Back Safety, Safe Patient Handling, & Assisted Mobility Skills

1. Back Safety,Safe Patient Handling,& Assisted Mobility Skills Finger Lakes DDSO New Employee Orientation April 2012

2. What is Back Safety/Safe Patient Handling(SPH)?1 • A set of policies and programs designed to decrease the strain and injury on staff while they move and care for consumers • Focuses on minimizing and eliminating manual lifting by using equipment instead of the caregiver’s body • Legislation in NYS is passed in the Assembly and is pending in the Senate to make SPH mandatory in all healthcare facilities.

3. Why is Back Safety/Safe Patient Handling important? • Healthcare work is among the most hazardous occupations in NYS2 • Back injury is the 2nd leading occupational injury3 • Back injuries are expensive2 • Cost of medical care • Cost to pay overtime coverage • Significant time is lost with injury • Mandated overtime, training new staff • Safe body mechanics are not enough to prevent injury3,5 • Prior to SPH, stand pivot transfers were the #1 way FLDDSO staff were injured when caring for consumers

4. Benefits to Staff2 • Decreases Injuries • Decreases Pain and Muscle Fatigue • Decreases Lost Work Days • Decreases Overtime • Increases Morale • Increases Job Satisfaction • “My company/supervisor/worksite cares about me!” • SPH is an investment in the employee

5. Consumer Benefits of SPH2 • Improves quality of life • Lowers levels of depression and “behaviors” • Consumers feel more secure and less anxious when being transferred in a consistent manner • Improves urinary continence • Increases consumer participation in activities • Increases level of daytime alertness • Increases/maintains upper extremity ROM • Decreases fall risk • Decreases in fractures (spiral, compression) • Decreases skin tears and bruising

6. What About the Consumers? • Bottom line: • We can not provide safe care for the consumers if we do not take care of ourselves!

7. Back Safety Injuries Risk Factors Proper Lifting

8. Healthy Spine Image from http://www.orlandocaraccidentlawyerblog.com/2009/08/ Image from www.squidoo.com

9. Posture • Purpose of the spine: • Protects the spinal nerve • Demo: posture/curves • Muscles support the spine • Back muscles tend to be small in size • Lifting muscles are larger quads and gluts • Good posture relies on flexibility & core strength • Stretch your low back into extension • Strengthen your abs Image from: http://davidsalse.files.wordpress.com/2011/06/posturesitting.jpg

10. Risk Factors2,3,6,7,8,9 • Poor posture • Stretches & weakens key muscles • Examples: car seating, brushing teeth, washing dishes • Frequency of forward flexion • Typically 3,000-5,000 times/day • Previous injury • Known or unknown • Lack of exercise • Lack of social support • Low job satisfaction • Age • Lifting more than 35lbs • NIOSH safe weight limit • Lack of sleep • Less than 8 hours • Smoking • Decreases body’s ability to heal

11. Microtraumas: “Unknown” Injuries • Mechanical processes • Compression • Shear • Rotation/Twist • Awkward Postures Image from http://www.sandiego-spine.com/2010/degenerative-spine.png

12. Common Injury in Spine • Disc Herniation • Over time the outer layer of the disc weakens from repeated microtraumas • The inner jelly of the disc bulges out of position, usually toward the back where it can put pressure on the nerve Image from http://www.backpainhelptoday.com/wp-content/uploads/2010/12/Hdisc1.jpg

13. Other Common Injuries • Muscle Strain • Tear in muscle fibers • Pain • Inflammation • Tightness • Tendinopathy • Pain • Tenderness • Related to gradual wear & tear • Compression Fracture • Directly related to disc health • Various Locations • Shoulder • Rotator cuff, impingement • Knees • Torn cartilage, ligament issues • Neck • Nerve problems radiating down arm, stiffness

14. Body Mechanics DO DO NOT • Get in the ready position • Wide base of support • One foot slightly forward • Firmly plant your feet • Soften your knees • Wear appropriate clothing and footwear • Per DDSO dress code, shoes must cover toes and have flat contact with ground • Make quick and jerky movements • Causes strain on back muscles • Twist when lifting • “Keep nose and toes pointed in the same direction” • Wear clothing that interferes with safe patient care • Large jewelry • Shoes with high heels, flip-flops

15. Body Mechanics / Lifting • Assess the situation • Know your limitations • Is there equipment available to make this safer? • Plan ahead and prepare the environment • Clear pathway • Hold the load close and firm • Hips & shoulders square to load • If hold is not firm- start over! • With heavy objects, break up the load • Communicate with other staff member and consumer

16. Chores Challenge • Laundry • Top loading washer & front loading dryer • Making beds • Shoveling snow • Push, squat, do not toss over shoulder • Yard work • Use wheelbarrows, kneel on knee pads • Carrying groceries & supplies • Divide up loads, use carts on wheels

17. SPH & Assisted Mobility Skills

18. Course Objectives • Given direction by a licensed physical or occupational therapy staff, the FLDDSO new employee/trainee will demonstrate their knowledge by performing the following: • General concepts for joint range of motion (not specific to a consumer) • General concepts to prevent and manage decubiti (pressure sores) • Safe and effective transferring and handling techniques including use of non-friction devices, rolling devices, mechanical floor lifts, sit/stand lifts and gait belts • Safe and effective positioning of consumers on support surfaces (wheelchairs, beds)

19. Competencies • 4.17 Lifting & Transferring • 4.19 Range of Motion • 3.5 Blind Trailing-Mobility Techniques for consumers with Visual Deficits • Competencies get officially signed at the worksite. This class will give you the basics and will result in signature in the “Comments” section of these 3 competencies.

20. Range of Motion (ROM) = The available movement at a joint ROM deficits are commonly seen in: • Consumers with cerebral palsy (high tone) • Consumers who have had a stroke (high tone) • Consumers with arthritis (cartilage less pliable) Benefits of Joint Movement • Increased comfort and flexibility • Increased circulation and nutrition to joint • Maintenance of ADLs (dressing, bathing, etc.) • Greater ease for staff to perform skin/hygiene care

21. ROM Programs • ROM is performed by staff when muscle and/or joint tightness: • Interferes with cleanliness and hygiene care • Interferes with dressing • Causes pain and discomfort • Formal programs may be provided by OT/PT • Found in the IPOP • Require further consumer specific training by the therapist

22. Keys to Remember • Your approach matters: • Quiet voice, dim lights, firm, but gentle touch, after a warm bath/shower • Always tell the consumer what you are doing • Surround the joint • One hand on each side of the joint • Only range one joint at a time • Full hand control • Keep fingers together, flat surface • Fingertips can bruise; avoid claw hands • Smooth and controlled • Never push into restrictions • Never bounce • Move slowly: fast jerks can increase tone and cause injury

23. ROM Terms to Know • Flexion • To bend • Extension • To straighten • Abduction • Moving the body part away from midline • Abduct means to take away! • Adduction • Moving the body part towards midline • “ADD”ing to the body • Internal Rotation • Rotation towards the center of the body • External Rotation • Rotation away from the center of the body

24. Flexion • Extension Images from HEP2go.com

25. Abduction • Adduction Images from HEP2go.com

26. Internal Rotation • External Rotation Images from HEP2go.com

27. Decubitus Ulcers“Pressure Ulcers” “Bed Sores” • Risk factors • Boney areas of the body • Tail bone, heel, ankle, hip, elbow, back • Prolonged pressure • Healthcare best practice requires repositioning at least every two hours! • Fragile skin • Decreased circulation • Diabetes, other vascular diseases • Poor nutrition • May have adequate intake, but poor absorption

28. Decubitus Ulcers • Risk Factors continued… • Friction • Repeated movement across a surface • Shearing • Body tissue moves over top the skin which has adhered to the support surface • Example: bare legs on a vinyl car seat on a hot day • Moisture & heat • Sweat • Incontinence • Bowel and bladder • Caustic to skin

29. Decubitus Ulcers • Most are preventable by • Keeping the skin clean and dry • Changing position at least every 2 hours • Properly using support surfaces that relieve pressure • seat cushions, mattresses… • Assuring clothing is not a risk factor • avoid jeans, avoid nylon pants, ensure footwear is ON when in wheelchair

30. Discussion points on seating demo • Tell us about how you feel after being on improper seating during the short discussion • Remember that consumers sit in positions for up to two hours at a time • Make sure consumers are seated appropriately! • Fragility of consumer skin even before seating concerns

31. Cushion 101 • Used for pressure relief, comfort, and positioning • Positioning cushions have: • Bump in front to separate legs • Soft well in the back for tailbone • Check to make sure they are in properly • Hand sweep to check front and back • Check the labels • Often labeled front and back • Do not assume the cover is on the cushion correctly

32. Wheelchair parts Pelvic Positioning Belt Hand Rim Rear Anti-Tippers Front Castor

33. All WCs used by consumers at the FLDDSO must have: • 2 working brakes (wheel locks) • Pelvic positioning belt (seat belt) • Rear anti-tippers • Arm rests • Foot rests • may be removed inside buildings for people who foot propel, must be replaced prior to transportation • Tilt chairs must have headrests *Any exceptions are found in the IPOP

34. Wheelchair Maintenance & Care • Frequent cleaning necessary for function • Not just for night shift • Cleaning should occur as chair gets soiled • Especially following meals • Upholstery should be wiped down • More to come with Personal Care Skills course… • If the wheelchair is broken or missing parts, DO NOT bring consumer to day program or outings • Cannot be transported in that condition • Immediately contact OT, PT, house or program managers

35. “Soft Goods” include: Wheelchair Cushion Covers Canvas and Mesh Slings Non-friction sheets for bed repositioning One-way (anti-slip) devices Gait belts Washing Hand wash Machine wash: lukewarm water & detergent Garment bag may be used **DO NOT USE BLEACH** Drying All soft goods MUST be hung or laid flat to dry **DO NOT PUT IN THE DRYER** Soft Goods Maintenance & Care

36. Bed Mobilityand Positioning

37. Keys to Bed Mobility and Positioning • COMMUNICATION • Always talk to the consumer to tell them what you are doing; ask them to help if they can assist • Always talk to the other staff person • Don’t forget good body mechanics • If the task is unsafe or difficult, is there equipment that would make it safer and easier? If you aren’t sure, ask a PT or OT!

38. Supine positioning • Body position • laying on their back • Pressure points • Back, tail bone, heels, back of head, elbows • Use bed controls for positioning • Pillow/support placement • Under head • Under knees • Behind calves • Heels floating Image from http://www.me-jaa.com/mejaa21Mar2009/pressureulcer-pt2-fig1.gif

39. Side-lying positioning • Body position • Head, neck, trunk, and hip aligned • Both legs bent at hips and knees • Pressure points • Shoulder, hip, knees, ankles • Pillow/support placement • Under head • Between knees • Supporting top arm • Behind back Image from http://lifecenter.ric.org Image from http://www.me-jaa.com/mejaa21Mar2009/pressureulcer-pt2-fig1.gif

40. SPH Rolling • Communicate with the consumer and other staff • Equipment possibilities include: • Non-friction sheets • Positioning devices (Tri-turner, full body, split sheet) • Grab bars (side rails, bed assist bars) • Position the person for best mechanical advantage • Bend knee opposite the direction of the roll or cross leg over towards roll • Ensure their arms are out of the way

41. Rolling With SPH Techniques & Devices • Top Sheet (“Split Sheet”) • Used with mechanical lifts • Used for wound care, pressure relief • Can be used with 1 or 2 staff members because it is for positioning & is not a transfer out of bed • Must be left on bed • Make the bed with the Top-Sheet on Images from romedic.com/usa

42. More SPH Techniques & Devices • Non-Friction Sheets • Use: Repositioning up/down, side/side in bed, rolling for care in sidelying • Closed end of tube in the direction you are moving the consumer • Headfoot for up/down positioning • Sideside for lateral shift or rolling • Must be used with two staff • Must hold and use secondary sheet (draw sheet/cloth chux) atop NF sheet • Rules for Non-Friction Sheets • Hands are never on the NF sheet after it is under the person • Hands are driving DOWNWARD into the bed • Lunge/step to move, square body towards direction you are going • Arms/legs/trunk move as ONE unit • Place and remove without turning or rolling consumer • Tuck method in demo lab • Does NOT stay on bed Images from romedic.com/usa

43. Transfers

44. Gait belts Image from romedic.com/usa • Why • Consistent, firm grasping surface for staff • Provides a sense of security to the consumer • Protects both parties from injury when transferring or ambulating • When • Consumer requires assistance to maintain balance standing or ambulating as determined by PT/OT/RN with input from staff • Remember • NOT a lifting belt • Consumer must have good sitting balance • Consumer must be able to move their feet • Should not require lifting to maintain standing position • Not intended to prevent most falls • Always hold at the handle • Make sure belt is snug but not restrictive • Be aware of location of medical concerns (tubes)

45. Assistance Levels • Contact Guard • Gait belt required • Hands on the gait belt • Used when consumer requires physical and/or directional guidance and verbal cueing • Stand-By Guard • Gait belt frequently required • Within an arms reach of the consumer, prepared to assist if needed • Used when consumer only needs occasional balance assistance or guidance • Range of Scanning • Visual supervision *Level of assistance determined by PT/OT/RN • Documented in IPOP

46. Keys to Transfers with Mechanical Devices • COMMUNICATION • Always talk to the consumer to tell them what you are doing; ask them to help if they can assist • Always talk to the other staff person • Don’t forget good body mechanics • If the task is unsafe or difficult, is there equipment that would make it safer and easier? • If you aren’t sure, ask a PT or OT!

47. Lifting Sling Sizing and Materials Sizing • Height • Mid-head to mid-buttock for full coverage • Width • 2-3 finger-width of material on either side of body • Weight • Slings will have weight as well as sizing restrictions • Check label • Color Coded (most) • Small= red, Medium= yellow, Large= green, XLarge= blue Materials • Canvas/Quilted • Dry transfers only (not for bathing) • Not left under consumer • Mesh • ANY transfer, including bathing • Typically best if IPOP requires sling to stay under consumer • Dries fastest

48. Lifting Sling Check • When to NOT use sling: • Frayed material on loops (even if it’s not the loop you will be using) • Holes in any portion of sling • Cut-off loops • Evidence of previous repair (sewn) • Evidence of being shrunk in washer • Dusty residue from previous bleaching • Report to supervisor if you take sling out of use, clearly label concern on sling • Contact OT/PT

49. Lifting Sling Types… • Split Leg Sling • Has full trunk and separate leg extensions to support each leg • Available with or without head support • Can be placed & removed with consumer in chair Images from Romedic.com/usa and http://www.a3bs.com/imagelibrary/W49825M/W49825M_01_Universal-Mesh-Sling-Split-Leg-Medium.jpg

50. Lifting Sling Types… • Full Body Sling • Must stay under consumer • Ideally, it should be mesh • Head control • No separate pieces for legs Image from http://www.a3bs.com