introduction to queensland health’s patient handling risk assessment tool (furat)
Post on 19-Oct-2014
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DESCRIPTION
Tony Johnston Principal Health and Safety Adviser, Safety and Wellbeing, Human Resource Services, Queensland Health (P51, Friday, NZI 5 Room, 11-1)TRANSCRIPT
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Introduction to Queensland Health’s Patient Handling Risk
Assessment ToolFacility/Unit Risk Assessment
Tool (FURAT)
Tony JohnstonPrincipal Health & Safety Adviser
Queensland Health
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Outline
• Introductions– Who, Where, objectives– Experience with other
tools• Background
– History– Legislation– Patient Handling tools
• FURAT & profile– What is it; using it– Objectives
• Implementation strategies– Priority areas– Methodology– Issues and solutions
• Duration & frequency• Buy-in• recording
• Future enhancements• Key summary points• QH resources
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Why Assess Patient Handling Risks?
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Patient Handling: Through the ages…
1998 2001 2007 2012
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Patient Handling: Through the ages…
Not so distant past
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Patient Handling: Through the ages…
1998
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Patient Handling: Through the ages…
1998 2001
2001
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Patient Handling: Through the ages…
1998 2001 2007 2012
2007
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Patient Handling: Through the ages…
1998 2001 2007 2012
What’s the problem?… with so much regulation and guidance material
around..
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• Behaviours– High risk tasks– Training solution
• Equipment– Hoists– Slide sheets– Walk belts
• Risk Assessment– Individual patient Mobility
• Longevity– Individual dependent– Interpretation
• Banned Walk-belts
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Objective
Develop and implement a comprehensive healthcare
patient handling risk management tool.
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Activity
How many risk assessment tools do you know of?
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ORGANISATIONAL RISK
Individual Patient
Task
Facility / Unit
Risk Management
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Guidance from around the world…
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Industry standards … Acceptable handling practices
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Legislative Basis
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Managing Health and Safety Risks
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Regulations … 4.2 Hazardous Manual TasksPCBU must have regard to all relevant matters that may
contribute to a musculoskeletal disorder … (a) postures, movements, forces and vibration relating to the
hazardous manual task; and
(b) the duration and frequency of the hazardous manual task; and
(c) workplace environmental conditions that may affect the hazardous manual task or the worker performing it; and
(d) the design of the work area; and
(e) the layout of the workplace; and
(f) the systems of work used; and
(g) the nature, size, weight or number of persons, animals or things involved in carrying out the hazardous manual task.
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Risk Assessment Principles
POSTURE
TIMEFORCE
Work Area - Design / Layout
Nature/Characteristics of Load –pt profile
Work Environment- Eg lighting, floor surfaces Work Practices
& Systems –- PH tasks performed- Design of work procedures
Work Organisation - staffing & training
Tools & Equipment - PH aids
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Facility / Unit Risk
Assessment Tool(FURAT)
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FURAT
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Section 1 Facility/ Unit Description
• Persons completing risk assessment• Work area Key contacts• Communication arrangements
– District– Division– Ward
Facility Unit
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Section 2 Patient Profile
• Age range• Service type• Dependency- I, SN,AN,D• Size (use BMI as guide)• Weight range• Primary diagnosis• Special requirements for patient handling
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Section 3 Environment
• Floor surface• Access• Space• Overhead clearance• Noise• Lighting• Temperature• Other
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Section 4 Equipment
• Includes equipment, aids and furniture• SWL• Quantity
– Existing– Future needs
• Condition, maintenance arrangements• Location/ access/ storage• Meets needs?
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Section 5 Staffing and Training
• Skill mix• Capacity-
– PH experience– Functional limitations – Access to PH expertise
• Work organisation• PH training- number of trainers, training arrangements• Injury, absenteeism, turnover
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Section 6 Patient Handling Tasks
• Patient Handling Transfer Table, adapted from:– WorkSafe Victoria Transferring People Safely 2nd edition 2006– Sir Charles Gairdner Hospital S.A.F.E.R Patient Handling (2006)
• Preferred, not preferred and not recommended methods• Range of patient dependency• Standard conditions apply
Observe Consult Past History
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Section 7 Risk analysis
• From section 6: Pt Handling Tasks Performed, identify – not preferred methods– not recommended methods– Alternate methods– Additional tasks
• Frequency • Analyse the
– Direct risk factors– Contributory risk factors (from sections 1-5)
2. Patient Profile3. Environment4. Equipment5. Staffing & training
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Section 8 Risk control worksheet
• Hierarchy of control explained and examples given
• Risk control table existing controls brainstorm others to be considered
• Risk control plan and evaluation short and long term controls to be implemented Evaluation
• Sign-off
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Patient Handling Risk Profile Form
• Displayed in the work area• Updated as often as required to keep the information
current• A quick tool for
– Induction– Casual– Students etc
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Patient Handling Risk Profile Form
• Patient profile; range of PH activities; precautions• Individual PH assessment procedure• Summary of risks and controls• Equipment register• Training and assessment program• Documentation• Compliance monitoring
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Activity(1)
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The Incident …• RN Smith was transferring Mrs Jones (bed 13) back to bed.
– Pt slipped and fell to the floor. – With the assistance of Operational Officer (Bill) lifted pt
back to bed.
• RN Smith – noticed a slight back twinge at the time of the incident but
was able to continue working. – Pain increased slightly by the end of the shift. – Woke Sunday morning in excruciating pain. – Went to LMO and was given pain relief and medical
certificate for 2 weeks leave.
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Elements of a Facility / Unit PH Risk Assessment
POSTURE
TIMEFORCE
Work Area - Design / Layout
Nature/Characteristics of Load –pt profile
Work Environment- Eg lighting, floor surfaces
Work Practices & Systems –- PH tasks performed- Design of work procedures
Work Organisation - staffing & training
Tools & Equipment - PH aids
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Systems Approach (Swiss cheese)
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Activity(2)
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Implementation Strategies
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• Work Practice Directive (mandatory)– Facility or Unit level– Implementation plan with 6 months– Annual review– Re-assessment at least every 3 years– Team approach– Documentation
• Retained locally; copies centrally to OHS Unit• Profile Form
Implementation 2007 - Developed 2008 – Pilot 2009 - Approved
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Service Level Agreements
• Timeline for Key Deliverables– 3mths gap analysis and plan– Prioritisation of work areas
• Performance Measures – Quarterly reporting– % staff trained– % FURAT completed– Ratio Trainers to Staff (target 1:10 in priority 1 areas)
2009 20122010 2011
Planning Priority 1 Areas Priority 2 Areas Priority 3 Areas
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Strengths• Builds capacity• Encourages collaboration and participation• Risk management demonstrated• Consistent process• Clear accountability but shared responsibility• Covers direct and contributory risk factors• Highlights high risk practices• Prioritisation
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Weaknesses• Significant shift in culture • Looks daunting• IT systems do not allow uploading to central monitoring
point• Benefits not immediately obvious• No one person has the skills/ knowledge to complete • Aimed at clinical managers- competing demands
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Opportunities• Due diligence• Business outcomes- use of resources; costs• Safety culture• Improved physical and psychosocial aspects of work• Justification/ escalation of high risk issues• Sustainability and quality of risk management• Capability
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Threats• Competing priorities• Budget• Reactive safety culture• Conflict over responsibilities• Fear about liabilities• Does not result in actual reduction of risk factors• Perceived effort vs return• Lack of capability
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Outcomes• Anecdotal reports of improved success with business
cases• Gradually improving uptake, probably better in smaller
areas• OHS doing a lot of the work• ‘Once I actually gave it a go, it wasn’t that bad’ ‘I can see
the benefit now I’ve done it’• Quality issues- risk analysis and controls• Improved awareness of proactive approach- OHS and
managers
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Future Enhancements• Usability and integration with
business systems
– Central collation and reporting
– Prioritisation and escalation
• Education
– Risk Analysis and higher order controls
• Relationships
• Culture
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Future Direction
• Other Tools and guidelines available.– MAPO– Dortmund– PTAI– Care Thermometer
• ISO Ergonomics – Manual handling of people in the healthcare sector
• Legislation for Safe Patient Handling Laws– USA– Hospital Patient and Health Care Worker Injury Protection Act
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