Safe Patient Handling and Movement

1
Safe Patient Handling and Movement
Conference title date Presenters
name Presenters contact information
2
Safe Patient Handling Movement Purpose

• Promote safe patient handling and movement (SPHM)
  guidelines and techniques for all healthcare
  providers
• Communicate and integrate throughout healthcare
  environments by advocacy efforts
• Collaborate with other professionals to advance
  this practice.

3
Safe Patient Handling Movement Definition

• A process which provides an alternative to manual
  patient lifting, transferring and repositioning
• Systematically addresses the ergonomics issues
  present during lifting, transferring and
  repositioning a patient
• Aids in recognizing and preventing occupational
  safety and health hazards
• A program that minimizes manually lifting
  residents in all cases and eliminates when
  feasible

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Learning Objectives

• Awareness of
• Emerging SPHM culture
• Trends regarding work related musculoskeletal
  disorders in health care professions
• Physical risk factors that may cause WMSDs
• Elements of a SPHM process
• SPHM equipment options
• Implementation of SPHM program issues
• Costs benefits of the SPHM program

5
Healthcare Culture

• Needs of patient comes first
• Patients needs supersede healthcare providers
  physical well-being
• Healthcare requires hands on care
• Change to use of equipment while continuing hands
  on care
• Prevention of injury by using good body mechanics
  
• The myth of injury immunity

6
Health Care Culture

• Interpretation of assistance levels between
  nursing and therapy
• MDS Coordinators definition of assistance levels
• Care plan requirements
• Shift report
• Formal and informal

7
Healthcare Culture

• Physical therapists are experts in movement and
  prevention in rehabilitation
• Is this a myth that all physical therapists are
  experts in SPHM?
• Are you using SPHM methods in your daily
  professional duties?

8
Incidence Rate Number of Injuries Illnesses
Due to MSDs 2007
Bureau of Labor Statistics 2008
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SPHM The Emerging Culture

• Collaboration
• Veterans Administration Patient Safety Center
• National Institute of Occupational Safety
  Health
• Occupational Safety and Health Administration
• American Nurses Association
• Association of Rehab Nurses
• Association of Occupational Health Professionals
• American Physical Therapy Association
• Association of Perioperative Registered Nurses
• Critical Care Nurses
• Orthopaedic Nurses

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The American Nurses Associations Nationwide
State Legislative Agenda
SAFE PATIENT HANDLING/MOVEMENT
WA
ME
MT
ND
VT
NH
MN
NY
OR
MA
WI
ID
RI
SD
MI
CT
WY
PA
NJ
IA
NE
OH
MD
NV
DE
IN
IL
UT
wv
VA
MO
DC
CO
CA
KS
KY
NC
TN
SC
OK
AR
NM
AZ
GA
AL
MS
AK
TX
LA
FL
Enacted legislation/adopted regulations to date
(8 states) MD, MN, NJ, NY, OH, RI, TX, and WA,
with a resolution from HI two of which passed
bills in 2007 (MD and MN) Legislation introduced
in 2008 (12 states) CA, CT, FL, IL, MD, MA, MI,
MN, NV, NJ, NY, and VT.
HI
AUGUST 2008
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True or False?

• Classes in body mechanics and lifting techniques
  are effective in reducing injuries.

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False!

• Classes in body mechanics and lifting techniques
  are effective in reducing injuries.
• 30 years of experience shows us training alone
  is not effective.

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Risk Factors

• Risks which could potentially cause
  musculoskeletal injury
• Force
• Lifting own body weight plus patients weight
• Awkward posture
• Prolonged forward bending
• Twisting
• Holding a position
• Tight or awkward locations
• space restrictions

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Risk Factors

• Repetition
• Number of transfers per shift
• Number of repositionings per shift
• Helping other staff with their patient
• Duration
• Length of shift
• overtime
• Shifts per week
• Longevity in profession

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Rank of High Risk Tasks

• Transfer from toilet to chair
• Transfer from chair to toilet
• Transfer from chair to bed
• Transfer from bed to chair
• Transfer from bathtub to chair
• Weighing patient
• Lift patient up in bed
• Reposition patient from side to side in bed
• Reposition patient in chair
• Change absorbent pad
• Make bed with patient in it
• Undress patient
• Feed bed ridden patient

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Why?

• Biomechanical evidence
• Horizontal leverage a patient is not a box
• Difficult to keep the load close because the load
  is a person
• There are varied body sizes shapes and the
  handles dont always stay put
• End result more likely to have greater stresses
  the shoulder spine
• NIOSH recommends for most patient lifting tasks
• maximum weight limit is 35 pounds under IDEAL
  lifting conditions

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Bariatric Risks

• Specific considerations
• Greater force required to manually lift or move
  patient
• Resource intensive
• Higher cost of equipment

Obesity Trends Among U.S. Adults overweight by
30
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• Take Care of Yourself!
• Assess Each Task for Potential Hazards

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Safe Resident Handling Movement Program
For success, required infrastructure MUST be in
place prior to implementing SPHM Program
http//www.visn8.med.va.gov/patientsafetycenter/sa
fePtHandling/default.asp
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Safe Resident Handling Movement Program Core
Elements

• Purpose of a safe lifting policy
• Goals and objectives of policy
• Reducing worker injury and improving quality of
  patient care
• Assessment to determine
• Equipment requirements
• Potential workplace modifications
• Assess the transfer needs of each patient
  (algorithms)

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Safe Resident Handling Movement Program Core
Elements

• Resources for
• Lifting/bathing equipment
• Repositioning aids
• Roles and responsibilities of
• Administrators and managers
• Front line caregivers
• Maintenance
• Housekeeping
• Training and education requirements for
• Caregivers
• Administrators
• Nurse managers
• Therapy staff
• Maintenance
• Housekeeping staff

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Safe Resident Handling Movement Program Core
Elements

• Infection control issues
• Equipment maintenance
• Schedules
• Procedures
• Battery charging
• Equipment storage
• Procedures and equipment for
• Bariatric patients
• Special needs patients

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Implementation Process Organizational Support

• Admission policy statement
• Facility
• Admission
• Resident council
• Introduce new equipment and use
• Deal with resident refusals
• Caregivers involvement
• Buy-in to champion the process

• Purchasing
• Equipment trials from several vendors
• Evaluated by caregivers
• Maintenance
• Battery charge
• Regular scheduled
• Laundry
• Sling inspection
• Infection control

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Implementation Process Roles Responsibilities

• Administrators/ Managers
• Champion and participate in the process
• Provide human and monetary resources to manage
  program
• Develop and implement facility policies
• Enforce/discipline facility policies and
  procedures
• Promote caregiver involvement buy- in
• Train in the SPHM facility policy procedures
• Competent in use of the equipment devices
• Competent in assessing needs of each
  patient/resident consistent with care plan
• Provide equipment devices
• Available accessible
• Well maintained

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Implementation Process Roles Responsibilities

• Caregivers
• Knowledgeable of facility SPH policy and
  procedures
• Involvement in process
• Competent in use of equipment devices
• Equipment review with hands on assessment
• Assessing patient/resident
• Equipment maintenance
• Notify supervisor of any injury sustained
• Aware of infection control needs

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Implementation Process Assessment

• Patient characteristics
• Affect treatment decisions
• Techniques for handling movement
• Goal is to carefully match use of equipment to
  specific patient characteristics

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Implementation Process Assessment Procedures

• Who performs?
• When and how often?
• How communicated?
• Process for updating/revising?

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Implementation Process Algorithms

• Tool to guide decision making
• Based on
• Patients ability
• Equipment availability
• Standardizes practice
• Guides for planning handling tasks
• Tools not rules
• Clinical judgment still needed

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Implementation Process Equipment

• Types of devices
• Overhead
• Floor based total lift
• Lateral assist
• Sit to stand
• Slide sheet
• Select appropriate equipment
• Patient population
• Facility constraints
• Layout, size of room, flooring
• Slings
• Seated, Supine
• Standing, Ambulation
• Position Support
• Bariatrics
• Specialized equipment

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Implementation Process Training

• SPHM facility policy procedures
• Injury signs symptoms
• Administrators, maintenance, housekeeping,
  laundry staff
• Awareness training
• All direct caregivers
• Hands-on equipment training with demonstrated
  competence

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Implementation Process Medical Management

• Encourage early reporting of signs or symptoms
• Determine root cause of incident
• Provide prompt evaluation by a physician
• Maintain accurate records of injury and incident
  investigation

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Costs

• Direct Costs
• Wages
• Workers compensation
• Short Term disability
• Long Term disability
• Cost of medical treatment
• Lost productivity

• Indirect Costs
• Employee morale
• Lower job satisfaction
• High turnover rates
• FTE shortage
• ? health care insurance premium

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Frequency of Resident Transfer Claims 7 WI
Facilities 6 months Pre-Limited Lift versus 6
months Post-Limited Lift
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Severity of Resident Transfer Claims 7 WI
Facilities 6 months Pre-Limited Lift versus 6
months Post-Limited Lift
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Benefits of Intervention

• ? number of caregiver injuries
• frequency and severity
• ? workers compensation claims premiums
• ? medical treatment costs
• ? employee productivity and morale
• Less staff turnover
• ? quality of patient care
• Reduction in resident injuries
• Reduction in resident falls
• Improved census
• Marketing advantage

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Implementation Process Help

• Assistance by
• Front line caregivers trained in SPHM
• Vendors
• Loss Prevention agents
• OSHA Consultation
• Resource guides

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Free Resource Guides
http//www.visn8.med.va.gov/patientsafetycenter/sa
fePtHandling/default.asp
http//www.cdc.gov/niosh/topics/ergonomics/
http//www.aohp.org/About/documents/GSBeyond.pdf
www.osha.gov/SLTCergonomics/index.html