Safe Patient Handling:

1. Safe Patient Handling: The Hazards of Immobility Prepared by :

2. Learning Objectives • Discuss the opportunity for quality improvement using SPHM practices • Discuss expected positive patient outcomes using SPHM practices • Discuss the role of SPHM practices in patient care initiatives • Discuss how a mobility assessment is able to meet individualized needs

3. Hospital Acquired Disability Hazards of immobility include: • accelerated bone loss • delirium • malnutrition • sensory deprivation • isolation • musculoskeletal weakness • decreased cardiopulmonary function

4. Early Mobility Avoid the effects of immobility which include: • functional decline • increased morbidity • increased mortality • increased cost of care • increased length of stay

5. Expected Practice • Bed mobility • Out of bed mobility • Ambulation • Toileting • Boosting/repositioning/turning • Transfers • Others

6. Benefits • Comfort, safety and dignity for patient • Accelerated patient mobility, independence and rehabilitation • Fall prevention • Improved skin integrity • Positive patient outcomes • Reduced hospital associated disability

7. Example: Clinical Application Certification in hip facture management • High volume of hip fractures • Orthopedic focus • Target population • Key metrics • ED to OR < 24 hours • < Hospital-acquired conditions • < LOS • < Readmissions

8. Positive Patient Outcomes SPHM supports early patient mobility • delirium prevention • post-op knee initiatives • small bowel initiatives • HA pressure ulcer prevention • HA pneumonia prevention

9. Positive Patient Outcomes(continued) SPHM benefits patient satisfaction • increased movement and activity • toileting and hygiene dignity and privacy • improved response time

10. Revised NIOSH Lifting Equation

11. Summary of the Evidence • Confirms risks associated with manual patient handling • Shows tasks cannot be performed safely manually • Demonstrates the result of cumulative trauma

12. 2007 NIOSH Revision • Maximum weight a caregiver should lift = 35 lbs (single leg of 200 lb patient) • Lateral transfer guidelines: >157 lbs, use mechanical device or air-assisted device

13. Excessive Biomechanical Force 3400 N DCF Limit 1000 N SF Limit Type of patient transfer Disc compression forces (DCF): one person, two person; shear force (SF): one person, two person Marras et al., 1999

14. Evaluating Risk Factors • Lifting heavy, awkward loads • Supporting the patient’s body weight • Working in small and/or tight spaces • Maintaining awkward postures • Reaching away from the body • Pushing and pulling forces

15. Classifying Risk • High risk activity • High frequency task • High probability for injury

16. Risk Assessment and Ergonomic Analysis • How many patients are you caring for today? • What physical tasks are the most frequent and difficult? • How many people are typically needed to accomplish the following patient handling task?

17. Boosting with Draw Sheet Moving up in bed (Photo from Griffin AG, Potter PA: Clinical nursing skills & techniques, ed 17, St. Louis, Mo, 2010, Elsevier Mosby)

18. Stand and Pivot Transfer (Photo from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby)

19. Slide Board Transfer (Photo from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby)

20. Risk Assessment and Ergonomic Analysis(continued) • How do you define the dependency level of your patients? • How do you define the mobility level of your patients? • How do you make decisions about how to do tasks and how many people are needed to perform them safely?

21. JAMA, October 26,2011 Vol. 306, No. 16; 1782-1793

22. Clinical Application • Define the root cause of exposure • Develop common language—consistency • Standardize decision making • Customize solutions for routine procedures • Select appropriate equipment

23. Banner Mobility Assessment Tool

24. Clinical Application • Risk assessment tool for nurses • Solutions for “Good, Better, Best, and Avoid” • Linkage with clinical outcomes • Developed and mentored champions • Integration with shared-leadership councils

25. Mobility is Linked with Solutions Total lift, rollboards, air-assistive device, slide-sheets or slide-tubes Mobility Level 1: Mobility Level 2: Total lift or powered sit-to-stand lift Non-powered stand aid, gait belt, cane, crutches, walker or ambulation equipment Mobility Level 3: Modified Independence No equipment required however, supervision is needed to promote safety Always default to the safest method (total lift) if there is any doubt in the patient’s ability to perform the task.

26. SPHM Equipment

27. Equipment Solutions Slider Sheets Roller Board Ambulation Pants Sit-to-Stand Ambulation Vest Sitting Upright Transfer Device Convertible Chair Range of Motion

28. Why Safe Patient Handling? • Essential skill set for patient outcomes • Rethink how we provide care • Innovative practices • Technology and equipment • Clinical tools, protocols and procedures • Work design changes • Results—better, safer and more reliable

29. Bariatric Considerations • Provide rooms with overhead/ceiling-mounted lifts • Evaluate weight capacity of lift system • Propose minimum room dimensions • Measure bathroom door width • Measure shower stall width • Evaluate shower bench weight capacity

30. Bariatric Considerations (continued) • Evaluate toilet weight capacity • floor mounted toilet • wall mounted toilet • toilet jack installation • Consider proximity to nurses’ station

31. Create a Bariatric Suite • Bariatric bed with pressure reducing mattress • Extended capacity patient lift(s) • Extended capacity wheelchair • Extended capacity and extra wide walker • Extended capacity shower chair or shower stretcher • Extended capacity standing aids

32. Create a Bariatric Suite (continued) • Extended capacity floor-based toilet • Extended capacity bedside commode • Bariatric patient recliner • Bariatric size friction reducing devices (air-assisted and/or slide sheets or tube sheets) • Bariatric rollboard • Optimal space in room and bathroom • Doors that are wide enough for egress

33. Results of a Pilot Program • Program milestone metrics • Workers’ compensation data • frequency • severity • task specificity

34. Frequency of Injury

35. Pilot Project Light Duty Days (2010–2012)

36. Pilot Project Lost Duty Days(2010–2012) Prepared by :

37. Pilot Project (2007–2009 vs. 2010–2012) 54% Decrease 65% Decrease 40% Decrease 66% Decrease

38. Implementation Success • Dedicate an SPHM coordinator • Encourage interdisciplinary involvement • Partner with facility leadership • Integrate with system initiatives and projects • Create opportunities to share the need and shape vision

39. Safe Patient Handling and Movement Safe for staff and patients: • process driven (continuous improvement) • evidence-based • behavior based: • assessment and critical thinking • competent selection of proper equipment • proficient execution of task • tool for achieving objectives

40. If you have questions or would like a copy of this presentation, please contact: Merl Miller, MS, ATC, CIE Ashton Tiffany, LLC (602) 751-3769 merl.miller@ashtontiffany.com