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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 root.dana@dol.gov. Terminology . Caregivers: RNs, LPNs, CNAs

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Assessing facility patient needs towards appropriate selection of safe lift equipment

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

root.dana@dol.gov


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 Equipment

  • Achievable and simple

  • Constraints

  • Costs


Step 8 implement recommendations
Step 8: Implement Recommendations Equipment

  • 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 Equipment

  • 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: EquipmentEngineering 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: EquipmentEngineering 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: EquipmentEngineering 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: EquipmentWhat 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: EquipmentWhat 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


  • Assessing facility patient needs towards appropriate selection of safe lift equipment

    Lift Aid Equipment Determination Grid Equipment

    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: EquipmentWhat 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: EquipmentWhat 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: EquipmentWhat 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: EquipmentWhat 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 Equipment

    • 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 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 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 Equipment

    • 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 Equipment

    OSHA Home Page

    OSHA Hospital/Nursing Home Pages

    OSHA Ergonomics Page


    Other resources
    Other Resources Equipment

    • 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