Safe Patient Handling

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Safe Patient Handling Movement (SPHM) at the
VA San Diego Healthcare System

• Kathleen L. Dunn, MS, RN, CRRN-A, CNS

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Where we were in 2000

• Most patient movement was being done manually.
• Some areas had 1 mobile lift, which was rarely
  used.
• Nurse injuries were frequent costly.
• SCI had highest nurse injury rate in the entire
  hospital.

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Transfers such as quad pivots, 2-person lifts,
and 2 person sheet pulls were common.
Quad Pivot
Sheet Pull
2-person lift
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Where we were in 2000

• Traditional body mechanics training was included
  in orientation and reviewed annually.
• Those injured were required to repeat this
  training.

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February-April 2001

• VASDHS staff attended VISN 8 Safe Patient
  Handling Movement Conference.
• We saw the light!

• Solicited support for program
  within Nursing Service
• Presented to PIC approved for
  PIT chartering.

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Costs of Injuries FY02 VASDHS

• 30 nurse injuries associated with patient
  handling and movement tasks
• 17 occurred on the Spinal Cord Injury Center
  resulting in 162,815.53 in charge back (direct)
  costs.
• With indirect costs being 4-10X that of direct,
  it is estimated that in FY02, the SCI unit had
  over 650,000.00 in costs related to nurse
  injuries caused by patient handling and movement.

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Fall 2001-Summer 2002

• Banned manual lifting (2 person lifts quad
  pivots) on SCI unit.
• Established SPHM committee.
• Collected pre-project baseline data.
• Planned and held 2 equipment fairs.
• Trial install of 4 ceiling track lift systems in
  SCI over 2 months.

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SCI Patient Room
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SCI Inpatient RoomSingle-track ceiling lift for
two beds in one room.
Battery Charge position
Auto return to preset height.
Sling hook on bedside cabinet
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SCI Inpatient Room Patients are issued a sling
at admission that stays on their bedside closet
hook.
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Privacy Curtain Modifications
Curtains split Velcroed
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SCI Clinic
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SCI clinic exam room
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SCI Therapy GymSingle-track ceiling lift over
P.T. parallel bars. Scales allow measurement of
weight bearing.
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Use of Ceiling Track Lift for Suspended Gait
Training
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Transverse-track ceiling lift over therapy mat
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Cost Savings Phase 1

• 150,000 spent for Phase 1 (SCI) ceiling track
  lift installation in October 2002.
• October 2002-March 2003
• Zero (0) SCI nurse injuries related to transfers
  or lifting.
• 1 SCI nurse injury related to patient turning.
• Estimated costs savings 600,000 for Phase I
  pilot

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June-July 2003

• Presentation of Phase 2. proposal to Status of
  Funds
• Approximately 600,000 for equipment approved
  for Phase 2.

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October-December 2003

• Installation of Phase II
• Partial ceiling track lifts on all inpatient
  units.
• New mobile lifts obtained for most areas.
• No-Lift (SPHM) Nursing PCS Services Policy
  approved.
• Staff Education Training.

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Strategies

• Develop Champions for culture change.
• VASDHS PINs
  (Preventing Injuries Now facilitators).
  Includes non-nursing staff as well.
• Credible peer leaders.
• Ongoing hazard identification.
• Train-the-trainers.
• Implement algorithms in all units/areas.

PIN
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Transfer to and from Bed to Chair Chair to
Toilet Chair to Chair or Car to Chair
Does the patient have UE strength?
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Other Examples of Re-Engineering at the VASDHS
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ICU Ceiling Track Lifts
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Wall Mounted System in Med-Surg areas
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Dialysis Ceiling Track Lifts
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Radiology Ceiling Track Lifts
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Morgue Lift
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Where are we now?

• ALL OF VASDHS
• Complete total patient room ceiling track
  install Spring 2007.
• Radiology, MRI, cardiac lab, and Morgue
  re-engineered.
• Rarely-used equipment bank (Escort).
• Increased compliance and skill in use of
  algorithms.

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Where are we now?

• Before averaged 40 injuries a year due to
  patient handling and movement.
• Now average 20 injuries a year with just partial
  implementation of the program.
• Costs approx. 950,000 spent on equipment and
  re-engineering.
• Cost Savings 2.8 million (direct and indirect)

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Where are we now?

• Policy is now applicable to all direct patient
  care staff (not just nursing staff) as an MCM
  (3/06).
• List of banned manual handling tasks
• Universal requirement to use SPHM techniques and
  equipment.
• Staff, supervisor and administrative
  responsibilities detailed.

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Where are we now?

• Radiology, Rehab Medicine, and other services
  represented on Committee, which now reports to
  Process Improvement Council (PIC).
• On-going education monitoring.
• Plans to have input on all patient care equipment
  purchases from ergonomic stand-point.

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Where are we now?

• VA National Directive mandating SPHM is expected
  this summer.
• Additional 336,000 received as VACO grant for
  projects through FY 08
• SPHM Facility Champion position will be
  implemented by start of FY 09.

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VASDHS Safe Patient Handling Movement MCM

• Defines responsibilities at all levels.
• Applies to all clinical staff.
• Lists banned patient/equipment handling
  movement activities.
• Defines possible consequences for staff failure
  to follow this policy these rules.
• Contains decision making algorithms.

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Thank You for Your Attention!