Kirstyn AlbrechtPhysiotherapist, Safe Handling Advisor

Counties Manukau District Health BoardAuckland, New Zealand

Design Considerations for Safe Patient Handling in

Healthcare Facilities

Overview

CMDHB Clinical Services Building (CSB) Patient Handling Needs Considerations

Equipment Dimensional Process

Overcoming Challenges Learnings &

Recommendations

Clinical Services Building (CSB)

Patient Care Area Beds (117)

Theatres 14

Recovery Unit 23

Theatre Admission and Discharge Unit 20

Short Stay Assessment & Planning Unit 42

High Dependency Unit 18

Other Services

Sterile Supply Unit

Support Services

Design Phases

Concept Design Preliminary Design: Meetings

– Architects– Project Managers: CMDHB and External– Clinicians and Physicians– CMDHB Service Improvement Managers– Other stakeholders eg OH&S, Infection control, Engineering

Develop Design: More meetings… Detailed Design: Meetings & more meetings… Construction

Design Risk Risk: Design and build a clinical environment that doesn’t

support safe moving and handling practice– Patient Moving and Handling challenges for the lifetime of the facility

Copyright CMDHB 2011

Impact of poor ergonomic design Clinical time Injury

27% Patient Handling, 20% Manual HandlingCMDHB Injury Claims Data 2003-2011

Cost Quality of care Model of care and practice

57% of staff sometimes, infrequently or never have sufficient space in room to safely use equipment

CMDHB Staff Survey November 2011

Patient Handling Needs Analysis

Patients Medical condition Physical characteristics Mobility level

Moving and Handling Tasks High risk activities and scenarios

Environment Space in room Other equipment and Storage

CMDHB Adapted ToolConcise Patient Ceiling Track Needs Assessment Tool for CMDHB – October 2011 Adapted for CMDHB use from: Patient Care Ergonomics Resource Guide: Safe Patient Handling & Movement, Department of Veterans Affairs (October 2001)

1) Patient Physical Characteristics and Dependency Levels

a. Describe the patients/residents on your unit. b. Describe their level of cognitive participation.

c. Average Unit population characteristics (# hospice beds, Alzheimer beds, TBI beds,

etc.) and variability in this.

d. Discuss proposed changes in the average daily census over the next two years.

e. Identify typical distribution of patients by physical dependency level according to the definitions below. (Base on PHYSICAL LIMITATIONS not on clinical acuity)

Note: This is not the same as patient acuity. The total for the 5 categories should equal your average daily census.

____ Total Dependence – Cannot help at all with transfers, full staff assistance for activity during entire seven-day period. Requires total transfer at all times.

____ Extensive Assistance – Can perform part of activity, usually can follow simple directions, may require tactile cueing, can bear some weight, sit up with assistance, has some upper body strength, or may be able to pivot transfer. Over the last seven-day period, help provided three or more times for weight-bearing transfers or may have required a total transfer.

____ Limited Assistance – Highly involved in activity, able to pivot transfer and has considerable upper body strength and bears some weight on legs. Can sit up well, but may need some assistance. Guided maneuvering of limbs or other non-weight bearing assistance three or more times, or help provided one or two times during the last seven days.

____ Supervision – Oversight, encouragement, or cueing provided three or more times during the last seven days or physical assistance provided only one or two times during the last seven days.

____ Independent – Can ambulate normally without assistance in unusual situations may need some limited assistance. Help or oversight may have been provided only one or two times in the last seven days.

Total Number of Patients on Unit: ____

f. Indicate the weight range of patients on your unit. g. Indicate the number of patients over 137kg. h. Indicate the number of patients over 200kg.

2) Tool for Prioritizing High-Risk Patient Handling Tasks

Directions: For each task, consider the frequency of the task (high, moderate, low) and musculoskeletal stress (high, moderate, low) of each task. Cross out tasks not typically performed on your unit. Assign a rank (from 1 to 10) to the tasks you consider to be the highest risk tasks contributing to musculoskeletal injuries for persons providing direct patient care. A “10” should represent the highest risk, “9” for the second highest, etc.

TASK

FREQUENCY

H= high

M= moderate

L= low

STRESS OF Task

H= high

M= moderate

L= low

RANK

10= high-risk

1= low risk

PATIENT HANDLING TASKS

Transferring a patient: (includes reverse activity)

From bed to wheelchair or shower/commode chair

From bed to chair/arm chair

From wheelchair or shower/commode to toilet

From bed to stretcher/bed

Moving a patient:

Lifting patient to the head of the bed

Repositioning patient in bed from side to side

Repositioning patient in chair or wheelchair

Lifting a patient up from the floor

Weighing a patient

Bathing a patient:

In bed

In a shower chair

On a shower trolley or stretcher

Other handling activities

Undressing/dressing a patient

Applying antiembolism stockings

Making an occupied bed

Feeding bed-ridden patient

Changing absorbent pad

Transporting patient off unit

Other Task:

Adapted from Owen, B.D. & Garg, A. (1991). AAOHN Journal, 39, (1).

What and How Much Equipment

Floor hoists - 1 hoist to 10 patients

Sit to Stand - 1 hoist to 10 patients

Other Equipment - PAT slides, Sliding Sheets, Handling Belts

Ceiling Hoist Coverage – Limited information available– Patient Handling and Movement Assessments: A White Paper (2010)

Comprehensive Risk Assessment

Ceiling Hoist Estimations

Determine % of patients requiring lift% Dependent + % Extensive Assistance = % Requiring lift

Determine # of rooms requiring lift # Patients x % Requiring Lift = # of Rooms with lift

The Facility Guidelines Institute 2010, Patient Handling and Movement Assessments: A White Paper (2010 )

Example:30% Dependent + 20% Ext Assist = 50% Require lift50 Patients x 50% Require lift = 25 Bed spaces have a lift

Equipment Considerations Where it will be used and stored Number of staff required Size and dimensions Maintenance Features Safe Working Load (SWL) Provision for Bariatric patients

33% CMDHB adults are obese Compared with 23% for NZ

NZ Health Survey 2006/2007

www.liko.com

Turning Space

Sourced: ARJO Guidebook for Architects and Planners, 2005

Dimensional Considerations Width of the room – for turning space

Room layout and adaptability – bathroom and bedroom

Wide doorways and corridors - to fit equipment through

Position of toilet - with space each side

Location of services – storage of equipment

Bariatric and other specialist areas

Copyright CMDHB 2011 NZ Patient Handling Guidelines 2003

Process Considerations

Stakeholder awareness of safe handling Specialist Resource Availability Meeting Format Stakeholders requirements and focus Layers of hierarchy Prioritisation of needs

– Clinical– Functional– Budgetary

Overcoming Challenges

Research: – Articles and resources– Industry expertise – Assessment Tools

Moving and Handling network Supplier advice___________________________________________________________________________________________________________________________________________________________________________________________________________________

Work directly with clinicians Obtain senior management commitment Develop committee OH&SS team generic guidelines

Learnings

Highly consultative process

Project of this size needs clear:– Process for specialist input into decision making process– Prioritisation process to negotiate different stakeholder requirements

More industry research required

Recommendations

Early input from specialist Determine effective method for specialist input Business case as soon as possible Determine safe handling priorities Clearly establish patient handling needs and equipment

requirements Educate and liaise with stakeholders Hang in there!

CSB Stage 1, Phase 2 today

References

A Guide to designing Workplaces for Safer Handling of People, Worksafe Victoria, 3rd edition, Sept 2007ARJO Guidebook for Architects and Planners – Elderly Care Facilities, 2nd Edition, 2005, SwedenAustralian Health Facility Guidelines Vol 1 – Vol IV 2009CMDHB Risk Pro Incident reporting system 2011CMDHB Staff Patient Handling Survey 2011Cohen M.H, et al, Patient Handling and Movement Assessments: A White Paper. April 2010. Prepared by the 2010 Health

Guidelines REvison committee Specialty Subcommittee on Paient Movement. The Facility Guidelines Institute, April 2010.

ECRI Institute, Ceiling Mounted Patient Lifts, Health Devices, April 2009FGI Guidelines for Design and Construction of Health Care Facilities 2010 edition Joliff, J., The miracle of lifting technology. Nursing Homes Magazine. September 2006Owen, B.D. & Garg, A. (1991), AAOHN Journal, 39 (4)Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Department of Veteran Affairs (October 2001)Ronald, L.A, Yassi, A, Spiegel, J., Tate, R.B, Tait, D. and Mozel, M.R., Effectiveness of Installing Overhead Ceiling Lifts. AAOHN

Journal, Mar 2002, Vol 50, No 3.Spiegel, J., Yassi, A., Ronald, L.A., Tate, R.B, Hacking, P. and Colby, T. Implementing a Resident Lifting System in an Extended

Care Hospital. AAOHN Journal, Mar 2002, Vol 50, No 3.The New Zealand Patient Handling Guidelines, The Liten up Approach, ACC Worksafe 2003Weinel, D., Successful Implementation of Ceiling-Mounted Lift Systems. Rehabilitation

Nursing, Mar/Apr 2008: Vol 33, No. 2Weitekamp, K., 2011. Just five years ago Gundersen Lutheran Health System, based in La Crosse, WI, was facing a challenge

that’s common among healthcare facilities. Advance for Nurses.

Thank you

Kirstyn Albrecht– Kirstyn.albrecht@middlemore.co.nz– Occupational Health & Safety– Middlemore Hospital– Otahuhu, Auckland 1640– New Zealand– Ph: 0064 9 276 0044 extn 8570