Assessing Facility & Patient Needs Towards Appropriate Selection of Safe-Lift Equipment

1. Safe Patient Handling and Movement Assessing Facility & Patient Needs Towards Appropriate Selection of Safe-Lift Equipment Dana L. Root, MS, PT, CPE Regional Ergonomics Coordinator Chicago, IL 312-353-2220 414-297-3315 root.dana@dol.gov

2. Terminology • Caregivers: • RNs, LPNs, CNAs • PTs, PTAs, OTs, OTAs • Aides • Transporters • Family members • Etc.

3. Where To Start Step 1: Collect Baseline Data Step 2: Identify High-Risk Units Step 3: Gather Data About High-Risk Units Step 4: Identify High-Risk Tasks Step 5: Conduct Team Assessments of These Tasks Step 6: Analyze the Risk Step 7: Involve the Caregiver and Patient in Selecting the Equipment Step 8: Determine Recommendations Step 9: Implement Recommendations Step 10: Monitor Results

4. Step 1: Collect Baseline Injury Data • Focus oninjuries related to patient handling/movement • Information from: • OSHA log • Nurse manager files • Facility accident stats • Office of Workers’ Comp Prog • For each unit assess: • Number of injuries • Work Days Lost • Modified Duty Days

5. Step 2: Identify High-Risk Units • How? • Using baseline data on the incidence and severity of injuries • Why? • Allows you to prioritize time and resources.

6. Step 3: Gather Data About High Risk Units • Patient Population/Staffing/Equipment Use • Staffing • Discuss projected plans • Describe the patient, including dependency level 0 Independent 1 Supervision 2 Limited Assistance 3 Extensive Assistance 4 Total Dependence

7. Space considerations General facility layout Doorway width Angles and turns Storage Dining rooms Hallway Railings Visiting rooms Activity rooms Common bathrooms Step 3: Gather Data About High Risk Units

8. Step 3: Gather Data About High Risk Units • Space/Maintenance/Storage • Identify anticipated changes in the physical layout • Describe space constraints for patient care tasks • Focus on patient rooms • Bathrooms • Shower areas • Describe process for equipment maintenance

9. Step 3: Gather Data about High Risk Units • Inventory of all patient care equipment • Describe working condition • How frequently equipment is used • Perception of problem areas

10. Current equipment/ furniture Beds Height Type Chairs Wheelchairs Geri chairs Regular chairs Recliners Toilets High rise Regular Tables Height Types Life devices Positioning and repositioning devices Other equipment Scales Step 3: Gather Data About High Risk Units

11. Step 4: Identify High Risk Tasks • Identify and assess nursing staff perceptions of high-risk tasks. • Identify variation between units • Patient characteristics • Availability of equipment • Physical layout • Work organization

12. Step 4: Identify High Risk Tasks • General observation • Employee discussions • Employee questionnaires • Review of medical data • Symptom surveys • Quantitative evaluations • Previous studies • Job consistency and fatigue • Brainstorming and group activities

13. Frequency of Task H= high M= moderate L= low Perceived Stress of Task H= high M= moderate L= low Rank Order 1= high-risk 10= low risk Patient Handling Tasks Transferring patient from wheelchair to toilet to toilet Bathing a patient in a shower chair Repositioning patient in bed from side to side Transferring a patient from bed to stretcher Lifting a patient up from the floor Repositioning patient in bed from side to side Repositioning patient in geriatric chair or wheelchair Making bed an occupied bed Feeding bed-ridden patient Changing absorbent pad Transporting patient off u Other Task: Other Task: Other Task: Step 4: Identify High Risk Tasks

14. Step 5: Conduct Assessment by the team • Purpose: • Include staff input in assessment and solutions. • Recognize the many direct and indirect factors that may contribute to potentialrisk • Identify potential solutions that will serve to minimize risk of injury to the caregivers and patients

15. Step 6: Risk Analysis • Review data for each unit: • Baseline injury data • Other data • Staffing • Equipment inventory • Anticipated changes • Rank high risk tasks • Frequency • Stress • Observation data 2. Identify problem areas 3. Set priorities

16. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment ✲Obtain Patient & Healthcare ProviderBuy-In✲ Purpose: To enhance effectiveness by increasing acceptance and adherence.

17. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment • Two end user groups: • Caregiver • Patient • Both participate in the decision making process • Equipment fairs • Trial sessions

18. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment • Patients can rate/rank the equipment using surveys • Family members can have input to selection

19. Step 8: Determine Recommendations • Achievable and simple • Constraints • Costs

20. Step 8: Implement Recommendations • 4. Approaches • Engineering Controls • Reduce or eliminate hazard • Equipment • Furniture • Tools • Administrative Controls • Work practices changes • Management policies • Staffing levels • Staff needed for each type • of transfer • Lifting schedules • Lifting teams

21. EQUIPMENT SELECTION: Engineering Controls • Eliminate the need to do the hazardous activity • Redesign the activity to reduce the hazard or minimize the hazard • Formal equipment selection and evaluation process • Selected at equipment fairs

22. EQUIPMENT SELECTION: Engineering Control Strategies • Devices are appropriate for the tasks to be accomplished • Devices must be safe for both the caregiver and the patient • Device must be comfortable for the patient • Device should be easily understood and managed • Device must be efficient in use of time • Maintenance should be minimal

23. EQUIPMENT SELECTION: Engineering Control Strategies • Storage should be reasonable • Device must be easy to maneuver in tight spaces • Device should be versatile • Device must be easy to clean • Device must be adequate in number • Cost

24. EQUIPMENT SELECTION: Engineering Control Strategies • Equipment availability • Adequate variety of slings • In a convenient location • Toilet and bathing mesh slings • Available and in accessible areas • Storage room • Empty room • Short term use in the hallway

25. EQUIPMENT SELECTION:What to Buy?? • Total dependence Patients Level 4 • Full sling mechanical lift device • Extensive Assistance Level 3 • Use of aid of a mechanical device • Stand assist device • Supervision/Limited Assist Level 2 & 1 • Depending on the patient’s condition • Stand assist lift • Walking aid device • Gait belts • Sliding board • Avoid manual lifting

26. EQUIPMENT SELECTION:What to Buy?? • Independent Patients Level 0 • Capable of bearing own weight • Walk without assistance • Lifts from Floor • A single full sling mechanical lift • If patient can regain standing with minimal assist: transfer gait with handles

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

28. EQUIPMENT SELECTION:What to Buy?? 6. Repositioning • Bed: • Bed controls utilized • Trendelenberg positioning • Friction reducing devices • Chair: • Stand assist lift • Gait Belts • Hand slings

29. EQUIPMENT SELECTION:What to Buy?? 7. Special Situations Devices • Bariatric patients ⇒ special equipment • Transfer chairs ⇒ stretcher chairs • Mechanical friction reducing • Sliding boards • Transfer belts • Special training

30. EQUIPMENT SELECTION: What to Buy?? 8. Combative & Mentally Impaired Patients • Use the appropriate lifting aid device • Additional care providers as needed

31. EQUIPMENT SELECTION: What to Buy?? • Equipment Availability • Should be available • Stored and available in accessible areas • Batteries charged • Slings available for all shifts • Variety of sling sizes • Toileting and bathing slings available • Friction reducing devices available • Sliding boards • Transfer belts • Gait belts

32. Key Questions • Are funds best utilized for the acquisition of new technologies, or for the upgrade or replacement of old equipment? • Should you purchase or to lease patient handling equipment? • Should you provide ceiling-mounted lifts or floor based lifts throughout the unit? • What accessories should be included? • What quantity of various devices is needed?

33. SAFE PATIENT HANDLING EQUIPMENT • Sliding Boards • Air Assisted lateral sliding aids • Friction reducing devices • Mechanical lateral transfer aids • Transfer chairs • Gait belts with handles • Powered full body sling lifts

34. SAFE PATIENT HANDLING EQUIPMENT • Powered standing assist and repositioning lifts • Standing assist and repositioning aids • Bed Improvements to support transfers • Dependency Chairs • Other ergonomic transfer devices

35. Monitor Results • Ongoing success of process • Established key indicators • Established time line

36. Information on OSHA’s Website – www.osha.gov OSHA Home Page OSHA Hospital/Nursing Home Pages OSHA Ergonomics Page

37. Other Resources • Patient Safety Center Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement www.visn8.med.va.gov/patientsafetycenter • CDC/NIOSH Safe Lifting and Movement of Nursing Home Residents, publication #2006-117 www.cdc.gov/niosh

38. QUESTIONS……………