6. Perform Risk Analysis Analyzing Unit Baseline Injury Data What does the unit injury data tell you?

122. Step 6. Perform Risk Analysis Data to Direct Recommendations Incidence (# injuries per unit) Severity (defined by # of lost and modified duty days) 1 - 2 Primary task/s involved in injuries 1 - 2 Primary cause/s of injuries on unit Patient Dependency Levels Number/configuration of rooms Whatever is significant to your needs

123. Step 6. Perform Risk Analysis Information from the Risk Analysis drives formation of Recommendations�

124. 9 Step Ergonomic Workplace Assessment of Nursing Environments Step 7. Formulate Recommendations

125. Step 7. Formulate Recommendations Solutions involve: #1 Hazard Elimination #2 Engineering Controls #3 Administrative Controls

126. Step 7. Formulate Recommendations Hazard Elimination Examples?

127. Step 7. Formulate Recommendations Hazard Elimination Scale in sling lift Transfer Bed

128. Step 7. Formulate Recommendations Administrative Controls Examples?

129. Step 7. Formulate Recommendations Administrative Controls Changes in Scheduling Minimizing # times transfers are required Job Rotation Redistribution of Workload Based on Acuity Lifting Teams Procedures for repair/maintenance Allot Storage Space to make equipment more accessible

130. Step 7. Formulate Recommendations Engineering Control Examples?

131. Step 7. Formulate Recommendations Engineering Controls Result: Caregivers conduct their job in a new way Physical Change to the way a job/task is conducted Utilization of an aid/equipment to reduce the hazard Modifications to the Workplace

132. Step 7. Formulate Recommendations Engineering Controls are the keys to improving safety in a health care environment�. Let�s see some examples.