9 Step Ergonomic Workplace Assessment of Nursing Environments

1. 9 Step Ergonomic Workplace Assessment of Nursing Environments Step 7. Formulate Recommendations (continued)

2. Step 7. Formulate Recommendations To Select Appropriate Interventions� Match preferred interventions with dependency classifications

3. Step 7. Formulate RecommendationsDependency Status Key ADL Self-Performance Codes 0 Independent 1 Supervision 2 Limited Assistance 3 Extensive Assistance 4 Total Dependence

4. Step 7. Formulate RecommendationsTotal Dependence � Class 4 Minimize transfers if possible Mechanical full body sling lift Powered lateral assist device Friction reducing device

5. Step 7. Formulate RecommendationsExtensive Assistance � Class 3 Minimize transfers if possible Mechanical full body sling lift Powered lateral assist device Friction reducing device Stand assist lift

6. Step 7. Formulate RecommendationsLimited Assistance � Class 2 Stand assist lift Stand assist aid Gait/transfer belt with handles Sliding board

7. Step 7. Formulate RecommendationsSupervision � Class 1 Stand assist aid Gait/transfer belt with handles Sliding board

8. Step 7. Formulate RecommendationsIndependent � Class 0 Normally unassisted If condition is variable.. Do NOT categorize as Independent

10. Step 7. Formulate Recommendations Criteria for Selecting the Right Equipment Ease of use, availability Match with Patient characteristics Comfort, safety and dignity for Patients Exertion/safety for caregiver Space restrictions Cost and Durability Acceptance of staff

11. Now you know� what program elements to include, risk control strategies, and what is equipment is available�. Next Step: Program Implementation

12. Ergonomics & Equipment alone are not magical solutions� To be effective, a well thought out system of implementation must be developed.

13.

14. Step 8. Implement Recommendations Selling the SPHM Program at Your Facility

15. Learning from History

16. Avoid Costly Mistakes Anxious to fix the problem, Administrators implement these �known� but largely ineffective strategies. Administrators lost money, saw no benefit, so it�s getting harder to convince them to spend more money

17. Level of Evidence Needed�!

18. Previously Used Flawed Implementation Plans Pattern of implementing a strategy, finding positive results in 3 months, and then pulling out. Need for maintenance strategies to sustain positive effects.

19. Failure to Market the Program Effectively Need for �Buy-In� at all levels Need for adequate Resource allocation Need to share �success stories� and best practices.

20. Limited Involvement of Direct Care Providers Solutions didn�t always fit unit Forced standardization Limited clinician �buy-in�

21. Nurses are Worth it We cannot afford to lose 12% of our most experienced nurses each year due to injuries. Nursing should be focused on brains� not brawn!

22. Successful SPHM Implementation Strategies Use SPHM Implementation Team * Use Goals & Objectives as Implementation Drivers * Use Existing Resources for Program Development: ANA/OSHA/VA Use Social Marketing Strategies Be Aware of Barriers Utilize Change Strategies Know� The Problem CAN be fixed!

23. Step 8. Implement Recommendations Use Existing Resources for Program Development: ANA/OSHA/VA

24. ANA Ergonomic/Workplace MSD Campaign Released Position Statement asking to �Eliminate Manual Patient Handling�� Partnering with researchers Sponsoring conference workshops Pursuing state legislation (federal?) Training and education among CMAs Incorporating safe patient handling education into schools of nursing 2000: 2.7 million RNs (largest healthcare profession) (estimated 1.89 million RN FTE) Aging RN Workforce Mean Age of Employed RNs = 43 years 2010: 40% of RNs will be older than 50 years old Retention Rising RN Vacancy Rates National Turnover Rate (Hospital Staff Nurses) 1. 15% in 1999 (12% in 1996) The Nursing Executive Center, The Nurse Perspective: Drivers of Nurse Job Satisfaction & Turnover (Washington, DC: The Advisory Board Company, 2000). 2. 26.2% in 2000 (11.7% in 1998) Hospital and Healthcare Compensation Service, Hospital Salary and Benefits Report, 2000-2001(Oakland, NJ: Hospital & Healthcare Compensation Service, 2000 Maryland, 2000: 14.7% California, 2000: 20% Vermont, 2001: 7.8% Florida, 2001: 16% Nevada, 2001: 13% Shifts in patient care settings (i.e., hospital to home care) Recruitment Declining Nursing School Enrollment and Graduates Declining Rates of Passing RN Board Exam (Licensure) Exploring Foreign Labor Markets � particularly developing countries 2000: 2.7 million RNs (largest healthcare profession) (estimated 1.89 million RN FTE) Aging RN Workforce Mean Age of Employed RNs = 43 years 2010: 40% of RNs will be older than 50 years old Retention Rising RN Vacancy Rates National Turnover Rate (Hospital Staff Nurses) 1. 15% in 1999 (12% in 1996) The Nursing Executive Center, The Nurse Perspective: Drivers of Nurse Job Satisfaction & Turnover (Washington, DC: The Advisory Board Company, 2000). 2. 26.2% in 2000 (11.7% in 1998) Hospital and Healthcare Compensation Service, Hospital Salary and Benefits Report, 2000-2001(Oakland, NJ: Hospital & Healthcare Compensation Service, 2000 Maryland, 2000: 14.7% California, 2000: 20% Vermont, 2001: 7.8% Florida, 2001: 16% Nevada, 2001: 13% Shifts in patient care settings (i.e., hospital to home care) Recruitment Declining Nursing School Enrollment and Graduates Declining Rates of Passing RN Board Exam (Licensure) Exploring Foreign Labor Markets � particularly developing countries

25. ANA Ergonomic/Workplace MSD Campaign Handle with Care Training Program 2000: 2.7 million RNs (largest healthcare profession) (estimated 1.89 million RN FTE) Aging RN Workforce Mean Age of Employed RNs = 43 years 2010: 40% of RNs will be older than 50 years old Retention Rising RN Vacancy Rates National Turnover Rate (Hospital Staff Nurses) 1. 15% in 1999 (12% in 1996) The Nursing Executive Center, The Nurse Perspective: Drivers of Nurse Job Satisfaction & Turnover (Washington, DC: The Advisory Board Company, 2000). 2. 26.2% in 2000 (11.7% in 1998) Hospital and Healthcare Compensation Service, Hospital Salary and Benefits Report, 2000-2001(Oakland, NJ: Hospital & Healthcare Compensation Service, 2000 Maryland, 2000: 14.7% California, 2000: 20% Vermont, 2001: 7.8% Florida, 2001: 16% Nevada, 2001: 13% Shifts in patient care settings (i.e., hospital to home care) Recruitment Declining Nursing School Enrollment and Graduates Declining Rates of Passing RN Board Exam (Licensure) Exploring Foreign Labor Markets � particularly developing countries 2000: 2.7 million RNs (largest healthcare profession) (estimated 1.89 million RN FTE) Aging RN Workforce Mean Age of Employed RNs = 43 years 2010: 40% of RNs will be older than 50 years old Retention Rising RN Vacancy Rates National Turnover Rate (Hospital Staff Nurses) 1. 15% in 1999 (12% in 1996) The Nursing Executive Center, The Nurse Perspective: Drivers of Nurse Job Satisfaction & Turnover (Washington, DC: The Advisory Board Company, 2000). 2. 26.2% in 2000 (11.7% in 1998) Hospital and Healthcare Compensation Service, Hospital Salary and Benefits Report, 2000-2001(Oakland, NJ: Hospital & Healthcare Compensation Service, 2000 Maryland, 2000: 14.7% California, 2000: 20% Vermont, 2001: 7.8% Florida, 2001: 16% Nevada, 2001: 13% Shifts in patient care settings (i.e., hospital to home care) Recruitment Declining Nursing School Enrollment and Graduates Declining Rates of Passing RN Board Exam (Licensure) Exploring Foreign Labor Markets � particularly developing countries

26. OSHA RESOURCES OSHA Ergonomic Guidelines for Nursing Homes www.osha.gov/ergonomics/guidelines/nursinghome/index.html OSHA website www.osha.gov OSHA Compliance Assistance Specialists in OSHA area offices

27. OSHA RESOURCES OSHA Regional Office in Atlanta, GA OSHA Training Institute (OTI) Educational Resource Center Cal/OSHA �A Back Injury Prevention Guide for Health Care Providers� (www.dir.ca.gov/dosh/dosh_publications/ backinj.pdf)

28. VA RESOURCES This Training Program VA Patient Care Ergonomics Resource Guide: Safe Patient Handling & Movement VA Technology Resource Guide Bariatrics Resource Guide Website: www.patientsafetycenter.com

29. Step 8. Implement Recommendations Use Social Marketing Strategies

30. Step 8. Implement Recommendations Social Marketing Identifies what angle will be most convincing to each group you need to target�

32. Step 8. Implement Recommendations Social Marketing Plan 1. Define Goal/s What are your goal/s? What are you wanting to change? Why? 2. Define Target Groups Who are you wanting to target?

33. Step 8. Implement Recommendations Social Marketing Strategies Target Groups� Patients Staff Organization

34. Step 8. Implement Recommendations Marketing Strategies to Patients Use of Equipment increases Patient: Comfort Security Dignity Safety - Seen as decreases in falls, skin tears, abrasions

35. Step 8. Implement Recommendations Marketing Strategies to Patients Use of Patient Handling Equipment.. Promotes Patient mobility and independence Enhances toileting outcomes and decrease incontinence Improves Quality of Life

36. Step 8. Implement Recommendations Marketing Strategies to Staff Reduces # of injuries Reduces severity of injuries Lost work days & Light Duty days Keeps more able-bodied co-workers on unit Reduces direct costs Decreases musculoskeletal discomfort Decreases staff turnover

37. Step 8. Implement Recommendations Marketing Strategies to Organization Employer of Choice Improve recruitment Staff satisfaction Retention Safety Enhances regulatory compliance

38. Step 8. Implement Recommendations Marketing Strategies to Organization Improves Staff Efficiency Improves Patient Safety Fosters Culture of Safety

40. Step 8. Implement Recommendations Social Marketing Plan 1. Define Goal/s What are your goal/s? What are you wanting to change? Why? 2. Define Target Groups Who are you wanting to target? Complete �A & B�, A-1 Handout, Developing a SPHM Action Plan

41. Step 8. Implement Recommendations Be Aware of Barriers to Successful Implementation

42. Step 8. Implement Recommendations Don�t Know How Haven�t Figured Out That Training Isn�t Working Still Blaming Staff Who Get Injured Lack of Time Don�t Believe Published Findings Resource Impaired Not a Priority No One is Championing This

43.  Barriers Staff Level Patient Level Organizational Level Nursing Unit Facility Organization

44. Step 8. Implement Recommendations Staff Level Barriers?

45. Step 8. Implement Recommendations Staff Level Barriers �This is that way we�ve always done it.� �I don�t have time.� �My way is better.� �This is just another fad.� �It won�t work.� �We�ve already tried, and it didn�t work.�

46. Step 8. Implement Recommendations Response to: �We�ve already tried, and it didn�t work.� BUT, previously� Equipment� quality was poor wasn�t easy to use wasn�t accessible wasn�t maintained properly wasn�t matched to Unit needs Staff weren�t trained adequately

47. Step 8. Implement Recommendations Patient Level Barriers?

48. Step 8. Implement Recommendations Patient Level Barriers �Why can�t we keep doing things like we�ve always done them?� �I like the �personal touch�.� �I�m afraid of being lifted up.� �This is just another fad.� Dignity Issues Loss of Independence Family Resistance

49. Step 8. Implement Recommendations Strategies to Overcome Patient Barriers to Equipment Use Staff demonstrate equipment use Take advantage of �snowball effect� Patient & Family Council Outlet for fears of family member Discuss pros/cons Testimony from Patients using equipment

50. Step 8. Implement Recommendations Organizational Level Barriers?

51. Step 8. Implement Recommendations Organizational Level Barriers Lack of Leader Support Lack of Understanding Not a Priority Lack of Incentives Outdated Policy Space Cost More�

52. Step 8. Implement Recommendations  Utilize Change Strategies (Facilitators)

53. Step 8. Implement Recommendations Facilitators of Change Knowledge � All must be aware of the problem and the solutions Attitudes � Those involved must agree with recommendations Behavior � Culture must be in place to promote, support & accept behavior changes Maintenance � Reinforcement sustains changes�

54. Step 8. Implement Recommendations Change Strategies Transfer Knowledge (Educate & Train) Involve Front-line Workers Use Unit Peer Leaders or Facility Expert Promote Costs/Savings Benefit Foster Change/Develop Action Plans

55. Mechanisms of Knowledge Transfer Michael Hodgson: Thanks. So, what can you say about learning? Mary Matz: First of all, instead of using the term learning, I like to use the term �knowledge transfer�. This implies a more active role for both the giver and the receiver, and this is important, because knowledge transfer should be a two-way street. Certainly, a front line worker can learn from his supervisor, but very importantly, a supervisor can learn from his or her employees. In all methods of knowledge transfer, a person learns from the experiences of someone else�. As you can see though, you can transfer knowledge before hand, proactively, in order to attempt to prevent an incident from ever occurring. And, you can also transfer knowledge after one occurs, as a reaction to an incident. Certainly, the former is preferred. You can also transfer knowledge during an incident. This method has been used very successfully by the military for years and is called an After Action Review Process. Michael Hodgson: Thanks Mary, now tell us more about After Action Review. Michael Hodgson: Thanks. So, what can you say about learning? Mary Matz: First of all, instead of using the term learning, I like to use the term �knowledge transfer�. This implies a more active role for both the giver and the receiver, and this is important, because knowledge transfer should be a two-way street. Certainly, a front line worker can learn from his supervisor, but very importantly, a supervisor can learn from his or her employees. In all methods of knowledge transfer, a person learns from the experiences of someone else�. As you can see though, you can transfer knowledge before hand, proactively, in order to attempt to prevent an incident from ever occurring. And, you can also transfer knowledge after one occurs, as a reaction to an incident. Certainly, the former is preferred. You can also transfer knowledge during an incident. This method has been used very successfully by the military for years and is called an After Action Review Process. Michael Hodgson: Thanks Mary, now tell us more about After Action Review.

56. Making the Most of the Knowledge Transfer Process Ex: You want to transfer knowledge related to injuries due to patient handling tasks�

57. Making the Most of the Knowledge Transfer Process 1. Identify what you need to know. Factors that place worker at risk for injury Factors that reduce the risk of injury

58. Systematizing Knowledge Transfer 2. What do you already know about this issue? What is the target audience? Knowledge: Patient handling tasks are frequent and risk is from both routine and non-routine aspects Target Audience: Front line patient care staff at the unit level

59. Systematizing Knowledge Transfer 3. Develop a dissemination plan Train peer leaders (Back Injury Resource Nurses) in After Action Review (AAR), face-to-face method Train staff in After Action Review (AAR), staff safety meeting Develop & Distribute AAR brochure

60. Systematizing Knowledge Transfer 4. Implement the dissemination plan Staff training and buy-in, dissemination of AAR brochure, in-services Implementation of After Action Review at the unit level by the Back Injury Resource Nurses. Consider staff needs, motivators, unit organization, etc.

61. Systematizing Knowledge Transfer 5. Evaluate the knowledge transfer process/outcomes Monthly process logs completed by Back Injury Resource Nurses Is activity level of After Action Reviews related to incidence of back injuries?

62. Knowledge Transfer� Fosters a Culture of Safety Solves problems quickly Facilitates implementation of best practices effectively and efficiently Empowers staff by using the knowledge they possess

63. Step 8. Implement RecommendationsUse Change Strategies Change Strategy: Educate and Train Education: Present theory, philosophy and why Program is being implemented. Develop foundation to develop attitudes that will support the value of an ergonomics-based program. Training: Develop skill and competency in use of equipment and utilization of program elements. Source: An Ergonomic Based Back Injury Prevention Program for Healthcare Advisory Panel for Safe Patient Handing & Movement June, 2000, Guy Fragala, PhD, PE, CSP

64. Step 8. Implement Recommendations Educate, Educate, Educate� Train, Train, Train� Policy Program Elements Equipment Skills-based Give MORE than one or two times! Annual Refreshers Must show Competency in Use

65. Step 8. Implement Recommendations A �Comprehensive� Training Program is CRITICAL!

66. Step 8. Implement Recommendations Get Staff Input on: Unit Needs (storage/space/etc.) Unit Hazards/Risks Ergonomic Evaluation Equipment Selection More� Use: Brainstorming AAR Interviews Questionnaires Team Activities Focus Groups Group Discussions

67. Step 8. Implement Recommendations Think for a minute�. What do you think would be the best way to �involve� frontline workers in your patient care environment?

68. Step 8. Implement Recommendations Change Strategy: Use Unit Peer Leaders/ Facility Experts Back Injury Resource Staff Act as Resource, Coach, Trainer, �Team� Leader, Good Behavior Model Share/Transfer Knowledge/ Information Assist in building a 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

69. Step 8. Implement Recommendations Use past experiences�. What has been your experience with similar (injury prevention) programs? How were you involved? What was the program approach/content? What barriers were encountered? What elements were successful? How effective was the overall program? Do you feel your approach was optimum? How would you improve in the future?

70. Step 9. Monitor Results Outcome Measures - Ch. 11 Incidence/severity of MS injuries (p.131 & 133) Intensity/duration/frequency of MS discomfort (C) Job Satisfaction (p. 139) Adherence to/Acceptance of Program (p.97 & 145)

71. Step 9. Monitor Results Outcome Measures - Ch. 11 Equipment Use (p.147) Competency (p. 119) Cost & Cost Savings (p.129) Performance Measures (An Ergonomic Based Back Injury Prevention Program for Healthcare, Advisory Panel for Safe Patient Handing & Movement June 1 & 2, 2000, Guy Fragala, PhD, PE, CSP)

72. Conclusion There is a problem� But know� something CAN be done about the problem. Complex activity that takes a concerted effort from the many involved. Staff & Management need to be motivated. Efforts are needed over time to sustain the change.

73. BIRN Certification Training Back Injury Resource Staff The key to successful Safe Patient Handling and Movement Programs.

74. Never underestimate the ability of a small group of committed individuals to change the world. Indeed, it is the only thing that ever has. Margaret Meade

75. Foster Change/Develop Action Plans Complete: Developing a SPHM Action Plan * * Developing A SPHM Action Plan (A-1)