Applied Ergonomics for LTC

1. Applied Ergonomics for LTC University of Oregon, Labor Education and Research Center (LERC) and Oregon Occupational Safety and Health Administration (OR-OSHA) This material has been made possible by a grant from the Oregon Occupational Safety and Health Division, Department of Consumer and Business Services

2. Acknowledgements Materials for this presentation material made possible by Oregon OSHA Veterans Health Affairs SAIF Corporation HumanFit Bay Area Hospital, Coos Bay, OR Oregon Nurses Association (ONA) University of Oregon, Labor Education and Research Center Back Injury Resource Nurses (BIRN) National Institute of Occupational Safety and Health (NIOSH)

3. Introduction • Ergonomic concepts • Risk factors for musculoskeletal injury • Elements of an ergonomics program • SRH Case studies Today’s workshop will cover

4. Learning Objectives By the completion of this class you should be able to: • List 4 risk factors for musculoskeletal injury • Describe 4 action steps that can reduce your risk of injury during resident handling activities • Identify effective solutions to prevent injuries in for number of common resident handling activities

5. What is Ergonomics? Worker Environment Task/job The goal of ergonomics is to design the job to fit the worker NOT make the worker fit the job

6. What kinds of Injuries are Musculoskeletal Disorders (MSDs)? Acute injuries • Happen immediately due to overload • Can become chronic • Re-injury possible • Strains, sprains, disc herniations • Chronicinjuries • Pain or symptoms lasting more • than a month • Cumulativetrauma • Happenover time • Difficult to cure

7. Cumulative Trauma/Injury Activity microtrauma (small tears) irritation to tissue produces scar tissue Keeps repeating as long as activity continues • results in: •  flexibility •  strength • Function *INJURY* adhesions form tears combine

8. The Cumulative Effect Fatigue Continued exposure to risk factors Discomfort Nurses/CNAs report here Pain Injury Disability Time

9. Terms for Disorders • Work-related Musculoskeletal Disorder (WRMSD) • Cumulative Trauma Disorder • Repetitive Strain Injury • Overexertion or Overuse Injury • Types of disorders • Strains and sprains • Rotator cuff injuries • Disc herniations • Carpal Tunnel Syndrome • Bursitis, tendonitis • Sciatica

10. Why is Manual Resident Handling so Hazardous? • Physical demands of the work • Job exceeds physical demands of individuals • Poor equipment and facility design • Poor work practices • Individual characteristics • Age, past injuries, physical condition, leisurely activities

11. What are the Risk Factors for Musculoskeletal Disorders? • Excessive force • Awkward postures • Prolonged postures • Repetition

12. Excessive Forces Common activities contributing to excessive force: • Lifting and carrying • Pushing and pulling • Reaching to pick up loads • Prolonged holding • Pinching or squeezing

13. Awkward Postures Common risky postures: • Working overhead • Kneeling all day • Reaching to pick up loads • Twisting while lifting • Bending over to floor/ground • Working with wrist bent

14. Prolonged Postures • Standing or sitting for long • periods of time • Holding arms in fixed • positions for extended • periods

15. Repetitive Motions Common problem to look for: • Same posture or motions again and again • can be very frequent over short period of time • can be less frequent but repeated over time injury time injury time

16. Common Problems Leading to MSDS : • Poorly Designed Equipment • Does not have a good grip • Too heavy • Hard to use • Uncomfortable • Bad condition • Wrong tool/equipment for the job

17. Common Problems Leading to MSDs • Poor work organization • In adequate scheduling • Lack of planning • Poor communication among staff and other • resident stakeholders • Poor work practices

18. When is an Activity Likely to Become an Injury? • Activity performed frequently • You do the activity a long time • Work intensity is high • There are a combination of risk factors

19. How do you find solutions? Job Tasks Solution Hazards Solution • Form SRH team • Ergonomic Risk Analysis • Needs Assessment • Formulate solutions Solution Solution

20. Work practice controls Engineering controls/ Equipment improvement Proper body mechanics Fitness & wellness Risk of musculoskeletal injury Administrative controls Personal protective equipment

21. Choose Effective Solutions Most Effective • Engineering • Tools/equipment • Workplace design • Administrative • Job rotation • Number of workers • Work practices • Changing bed height • Behavioral • Body mechanics • Stretching/Fitness • PPE Least Effective

22. Preventing MSDS • First Choice: Engineering Controls • Eliminate or reduce primary risk factors • Use resident handling equipment, such as, • ceiling and portable floor lifts, air assist transfer devices, and mechanical sit to stand lifts • Must match equipment use with • Resident dependency (physical and cognitive abilities) • Type of lift, transfer or movement • Number of staff available

23. Preventing MSDS Second Choice: Administrative Controls • Reduce employee exposure to primary risk factors • Ergonomics training • Policy & procedures that define good work practices • Staffing and overtime practices • Job rotation

24. Preventing MSDS Second Choice: Work Practice Controls • Reduce employee exposure to primary risk factors by using best work methods: • Plan work organization • Use good housekeeping practices • Use adjustments on equipment • Get help when needed • Eliminate unnecessary movements • Don’t use broken equipment Remember – it’s the employee’s responsibility to use good work practices and follow the organizations’ safe resident handling policy and procedures

25. Preventing MSDs Second Choice: Work Practice Controls • Neutral spine posture - 3 Curves make your spine strong and minimize physical stress • It is important to KEEP THESE CURVES when moving, bending and lifting • Neutral spine is the reason body builders can lift so much weight without injury Cervical Thoracic Lumbar Using good body mechanics is important, even when using equipment, but alone body mechanics will NOT prevent MSDs

26. Conduct Ergonomic Risk Assessment • Recognizing hazards is the first step toward injury prevention • Job analysis performed by people with ergonomics training • Ergonomics team • Safety committee members • Line personnel

27. What Can You Do to Reduce Your Risk of MSDs? The following materials from the Safe Resident Handling in Health Care Guide, and made possible by a grant from Oregon OSHA, Department of Consumer and Business Services, 2004. Used with permission from Oregon Nurses Association, UO LERC and Bay Area Hospital, Coos Bay, OR

28. Risk Assessment steps • Assess the resident • Assess & prepare the environment • Get necessary equipment & help • Perform the Resident care task, lift or movement safely Plan and Prepare – It only takes a minute but can save a career

29. Assess the Resident Goal: To assess if resident status (physical and cognitive abilities) has changed and to determine the safest method to transfer or move the resident. Compare assessment with resident handling orders or instructions in the Resident's Care Plan and ensure that staff are alerted to changes in resident status.

30. Assess the Resident This brief observation includes assessment of the resident’s: • Ability to provide assistance • Physical status – ability to bear weight, upper extremity strength, coordination and balance • Ability to cooperate and follow instructions • Medical status – changes in diagnosis or symptoms, pain, fatigue, medications When in doubt, assume the resident cannot assist with the transfer/ repositioning

31. Assess & Prepare the Environment • Ensure that the path for transfer or movement is clear and remove obstacles and clutter that constrain use of good posture and access to the Resident, e.g., • bed tables, and chairs • trip hazards, e.g., cords from medical equipment • slip hazards , e.g., spilled beverages or other fluids on the floor

32. Assess & Prepare the Environment • Consider safe handling of medical devices, such as catheters, intravenous tubing, oxygen tubing, and monitoring devices • Ensure good lighting. • Adjust equipment, such as beds to correct working height to promote good postures • Keep supplies close to body to avoid long reaches

33. Get Necessary Equipment & Help • Get the correct equipment and supplies for the task as determined in the Resident Care Plan and after the Resident Assessment in Step 1 • Get additional help as required • Ensure that • Equipment is in good working order • Devices such as gait belts and slings are in good condition and the correct size • The resident is wearing non-slip footwear if they are to be weight bearing

34. Perform Resident Care Task, Lift or Movement Safely • Explain the task to the resident – agree on how much help he or she can give during the task • Position equipment correctly, e.g., height between a stretcher and bed is equal • Apply brakes on equipment and furniture used • Lower bed rails when necessary You should receive training on correct use of equipment, resident assessment and safe work practices before handling Residents

35. Perform Resident Care Task, Lift or Movement Safely • Coordinate the task as a team (nurses and Resident) • Have the Resident assist as much as possible • Use good body posture – keep work close to the body and at optimal height • Know your physical limits and do not exceed them Follow your organizations safe Resident handling policy and procedures

36. What else can you do? • Report ergonomic problems to your supervisor • Apply back injury prevention principles to your off -the-job activities • Report any physical problems early – leads to a quicker recovery

37. Case Studies Safe Resident Handling Program:Applied Ergonomics for Nurses and Health Care Workers

38. Case Studies • Case study 1: Repositioning resident in bed • Case study 2: Transfer from chair to bed • Case study 3: Transfer from bed to stretcher • Case study 4: Transfer from wheelchair to bed • Case study 5: Making a bed & repositioning resident in bed • Case study 6: Resident ambulation and fall recovery

39. Ergonomic Analysis Form

40. Case Studies • Remember – what you are about to practice is not a substitute for specific training on safe use of resident handling equipment • Not all resident handling equipment available is shown in the video • Always follow the Resident handling policy at your facility

41. Case Study 1Repositioning Resident in Bed What Did You See? • Identify primary risk factors for MSDs • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries • Determine the cause or the primary risk factors and hazards observed • Determine a safer way to perform the task

42. Case Study 1Repositioning Resident in Bed

43. Case Study 1Repositioning Resident in Bed

44. Case Study 1Repositioning Resident in Bed: The Safer Way • Assess the Resident • Has upper extremity strength, can sit unaided, is non-weight bearing, cooperative (consider medical status etc.) • Assess the Environment • Move bed table and phone, raise bed, lower rail when administering injection • Raise bed and lower bed rails before moving resident

45. Case Study 1Repositioning Resident in Bed: The Safer Way • Get Necessary Equipment & Help • Friction reducing device (slippery sheet) & two nurses or CNAs • Perform the Task Safely • Coordinate the move • Use good posture • Have resident assist

46. Case Study 2 Transfer from Chair to Bed What Did You See? • Identify primary risk factors for MSDs • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries • Determine the cause or the primary risk factors and hazards observed • Determine a safer way to perform the task

47. Case Study 2Transfer from Chair to Bed

48. Case Study 2Transfer from Chair to Bed

49. Case Study 2Transfer from Chair to Bed: The Safer Way • Assess the Resident • Partial weight bearing, cooperative, has upper extremity strength and can sit unaided • Assess the Environment • Move bed table, lower head of bed; lower bed rail using good posture

50. Case Study 2Transfer from Chair to Bed:The Safer Way • Get Necessary Equipment & Help • Powered Sit-to-Stand device • Only one caregiver needed • Perform the Task Safely • Apply equipment brakes when raising or lowering resident • Raise bed before lifting resident’s legs • Use good posture • Have Resident assist