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 • Decreased 31% (144 to 99 injuries)

5. Results: Injury Rates* • Decreased from 24 to 16.9 • Difference was significant at 0.036 level *Defined as # reported injuries per 100 workers per year

6. Results: Light Duty Days Decreased 70% (1777 to 539 days) Significant at 0.05 level

7. Results: Lost Work Days Decreased 18%, from 256 to 209 days

8. Results: Job Satisfaction • Pay • Professional Status* • Task Requirements* • Autonomy • Organization Policy • Interaction • Overall • *Denotes Significance

9. Successful Solutions Overview of a Safe Patient Handling & Movement Program

10. Management Support Champion SPHM Team Program Elements Equipment Knowledge Transfer Mechanisms Technical Support Safe Patient Handling & Movement Program For success, required infrastructure MUST be in place prior to implementing SPHM Program

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. 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… SPHM Team Members

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

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

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” • Cheeron 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

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

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.

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….