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Safe Patient Handling and Movement. Assessing Facility & Patient Needs Towards Appropriate Selection of Safe-Lift Equipment. Dana L. Root, MS, PT, CPE Regional Ergonomics Coordinator Chicago, IL 312-353-2220 414-297-3315 [email protected] Terminology . Caregivers: RNs, LPNs, CNAs

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slide1

Safe Patient Handling

and Movement

Assessing Facility & Patient Needs Towards Appropriate Selection of

Safe-Lift Equipment

Dana L. Root, MS, PT, CPE

Regional Ergonomics Coordinator

Chicago, IL

312-353-2220

414-297-3315

[email protected]

terminology
Terminology
  • Caregivers:
    • RNs, LPNs, CNAs
    • PTs, PTAs, OTs, OTAs
    • Aides
    • Transporters
    • Family members
    • Etc.
where to start
Where To Start

Step 1: Collect Baseline Data

Step 2: Identify High-Risk Units

Step 3: Gather Data About High-Risk Units

Step 4: Identify High-Risk Tasks

Step 5: Conduct Team Assessments of These Tasks

Step 6: Analyze the Risk

Step 7: Involve the Caregiver and Patient in Selecting the Equipment

Step 8: Determine Recommendations

Step 9: Implement Recommendations

Step 10: Monitor Results

step 1 collect baseline injury data
Step 1: Collect Baseline Injury Data
  • Focus oninjuries related to patient handling/movement
  • Information from:
    • OSHA log
    • Nurse manager files
    • Facility accident stats
    • Office of Workers’ Comp Prog
  • For each unit assess:
    • Number of injuries
    • Work Days Lost
    • Modified Duty Days
step 2 identify high risk units
Step 2: Identify High-Risk Units
  • How?
    • Using baseline data on the incidence and severity of injuries
  • Why?
    • Allows you to prioritize time and resources.
step 3 gather data about high risk units
Step 3: Gather Data About High Risk Units
  • Patient Population/Staffing/Equipment Use
    • Staffing
    • Discuss projected plans
    • Describe the patient, including dependency level

0 Independent

1 Supervision

2 Limited Assistance

3 Extensive Assistance

4 Total Dependence

step 3 gather data about high risk units1
Space considerations

General facility layout

Doorway width

Angles and turns

Storage

Dining rooms

Hallway

Railings

Visiting rooms

Activity rooms

Common bathrooms

Step 3: Gather Data About High Risk Units
step 3 gather data about high risk units2
Step 3: Gather Data About High Risk Units
  • Space/Maintenance/Storage
    • Identify anticipated changes in the physical layout
    • Describe space constraints for patient care tasks
      • Focus on patient rooms
      • Bathrooms
      • Shower areas
    • Describe process for equipment maintenance
step 3 gather data about high risk units3
Step 3: Gather Data about High Risk Units
  • Inventory of all patient care equipment
  • Describe working condition
  • How frequently equipment is used
  • Perception of problem areas
step 3 gather data about high risk units4
Current equipment/ furniture

Beds

Height

Type

Chairs

Wheelchairs

Geri chairs

Regular chairs

Recliners

Toilets

High rise

Regular

Tables

Height

Types

Life devices

Positioning and repositioning devices

Other equipment

Scales

Step 3: Gather Data About High Risk Units
step 4 identify high risk tasks
Step 4: Identify High Risk Tasks
  • Identify and assess nursing staff perceptions of high-risk tasks.
  • Identify variation between units
    • Patient characteristics
    • Availability of equipment
    • Physical layout
    • Work organization
step 4 identify high risk tasks1
Step 4: Identify High Risk Tasks
  • General observation
  • Employee discussions
  • Employee questionnaires
  • Review of medical data
  • Symptom surveys
  • Quantitative evaluations
  • Previous studies
  • Job consistency and fatigue
  • Brainstorming and group activities
step 4 identify high risk tasks2

Frequency of

Task

H= high

M= moderate

L= low

Perceived Stress of

Task

H= high

M= moderate

L= low

Rank Order

1= high-risk

10= low risk

Patient Handling Tasks

Transferring patient from wheelchair to toilet to toilet

Bathing a patient in a shower chair

Repositioning patient in bed from side to side

Transferring a patient from bed to stretcher

Lifting a patient up from the floor

Repositioning patient in bed from side to side

Repositioning patient in geriatric chair or wheelchair

Making bed an occupied bed

Feeding bed-ridden patient

Changing absorbent pad

Transporting patient off u

Other Task:

Other Task:

Other Task:

Step 4: Identify High Risk Tasks
step 5 conduct assessment by the team
Step 5: Conduct Assessment by the team
  • Purpose:
    • Include staff input in assessment and solutions.
    • Recognize the many direct and indirect factors that may contribute to potentialrisk
    • Identify potential solutions that will serve to minimize risk of injury to the caregivers and patients
step 6 risk analysis
Step 6: Risk Analysis
  • Review data for each unit:
    • Baseline injury data
    • Other data
      • Staffing
      • Equipment inventory
      • Anticipated changes
    • Rank high risk tasks
      • Frequency
      • Stress
    • Observation data

2. Identify problem areas

3. Set priorities

step 7 involve healthcare provider patient in selecting equipment
Step 7: Involve Healthcare Provider & Patient in Selecting Equipment

✲Obtain Patient & Healthcare ProviderBuy-In✲

Purpose:

To enhance effectiveness by increasing acceptance and adherence.

step 7 involve healthcare provider patient in selecting equipment1
Step 7: Involve Healthcare Provider & Patient in Selecting Equipment
  • Two end user groups:
    • Caregiver
    • Patient
  • Both participate in the

decision making process

    • Equipment fairs
    • Trial sessions
step 7 involve healthcare provider patient in selecting equipment2
Step 7: Involve Healthcare Provider & Patient in Selecting Equipment
  • Patients can rate/rank the equipment using surveys
  • Family members can have input to selection
step 8 determine recommendations
Step 8: Determine Recommendations
  • Achievable and simple
  • Constraints
  • Costs
step 8 implement recommendations
Step 8: Implement Recommendations
  • 4. Approaches
    • Engineering Controls
      • Reduce or eliminate hazard
        • Equipment
        • Furniture
        • Tools
    • Administrative Controls
      • Work practices changes
      • Management policies
        • Staffing levels
        • Staff needed for each type
        • of transfer
        • Lifting schedules
        • Lifting teams
equipment selection engineering controls
EQUIPMENT SELECTION: Engineering Controls
  • Eliminate the need to do the hazardous activity
  • Redesign the activity to reduce the hazard or minimize the hazard
  • Formal equipment selection and evaluation process
  • Selected at equipment fairs
equipment selection engineering control strategies
EQUIPMENT SELECTION: Engineering Control Strategies
  • Devices are appropriate for the tasks to be accomplished
  • Devices must be safe for both the caregiver and the patient
  • Device must be comfortable for the patient
  • Device should be easily understood and managed
  • Device must be efficient in use of time
  • Maintenance should be minimal
equipment selection engineering control strategies1
EQUIPMENT SELECTION: Engineering Control Strategies
  • Storage should be reasonable
  • Device must be easy to maneuver in tight spaces
  • Device should be versatile
  • Device must be easy to clean
  • Device must be adequate in number
  • Cost
equipment selection engineering control strategies2
EQUIPMENT SELECTION: Engineering Control Strategies
  • Equipment availability
    • Adequate variety of slings
      • In a convenient location
      • Toilet and bathing mesh slings
    • Available and in accessible areas
      • Storage room
      • Empty room
      • Short term use in the hallway
equipment selection what to buy
EQUIPMENT SELECTION:What to Buy??
  • Total dependence Patients Level 4
      • Full sling mechanical lift device
  • Extensive Assistance Level 3
      • Use of aid of a mechanical device
        • Stand assist device
  • Supervision/Limited Assist Level 2 & 1
      • Depending on the patient’s condition
        • Stand assist lift
        • Walking aid device
        • Gait belts
        • Sliding board
      • Avoid manual lifting
equipment selection what to buy1
EQUIPMENT SELECTION:What to Buy??
  • Independent Patients Level 0
      • Capable of bearing own weight
      • Walk without assistance
  • Lifts from Floor
      • A single full sling mechanical lift
      • If patient can regain standing with minimal assist: transfer gait with handles
slide27

Lift Aid Equipment Determination Grid

For a typical patient with the dependency status classification as shown, this grid indicates normal equipment requirements to conduct a safe transfer. Some patients may have special characteristics and not exactly match a typical profile. In those situations, special consideration will be required.

equipment selection what to buy2
EQUIPMENT SELECTION:What to Buy??

6. Repositioning

  • Bed:
    • Bed controls utilized
    • Trendelenberg positioning
    • Friction reducing devices
  • Chair:
    • Stand assist lift
    • Gait Belts
    • Hand slings
equipment selection what to buy3
EQUIPMENT SELECTION:What to Buy??

7. Special Situations Devices

  • Bariatric patients ⇒ special equipment
  • Transfer chairs ⇒ stretcher chairs
  • Mechanical friction reducing
  • Sliding boards
  • Transfer belts
  • Special training
equipment selection what to buy4
EQUIPMENT SELECTION: What to Buy??

8. Combative & Mentally Impaired Patients

  • Use the appropriate lifting aid device
  • Additional care providers as needed
equipment selection what to buy5
EQUIPMENT SELECTION: What to Buy??
  • Equipment Availability
      • Should be available
      • Stored and available in accessible areas
      • Batteries charged
      • Slings available for all shifts
      • Variety of sling sizes
      • Toileting and bathing slings available
      • Friction reducing devices available
      • Sliding boards
      • Transfer belts
      • Gait belts
key questions
Key Questions
  • Are funds best utilized for the acquisition of new technologies, or for the upgrade or replacement of old equipment?
  • Should you purchase or to lease patient handling equipment?
  • Should you provide ceiling-mounted lifts or floor based lifts throughout the unit?
  • What accessories should be included?
  • What quantity of various devices is needed?
safe patient handling equipment
SAFE PATIENT HANDLING EQUIPMENT
  • Sliding Boards
  • Air Assisted lateral sliding aids
  • Friction reducing devices
  • Mechanical lateral transfer aids
  • Transfer chairs
  • Gait belts with handles
  • Powered full body sling lifts
safe patient handling equipment1
SAFE PATIENT HANDLING EQUIPMENT
  • Powered standing assist and repositioning lifts
  • Standing assist and repositioning aids
  • Bed Improvements to support transfers
  • Dependency Chairs
  • Other ergonomic transfer devices
monitor results
Monitor Results
  • Ongoing success of process
    • Established key indicators
    • Established time line
information on osha s website www osha gov
Information on OSHA’s Website – www.osha.gov

OSHA Home Page

OSHA Hospital/Nursing Home Pages

OSHA Ergonomics Page

other resources
Other Resources
  • Patient Safety Center

Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement

www.visn8.med.va.gov/patientsafetycenter

  • CDC/NIOSH

Safe Lifting and Movement of Nursing Home Residents, publication #2006-117

www.cdc.gov/niosh

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