Elements of a Successful Patient Handling & Movement Program: Why and How

1. Elements of a Successful Patient Handling & Movement Program: Why and How Dana Root, MS, PT, CPE, CSPHP Root.dana@dol.gov 414.297.3315

2. Why? • Risks which could potentially cause musculoskeletal injury: • Force • Lifting own body weight plus patient’s weight • Awkward posture • Prolonged forward bending • Twisting • Holding a position • Tight or awkward locations • space restrictions

3. Why? • 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

4. Why? • 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

5. Why? • The resident/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” don’t 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 • Using good body mechanics to protect the back is a myth!

6. Why? Healthcare Provider Safety Manual lifting of residents be minimized in all cases and eliminated when feasible

7. How to Establish a SPH Handling Program? The Process: • Evaluate Injury and Illness costs • Obtain funding • Establish a lifting committee • Resident/Family notification • Training • Coordination with all staff • Evaluate & select equipment • Receive and prep equipment • Resident assessment • Enforcement • Performance measurement

8. How: The Program For success, required infrastructure MUST be in place prior to implementing SPHM Program http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp

9. RHIR & RHSR for Past Three Years • Resident Handling Incident Rate = # OF RH CASES With days away from work job transfer DAYS or Restricted days x 200,000 Resident Handling Hours worked • Resident Handling Severity Rate = (days away from work + On job transfer DAYS or Restricted days) x 200,000                     Resident Handling Hours worked • MSD days away rate: 9.6 for 2010

10. The Process: Champions • Management commitment • Quality assurance • Competent in equipment usage • Enforcement/discipline of facility policy and procedures • Employee involvement • The REAL Champions for the process

11. The Process: Champions • Establish a Lifting Committee • Select outgoing CNAs • Meet weekly • Food, fun & praise • Leader • Has budget authority • Motivator

12. The Process: Policy & Notification • Admission policy statement • Resident right issues: use of equipment depending on functional abilities • Resident’s Council • Notify residents of change • Deal with resident refusals • Notify family of change • Introduce new equipment and use

13. The Process: Training One-on-one training for each employee Employees competency checked on each piece of equipment Competency check signed off by aide Not use equipment until competency checked Discipline for not using lift properly or at all

14. The Process: Staff Coordination • Maintenance • Preventive maintenance schedule • Wheels, etc. • Battery charge • Laundry • Sling inspection & cleaning • Infection control • Rehab staff • Need to be trained on use of equipment • Lifts require use of resident’s muscles • How can use in treatment goals

15. The Process: Equipment • Evaluate • Hold vendor open houses • Try out different equipment • CNAs test equipment • Provide feedback • Consider types of devices • Overhead • Floor based total lift • Lateral assist • Sit to stand • Slide sheet • Select for resident population • Facility constraints

16. The Process: Equipment • Evaluate Type of Slings • Seated • Supine • Standing • Ambulation • Position Support

17. The Process: Equipment • Get feedback evaluations from CNAs • Equipment • Slings • Decision meeting with Lifting Committee • Get budget approval and purchase • Set date for initiation of program

18. The Process: Equipment • Right number of lifts • Appropriate locations • Lifts need to be easily available to CNA • With sling • Battery storage

19. The Process: Equipment • Copy manufacturer instructions, laminate, and attach to equipment • Attach a warning sign that each lift and sling must be checked prior to use • Develop competency checklist on use of equipment • Who will charge the battery?

20. The Process: Resident Assessment • Type of equipment • Resident needs • Staff safety • Manual lifting of residents be minimized in all cases and eliminated when feasible • Develop assessment sheet • Algorithms • MDS • ADL self assessment • ADL support provided • FIMS • Communication

22. Fresh Eyes: Resident Assessment • Functional Independence Measure (FIM) • 7 level functional assessment scale of resident's actual performance • Evaluates the amount of assistance required to perform basic life activities • Need for assistance from another person or a device • Measures what the resident actually does Independent • Complete Independence • Modified independence – requires assistive device, ….. Modified Dependence – resident expends 50% or more of the effort • Supervision (setup) – without physical contact by helper, or applies assistive device 4 Minimal Contact Assistance – resident expends 75% of effort 3 Moderate Assistance – resident expends between 50% to 75% effort 2 Maximal Assistance – resident expends between 25% to 50% of effort 1 Total Assistance – resident expends less that 25% of effort

23. Floor surfaces Ramps Carpet transitions Wet Equipment storage Battery charging Size and configuration Resident room Bathroom Shower room Clutter The Process: Workplace Assessment

24. The Process: Enforcement • Policed by Lifting Committee members • Empowered to recommend suspensions • # of days suspension • Pick suspension days for best use of facility resources • Less impact on employee's paycheck

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