1 unit-based hazard assessment for safe patient handling
TRANSCRIPT
11
Unit-based Hazard Assessment Unit-based Hazard Assessment for Safe Patient Handlingfor Safe Patient Handling
22
Unit-based Hazard Assessment for Safe Patient Handling
Unit-based Hazard Assessment for Safe Patient Handling
Mary Willa Matz, MSPHMary Willa Matz, MSPHVHA Patient Care Ergonomics Program Manager/Consultant VHA Patient Care Ergonomics Program Manager/Consultant
Occupational Health Science Researcher Occupational Health Science Researcher Industrial Hygienist Industrial Hygienist
VISN 8 Patient Safety Center of InquiryVISN 8 Patient Safety Center of InquiryJames A. Haley VA HospitalJames A. Haley VA Hospital
Tampa, FloridaTampa, Florida(813) 558-3928 (813) 558-3990 fax(813) 558-3928 (813) 558-3990 fax
[email protected]@va.gov
33
Faculty Disclosure Faculty Disclosure
Ms. Matz does not endorse any specific vendor or Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or manufacturer of patient handling equipment or devices. devices.
Ms. Matz has no financial relationships or interests Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this with any commercial topics that are discussed in this activity. activity.
This activity includes no discussion of uses of FDA This activity includes no discussion of uses of FDA regulated drugs or medical devices which are regulated drugs or medical devices which are experimental or off-label. experimental or off-label.
The opinions expressed in this presentation are the The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.views/opinions of the Veterans Health Administration.
44
Ergonomics Ergonomics
andandPatient HandlingPatient Handling
55
Ergonomics…Ergonomics…
"Ergonomics is the scientific study of the relation between people and their… Occupation Equipment Environment“
(Shackel)
66
Ergonomics PrinciplesErgonomics Principles
• Design for human use
• Fits the task to the worker
• People are different
• People have limitations
• People age
77
An Ergonomic Approach…An Ergonomic Approach…
Provides a step-by-step process Provides a step-by-step process to ensure the appropriate to ensure the appropriate technology is in place to technology is in place to
reduce musculoskeletal stress reduce musculoskeletal stress & strain…. reducing the risk & strain…. reducing the risk
of injury.of injury.
88
A Simple Look at an Ergonomic ApproachA Simple Look at an Ergonomic Approach
Tasks: Tasks: Identify jobs and job tasks which stress body parts Identify jobs and job tasks which stress body parts
beyond limits beyond limits Develop solutions to change these task demands.Develop solutions to change these task demands.
Workplace Environment:Workplace Environment: Review the design of the physical work environment Review the design of the physical work environment
to reduce risk, remove barriers, minimize travel, etc. to reduce risk, remove barriers, minimize travel, etc.
Other Factors:Other Factors: Consider other factors that affect work Consider other factors that affect work
performance, such as lighting, noise, equipment performance, such as lighting, noise, equipment storage & maintenance issues.storage & maintenance issues.
Implement these changes in the work place.Implement these changes in the work place.
99
ERGO INJURY TRIANGLE
Injury
Force
Frequency/DurationPosture
1010
Ergonomic HazardsErgonomic Hazards
What are Ergonomic Hazards?What are Ergonomic Hazards? Musculoskeletal SystemMusculoskeletal System Energy/Forces/StressorsEnergy/Forces/Stressors Exceed the biomechanical limits of the Exceed the biomechanical limits of the
human body human body
1111
What Do “Patient Care” Ergonomic Hazards result from?
What Do “Patient Care” Ergonomic Hazards result from?
Patient lifting and moving Patient lifting and moving exceed caregivers’ exceed caregivers’
biomechanical limits…biomechanical limits…
1212
What Do “Patient Care” Ergonomic Hazards result from?
What Do “Patient Care” Ergonomic Hazards result from?
Ergonomic hazards for caregivers include… Ergonomic hazards for caregivers include… pushing, pullingpushing, pulling lifting heavy loadslifting heavy loads horizontal & vertical liftinghorizontal & vertical lifting lifting light loads for long periods of timelifting light loads for long periods of time twisting, bending, reachingtwisting, bending, reaching standing for long periods of timestanding for long periods of time awkward posturesawkward postures repetitive motionsrepetitive motions others….others….
1313
What Do “Patient Care” Ergonomic Hazards result from?
What Do “Patient Care” Ergonomic Hazards result from?
““Safe” lifting rules don’t apply Safe” lifting rules don’t apply (Horizontal (Horizontal andand vertical lifting) vertical lifting)
Patients:Patients: are are asymmetric & bulkyasymmetric & bulky can’t be held closecan’t be held close to the body to the body have no have no handleshandles
Patient Patient assistance variesassistance varies
1414
What Do “Patient Care” Ergonomic Hazards result from?
Patient care is unpredictable due to Patient care is unpredictable due to unanticipated patient responses… unanticipated patient responses… muscle spasms, combativeness, or resistancemuscle spasms, combativeness, or resistance
Results in… Results in… UnexpectedlyUnexpectedly heavy loads heavy loads Patient Patient MovementMovement
When lifting/handling a moving object, When lifting/handling a moving object, loading/stress on the spine increases loading/stress on the spine increases beyond what it would be for a slow, smooth beyond what it would be for a slow, smooth lift of a stable object. lift of a stable object.
1515
d
F=ma
Simple Biomechanical Model
Work = Force x DistanceW = F x d
1616
Exceeding Biomechanical Capabilities results in…Exceeding Biomechanical Capabilities results in…
Musculoskeletal impact/stress on…Musculoskeletal impact/stress on… BackBack ShouldersShoulders NeckNeck WristWrist HandHand KneesKnees Other body parts…Other body parts…
1717
Example 1: Pull up in Geri-ChairExample 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
1818
Example 2: Transfer to StretcherExample 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
1919
Example 3: Transfer from Chair of partial weight-bearing patient 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
2020
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
2121
Unit-Based Hazard Assessment for Unit-Based Hazard Assessment for Safe Patient HandlingSafe Patient Handling
2222
Unit-based Hazard Assessment for Safe Patient Handling
Unit-based Hazard Assessment for Safe Patient Handling
‘‘Patient Care’ Practice Settings include…Patient Care’ Practice Settings include…• ALL practice settings that move and lift patientsALL practice settings that move and lift patients
NON-NURSINGNON-NURSING•PTPT•DiagnosticsDiagnostics•Treatment AreasTreatment Areas•Procedure AreasProcedure Areas•MorgueMorgue•DialysisDialysis•Others..Others..
NURSINGNURSING•Acute CareAcute Care•Long Term CareLong Term Care•Critical CareCritical Care•OROR•ERER•SCISCI•Others…Others…
2323
Unit-Based Hazard Assessment Unit-Based Hazard Assessment
RoleRole Drives UNIT recommendations for Drives UNIT recommendations for
equipment, policy, and procedures equipment, policy, and procedures
Identifies areas in need of improvement Identifies areas in need of improvement that impact safety of work environment & that impact safety of work environment & use of equipmentuse of equipmentStorage, maintenance, clutter, etc.Storage, maintenance, clutter, etc.
2424
Unit-Based Hazard AssessmentUnit-Based Hazard Assessment
I.I. Prior to Ergo Evaluation Prior to Ergo Evaluation – Data Collection– Data Collection
1.1. Identify UNIT High Risk Identify UNIT High Risk TasksTasks
Staff Perception of High Staff Perception of High Risk TasksRisk Tasks
Unit Injury dataUnit Injury data
2.2. Identify High Risk UnitsIdentify High Risk Units
3.3. Collect Information on Collect Information on Unit Characteristics/IssuesUnit Characteristics/Issues
II.II. During Ergo Evaluation During Ergo Evaluation1.1. Meet with Mgmt/StaffMeet with Mgmt/Staff
2.2. Conduct Site VisitConduct Site Visit
3.3. Meet with Mgmt/StaffMeet with Mgmt/Staff
III.III. After Ergo Evaluation After Ergo Evaluation1.1. Perform Risk AnalysisPerform Risk Analysis
2.2. Formulate Formulate RecommendationsRecommendations
2525
Unit-Based Hazard Assessment Unit-Based Hazard Assessment
I.I. Prior to Ergo Evaluation – Data Collection Prior to Ergo Evaluation – Data Collection1.1. Identify UNIT High Risk TasksIdentify UNIT High Risk Tasks
Staff Perception of High Risk TasksStaff Perception of High Risk Tasks Unit Injury dataUnit Injury data
2.2. Identify High Risk UnitsIdentify High Risk Units
3.3. Collect Information on Unit Collect Information on Unit Characteristics/IssuesCharacteristics/Issues
2626
I. Prior to Ergo Evaluation
1. Identify High Risk Tasks I. Prior to Ergo Evaluation
1. Identify High Risk Tasks
Collect Staff Perceptions of Unit High-Risk TasksCollect Staff Perceptions of Unit High-Risk Tasks‘‘Tool for Prioritizing High Risk Tasks’ Tool for Prioritizing High Risk Tasks’
Rank Tasks from 1 to 1010 = 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
2727
I. Prior to Ergo Evaluation
1. Identify Unit High Risk Tasks I. Prior to Ergo Evaluation
1. Identify Unit High Risk Tasks
PATIENT CARE INCIDENT/INJURY PROFILE
Patient Care
Activity
Cause of Injury
Type of Injury
Body Part(s)
Location Time of Injury
Lost Days
Modified Duty Days
Sample: Patient transfer bed to stretcher
Reaching across stretcher for patient
Strain Upper back Patient bedside
09:30 3 5
*Be sure to note which source is used on your Injury Log
Collect Unit Injury DataCollect Unit Injury Data
2828
I. Prior to Ergo Evaluation
2. Identify High Risk UnitsI. Prior to Ergo Evaluation
2. Identify High Risk Units
Beware of using Injury data….
2929
I. Prior to Ergo Evaluation
2. Identify High Risk UnitsI. Prior to Ergo Evaluation
2. Identify High Risk Units
Directs focus for equipment and policy interventions Directs focus for equipment and policy interventions Identification of High Risk UnitsIdentification 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
3030
I. Prior to Ergo Evaluation
3. Collect Pre-Site Visit Unit DataI. Prior to Ergo Evaluation
3. Collect Pre-Site Visit Unit Data
Use ‘Unit Characteristics/IssuesUse ‘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 dataConfirms site visit data Used for making recommendationsUsed for making recommendations
3131
Unit-Based Hazard AssessmentUnit-Based Hazard Assessment
II.II. During Ergo Evaluation/Site Visit During Ergo Evaluation/Site Visit1.1. Opening Meeting Opening Meeting
2.2. Site Visit/Walk-throughSite Visit/Walk-through
3.3. Closing Meeting (optional for unit, required for Closing Meeting (optional for unit, required for administration)administration)
3232
II. During Ergo Evaluation/Site Visit 1. Conduct 1. Conduct Opening Meeting
II. During Ergo Evaluation/Site Visit 1. Conduct 1. Conduct Opening Meeting
Discuss Discuss Pre-Site Visit DataPre-Site Visit Data Issues of ConcernIssues of Concern
IncludeInclude StaffStaff Unit/Area ManagerUnit/Area Manager Safety/Risk ManagementSafety/Risk Management Facilities ManagementFacilities Management UnionUnion OthersOthers
3333
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
During Site Visit Walk-through, During Site Visit Walk-through, interview interview staffstaff…… Confirms Pre-Site Visit Unit Data CollectedConfirms Pre-Site Visit Unit Data Collected Discovers staff attitudes, concerns, ideas, Discovers staff attitudes, concerns, ideas,
informationinformation
3434
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
During Site Visit Walk-through, During Site Visit Walk-through, observeobserve…… Equipment Equipment
AvailabilityAvailability AccessibilityAccessibility UseUse ConditionCondition StorageStorage Structural issues that impact useStructural issues that impact use
3535
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
During Site Visit Walk-through, During Site Visit Walk-through, notenote…… Patient room sizes/configurationsPatient room sizes/configurations Ceiling Characteristics/AC vents/TVs/SprinklersCeiling Characteristics/AC vents/TVs/Sprinklers Showering/bathing facilities & processShowering/bathing facilities & process Toileting processToileting process Safety Design Issues: Thresholds, DoorwaysSafety Design Issues: Thresholds, Doorways Storage Storage
3636
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
During Site Visit Walk-through, During Site Visit Walk-through, documentdocument… … Existing/ordered patient handling equipmentExisting/ordered patient handling equipment Occurrence of high risk tasksOccurrence of high risk tasks % total dependent & extensive assistance pts% total dependent & extensive assistance pts % partial assistance patients% partial assistance patients Occurrence of bariatric/obese patientsOccurrence of bariatric/obese patients Room configurationsRoom configurations # beds on unit/average daily census# beds on unit/average daily census Storage issuesStorage issues Equipment/Sling recommendationsEquipment/Sling recommendations NotesNotes (Sample PCE Templates - Handouts A-2a & A-2b)(Sample PCE Templates - Handouts A-2a & A-2b)
3737
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Unit Ceiling Lift SystemCeiling Lift System Coverage Coverage Based on… Based on…
1.1. Dependency Level of patient/resident population Dependency Level of patient/resident population
2.2. Room configurations on unit: # of private, semi-Room configurations on unit: # of private, semi-private, 3-bed, 4-bed rooms, etc. on unit. private, 3-bed, 4-bed rooms, etc. on unit.
3838
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Unit Ceiling Lift SystemCeiling Lift System Coverage Coverage Limitations… Limitations…
1.1. Structural integrity of mounting surface (I-beam/ Structural integrity of mounting surface (I-beam/ concrete pan)concrete pan)
2.2. Ceiling fixtures - lights, sprinkler heads, AC vents, etc.Ceiling fixtures - lights, sprinkler heads, AC vents, etc.3.3. Ceiling Height Ceiling Height 4.4. Ceiling configuration/drop ceiling/AC housingCeiling configuration/drop ceiling/AC housing5.5. ICU Power ColumnsICU Power Columns6.6. OthersOthers
3939
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Unit Ceiling Lift SystemCeiling Lift System Track Options Track OptionsTraverse (x-y or H)Traverse (x-y or H)StraightStraight
CurvedCurved U-shapedU-shaped
4040
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…Unit Ceiling Lift System Coverage continued…
1.1. Determine Average % of Patients Requiring Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage:Ceiling Lift (CL) System Coverage:
Sum average % of Sum average % of total dependent patients total dependent patients extensive assistance patients/residents extensive assistance patients/residents
4141
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…Unit Ceiling Lift System Coverage continued…
2. Determine # & Configuration of Rooms 2. Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit: requiring Ceiling Lift Systems per unit: To calculate number of rooms needing ceiling To calculate number of rooms needing ceiling
lifts, use Average % of Patients requiring CL lifts, use Average % of Patients requiring CL Coverage (Previous slide)Coverage (Previous slide)
4242
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…Unit Ceiling Lift System Coverage continued…
For units w/ only private patient roomsFor units w/ only private patient rooms:: Average % of Patients Requiring CLs x # patients Average % of Patients Requiring CLs x # patients
= # = # privateprivate patient rooms w/ CLs patient rooms w/ CLs
For units w/ only semi-private roomsFor units w/ only semi-private rooms: : Average % of Patients Requiring CLs x # patients / 2 Average % of Patients Requiring CLs x # patients / 2
= # = # semi-privatesemi-private patient rooms w/ CLs patient rooms w/ CLs
4343
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…Unit Ceiling Lift System Coverage continued…
For units with a mixture of room configurationsFor units with a mixture of room configurations: : For cost effectiveness in existing construction, and if For cost effectiveness in existing construction, and if
appropriate for the unit…appropriate for the unit… First begin calculations with ceiling lifts placed in most First begin calculations with ceiling lifts placed in most
or all larger wards (3-bed & 4-bed wards) or all larger wards (3-bed & 4-bed wards) Then, as appropriate, place in smaller rooms (private Then, as appropriate, place in smaller rooms (private
and semi-private)and semi-private)
4444
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…Unit Ceiling Lift System Coverage continued…
Example: Example: MedSurg Unit MedSurg Unit
30 patients 30 patients 4 private rooms, 10 semi-private rooms, and two 3-bed rooms. 4 private rooms, 10 semi-private rooms, and two 3-bed rooms. Approximately 70% of the patients will require use of Ceiling Approximately 70% of the patients will require use of Ceiling
Lifts; therefore this unit should have coverage for 21 patients Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients). (70% x 30 patients).
For cost effectiveness, and if appropriate for unit needs, For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in... to provide 70% ceiling lift coverage, include in...
two (2) 3-bed rooms (covering 6 patients)two (2) 3-bed rooms (covering 6 patients) seven (7) semi-private rooms (covering 14 patients)seven (7) semi-private rooms (covering 14 patients) one (1) private room (covering one patient) one (1) private room (covering one patient)
4545
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
II. During Ergo Evaluation/Site Visit 2. 2. Conduct Site Visit
Unit Ceiling Lift System Coverage PracticeUnit Ceiling Lift System Coverage Practice(Handout A- 3)(Handout A- 3)
NHCU Unit NHCU Unit Med/Surg (Tele) Unit Med/Surg (Tele) Unit Med/Surg (Rehab) Unit Med/Surg (Rehab) Unit
1.1. How many (#) patients/beds should be covered?How many (#) patients/beds should be covered?2.2. In what rooms would you place ceiling lifts on this In what rooms would you place ceiling lifts on this
unit?unit?3.3. How many ceiling lifts would you purchase/install for How many ceiling lifts would you purchase/install for
this unit?this unit?
4646
II. During Ergo Evaluation/Site Visit 3.3. Conduct UNIT Closing Meeting (optional)
II. During Ergo Evaluation/Site Visit 3.3. Conduct UNIT Closing Meeting (optional)
Discuss Discuss Preliminary Findings Preliminary Findings
from Site Visit from Site Visit Pre-Site Visit Data as Pre-Site Visit Data as
related to findingsrelated to findings Priorities in need of Priorities in need of
immediate immediate remediationremediation
Issues of ConcernIssues of Concern
IncludeInclude StaffStaff Unit/Area ManagerUnit/Area Manager Safety/Risk Safety/Risk
ManagementManagement Facilities ManagementFacilities Management UnionUnion OthersOthers
4747
II. During Ergo Evaluation/Site Visit 3.3. Conduct ADMINISTRATOR Closing Mtg
II. During Ergo Evaluation/Site Visit 3.3. Conduct ADMINISTRATOR Closing Mtg
Discuss Discuss Rationale for Site VisitRationale for Site Visit Preliminary Findings from Preliminary Findings from
Site Visit Site Visit Priorities in need of Priorities in need of
immediate remediationimmediate remediation Issues of ConcernIssues of Concern Show photos of equipment Show photos of equipment
recommendationsrecommendations
IncludeInclude StaffStaff Union Union Unit/Area ManagersUnit/Area Managers Safety/Risk Safety/Risk
Management/Employee Management/Employee HealthHealth
Facilities ManagementFacilities Management CFO/PurchasingCFO/Purchasing OthersOthers
4848
Unit-Based Hazard AssessmentUnit-Based Hazard Assessment
III.III. After Ergo Evaluation After Ergo Evaluation1.1. Perform Risk AnalysisPerform Risk Analysis2.2. Generate RecommendationsGenerate Recommendations
4949
III. After Ergo Evaluation1. 1. Perform Risk Analysis
III. After Ergo Evaluation1. 1. Perform Risk Analysis
Sources of Risk: You must know the SOURCES of risk in
your patient care environment to perform Risk Analyses…
5050
Sources of RiskSources of Risk
Risk Sources:Risk Sources: Health Care Health Care EnvironmentEnvironment PatientPatient Patient Handling Patient Handling TasksTasks
Once risks are identified, steps can be taken to protect Once risks are identified, steps can be taken to protect Staff and Patients!Staff and Patients!
5151
What’s Wrong with this Picture??
5252
Sources of RiskSources of Risk
Health Care Health Care EnvironmentEnvironment Risk Factors Risk Factors Space limitations Space limitations
Small roomsSmall rooms Lots of equipmentLots of equipment ClutterClutter Cramped working spaceCramped working space
Poor placement of room furnishingsPoor placement of room furnishings
5353
Sources of RiskSources of Risk
Health Care Health Care EnvironmentEnvironment Risk Factors Risk Factors Slip, trip, and fall hazardsSlip, trip, and fall hazards Uneven work surfaces (stretchers, beds, Uneven work surfaces (stretchers, beds,
chairs, toilets at different heights)chairs, toilets at different heights) Uneven Floor Surfaces (thresholds)Uneven Floor Surfaces (thresholds) Narrow DoorwaysNarrow Doorways Poor bathing area designPoor bathing area design
5454
Sources of RiskSources of Risk
Health Care Health Care EnvironmentEnvironment Risk Factors Risk Factors Broken EquipmentBroken Equipment Inefficient Equipment (non-electric, slow-Inefficient Equipment (non-electric, slow-
moving, bed rails)moving, bed rails) Not enough or Inconvenient Storage SpaceNot enough or Inconvenient Storage Space Staff who don’t help each other or don’t Staff who don’t help each other or don’t
communicatecommunicate
5555
What’s Wrong with this Picture??
5656
Sources of RiskSources of Risk
PatientPatient Risk Factors Risk Factors Weak/unable to help with Weak/unable to help with
transferstransfers UnpredictableUnpredictable Hit or biteHit or bite Resistive BehaviorResistive Behavior Unable to follow simple Unable to follow simple
directionsdirections
5757
Sources of RiskSources of Risk
PatientPatient Risk Factors Risk Factors OverweightOverweight Experiencing PainExperiencing Pain Hearing or vision lossHearing or vision loss No/little communication No/little communication
between staff about Patient between staff about Patient or with Patientor with Patient
5858
What’s Wrong with this Picture??
5959
Sources of RiskSources of Risk
Patient Handling Patient Handling TasksTasks Risk Factors Risk Factors Reaching and lifting with loads far from the bodyReaching and lifting with loads far from the body Lifting heavy loadsLifting heavy loads Twisting while liftingTwisting while lifting Unexpected changes in load Unexpected changes in load
demand during liftdemand during lift Reaching Reaching Long DurationLong Duration
6060
Sources of RiskSources of Risk
Patient Handling Patient Handling TasksTasks Risk Factors Risk Factors Moving or carrying a load Moving or carrying a load
a significant distance a significant distance Awkward PostureAwkward Posture Pushing/PullingPushing/Pulling Completing activity with Completing activity with
bed at wrong heightbed at wrong height Frequent/repeated Frequent/repeated
lifting & movinglifting & moving
6161
III. After Ergo Evaluation1. 1. Perform Risk AnalysisIII. After Ergo Evaluation1. 1. Perform Risk Analysis
High Risk Task Identification: To determine the risk of injury for each
unit/patient population, high risk tasks specific to the unit must be identified…
6262
III. After Ergo Evaluation 1. 1. Perform Risk AnalysisIII. After Ergo Evaluation 1. 1. Perform Risk Analysis
Identify UNIT high risk tasks by…Identify UNIT high risk tasks by…
1.1. Analyzing Analyzing Unit Injury DataUnit Injury Data
2.2. Collecting Collecting Staff Perception of High Risk Staff Perception of High Risk TasksTasks
3.3. Interviewing Interviewing EmployeesEmployees
6363
III. After Ergo Evaluation 1. 1. Perform Risk AnalysisIII. After Ergo Evaluation 1. 1. Perform Risk Analysis
1. Analyze Unit Injury Data1. Analyze Unit Injury Data
Determine:Determine: #1 & 2 #1 & 2 CausesCauses of Injuries of Injuries #1 & 2 #1 & 2 ActivitiesActivities being performed when staff being performed when staff
are injuredare injured What’s going on? What trends are seen?What’s going on? What trends are seen?
’’Injury Incidence Profile’ Injury Incidence Profile’ (Handout A-4)(Handout A-4)
6464
III. After Ergo Evaluation 1. 1. Perform Risk AnalysisIII. After Ergo Evaluation 1. 1. Perform Risk Analysis
2. 2. Complete & Collate Staff Responses for ‘Tool for Complete & Collate Staff Responses for ‘Tool for Prioritizing High Risk Tasks’Prioritizing High Risk Tasks’ (Handout A-5)(Handout A-5)
Rank Tasks from 1 to 1010= most difficult/highest risk 1 = least difficult/ lowest risk
When ranking, consider: Frequency, Duration, & Musculoskeletal Stress
Completed by Each Staff member Collectively by Shift
Compile by Unit and Shift
6565
III. After Ergo Evaluation 1. 1. Perform Risk AnalysisIII. After Ergo Evaluation 1. 1. Perform Risk Analysis
High Risk Tasks will vary by High Risk Tasks will vary by Clinical Setting….Clinical Setting….
6666
High Risk Tasks: Long Term Care High Risk Tasks: Long Term Care
Repositioning in Bed* Repositioning in Bed* Making occupied bed*Making occupied bed* Transferring patient from Transferring patient from
bathtub to chair*bathtub to chair* Transferring patient from Transferring patient from
wheelchair to bed*wheelchair to bed* Transferring patient from Transferring patient from
wheelchair to toilet*wheelchair to toilet* Lifting a patient up from Lifting a patient up from
the floor*the floor* Weighing a patient*Weighing a patient* Applying antiembolism Applying antiembolism
stockingsstockings
Bathing a patient in Bathing a patient in bed* bed*
Bathing a patient in a Bathing a patient in a shower chair /trolley*shower chair /trolley*
Undressing/dressing a Undressing/dressing a patient*patient*
Repositioning patient in Repositioning patient in dependency chair* **dependency chair* **
Making an occupied Making an occupied bed*bed*
Feeding bed-ridden Feeding bed-ridden patientpatient
Changing absorbent Changing absorbent pad*pad*
* Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD) * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)
6767
High Risk Tasks: Critical Care Units High Risk Tasks:
Critical Care Units
Transporting patients (Road Trips)** Transporting patients (Road Trips)** Lateral Transfers (bed to stretcher)* *** Lateral Transfers (bed to stretcher)* *** Repositioning patient in bed from side Repositioning patient in bed from side
to side* *** to side* *** Vertical Transfers (bed/chair/commode)*Vertical Transfers (bed/chair/commode)* Lifting patient to the head of the bed* ***Lifting patient to the head of the bed* *** Making occupied bed* ***Making occupied bed* *** Applying antiembolism stockingsApplying antiembolism stockings Bending/Reaching behind & around Bending/Reaching behind & around
for equipment, etc.for equipment, etc.
* * Lifts ** Bed mover or powered bed *** Lateral transfer aid Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD) (FRD)
6868
High Risk Tasks:Medical/Surgical Units
High Risk Tasks:Medical/Surgical Units
Transfer from bed to Transfer from bed to chair*chair*
Transfer from bed to Transfer from bed to stretcher* ***stretcher* ***
Moving Occupied bed Moving Occupied bed or stretcher**or stretcher**
Making occupied bed* Making occupied bed* *** ***
Bathing a confused or Bathing a confused or totally dependent totally dependent patientpatient
Lifting a patient up from Lifting a patient up from the floor*the floor*
Weighing a patient*Weighing a patient* Applying antiembolism Applying antiembolism
stockings stockings Repositioning in bed* *** Repositioning in bed* *** Making occupied bed* Making occupied bed*
*** *** Extensive dressing Extensive dressing
changes*changes*
* * Lifts ** Bed mover or powered bed *** Lateral transfer aid Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)(FRD)
6969
High Risk Tasks: Operating Room High Risk Tasks: Operating Room
Standing long periods Standing long periods of timeof time
Lifting and holding Lifting and holding patient’s extremities*patient’s extremities*
Holding Holding retractors/organs for retractors/organs for long periods of timelong periods of time
Transferring patients Transferring patients on and off operating on and off operating room tables/beds* room tables/beds* ******
Reaching, lifting and Reaching, lifting and moving equipmentmoving equipment
Repositioning Repositioning patients on patients on operating room operating room beds* ***beds* ***
Reaching for Reaching for equipmentequipment
•Lifts ** Bed mover or powered bed Lifts ** Bed mover or powered bed •*** Lateral transfer aid (FRD) *** Lateral transfer aid (FRD)
7070
High Risk Tasks:Orthopedic UnitsHigh Risk Tasks:Orthopedic Units
Post-operative Total Hip Replacement Post-operative Total Hip Replacement Patient Patient
Patient with a cast/splint on extremity Patient with a cast/splint on extremity Use of Continuous Passive Motion Device Use of Continuous Passive Motion Device
(CPM) (CPM) Halo Vest, logrolling for dressing changesHalo Vest, logrolling for dressing changes Holding Extremity for procedureHolding Extremity for procedure Altered Gait Pattern - Platform Walker Altered Gait Pattern - Platform Walker Assembling TractionAssembling Traction Transfers In/Out a CarTransfers In/Out a Car Transfers of Patients with Pelvic & Transfers of Patients with Pelvic &
External FixatorsExternal Fixators
7171
High Risk Tasks: Home Settings
High Risk Tasks: Home Settings
Providing patient care Providing patient care in a bed that is not in a bed that is not height adjustableheight adjustable
Providing care in Providing care in crowded area, forcing crowded area, forcing awkward positionsawkward positions
Toileting and transfer Toileting and transfer tasks without proper tasks without proper lifting aidslifting aids
No assistance for tasks No assistance for tasks
7272
High Risk Tasks: Psychiatry High Risk Tasks: Psychiatry
Restraining a patient Restraining a patient Escorting a Escorting a confused or confused or
combative patient combative patient Toileting a Toileting a confused or confused or
combative patient combative patient Dressing a Dressing a confused or confused or
combative patient combative patient Picking a patient up from Picking a patient up from
floorfloor Bathing/ Showering confused Bathing/ Showering confused
or combative patient or combative patient Bed-related careBed-related care
7373
Other High Risk Tasks Other High Risk Tasks
• Lifting heavy linen bags• Standing for long periods of time behind med carts• Data entry• Others…
7474
Information from Risk Analysis Information from Risk Analysis
drives formation of drives formation of
Equipment Recommendations…Equipment Recommendations…
III. After Ergo Evaluation 2. 2. Generate Recommendations
7575
III. After Ergo Evaluation 2. 2. Generate Recommendations
III. After Ergo Evaluation 2. 2. Generate Recommendations
Patient Handling Equipment Patient Handling Equipment for each unit/areafor each unit/area
Storage Storage Design FeaturesDesign Features Repair/MaintenanceRepair/Maintenance Injury ReportingInjury Reporting Bariatric ProgramsBariatric Programs
Sample Report - Handout A-7Sample Report - Handout A-7
Equipment Support Equipment Support StructuresStructures Unit Peer LeadersUnit Peer Leaders Facility ChampionsFacility Champions Facility Safe Patient Handling Facility Safe Patient Handling
TeamTeam TrainingTraining Knowledge Transfer Knowledge Transfer
Mechanisms Mechanisms Change StrategiesChange Strategies
7676
Unit-based Hazard Assessments for Safe Patient Handling
Unit-based Hazard Assessments for Safe Patient Handling
‘‘Patient Care’ Practice Settings include…Patient Care’ Practice Settings include…• ALL practice settings that move and lift patientsALL practice settings that move and lift patients
NON-NURSINGNON-NURSING•PTPT•DiagnosticsDiagnostics•Treatment AreasTreatment Areas•Procedure AreasProcedure Areas•MorgueMorgue•DialysisDialysis•Others..Others..
NURSINGNURSING•Acute CareAcute Care•Long Term CareLong Term Care•Critical CareCritical Care•OROR•ERER•SCISCI•Others…Others…
7777