Ergonomics and Caregiver Safety

1. Ergonomics and Caregiver Safety Guy Fragala, PhD, CSP Audrey Nelson, PhD, RN, FAAN Rick Barker, MA, CPE

2. ERGONOMICS AND CAREGIVER SAFETYIssues Needing Attention • High Rates of Nursing Back Injuries • High Cost of Injuries • Regulatory Pressures • Need to Improve the Work Environment

3. Size of Hospitals Included for Injury Data Review

4. 2000 Strain/Sprain Injuries In 2000, 68.7 percent of strain or sprain injuries were related to patient handling

5. 2001 Strain/Sprain Injuries In 2001, 68.6 percent of strain or sprain injuries were related to patient handling tasks.

6. Ranking of Activities Causing Strain/Sprain Injuries to Hospital Workers

8. OSHA and ERGONOMICSThe History 1986 - Pilot Program to Reduce Back Injuries (NIOSH Lifting Equation Program) 1992 – Advanced Notice of Proposed Rulemaking 1995 – Draft Proposed Standard 1999 – Proposed Standard 2000 – Final Standard Issued 2001 – Repeal of Standard 2002 – Beverly Settlement

9. OSHA and ERGONOMICSCurrent Situation April 5, 2002 OSHA Four-Pronged Plan July 15, 2002 National Emphasis Program (Nursing Homes) March 13, 2003 Final Healthcare Nursing Home Guidelines More in 2003 Regional Emphasis Programs – HOSPITALS Emphasis Programs 9 out of 10 regions

10. JCAHO and WORKER SAFETY EC1.1.1 “The Hospital Plans for Worker Safety” Intent: • General Safety Processes • Area Specific Safety • Specific Job-Related Hazards • Safety-Related Information through Orientation and Continuing Education

11. JCAHO and PERFORMANCE MONITORING EC.4 “The Hospital Evaluates and Improves Conditions in the Environment” EC.4.2 “The Hospital Analyzes Identified Environment Issues and Develops Recommendations for Resolving Them”

12. ENVIRONMENT OF CAREPERFORMANCE IMPORVEMENT INITIATIVE Intent of EC.4.2: Based on the ongoing monitoring of performance in each of the seven management areas, recommendations for one or more performance improvement activities are communicated annually to the hospital’s leaders.

13. The Practice of Nursing...Difficult and Demanding How can we make improvements?

14. Ergonomic Assessments of Nursing Practice Settings • What has been done • Focus on long-term care • How does acute care differ • What are the needs for acute care

15. Selecting Appropriate Interventions • A workable approach for long-term care • Match preferred interventions with dependency classifications

16. Dependency Status Key ADL Self-Performance Codes 0 Independent 1 Supervision 2 Limited Assistance 3 Extensive Assistance 4 Total Dependence

17. Lift Aid Equipment Determination Grid (recommended example) For a typical resident with the dependency status classification as shown, this grid indicates normal equipment requirements to conduct a safe transfer. Some residents may have special characteristics and not exactly match a typical profile. In those situations, special consideration will be required.

18. Directions for Acute Care • Assessments driven by high-risk activity • Identification of high risk activity based on data analysis

19. The Task of Repositioning a Patient in Bed • Why is it a problem?

20. How Can We Approach this Problem of Repositioning • Trying to eliminate or minimize the need to reposition • Involving the patient in the repositioning activity where possible, such as application of retractable footboards • Have assist devices in the mattress surface • The use of friction-reducing devices to reposition the patient

21. Shearless Pivot

22. Retractable Footboard Extended

23. Retractable Footboard Used for Support

24. Turn Assist/Rotational Therapy

27. Examples of Some Other High Risk Activities Encountered in Critical Care Units in Acute Care Hospitals • Lateral transfers • Assist to standing position • Bed egress and transfer • Turning as opposed to repositioning patient in bed • Bed to chair transitioning

28. Lateral Transfer Aids • Friction reducing lateral slide aids • rigid boards • flexible sheets • rollers • air assisted • Mechanical lateral transfer aids • hand cranks • electric motor

32. Engineering Control Strategies…the Preferred Control Method • Eliminate the need to do the hazardous activity • Redesign the activity to reduce the hazard • Utilize an aiding device to minimize the hazard