Unit-based Hazard Assessment for Safe Patient Handling

1. Unit-based Hazard Assessment for Safe Patient Handling

2. Unit-based Hazard Assessment for Safe Patient Handling Mary Willa Matz, MSPH VHA Patient Care Ergonomics Program Manager/Consultant Occupational Health Science Researcher Industrial Hygienist VISN 8 Patient Safety Center of Inquiry James A. Haley VA Hospital Tampa, Florida (813) 558-3928 (813) 558-3990 fax mary.matz@va.gov

3. Faculty Disclosure • Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or devices. • Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this activity. • This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label. • The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.

4. Ergonomics and Patient Handling

5. Ergonomics… "Ergonomics is the scientific study of the relation between people and their… • Occupation • Equipment • Environment“ (Shackel)

6. Ergonomics Principles • Design for human use • Fits the task to the worker • People are different • People have limitations • People age

7. An Ergonomic Approach… Provides a step-by-step process to ensure the appropriate technology is in place to reduce musculoskeletal stress & strain…. reducing the risk of injury.

8. A Simple Look at an Ergonomic Approach Tasks: • Identify jobs and job tasks which stress body parts beyond limits • Develop solutions to change these task demands. Workplace Environment: • Review the design of the physical work environment to reduce risk, remove barriers, minimize travel, etc. Other Factors: • Consider other factors that affect work performance, such as lighting, noise, equipment storage & maintenance issues. Implement these changes in the work place.

10. Ergonomic Hazards What are Ergonomic Hazards? • Musculoskeletal System • Energy/Forces/Stressors • Exceed the biomechanical limits of the human body

11. What Do “Patient Care” Ergonomic Hazards result from? Patient lifting and moving exceed caregivers’ biomechanical limits…

12. What Do “Patient Care” Ergonomic Hazards result from? • Ergonomic hazards for caregivers include… • pushing, pulling • lifting heavy loads • horizontal & vertical lifting • lifting light loads for long periods of time • twisting, bending, reaching • standing for long periods of time • awkward postures • repetitive motions • others….

13. What Do “Patient Care” Ergonomic Hazards result from? • “Safe” lifting rules don’t apply (Horizontal and vertical lifting) • Patients: • are asymmetric & bulky • can’t be held close to the body • have no handles • Patient assistance varies

14. What Do “Patient Care” Ergonomic Hazards result from? • Patient care is unpredictable due to unanticipated patient responses… • muscle spasms, combativeness, or resistance • Results in… • Unexpectedly heavy loads • Patient Movement • When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object.

15. Simple Biomechanical Model F=ma d Work = Force x Distance W = F x d

16. Musculoskeletal impact/stress on… Back Shoulders Neck Wrist Hand Knees Other body parts… Exceeding Biomechanical Capabilities results in…

17. Example 1: Pull up in Geri-Chair • Risk Factor: • Manual Lifting • Body Parts Affected: • Back – posture, load/force • Shoulder – load/force • Elbow – load/force • Wrist/hand – load/force • Neck – load/force • Interventions: • Sit to Stand Lifts • Ceiling/Floor Full Body Sling Lifts • Friction Reducing Devices

18. Example 2: Transfer to Stretcher • Risk Factor: • Manual Lifting • Body Parts Affected: • Back – posture, load/force • Shoulder – load/force • Elbow/Wrist/Hand – load/force • Neck – load/force • Interventions: • Ceiling/Floor Full Body Sling Lifts • Lateral Transfer Devices (LTD) • Friction reducing devices • Air Assisted LTD • Mechanical LTD

19. Example 3: Transfer from Chair of partial weight-bearing patient • Risk Factor: • Manual Lifting • Body Parts Affected: • Back – posture, load/force • Neck – load/force • Shoulder – load/force • Elbow – load/force • Wrist/hand – load/force • Intervention: • Sit to Stand Lift

20. Example 4: Lateral Transfer • Risk Factor: • Space Constraints • Body Parts Affected: • Shoulder – posture/load • Elbow – position/load • Wrist/hand – position/load • Neck – posture/load • Back – posture/load • Intervention: • Ceiling Lift • Renovate room

21. Unit-Based Hazard Assessment for Safe Patient Handling

22. Unit-based Hazard Assessment for Safe Patient Handling ‘Patient Care’ Practice Settings include… • ALL practice settings that move and lift patients • NURSING • Acute Care • Long Term Care • Critical Care • OR • ER • SCI • Others… • NON-NURSING • PT • Diagnostics • Treatment Areas • Procedure Areas • Morgue • Dialysis • Others..

23. Unit-Based Hazard Assessment Role • Drives UNIT recommendations for equipment, policy, and procedures • Identifies areas in need of improvement that impact safety of work environment & use of equipment • Storage, maintenance, clutter, etc.

24. I. Prior to Ergo Evaluation – Data Collection Identify UNIT High Risk Tasks Staff Perception of High Risk Tasks Unit Injury data Identify High Risk Units Collect Information on Unit Characteristics/Issues II. During Ergo Evaluation Meet with Mgmt/Staff Conduct Site Visit Meet with Mgmt/Staff III. After Ergo Evaluation Perform Risk Analysis Formulate Recommendations Unit-Based Hazard Assessment

25. I. Prior to Ergo Evaluation – Data Collection Identify UNIT High Risk Tasks Staff Perception of High Risk Tasks Unit Injury data Identify High Risk Units Collect Information on Unit Characteristics/Issues Unit-Based Hazard Assessment

26. I. Prior to Ergo Evaluation 1. Identify High Risk Tasks Collect Staff Perceptions of Unit High-Risk Tasks ‘Tool for Prioritizing High Risk Tasks’ • Rank Tasks from 1 to 10 10 = most difficult/highest risk 1 = least difficult/ lowest risk • When ranking, consider: • Musculoskeletal Stress = Load, Posture, Frequency/Duration • Completed by • Each Staff member • Collectively by Shift • Compile by Unit and Shift

27. I. Prior to Ergo Evaluation 1. Identify Unit High Risk Tasks Collect Unit Injury Data *Be sure to note which source is used on your Injury Log

28. I. Prior to Ergo Evaluation 2. Identify High Risk Units Beware of using Injury data….

29. I. Prior to Ergo Evaluation 2. Identify High Risk Units Directs focus for equipment and policy interventions • Identification of High Risk Units • Analyze all facility UNIT injury data… • Highest number of patient handling injuries • Most severe patient handling injuries • Lost Time • Modified Duty • High Risk Unit Characteristics • Many dependent patients/residents • Patients are moved in and out of bed often • Many patient transfers

30. I. Prior to Ergo Evaluation 3. Collect Pre-Site Visit Unit Data Use ‘Unit Characteristics/Issues’ Tool (Handout A-1) • Space issues • Storage availability • Maintenance/repair issues • Patient population (% dependency*) • Staffing characteristics • Equipment inventory/issues • Confirms site visit data • Used for making recommendations

31. II. During Ergo Evaluation/Site Visit Opening Meeting Site Visit/Walk-through Closing Meeting (optional for unit, required for administration) Unit-Based Hazard Assessment

32. Discuss Pre-Site Visit Data Issues of Concern Include Staff Unit/Area Manager Safety/Risk Management Facilities Management Union Others II. During Ergo Evaluation/Site Visit1. Conduct Opening Meeting

33. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit During Site Visit Walk-through, interview staff… • Confirms Pre-Site Visit Unit Data Collected • Discovers staff attitudes, concerns, ideas, information

34. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit During Site Visit Walk-through, observe… • Equipment • Availability • Accessibility • Use • Condition • Storage • Structural issues that impact use

35. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit During Site Visit Walk-through, note… • Patient room sizes/configurations • Ceiling Characteristics/AC vents/TVs/Sprinklers • Showering/bathing facilities & process • Toileting process • Safety Design Issues: Thresholds, Doorways • Storage

36. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit During Site Visit Walk-through, document… • Existing/ordered patient handling equipment • Occurrence of high risk tasks • % total dependent & extensive assistance pts • % partial assistance patients • Occurrence of bariatric/obese patients • Room configurations • # beds on unit/average daily census • Storage issues • Equipment/Sling recommendations • Notes (Sample PCE Templates - Handouts A-2a & A-2b)

37. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage Based on… • Dependency Level of patient/resident population • Room configurations on unit: # of private, semi-private, 3-bed, 4-bed rooms, etc. on unit.

38. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage Limitations… • Structural integrity of mounting surface (I-beam/ concrete pan) • Ceiling fixtures - lights, sprinkler heads, AC vents, etc. • Ceiling Height • Ceiling configuration/drop ceiling/AC housing • ICU Power Columns • Others

39. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Track Options • Traverse (x-y or H) • Straight • Curved • U-shaped

40. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… • Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage: • Sum average % of • total dependent patients • extensive assistance patients/residents

41. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… 2. Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit: • To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage (Previous slide)

42. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… • For units w/ only private patient rooms: • Average % of Patients Requiring CLs x # patients = # private patient rooms w/ CLs • For units w/ only semi-private rooms: • Average % of Patients Requiring CLs x # patients / 2 = # semi-private patient rooms w/ CLs

43. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… For units with a mixture of room configurations: • For cost effectiveness in existing construction, and if appropriate for the unit… • First begin calculations with ceiling lifts placed in most or all larger wards (3-bed & 4-bed wards) • Then, as appropriate, place in smaller rooms (private and semi-private)

44. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage continued… Example: • MedSurg Unit • 30 patients • 4 private rooms, 10 semi-private rooms, and two 3-bed rooms. • Approximately 70% of the patients will require use of Ceiling Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients). • For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in... • two (2) 3-bed rooms (covering 6 patients) • seven (7) semi-private rooms (covering 14 patients) • one (1) private room (covering one patient)

45. II. During Ergo Evaluation/Site Visit2. Conduct Site Visit Unit Ceiling Lift System Coverage Practice (Handout A- 3) • NHCU Unit • Med/Surg (Tele) Unit • Med/Surg (Rehab) Unit • How many (#) patients/beds should be covered? • In what rooms would you place ceiling lifts on this unit? • How many ceiling lifts would you purchase/install for this unit?

46. Discuss Preliminary Findings from Site Visit Pre-Site Visit Data as related to findings Priorities in need of immediate remediation Issues of Concern Include Staff Unit/Area Manager Safety/Risk Management Facilities Management Union Others II. During Ergo Evaluation/Site Visit3.Conduct UNIT Closing Meeting(optional)

47. Discuss Rationale for Site Visit Preliminary Findings from Site Visit Priorities in need of immediate remediation Issues of Concern Show photos of equipment recommendations Include Staff Union Unit/Area Managers Safety/Risk Management/Employee Health Facilities Management CFO/Purchasing Others II. During Ergo Evaluation/Site Visit3.Conduct ADMINISTRATOR Closing Mtg

48. III. After Ergo Evaluation Perform Risk Analysis Generate Recommendations Unit-Based Hazard Assessment

49. Sources of Risk: You must know the SOURCES of risk in your patient care environment to perform Risk Analyses… III. After Ergo Evaluation1. Perform Risk Analysis

50. Risk Sources: Health Care Environment Patient Patient Handling Tasks Once risks are identified, steps can be taken to protect Staff and Patients! Sources of Risk