A TEAM APPROACH TO MANUAL HANDLING IN A COMMUNITY AGED CARE SETTING

GENIENE THOGERSEN BAppSc (Phty) Sydney

© Anglican Retirement Villages 2012

Overview

• Community North Team / client base• ARV Community Initiatives• Physiotherapy Assessment• Training• Risk Assessment / controls• Challenges• Benefits• Manual Handling Case Studies

The Team: July 2011 – Feb. 2012

• Manager: Co-ordinators : CACP, EACH & EACH D, CDC

• Physiotherapist Workplace Trainer – Manual handling focus

• Registered Nurse

• Workplace Trainer,

• Chaplain• Administration assistant/roster co-ordinators

• Access to staff within ARV Health

• Access external health professionals

• Care staff- Certificate 3 in Aged Care

Staff and Client Profile

• 44 Care staff

• 38 Extended Aged Care at Home and Dementia Clients

• 122 Community Aged Care Package

• 1 Consumer Directed Care - high care client

Community Services, Sydney North extends from: - Hornsby to Warriewood -

approx 33 kms - Warriewood to Gordon -

approx 14 kms-Gordon to Hornsby - approx 21 kms.

ARV Community Initiatives & Timeline

• Post ‘April Zero Falls’ Month 2011• Better Balance Program (BB) for at risk Community North CACP & EACH/D clients

planned. • Small client group of 8 + BB physio, Community physio, guest speakers-OT,

Pharmacist

• Nov. 2011 • Initial 4 week BB program for medium falls risk clients• 6 clients completed course

• Feb. 2012• Retested after 10 weeks continued exercise supervised by care staff)

Further 4 groups planned for 2012

Better Balance Program & Community North Team

ARV Community Initiatives continued …The Step Back Program

Step Back ProgramWhen would the step back approach be appropriate?

Aim: To improve client care & decrease staff injuries due to client aggression Initiative: Prompt staff to calmly assess & determine appropriate action.

Review: Physiotherapist with MH expertise

Step Back – Keep Yourself Safe

1.• STEP BACK

2• REVIEW

3• APPROACH WITH CAUTION

Physiotherapy Assessment

Validated testing • Physical Mobility scale, Berg, TUAG, x 5 chair stands, Quickscreen Falls risk;

Muscle tone, ROM & exercise requirements

Additional• Client symmetry, mobility, transfers, transport needs, adaptive clothing

needs, assistive devices [OT, sensory loss RN], primary carer’s role in MH• Substitution of risks• Causation • Documentation • Co-ordinator informs carers of manual handling updates

Ask yourself -‘What will my instructions convey to the newest, youngest, smallest

carer with potential cultural interpretations?’

Care Staff /Agency advised re equipment position

Assessment continued …

Assessment continued …

Assessment continued …Manual Handling Instruction Card

Clear Instructions

The Risk Assessment Approach1. Historically – near-miss reporting and formal risk assessments low.

2. Result = Frustration at all levels. High incidents of injuries.

3. Action

• ARV Community Risk register developed.

• Risk assessment within the team - New equipment, new clients, changes in client’s mobility, Manual Handling work practices.

• Risk Assessment Courses offered.

• Equipment trials in client’s home essential.

• Transporting clients – consideration of all factors.

• Policy rewritten to support hierarchy of control.

• Personal risk factors of carers - Each service for a client will be different.

Complacency is dangerous. It does not foster a risk assessment approach.

To reduce injuries we must take an assertive and proactive approach

to risk assessment.

Manual HandlingRisk Factors

Actions&

Movements

Duration &

Frequency Location of Loads&

Distances Moved

Work Organisation

WorkEnvironment

Weights&

Forces

Special Needs

Other Factors

Workplace&

Workstation Layout

Skills &

Experience

Characteristics of the

Load/Equipment

Working Posture& Position

Clothing

Manual Handling Risk Factors

Risk Assessment Workcover: Guideline to Risk Ax in Aged Care]

Training

Manual Handling Induction - Community

Initial training• Workplace trainer demonstrations of equipment• Safe work procedures and simulated learning activities• Minimum 2 day buddy shift• Review activities

Delayed staff competence • Buddy with WPT and/or physio and attend client’s service/ home.

Continued poor practice • Coaching & re-allocation• Modification of work tasks.

Training continued …

• For EACH & EACH D client’s with complex manual handling needs, co-ordinator will if possible engage preferred Agency staff with appropriate skills.

• Mandatory yearly updates for EACH and EACHD staff for manual handling to provide opportunity for up skilling and further mentoring. External training if necessary.

• Ad hoc coaching and mentoring by Physiotherapist / OT, Co-ordinator & or Workplace Trainer is provided where reassessment identifies altered manual handling work practices or client’s care/equipment needs .

Meeting the ChallengesChallenges Meeting the Challenges

ARV Community clients or their advocates have a greater awareness of end of life directives, choices in staying at home [eg Palliative Care] etc

Risk assessment is still required, greater carer support for manual handling hazards

Increased demands on Community service providers.

Engage CACP clients earlier,education,BB classes

An ageing workforce –showing some limited physical ability for sustained manual handling of high care clients

Rotation of tasks, mentoring & support, teaching posture, stance, static abdominals

Young, new Community staff lacking manual handling knowledge and skills.

Best practice buddying, mentoring and supervision.

Attracting Nursing & Allied Health students as carers for shared knowledge

Meeting the ChallengesChallenges Meeting the Challenges

Communication – client, family and staff all hearing the same message.

Co-ordinator directs the team

Families distress over client’s altered cognition or mobility may overshadow goals for client’s safe manual handling and care

Family Conferences -doctor , client or advocate, Co-ordinator, OT, RN, Physiotherapist, ‘Bright Minds’ Team.

Providing ongoing and timely staff education

Bright Minds team, mental health team, RN’s,Palliative Care,Physiotherapy

How to optimise client mobility & independence and decrease falls risk whilst prompting less manual handling of clients.

Continue 4 week Better Balance Programs for small groups Trial equipment

Dealing with clients who have a potential for aggressive behaviour.

Continue support for use of Step Back program by all staff .

Benefits of a Team Approach

• Empowerment of ARV Community care staff to understand their responsibilities and the importance of early disclosure of hazards & risks. [Co-ord .Survey Jan. 2012]

• Early disclosure and reduction of hazards and risks has improved

• Staff feel supported as part of the team by co-ordinators, WPT, physio, RN, WH&S rep. & manager. [ARV Community North Standards Review Report Sept.2011- NSW Dept.Health & Ageing.

• Staff in Community North can see a career path for themselves.

• Timely referral to relevant team members for assessment of CACP client with high risk manual handling needs.

ReferencesJournal Articles• Larsson,B. (2010). Evidenced-based ergonomics. Exploring new directions in people handling. AAMHP. Sydney.October 2010.• Marras, W., Davis, K., Kirking, B., and Bertsche, P. (1999) A comprehensive analysis of low back disorder risk and spinal

loading during the transferring and repositioning of patients using different techniques. Ergonomics, 42(7), 904-926• Mitchell, T., O'Sullivan, P.B., Burnett, A.F. and Rudd, C, J. (2008), Low back pain characteristics from undergraduate student to

working nurse in Australia: A cross-sectional survey, International Journal of Nursing Studies. Nov;45(11)• Naughton,V.and Stafford,D.(2010). Hands off training for health professions in effective mobility management for people with

dementia. Exploring new directions in people handling. AAMHP. Sydney, October.• Engkvist,I. (2006). Evaluation of an intervention compromising a No Lift Policy in Australian hospitals. Applied Ergonomics,

37(2).141-148.Books• Chaffin, D. & Andersson ,G. (1984), Occupational Biomechanics, USA:Wiley.• Hignett,S., Crumpton,E., Ruszala,S., Allexander,P., Fray,N. and Fletcher,B. (2003).Evidenced-based patient handling: Tasks,

equipment and interventions. London:Routledge.Teaching Materials• A.R.V, (2010), ARV Induction - Manual Handling : Safe Work Practice Summary-Version 5• A.R.V, (2011),Brightminds-The Step Back Program ,Trainers Guide.• Lusted, Marcia (2000).Manual Handling Instruction Card. Ergonomics Australia Pty.Ltd• Rothmore,,Paul and Elix,Gillian.(2004) ,Patient transfers-Forces. ,R.G.H Adelaide & Flinders Medical Centre,S.A

Websites• National Occupational Health and Safety Commission http://www.nohsc.gov.au/SmallBusiness/BusinessEntryPoint/laws/• Workcover http://www.workcover.nsw.gov.au/default.htm . Aged Care Risk Control Worksheet,,June 2010

CASE STUDY 1

• Client attended in bed –contracted right side, tonic movements left side,

actively assists by turning head only

• Rigid right elbow and right lower limb.

• Wife insists on client being dressed in singlet,button-up pyjama shirt and pyjama pants,over pull -up continence aid.

• Care staff increasingly complaining of back soreness and shoulder aches whilst rolling and dressing rigid client.

• PLAN ….

CASE STUDY 2• Palliative care client is now unable to stand but her husband wants to take

her out in wheelchair.

• Stand up lifter was used previously by 2 staff with client when client could partially weight bear.

• Now sling lifter is more appropriate for all clients transfers into air chair rather than wheelchair. Appropriate now as client has no antigravity sitting balance and is rigid in extension due to pain.

• Client’s husband still wants wife to be showered on commode, ‘’wash her hair etc’.’ To minimise a falls risk staff have been restraining client in wheeled commode whilst pushing commode to shower.

• PLAN ….

CASE STUDY 3• Client is a high falls risk as has Lewy Body Dementia with poor insight and

Parkinsons Disease,

• EACH D Client is varying in his mobility; morning for 2-3 hours much better mobility –Physio assessed him mid morning with 4 wheeled walker and stand-by assistance, short distances-poor turning ,’freezes’ in doorways.

• Client refuses to use newly prescribed four wheeled walker, & due to his cognitive deficit, staff are providing a 2 hour socialization in late afternoon (discussion, meal preparation program) x 5 per week. Compliance varies.

• Family do not prompt use of walker. Hip protectors prescribed but not worn.

• Falling frequently in a.m. now as client tries to get up from chair at will, if not supervised.

• PLAN ….