Implementing change in the NHS Factors to consider when implementing a ergonomics intervention

aimed at reducing back pain among nurses

¹ Health and Rehabilitation Research CentreAuckland University of Technology, NZ

² Robens Centre for Health ErgonomicsUniversity of Surrey, UK

Dr. Fiona Trevelyan¹ & Prof. Peter Buckle²

Extent of the problem

Bureau of Labour Statistics (2002)

1st = Truck drivers

2nd = Nursing aides, orderlies and attendants

3rd = Labourers

6th = Registered nurses

7th = Construction workers

Low back pain has been identified as a major reason why nurses leave their profession (Nelson et al, 2003)

Smedley et al (1995) found a 1-year prevalence of 45% with 10% having an absence from work for a cumulative period of greater than 4 weeks

Aim of our study

To implement and evaluate an ergonomics intervention in an health care setting

Smedley J., Trevelyan F., Inskip H., Buckle P., Cooper C., and Coggon D., (2003) Impact of an ergonomics intervention on back pain among nurses. Scand J Work Environ Health. 29 (2), 117 – 123.

Intervention process

3 main stages Definition Implementation Evaluation

Content of intervention

Policy and risk assessment Work organisation

Senior managers Change agents Manual handling link nurses

Equipment Training

Patient handling equipment

Intervention site

Baseline measurement

INTERVENTION

Re-assessment

Comparison site

Baseline measurement

No intervention

Re-assessment

Evaluation

Measurement strategy

1. Reported back pain

Self report questionnaire: low back and neck pain

2. Exposure to risk factors associated with back pain

a) Task analysis

Identify proportion of nursing shift accounted for by nursing tasks

b) Exposure to physical risk factors

Describe each nursing task with respect to time spent exposed to awkward posture (trunk flexion>20 degrees) and load

Data collection: PEO

Observed pre/post intervention at both sites:

• 16 nurses each for a full shift• Medical and orthopaedic

wards• Staff nurses and health care

assistants• Early and late shifts

Time spent on ‘intervention’ tasks

Proportion of shift Min. – Max.

Administration 14% 3 - 26% Attend patient 12% 5 - 16% Clean/tidy 7% 1 - 14% Wash/dress 6% 0 - 15% Make bed 3% 0 - 7% Patient transfers 3% -

TOTAL 45%

Examples of task identification

attend patient administration

Time spent on ‘non-intervention’ tasks

Proportion of shift Min. – max. Communication 23% 10 - 25% Fetch/carry 7% 3 - 9% Other general 11% 6 - 31% Other misc. 1% 0 - 12% Rest break 8% 2 - 11%

TOTAL 50%

Time spent on ‘other’ tasks

Proportion of shift Min. – max.

Assist to eat 0% 0 - 5% Drugs 1% 0 - 9% IV/injection 0% 0 - 5% Mealtime 1% 0 - 5% Move object 3% 1 - 6% Other basic 0% 0 - 4% Other technical 1% 0 - 3% TPR 0% 0 - 2% Wound 0% 0 - 0.3%

TOTAL 6%

Duration of ‘intervention’ tasks

Comparison Intervention

Pre (post) Pre (post)

Administration 52 (55) 58 (36)

Attend patient 38 (45) 47 (46)

Clean/tidy 68 (60) 74 (78)

Make bed 157 (260) 161 (209)

Wash/dress 415 (342) 534 (298)

Median duration (seconds)

Results: task analysis

administration’ and ‘clean/tidy’ tasks were associated with the least amount of trunk flexion > 20 degrees

‘wash/dress’ task was associated with the greatest amount of trunk flexion > 20 degrees

‘make bed’ task changed by the greatest amount at both sites

Results: patient transfers

Patient transfers were characterised by short duration high percentage time in trunk flexion > 20 degrees

Large variability due in part to:- level of patient dependency handling technique and equipment used work environment

Conclusions: exposure data

Changes in exposure were less than expected

Variability in nursing tasks made true estimates of change in exposure very difficult to interpret

Changes at comparison site were not anticipated

Conclusions

Methods must be sensitive to anticipated change Tasks where interventions are targeted may form a small

part of a shift Organisational factors can influence the intensity and

uptake of an intervention The impact of an ergonomic intervention may vary in

different parts of an organisation

Factors that influenced the intervention

Intervention took place in a ‘real life’ setting Large scale of intervention (24 wards and 1600

nurses) Problems with staff attendance to manual handling

training Work load of Health & Safety Advisers Profile of health and safety in the hospital

Recommendations If planning a similar intervention

Recommend a top-down/bottom-up approach Adopt a participatory approach Agree a strategy that ‘fits’ the organisation and is supported by key

stakeholders Target high risk work areas – depending on size of organisation Target high risk ‘intervention’ tasks Ensure change agent that leads the intervention is respected within

the organisation Empower local experts e.g. manual handling link nurses Create a sustainable structure that will survive staff turnover