1 unit-based hazard assessment for safe patient handling

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Unit-based Hazard Assessment Unit-based Hazard Assessment for Safe Patient Handlingfor Safe Patient Handling

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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

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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.

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Ergonomics Ergonomics

andandPatient HandlingPatient Handling

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Ergonomics…Ergonomics…

"Ergonomics is the scientific study of the relation between people and their… Occupation Equipment Environment“

(Shackel)

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Ergonomics PrinciplesErgonomics Principles

• Design for human use

• Fits the task to the worker

• People are different

• People have limitations

• People age

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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.

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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.

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ERGO INJURY TRIANGLE

Injury

Force

Frequency/DurationPosture

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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

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What Do “Patient Care” Ergonomic Hazards result from?


Patient lifting and moving Patient lifting and moving exceed caregivers’ exceed caregivers’

biomechanical limits…biomechanical limits…

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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….

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““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

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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.

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d

F=ma

Simple Biomechanical Model

Work = Force x DistanceW = F x d

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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…

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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

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Example 2: Transfer to StretcherExample 2: Transfer to Stretcher


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

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Example 3: Transfer from Chair of partial weight-bearing patient Example 3: Transfer from Chair of partial weight-bearing patient


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

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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

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Unit-Based Hazard Assessment for Unit-Based Hazard Assessment for Safe Patient HandlingSafe Patient Handling

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‘‘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…

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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.

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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

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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

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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

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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

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2. Identify High Risk UnitsI. Prior to Ergo Evaluation

2. Identify High Risk Units

Beware of using Injury data….

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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

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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

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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)

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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

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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

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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

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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

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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)

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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.

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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

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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

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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

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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)

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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

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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)

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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)

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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?

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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

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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

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III.III. After Ergo Evaluation After Ergo Evaluation1.1. Perform Risk AnalysisPerform Risk Analysis2.2. Generate RecommendationsGenerate Recommendations

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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…

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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!

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What’s Wrong with this Picture??

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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

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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

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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

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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

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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


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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

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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

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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…

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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

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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)

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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

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High Risk Tasks will vary by High Risk Tasks will vary by Clinical Setting….Clinical Setting….

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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)

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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)

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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)

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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)

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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

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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

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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

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Other High Risk Tasks Other High Risk Tasks

• Lifting heavy linen bags• Standing for long periods of time behind med carts• Data entry• Others…

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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

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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

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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…

1 unit-based hazard assessment for safe patient handling

Documents

lift slide

body parts slide

human body slide

patient care ergonomic

patient risk factor

ergonomicsand patient

handles patient assistance

manual lifting body