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Unit-based Hazard Assessment for Safe Patient Handling. Unit-based Hazard Assessment for Safe Patient Handling. Mary Willa Matz, MSPH VHA Patient Care Ergonomics Program Manager/Consultant Occupational Health Science Researcher Industrial Hygienist VISN 8 Patient Safety Center of Inquiry

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Unit-based Hazard Assessment for Safe Patient Handling

Mary Willa Matz, MSPH

VHA Patient Care Ergonomics Program Manager/Consultant

Occupational Health Science Researcher

Industrial Hygienist

VISN 8 Patient Safety Center of Inquiry

James A. Haley VA Hospital

Tampa, Florida

(813) 558-3928 (813) 558-3990 fax

mary.matz@va.gov


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Faculty Disclosure

  • Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or devices.

  • Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this activity.

  • This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label.

  • The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.


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Ergonomics

and

Patient Handling


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Ergonomics…

"Ergonomics is the scientific study of the relation between people and their…

  • Occupation

  • Equipment

  • Environment“

    (Shackel)


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Ergonomics Principles

  • Design for human use

  • Fits the task to the worker

    • People are different

    • People have limitations

    • People age


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An Ergonomic Approach…

Provides a step-by-step process to ensure the appropriate technology is in place to reduce musculoskeletal stress & strain…. reducing the risk of injury.


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A Simple Look at an Ergonomic Approach

Tasks:

  • Identify jobs and job tasks which stress body parts beyond limits

  • Develop solutions to change these task demands.

    Workplace Environment:

  • Review the design of the physical work environment to reduce risk, remove barriers, minimize travel, etc.

    Other Factors:

  • Consider other factors that affect work performance, such as lighting, noise, equipment storage & maintenance issues.

    Implement these changes in the work place.


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Ergonomic Hazards

What are Ergonomic Hazards?

  • Musculoskeletal System

  • Energy/Forces/Stressors

  • Exceed the biomechanical limits of the human body


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What Do “Patient Care” Ergonomic Hazards result from?

Patient lifting and moving exceed caregivers’ biomechanical limits…


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What Do “Patient Care” Ergonomic Hazards result from?

  • Ergonomic hazards for caregivers include…

    • pushing, pulling

    • lifting heavy loads

    • horizontal & vertical lifting

    • lifting light loads for long periods of time

    • twisting, bending, reaching

    • standing for long periods of time

    • awkward postures

    • repetitive motions

    • others….


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What Do “Patient Care” Ergonomic Hazards result from?

  • “Safe” lifting rules don’t apply (Horizontal and vertical lifting)

  • Patients:

    • are asymmetric & bulky

    • can’t be held close to the body

    • have no handles

  • Patient assistance varies


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What Do “Patient Care” Ergonomic Hazards result from?

  • Patient care is unpredictable due to unanticipated patient responses…

    • muscle spasms, combativeness, or resistance

  • Results in…

    • Unexpectedly heavy loads

    • Patient Movement

      • When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object.


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Simple Biomechanical Model

F=ma

d

Work = Force x Distance

W = F x d


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Musculoskeletal impact/stress on…

Back

Shoulders

Neck

Wrist

Hand

Knees

Other body parts…

Exceeding Biomechanical Capabilities results in…


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Example 1: Pull up in Geri-Chair

  • Risk Factor:

  • Manual Lifting

  • Body Parts Affected:

  • Back – posture, load/force

  • Shoulder – load/force

  • Elbow – load/force

  • Wrist/hand – load/force

  • Neck – load/force

  • Interventions:

  • Sit to Stand Lifts

  • Ceiling/Floor Full Body Sling Lifts

  • Friction Reducing Devices


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Example 2: Transfer to Stretcher

  • Risk Factor:

  • Manual Lifting

  • Body Parts Affected:

  • Back – posture, load/force

  • Shoulder – load/force

  • Elbow/Wrist/Hand – load/force

  • Neck – load/force

  • Interventions:

  • Ceiling/Floor Full Body Sling Lifts

  • Lateral Transfer Devices (LTD)

    • Friction reducing devices

    • Air Assisted LTD

    • Mechanical LTD


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Example 3: Transfer from Chair of partial weight-bearing patient

  • Risk Factor:

  • Manual Lifting

  • Body Parts Affected:

  • Back – posture, load/force

  • Neck – load/force

  • Shoulder – load/force

  • Elbow – load/force

  • Wrist/hand – load/force

  • Intervention:

  • Sit to Stand Lift


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Example 4: Lateral Transfer patient

  • Risk Factor:

  • Space Constraints

  • Body Parts Affected:

  • Shoulder – posture/load

  • Elbow – position/load

  • Wrist/hand – position/load

  • Neck – posture/load

  • Back – posture/load

  • Intervention:

  • Ceiling Lift

  • Renovate room



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Unit-based Hazard Assessment for Safe Patient Handling patient

‘Patient Care’ Practice Settings include…

  • ALL practice settings that move and lift patients

  • NURSING

  • Acute Care

  • Long Term Care

  • Critical Care

  • OR

  • ER

  • SCI

  • Others…

  • NON-NURSING

  • PT

  • Diagnostics

  • Treatment Areas

  • Procedure Areas

  • Morgue

  • Dialysis

  • Others..


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Unit-Based Hazard Assessment patient

Role

  • Drives UNIT recommendations for equipment, policy, and procedures

  • Identifies areas in need of improvement that impact safety of work environment & use of equipment

    • Storage, maintenance, clutter, etc.


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I. patient Prior to Ergo Evaluation – Data Collection

Identify UNIT High Risk Tasks

Staff Perception of High Risk Tasks

Unit Injury data

Identify High Risk Units

Collect Information on Unit Characteristics/Issues

II. During Ergo Evaluation

Meet with Mgmt/Staff

Conduct Site Visit

Meet with Mgmt/Staff

III. After Ergo Evaluation

Perform Risk Analysis

Formulate Recommendations

Unit-Based Hazard Assessment


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I. patient Prior to Ergo Evaluation – Data Collection

Identify UNIT High Risk Tasks

Staff Perception of High Risk Tasks

Unit Injury data

Identify High Risk Units

Collect Information on Unit Characteristics/Issues

Unit-Based Hazard Assessment


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I. Prior to Ergo Evaluation patient 1. Identify High Risk Tasks

Collect Staff Perceptions of Unit High-Risk Tasks

‘Tool for Prioritizing High Risk Tasks’

  • Rank Tasks from 1 to 10

    10 = most difficult/highest risk

    1 = least difficult/ lowest risk

  • When ranking, consider:

    • Musculoskeletal Stress = Load, Posture, Frequency/Duration

  • Completed by

    • Each Staff member

    • Collectively by Shift

  • Compile by Unit and Shift


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I. Prior to Ergo Evaluation patient 1. Identify Unit High Risk Tasks

Collect Unit Injury Data

*Be sure to note which source is used on your Injury Log


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I. Prior to Ergo Evaluation patient 2. Identify High Risk Units

Beware of using Injury data….


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I. Prior to Ergo Evaluation patient 2. Identify High Risk Units

Directs focus for equipment and policy interventions

  • Identification of High Risk Units

    • Analyze all facility UNIT injury data…

      • Highest number of patient handling injuries

      • Most severe patient handling injuries

        • Lost Time

        • Modified Duty

  • High Risk Unit Characteristics

    • Many dependent patients/residents

    • Patients are moved in and out of bed often

    • Many patient transfers


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I. Prior to Ergo Evaluation patient 3. Collect Pre-Site Visit Unit Data

Use ‘Unit Characteristics/Issues’ Tool (Handout A-1)

  • Space issues

  • Storage availability

  • Maintenance/repair issues

  • Patient population (% dependency*)

  • Staffing characteristics

  • Equipment inventory/issues

  • Confirms site visit data

  • Used for making recommendations


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    II. patient During Ergo Evaluation/Site Visit

    Opening Meeting

    Site Visit/Walk-through

    Closing Meeting (optional for unit, required for administration)

    Unit-Based Hazard Assessment


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    Discuss patient

    Pre-Site Visit Data

    Issues of Concern

    Include

    Staff

    Unit/Area Manager

    Safety/Risk Management

    Facilities Management

    Union

    Others

    II. During Ergo Evaluation/Site Visit1. Conduct Opening Meeting


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    During Site Visit Walk-through, interview staff…

    • Confirms Pre-Site Visit Unit Data Collected

    • Discovers staff attitudes, concerns, ideas, information


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    During Site Visit Walk-through, observe…

    • Equipment

      • Availability

      • Accessibility

      • Use

      • Condition

      • Storage

      • Structural issues that impact use


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    During Site Visit Walk-through, note…

    • Patient room sizes/configurations

    • Ceiling Characteristics/AC vents/TVs/Sprinklers

    • Showering/bathing facilities & process

    • Toileting process

    • Safety Design Issues: Thresholds, Doorways

    • Storage


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    During Site Visit Walk-through, document…

    • Existing/ordered patient handling equipment

    • Occurrence of high risk tasks

    • % total dependent & extensive assistance pts

    • % partial assistance patients

    • Occurrence of bariatric/obese patients

    • Room configurations

    • # beds on unit/average daily census

    • Storage issues

    • Equipment/Sling recommendations

    • Notes

      (Sample PCE Templates - Handouts A-2a & A-2b)


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage

    Based on…

    • Dependency Level of patient/resident population

    • Room configurations on unit: # of private, semi-private, 3-bed, 4-bed rooms, etc. on unit.


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage

    Limitations…

    • Structural integrity of mounting surface (I-beam/ concrete pan)

    • Ceiling fixtures - lights, sprinkler heads, AC vents, etc.

    • Ceiling Height

    • Ceiling configuration/drop ceiling/AC housing

    • ICU Power Columns

    • Others


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Track Options

    • Traverse (x-y or H)

    • Straight

    • Curved

    • U-shaped


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage continued…

    • Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage:

      • Sum average % of

        • total dependent patients

        • extensive assistance patients/residents


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage continued…

    2. Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit:

    • To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage (Previous slide)


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage continued…

    • For units w/ only private patient rooms:

      • Average % of Patients Requiring CLs x # patients = # private patient rooms w/ CLs

    • For units w/ only semi-private rooms:

      • Average % of Patients Requiring CLs x # patients / 2 = # semi-private patient rooms w/ CLs


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage continued…

    For units with a mixture of room configurations:

    • For cost effectiveness in existing construction, and if appropriate for the unit…

      • First begin calculations with ceiling lifts placed in most or all larger wards (3-bed & 4-bed wards)

      • Then, as appropriate, place in smaller rooms (private and semi-private)


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage continued…

    Example:

    • MedSurg Unit

      • 30 patients

      • 4 private rooms, 10 semi-private rooms, and two 3-bed rooms.

      • Approximately 70% of the patients will require use of Ceiling Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients).

    • For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in...

      • two (2) 3-bed rooms (covering 6 patients)

      • seven (7) semi-private rooms (covering 14 patients)

      • one (1) private room (covering one patient)


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    II. During Ergo Evaluation/Site Visit patient 2. Conduct Site Visit

    Unit Ceiling Lift System Coverage Practice

    (Handout A- 3)

    • NHCU Unit

    • Med/Surg (Tele) Unit

    • Med/Surg (Rehab) Unit

    • How many (#) patients/beds should be covered?

    • In what rooms would you place ceiling lifts on this unit?

    • How many ceiling lifts would you purchase/install for this unit?


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    Discuss patient

    Preliminary Findings from Site Visit

    Pre-Site Visit Data as related to findings

    Priorities in need of immediate remediation

    Issues of Concern

    Include

    Staff

    Unit/Area Manager

    Safety/Risk Management

    Facilities Management

    Union

    Others

    II. During Ergo Evaluation/Site Visit3.Conduct UNIT Closing Meeting(optional)


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    Discuss patient

    Rationale for Site Visit

    Preliminary Findings from Site Visit

    Priorities in need of immediate remediation

    Issues of Concern

    Show photos of equipment recommendations

    Include

    Staff

    Union

    Unit/Area Managers

    Safety/Risk Management/Employee Health

    Facilities Management

    CFO/Purchasing

    Others

    II. During Ergo Evaluation/Site Visit3.Conduct ADMINISTRATOR Closing Mtg


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    III. patient After Ergo Evaluation

    Perform Risk Analysis

    Generate Recommendations

    Unit-Based Hazard Assessment


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    Sources of Risk: patient

    You must know the SOURCES of risk in your patient care environment to perform Risk Analyses…

    III. After Ergo Evaluation1. Perform Risk Analysis


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    Risk Sources: patient

    Health Care Environment

    Patient

    Patient Handling Tasks

    Once risks are identified, steps can be taken to protect Staff and Patients!

    Sources of Risk



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    Health Care patient Environment Risk Factors

    Space limitations

    Small rooms

    Lots of equipment

    Clutter

    Cramped working space

    Poor placement of room furnishings

    Sources of Risk


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    Health Care patient Environment Risk Factors

    Slip, trip, and fall hazards

    Uneven work surfaces (stretchers, beds, chairs, toilets at different heights)

    Uneven Floor Surfaces (thresholds)

    Narrow Doorways

    Poor bathing area design

    Sources of Risk


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    Health Care patient Environment Risk Factors

    Broken Equipment

    Inefficient Equipment (non-electric, slow-moving, bed rails)

    Not enough or Inconvenient Storage Space

    Staff who don’t help each other or don’t communicate

    Sources of Risk



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    Patient patient Risk Factors

    Weak/unable to help with transfers

    Unpredictable

    Hit or bite

    Resistive Behavior

    Unable to follow simple directions

    Sources of Risk


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    Patient patient Risk Factors

    Overweight

    Experiencing Pain

    Hearing or vision loss

    No/little communication between staff about Patient or with Patient

    Sources of Risk



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    Patient Handling patient Tasks Risk Factors

    Reaching and lifting with loads far from the body

    Lifting heavy loads

    Twisting while lifting

    Unexpected changes in load demand during lift

    Reaching

    Long Duration

    Sources of Risk


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    Patient Handling patient Tasks Risk Factors

    Moving or carrying a load a significant distance

    Awkward Posture

    Pushing/Pulling

    Completing activity with bed at wrong height

    Frequent/repeated lifting & moving

    Sources of Risk


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    High Risk Task Identification: patient

    To determine the risk of injury for each unit/patient population, high risk tasks specific to the unit must be identified…

    III. After Ergo Evaluation1. Perform Risk Analysis


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    III. After Ergo Evaluation patient 1. Perform Risk Analysis

    Identify UNIT high risk tasks by…

    • Analyzing Unit Injury Data

    • Collecting Staff Perception of High Risk Tasks

    • Interviewing Employees


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    1. Analyze Unit Injury Data patient

    Determine:

    #1 & 2 Causes of Injuries

    #1 & 2 Activities being performed when staff are injured

    What’s going on? What trends are seen?

    ’Injury Incidence Profile’ (Handout A-4)

    III. After Ergo Evaluation1. Perform Risk Analysis


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    III. After Ergo Evaluation patient 1. Perform Risk Analysis

    2. Complete & Collate Staff Responses for ‘Tool for Prioritizing High Risk Tasks’(Handout A-5)

    • Rank Tasks from 1 to 10

      10= most difficult/highest risk

      1 = least difficult/ lowest risk

    • When ranking, consider:

      • Frequency, Duration, & Musculoskeletal Stress

    • Completed by

      • Each Staff member

      • Collectively by Shift

    • Compile by Unit and Shift


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    III. After Ergo Evaluation patient 1. Perform Risk Analysis

    High Risk Tasks will vary by Clinical Setting….


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    Repositioning in Bed* patient

    Making occupied bed*

    Transferring patient from bathtub to chair*

    Transferring patient from wheelchair to bed*

    Transferring patient from wheelchair to toilet*

    Lifting a patient up from the floor*

    Weighing a patient*

    Applying antiembolism stockings

    Bathing a patient in bed*

    Bathing a patient in a shower chair /trolley*

    Undressing/dressing a patient*

    Repositioning patient in dependency chair* **

    Making an occupied bed*

    Feeding bed-ridden patient

    Changing absorbent pad*

    High Risk Tasks: Long Term Care

    * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)


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    Transporting patients (Road Trips)** patient

    Lateral Transfers (bed to stretcher)* ***

    Repositioning patient in bed from side to side* ***

    Vertical Transfers (bed/chair/commode)*

    Lifting patient to the head of the bed* ***

    Making occupied bed* ***

    Applying antiembolism stockings

    Bending/Reaching behind & around for equipment, etc.

    High Risk Tasks: Critical Care Units

    * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)


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    Transfer from bed to chair* patient

    Transfer from bed to stretcher* ***

    Moving Occupied bed or stretcher**

    Making occupied bed* ***

    Bathing a confused or totally dependent patient

    Lifting a patient up from the floor*

    Weighing a patient*

    Applying antiembolism stockings

    Repositioning in bed* ***

    Making occupied bed* ***

    Extensive dressing changes*

    High Risk Tasks:Medical/Surgical Units

    * Lifts ** Bed mover or powered bed *** Lateral transfer aid (FRD)


    High risk tasks operating room l.jpg

    Standing long periods of time patient

    Lifting and holding patient’s extremities*

    Holding retractors/organs for long periods of time

    Transferring patients on and off operating room tables/beds* ***

    Reaching, lifting and moving equipment

    Repositioning patients on operating room beds* ***

    Reaching for equipment

    High Risk Tasks: Operating Room

    • Lifts ** Bed mover or powered bed

    • *** Lateral transfer aid (FRD)


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    High Risk Tasks: patient Orthopedic Units

    • Post-operative Total Hip Replacement Patient

    • Patient with a cast/splint on extremity

    • Use of Continuous Passive Motion Device (CPM)

    • Halo Vest, logrolling for dressing changes

    • Holding Extremity for procedure

    • Altered Gait Pattern - Platform Walker

    • Assembling Traction

    • Transfers In/Out a Car

    • Transfers of Patients with Pelvic & External Fixators


    High risk tasks home settings l.jpg

    Providing patient care in a bed that is not height adjustable

    Providing care in crowded area, forcing awkward positions

    Toileting and transfer tasks without proper lifting aids

    No assistance for tasks

    High Risk Tasks: Home Settings


    High risk tasks psychiatry l.jpg

    Restraining a patient adjustable

    Escorting a confused or combative patient

    Toileting a confused or combative patient

    Dressing a confused or combative patient

    Picking a patient up from floor

    Bathing/ Showering confused or combative patient

    Bed-related care

    High Risk Tasks: Psychiatry


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    Other High Risk Tasks adjustable

    • Lifting heavy linen bags

    • Standing for long periods of time behind med carts

    • Data entry

    • Others…


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    Information from Risk Analysis adjustable

    drives formation of

    Equipment Recommendations…

    III. After Ergo Evaluation2. Generate Recommendations


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    Patient Handling Equipment for each unit/area adjustable

    Storage

    Design Features

    Repair/Maintenance

    Injury Reporting

    Bariatric Programs

    Sample Report - Handout A-7

    Equipment Support Structures

    Unit Peer Leaders

    Facility Champions

    Facility Safe Patient Handling Team

    Training

    Knowledge Transfer Mechanisms

    Change Strategies

    III. After Ergo Evaluation2. Generate Recommendations


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    Unit-based Hazard Assessments for Safe Patient Handling adjustable

    ‘Patient Care’ Practice Settings include…

    • ALL practice settings that move and lift patients

    • NURSING

    • Acute Care

    • Long Term Care

    • Critical Care

    • OR

    • ER

    • SCI

    • Others…

    • NON-NURSING

    • PT

    • Diagnostics

    • Treatment Areas

    • Procedure Areas

    • Morgue

    • Dialysis

    • Others..