Unitbased Hazard Assessment for Safe Patient Handling

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• Unit-based Hazard Assessment for Safe Patient
  Handling

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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
• [phone] [phone] fax
• mary.matz_at_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 dont apply
  (Horizontal and vertical lifting)
• Patients
• are asymmetric bulky
• cant 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
Fma
d
Work Force x Distance W F x d
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Exceeding Biomechanical Capabilities results in

• Musculoskeletal impact/stress on
• Back
• Shoulders
• Neck
• Wrist
• Hand
• Knees
• Other body parts

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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

• 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

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Unit-based Hazard Assessment for Safe Patient
Handling

• Patient Care Practice Settings include
• ALL practice settings that move and lift patients

• NON-NURSING
• PT
• Diagnostics
• Treatment Areas
• Procedure Areas
• Morgue
• Dialysis
• Others..

• NURSING
• Acute Care
• Long Term Care
• Critical Care
• OR
• ER
• SCI
• Others

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Unit-Based Hazard Assessment

• 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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Unit-Based Hazard Assessment

• I. 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

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Unit-Based Hazard Assessment

• I. 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

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I. Prior to Ergo Evaluation 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 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 2. Identify High
Risk Units
Beware of using Injury data.
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I. Prior to Ergo Evaluation 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 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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Unit-Based Hazard Assessment

• II. During Ergo Evaluation/Site Visit
• Opening Meeting
• Site Visit/Walk-through
• Closing Meeting (optional for unit, required for
  administration)

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II. During Ergo Evaluation/Site Visit 1. Conduct
Opening Meeting

• Discuss
• Pre-Site Visit Data
• Issues of Concern
• Include
• Staff
• Unit/Area Manager
• Safety/Risk Management
• Facilities Management
• Union
• Others

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II. During Ergo Evaluation/Site Visit 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 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 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 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 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 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 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 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 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 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 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 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 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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II. During Ergo Evaluation/Site Visit 3. Conduct
UNIT Closing Meeting (optional)

• Discuss
• 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

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II. During Ergo Evaluation/Site Visit 3. Conduct
ADMINISTRATOR Closing Mtg

• Discuss
• 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

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Unit-Based Hazard Assessment

• III. After Ergo Evaluation
• Perform Risk Analysis
• Generate Recommendations

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III. After Ergo Evaluation1. Perform Risk
Analysis

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

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Sources of Risk

• Risk Sources
• Health Care Environment
• Patient
• Patient Handling Tasks
• Once risks are identified, steps can be taken to
  protect Staff and Patients!

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Whats Wrong with this Picture??
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Sources of Risk

• Health Care Environment Risk Factors
• Space limitations
• Small rooms
• Lots of equipment
• Clutter
• Cramped working space
• Poor placement of room furnishings

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Sources of Risk

• Health Care 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

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Sources of Risk

• Health Care Environment Risk Factors
• Broken Equipment
• Inefficient Equipment (non-electric, slow-moving,
  bed rails)
• Not enough or Inconvenient Storage Space
• Staff who dont help each other or dont
  communicate

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Whats Wrong with this Picture??
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Sources of Risk

• Patient Risk Factors
• Weak/unable to help with transfers
• Unpredictable
• Hit or bite
• Resistive Behavior
• Unable to follow simple directions

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Sources of Risk

• Patient Risk Factors
• Overweight
• Experiencing Pain
• Hearing or vision loss
• No/little communication between staff about
  Patient or with Patient

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Whats Wrong with this Picture??
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Sources of Risk

• Patient Handling 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

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Sources of Risk

• Patient Handling 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

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III. After Ergo Evaluation1. Perform Risk
Analysis

• High Risk Task Identification
• To determine the risk of injury for each
  unit/patient population, high risk tasks specific
  to the unit must be identified

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III. After Ergo Evaluation 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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III. After Ergo Evaluation 1. Perform Risk
Analysis

• 1. Analyze Unit Injury Data
• Determine
• 1 2 Causes of Injuries
• 1 2 Activities being performed when staff are
  injured
• Whats going on? What trends are seen?
• Injury Incidence Profile (Handout A-4)

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III. After Ergo Evaluation 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 1. Perform Risk
Analysis

• High Risk Tasks will vary by Clinical Setting.

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High Risk Tasks Long Term Care

• Repositioning in Bed
• 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

Lifts Bed mover or powered bed
Lateral transfer aid (FRD)
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High Risk Tasks Critical Care Units

• Transporting patients (Road Trips)
• 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.

Lifts Bed mover or powered bed
Lateral transfer aid (FRD)
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High Risk TasksMedical/Surgical Units

• Transfer from bed to chair
• 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

Lifts Bed mover or powered bed
Lateral transfer aid (FRD)
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High Risk Tasks Operating Room

• Reaching, lifting and moving equipment
• Repositioning patients on operating room beds
  
• Reaching for equipment

• Standing long periods of time
• Lifting and holding patients extremities
• Holding retractors/organs for long periods of
  time
• Transferring patients on and off operating room
  tables/beds

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

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High Risk TasksOrthopedic 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

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High Risk Tasks Home Settings

• 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

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High Risk Tasks Psychiatry

• Restraining a patient
• 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

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Other High Risk Tasks

• Lifting heavy linen bags
• Standing for long periods of time behind med
  carts
• Data entry
• Others

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III. After Ergo Evaluation 2. Generate
Recommendations

• Information from Risk Analysis
• drives formation of
• Equipment Recommendations

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III. After Ergo Evaluation 2. Generate
Recommendations

• Patient Handling Equipment for each unit/area
• 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

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Unit-based Hazard Assessments for Safe Patient
Handling

• Patient Care Practice Settings include
• ALL practice settings that move and lift patients

• NON-NURSING
• PT
• Diagnostics
• Treatment Areas
• Procedure Areas
• Morgue
• Dialysis
• Others..

• NURSING
• Acute Care
• Long Term Care
• Critical Care
• OR
• ER
• SCI
• Others

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