Safe Patient Handling TEAMs Together Everyone AchieveS Mobility Safely

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Safe Patient HandlingTEAMsTogether Everyone
AchieveS Mobility Safely
John Dempsey Hospital
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Overview

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• This program will provide information on
  UConn Health Centers Safe Patient Handling
  policy and program and the responsibility of all
  healthcare staff to use patient handling
  equipment to minimize the risk of employee and
  patient injury

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Objectives

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Identify the major elements and procedures of
  UConn Health Centers policy and program
• Recognize the link between manual patient
  handling tasks and employee injuries and
  disability
• Be able to describe the posture guidelines to
  follow when caring for patients when using
  patient handling devices and lifts

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Objectives

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Be able to assess patient mobility levels know
  the key assessment criteria for correct
  assessment
• Be able to communicate and document patient
  mobility levels and equipment needs
• Be able to describe the patient handling devices
  and their functions, available in John Dempsey
  Hospital clinics

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Objectives

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Be able to identify the appropriate equipment to
  use to safely transfer, lift or re-position
  patients based on patient mobility and safety
• Be able to identify key resources and personnel
  available to help with patient handling issues,
  questions and equipment

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Safe Patient Handling

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Core Committee guides this program members from
  
• Employee Safety (Office of Research Safety)
• Employee Health Service
• Rehabilitation Services
• Staff from Participating Units Clinics
• Nursing Department
• University Medical Group (UMG) Ambulatory Clinics
• Support from the CT Dept. of Administrative
  Services (DAS)
• Consultation services from UCHCs Ergonomic
  Technology Center

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Safe Patient Handling

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Primary Goal to foster teamwork and cooperation
  among
• staff - with staff helping each other
  using devices for patient handling
• tasks, in order to eliminate patient
  handling injuries and keep patients
• safe
• Our motto - chosen from employee suggestions
• TEAMS
• Together Everyone AchieveS Mobility Safely

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Safe Patient Handling - A New Approach

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Extensive reviews of injury statistics have been
  done
• results show that back safety education, proper
  lifting techniques and good body mechanics have
  not prevented the epidemic of disabling injuries
  to healthcare personnel, including deterioration
  of the spine and other joints
• Conclusion Can not make traditional patient
  lifting safe through body mechanics alone

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Safe Patient Handling - A New Approach

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• New approaches are needed
• Programs that eliminate manual lifts have been
  very successful in other countries and new
  programs in the US are showing similar results
• Scandinavian countries, Europe and England are
  leaders in safe patient handling programs
• Legislation passed in these countries mandates
  the use of lifts and other devices to eliminate
  manual lifting by healthcare staff
• Some states in US have passed similar laws
• There is a bill currently before the U.S.
  Congress (2007) for a federal rule to eliminate
  manual moving of patients and require ergonomic
  solutions

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Safe Patient Handling - A New Approach

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Similar Situation exists - risk of HIV/Hepatitis
  infection
• The current protocol of Universal Precautions
  is well-accepted and followed, universally
  (with every single patient) to avoid the risk of
  employee bloodborne pathogen infection
• Now Universal Lifting Guidelines need to be
  followed, as a way to reduce the risk of
  musculoskeletal injury
• This type of injury does not happen in an
  instant or from one occurrence
• It develops over time, and the risk increases
  with the length of time spent in a healthcare
  career
• Other factors such as increasing patient weights
  and levels of disability also contribute to
  higher rates of employee injury

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Scope of the Problem

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• According to National Statistics
• The Top Ten jobs in the U. S. with the highest
  rates of injury include healthcare staff
• Nursing aides, orderlies, and attendants are
  Number 1 higher rates of injuries than truck
  drivers and laborers
• Registered nurses are the 7th highest in injury
  rates
• Of these injuries, almost 1 in 5 involve 31 or
  more days out of work

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Scope of the Problem

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• At John Dempsey Hospital (JDH)
• 1,000 employees, experienced 800 injuries over a
• 3-year period
• 4 of employees suffer a back injury each year
• Each of these average 14 days out of work
• Half of the back claims were from patient
  transfers or moves
• In 2004, in UCHC Workers Compensation costs were
  over 1 Million
• Indirect costs (other than medical expenses) are
  usually 5 times the direct costs

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Scope of the Problem

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• At JDH
• At the beginning of the SPH program, several
  units had almost half of the nursing aides out of
  work due to work-related injury
• We are now seeing decreases in the rates, costs
  and severity of staff injuries associated with
  patient handling

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Ergonomics Lifting

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Risk Factors Present in Health Care Tasks that
  increase the risk of injury from lifting
• Higher weights
• Holding weights away from body
• Twisting and lifting at the same time
• Poor grip
• Unexpected movement
• Greater lift heights
• Hands below knees or above shoulders during lift

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Ergonomics Lifting

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• In no other industry are employees expected to
  move or lift the weights that healthcare workers
  have been expected to move
• Current recommendation from NIOSH (research
  agency that advises OSHA) is that for a perfect
  lift repeated throughout the work shift, the
  weight should not exceed 51 pounds
• For healthcare workers, it has been estimated
  that the safe weight limit for repeated lifts is
  32 pounds (due to the risk factors present in
  patient handling tasks they are not perfect
  lifts)

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UCHC Policy

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• No Manual Patient Handling
• except in case of emergency
• THINK In terms of anti-lifting not correct
  lifting
• PLAN Dont rush in and move pt without
  equipment,
• help and a plan
• ACT Take the time to protect yourself
  your co-
• workers

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UCHC Policy

• R e m a r k a b l e C a r e T h r o u g h R
  e s e a r c h a n d E d u c a t i o n

• Promote patient independence
• Important to remember to foster patient moving by
  themselves as far as they are able
• Sometimes need to encourage, cajole or clearly
  state the need for them to cooperate and move or
  re-position themselves within their capacity

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Cannot Forget To Use Good Body Mechanics
R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n

• Neutral Posture Guidelines
• Keep knees bent
• Keep curve in lumbar area
• Avoid twisting
• Keep the hands close to the body (dont reach)
• Lift between knuckle height and shoulder height
• The COMFORT ZONE
• Ideal have knuckles at waist height
• Keep wrists straight

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
And Dont Forget the Lever Effect
100 lbs.
10 lbs.
the further the weight from the body, the
greater the force and effect on the spine. This
can magnify the effect of the weight by factor of
up to 10
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Body Mechanic Guidelines for Healthcare Tasks
R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n

• Move feet in direction you want to turn dont
  twist at the waist
• moving lift walk with lift in direction you
  want to turn
• using Slide Sheets point toes step, or shift
  weight
• Work in your comfort zone - dont reach bend
  over
• Get close to patient and equipment
• Work at waist height dont reach above
  shoulders or below waist
• Adjust bed to height correct for you Bend your
  knees and go down on legs dont bend from waist
  when working at floor level
• For example When putting a sling on a seated
  patient, bend from knees alongside the chair

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

• Assessment Key Questions
• Is the patient alert cooperative?
• Can the patient bear weight?
• Does the patient have upper body strength?
• Can the patient sit unassisted?
• Does the patient have balance problems?
• Are there other special considerations that
  
• need to be taken into account?

Equipment capability must match the capability of
patient and needs of the patient handling task
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

• Use UCHCs Tool SPH Reference Guide
• (This guide is attached to each binder or
  clipboard on JDH units or posted in clinics) (see
  next slides for individual sections of guide)
• Patient Capability Caregiver Provides
• for Movement the
  Difference
• Independent 100 0
• Supervised 100 0
• Minimum Assist 75 25
• Moderate Assist 50 50
• Maximum Assist 25 75-100
• Total Assist 0
  100

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

Is the patient
- Cooperative - Able to bear weight fully -
Consistent reliable in balance - Patient
mobilizes w/out assistance safely - May need to
define environment ie room unit
Independent
No Assistance
YES 7
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
UCHCs Tool SPH Reference Guide

Is the patient

• - Cooperative, able to bear weight
• Consistent reliable in balance but requiring
  some
• verbal reminders
• - And/or some help with equipment
• - Needs oversight/standby for safety

Supervised
Use Gait Belt
YES 7
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility
Is the patient

• Patient can perform 75 of activity - Able to
  bear some
• weight
• - Able to balance somewhat, and/or
• - Able to cooperate some what?
• - Patient highly involved in activity
• - Patient has considerable upper body strength
• - Patient bears some weight
• - Patient sits up well, may need some assistance

Min Assist
See Next Slide
YES 7
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

Min Assist -- Use
- 1-Person Assist - Stedy Stand-Assist
Device - Bed Features - Patient-Assist in
Movement - Gait Belt / Walker to Ambulate  
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility
Is the patient

- Patient can perform 50 of activity - Patient
follows simple directions - Patient bears some
weight - Patient has some upper body strength -
Patient sits up with assistance - Able to bear
any weight?
Mod Assist
See Next Slide
YES 7
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

Mod Assist -- Use

• - 2-Person Assist
• - Sabina or SARA Sit-to-Stand lift
• - Bed features 
• - Slide sheets
• Physical Therapist to Ambulate
• Can use Total or Ceiling Lift an extra measure
  of
• protection for any level of mobility

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility
Is the patient

- Dependent - In other words - Patient unable
to help or minimal help - Full staff assistance
required - Inconsistent? - Heavy or obese? -
Limited in movement? - Unable to bear weight? -
Unable or unwilling to cooperate?
Max or Total Assist
See Next Slide
YES 7
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assessment of Patient Mobility

Max or Total Assist

• Total or Ceiling Lifts
• Bed features
• - Slide Sheets
• - Hovermatt
• - No Ambulation

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Deciding Which Equipment to Use
Independent None Supervised Gait Belt Min
Assist 1-Person Assist Bed Features,
Stand-AssistStedy Gait Belt / Walker to
Ambulate Mod Assist 2-Person Assist Bed
Features, Sit-to-Stand Lift Slip Sheets,
Hovermatt Total Lift if necessary, PT to
Ambulate Max or Total Assist 2 Person
Assist Bed Features, Slip Sheets, Hovermat
t, Total Lift (Portable or Ceiling) No
Ambulation
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Documentation and Communication

• Nursing Flow Sheet (not applicable for UMG
  clinics)
• New section on Patient Mobility
• Complete once a shift or if change occurs
• Use Safe Patient Handling Reference Tool or
• Reference PT Notes in chart for additional input
• White Board in Patient Room
• Use to communicate status to others
• Fill in bottom portion with equipment to be used
  for
• patient
• Anyone coming into room will understand patient
• needs at a glance for patient and employee
  safety!

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Documentation and Communication

• Nursing Flow Sheet section
• SAFE PATIENT HANDLING - MOBILITY STATUS Complete
  the section below by circling the status for each
  of the categories.
• Refer to the Safe Patient Handling Reference
  tool (laminated green page on clipboard or in
  binder) for a description of status levels. Then
  write equipment information on pts. White Board
  using protocol for reference.
• Safe Patient Handling
• IN BED Ind. Sup. Min. Mod. Max Tot
• TRAN Ind. Sup. Min. Mod. Max Tot
• AMB Ind. Sup. Min. Mod. Max Tot

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
White Board Next to each Patients Bed
Patient Mobility Section
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n

• UCHC Patient Handling Equipment
• Total Lifts Mobile Ceiling
• Sit-to-Stand Lifts
• Movement-Assist Devices Stedy
• Slide Sheets Slide Boards
• Gait Belts
• Hovermatts
• New Bed Systems

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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Total Lift Tempos mfg by ARJO
Operas in ICU, Diag Imaging Seated Slings -
Disposable, Lgt. Blue On Par List M, L, XL
Seated Slings Reusable in Diag. Imaging
only Vertical transfers from bed to chair or
commode also from floor. 440 lb. max. weight
capacity (1 lift ea.) 3, 4, 5, 6, 7, CSD,
ICU, Diag. Imaging (2 lifts ea.) 4
6
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Total Lift Viking M mfg by LIKO Reusable
Slings - Black Mesh Repositioning/Turning Sheets
- Green Mesh Turn or reposition patient in bed,
and lateral transfers from bed to stretcher with
sheet. Sheet may remain under patient. Sling used
for seated transfers. 440 lb. max wgt. capacity
(1 lift ea) ICU
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Ceiling Likorall mfg by LIKO Reusable
Slings - Black Mesh Repositioning/Turning Sheets
- Green Mesh Turn or reposition patient in bed,
and lateral transfers from bed to stretcher with
sheet. Sheet may remain under patient. Sling used
for seated transfers. (1 lift ea) Med 4, Surg
7 550 lb. max wgt. capacity (1 lift ea)
ICU 440 lb. max wgt. capacity
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Sit-to-Stand Lift Sabina mfg by LIKO
Sara mfg by ARJO in
Diag. Imag. Vests M L - Green Nylon (4 6
have a SM vest also) Transfer from one seated
position to another, or use to safely stand
patient for a period of time. For those who have
at least 25 use of their legs. 440lb. weight
capacity (1 lift ea.) 4, 5, 6, 7, CSD, ED,
Diag Imaging
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Transfer Mattress Hovermatt mfg. by
HOVERTECH Reposition turn patient in bed
lateral transfers. No maximum weight cap. No max.
wgt. capacity (1 mattress ea. ) 4, 5, 6, 7,
ED (2 mattresses ea.) ICU (1 Lg, 1 Std.), CSD,
Cardiac Cath, Lab/Del (9 mattresses ea.) OR /
PACU (1 Lg, 8 Std) (5 mattresses ea.) Diag
Imaging (incl Rad Onc)
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Transfer Sheets Ross Ready Sheets
Ergoslides Reposition patient in bed help
turn pt. in bed, lateral transfer aid. 300 lb.
weight capacity. (UCHC recommends not using if
wgt gt250 lbs.) Variety of types and numbers on
all units
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n
Assist Device Stedy mfg. by
ARJO Transfer from one seated position to
another. For patients with upper body strength
and can bear weight. 265 lb. weight capacity. (1
ea.) 4, 6, CSD, ED, Diag Imaging, Lab/Del
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R e m a r k a b l e C a r e T h r o u g h R
e s e a r c h a n d E d u c a t i o n

• Resources
• Throughout UCHC, you may contact the following
  personnel for help in operating equipment, moving
  a specific patient, refreshing your operating
  skills on a particular device, or with program
  suggestions
• 1 Primary Resource Nurse Mgrs., Unit or Clinic
  Staff
• all have received hands-on in-service for
  all equipment
• 2 Rehabilitation Staff PTs assigned to each
  JDH unit are skilled
• in assessing, and handling patients (Kim
  Gasner, program co-chair)
• Request a PT Consult if patient has mobility
  issues
• 3 Clinical Nurse Specialists for JDH 4,5 7
  (A. Darcy D. Cratty)
• 4 Research Safety Patti Wawzyniecki, program
  co-chair
• 5 Clinical Engineering should be notified
  immediately for any
• device problems including batteries