For Healthcare Workers

1.  for Healthcare Workers

2. Fostering A Culture of Safety in a Health Care Environment Mary Willa Matz, MSPH VHA Patient Care Ergonomics Specialist Occupational Health Science Researcher Industrial Hygienist VISN 8 Patient Safety Center of Inquiry James A. Haley VA Hospital Tampa, Florida (813) 558-3928 (813) 558-3991 fax mary.matz@med.va.gov

3. Patient Care Ergonomics Training Based on: Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement www.patientsafetycenter.com Developed by: VA Patient Safety Center of Inquiry, Tampa, FL Audrey Nelson, PhD, RN, FAAN, Director Based on>>>>Based on>>>>

4. Patient Care Ergonomics Training Please note: The terms caregivers, nurses, and nursing staff are used interchangeably to depict health care providers. These terms apply to registered nurses, licensed practical nurses, certified nursing assistants, and nursing aides who provide direct patient care. Similarly, caregiving and nursing are also used interchangeably to depict the practice of providing care to patients.

5. Course Objectives On completion of this course, you will be able to: Implement a SPHM Program Identify Ergonomic and Other Hazards in Health Care Environments Make Effective Equipment Purchase and Use Decisions Train and Motivate Co-Workers in Safe Patient Handling and Movement Strategies Recognize why and how the SPHM Program fosters a “Culture of Safety”

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7. Biomechanics Research Lab

8. Patient/Employee Safety Engineering Lab

9. Patient Safety Simulation Lab

10. Gait and Balance Lab

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12. Purpose Provide a brief overview of the research related to nursing and musculoskeletal injuries-- pointing out what we know and common myths associated with nursing risks.

13. No wonder nurses are injured! In an eight hour shift, the cumulative weight that nurses lift equal to an average of ??? per day.

14. No wonder nurses are injured! In an eight hour shift, the cumulative weight that nurses lift equal to an average of 1.8 tons per day.

15. Significance of Problem Nursing is ranked 2nd after industrial work for physical workload intensity Nurses have approximately 30% more days off due to back pain as a percentage of all causes compared with 8% for the general population.

16. True or False? “Classes in body mechanics and lifting techniques are effective in reducing injuries”.

17. Common Myths “Classes in body mechanics and lifting techniques are effective in reducing injuries”. 30+ years of experience shows us training alone is not effective.

18. True or False? “Back belts are NOT effective in reducing risks to caregivers”.

19. Common Myths “Back belts are NOT effective in reducing risks to caregivers”. There is little to no evidence back belts are effective. It appears in some cases they predispose nurse to higher level of risk.

20. True or False? “Patient Handling Equipment is not affordable”.

21. Common Myths “Patient Handling Equipment is not affordable”. The long term benefits of proper equipment FAR outweigh costs related to nursing work-related injuries.

22. True or False? “Use of mechanical lifts eliminates all the risk of manual lifting”.

23. Common Myths “Use of mechanical lifts eliminates all the risk of manual lifting”. The patient must be handled in order to insert the sling. Furthermore, human effort is needed to move, steady, and position the patient.

24. True or False? “If you buy patient handling equipment, staff will use it”

25. Common Myths “If you buy it, staff will use it” Reasons staff do not use equipment: time, availability, time, difficult to use, space constraints, and patient preferences.

26. True or False? “Various lifting devices are equally effective”.

27. Common Myths “Various lifting devices are equally effective”. Some lifting devices are as stressful as manual lifting. Equipment needs to be evaluated for ergonomics as well as user acceptance.

28. True or False? “Staff in great physical condition are less likely to be injured”.

29. Common Myths “Staff in great physical condition are less likely to be injured”. The literature supports this is not true. Why? These staff are exposed to risk at a greater level; co-workers are 4X more likely to ask them for help.

30. True or False? “If you institute a No-Lift Policy nurses will stop lifting”.

31. Common Myths “If you institute a No-Lift Policy nurses will stop lifting”. Before Minimal Lift Policies are implemented, infrastructure needs to be in place -- technology and culture.

32. True or False? “Use of Patient Care Ergonomics will keep nursing staff and patients safer.”

33. Common Myths “Use of Patient Care Ergonomics will keep nursing staff and patients safer.” ABSOLUTELY! Let’s find out how and why….

34. Why the Focus on Patient Care Ergonomics?

35. Why the Focus on Patient Care Ergonomics? Nursing is a High Risk Occupation

36. Nursing is a High Risk Occupation OSHA Injury Incident Rates* Nursing Homes: 13.9/100 full time workers Industry: 6.1/100 full time workers *US Department of Labor, Occupational Safety & Health Administration. Hospital eTool- HealthCare wide hazards module: Ergonomics. Retrieved 6/12/02 from http://www.osha.gov/SLTC/hospital_etool/hazards/ergo/ergo.html

37. Although rates of total and lost time claims have been dropping in the private sector, in the field of health care these rates have been rising. This rise has occurred both in nursing homes and health care facilities. A major driver has been the increased rate of back injuries, injuries associated with high costs, high rates of residual permanent disability, and major reasons for premature retirement or leaving the field of health care. Although rates of total and lost time claims have been dropping in the private sector, in the field of health care these rates have been rising. This rise has occurred both in nursing homes and health care facilities. A major driver has been the increased rate of back injuries, injuries associated with high costs, high rates of residual permanent disability, and major reasons for premature retirement or leaving the field of health care.

38. Nursing is a High Risk Occupation 12% nurses leave the profession each year due to chronic/acute back injuries and pain (Charney, et.al, 1991) Over 52% nurses complain of chronic back pain lasting more than 14 days within the past 6 months (TerMat, 1993)

39. Nursing is a High Risk Occupation Why are Nursing Staff at High Risk?

40. Nursing is a High Risk Occupation What are the major causes of nursing injuries?

41. Nursing is a High Risk Occupation What are the major impacts of these injuries?

42. Why are Nursing Staff at High Risk? The sheer volume of lifting & turning of patients leads to fatigue, muscle strain, and injury Manual patient handling tasks are… intrinsically unsafe beyond the capabilities of the general work force

43. Why are Nursing Staff at High Risk? Still using unsafe Patient Handling Techniques… Many manual moving strategies have been outlawed in other countries Under Axilla Lift, Hook & Toss, Orthodox lift, Lift w/ patients’ arms around nurse’s neck UK, Australia, Netherlands, Ireland, British Columbia, S. Africa, Sweden, Denmark "The Guidance to the Manual Handling Operations Regulations (1992) recommends numerical guidelines on weights to manual handling. The figure given effectively preclude all lifting of patients....It is unsafe to lift at arm's length, at a distance from the body, either in front of or to one side....there are a number of unsafe patient handling methods that are still in routine use. They have long been condemned and should be proscribed. - the Drag lift - any lift where the nurse's arms are under the axilla of the patient - the Orthodox lift - traditional method whereby two nurses stood either side of the bed and lifted a patient on their clasped wrists under the patient's back and thighs. - lifting with the patient's arms around the nurse's neck - the use of poles and canvas The following lifts should not be used under any circumstances: - two sling lift - two people using a sling under the body to lift - through arm lift - two people with one set of arms under elbow and the other under the knees - through arm lift with one nurse and patient helping - the nurses reaches around in back of the patient and grasps the patient around the waist. - the shoulder lift - caregivers kneel on bed and patient places arms over the caregivers back - the shoulder slide - using the shoulder lift with slide sheets - the shoulder lift to transfer the patient from bed to chair/chair to toilet and vice versa - the shoulder lift from bed to chair - using a through arm lift to transfer to a wheelchair - through arm to transfer to a hammock - front transfer with one nurse - the pivot transfer - the elbow lift - the bear hug - belt holds from the front" and there are a few others that are variations on the theme. These all come from the chapter "unsafe lifting practices." They go on to say that "claims [from nurses where a failure of duty of care] are not hard to win because the principles have now been well established." And, "Criminal prosecutions also arise fro breaches of the Manual Handling Operations regulations." "The Guidance to the Manual Handling Operations Regulations (1992) recommends numerical guidelines on weights to manual handling. The figure given effectively preclude all lifting of patients....It is unsafe to lift at arm's length, at a distance from the body, either in front of or to one side....there are a number of unsafe patient handling methods that are still in routine use. They have long been condemned and should be proscribed. - the Drag lift - any lift where the nurse's arms are under the axilla of the patient - the Orthodox lift - traditional method whereby two nurses stood either side of the bed and lifted a patient on their clasped wrists under the patient's back and thighs. - lifting with the patient's arms around the nurse's neck - the use of poles and canvas The following lifts should not be used under any circumstances: - two sling lift - two people using a sling under the body to lift - through arm lift - two people with one set of arms under elbow and the other under the knees - through arm lift with one nurse and patient helping - the nurses reaches around in back of the patient and grasps the patient around the waist. - the shoulder lift - caregivers kneel on bed and patient places arms over the caregivers back - the shoulder slide - using the shoulder lift with slide sheets - the shoulder lift to transfer the patient from bed to chair/chair to toilet and vice versa - the shoulder lift from bed to chair - using a through arm lift to transfer to a wheelchair - through arm to transfer to a hammock - front transfer with one nurse - the pivot transfer - the elbow lift - the bear hug - belt holds from the front" and there are a few others that are variations on the theme. These all come from the chapter "unsafe lifting practices." They go on to say that "claims [from nurses where a failure of duty of care] are not hard to win because the principles have now been well established." And, "Criminal prosecutions also arise fro breaches of the Manual Handling Operations regulations."

44. Why are Nursing Staff at High Risk? Patients are asymmetric & bulky Patient assistance varies Patient handling tasks are unpredictable Patients are getting larger

45. Why are Nursing Staff at High Risk? Patients have changed… Patients are sicker Patients are more physically dependent on staff So…. there is more risk of injury to staff.

46. Unsuccessful Handling & Movement… Can lead to Patient/Resident: Falls Skin Tears Bruises Pain Resistant Behavior

47.  Why Do We Need Patient Care Ergonomics? Nurses Perform Risky Activities… Perform activities that require excessive trunk bending and/or twisting Perform repetitive motions patterns for long periods of time Maintain body posture for prolonged period of time without change Lift heavy materials Lift unstable materials More…… Stressful activities come in numerous types—some obvious others not so obvious. It is fairly obvious that bending your back excessively and/or for long periods of time may lead to injury. It is also intuitive that lifting heavy objects or loads that shift may also create injury. Not as obvious is the fact that restricting motion and holding the back in a position for an extended period of time may also cause injury.Stressful activities come in numerous types—some obvious others not so obvious. It is fairly obvious that bending your back excessively and/or for long periods of time may lead to injury. It is also intuitive that lifting heavy objects or loads that shift may also create injury. Not as obvious is the fact that restricting motion and holding the back in a position for an extended period of time may also cause injury.

48. Why Do We Need Patient Care Ergonomics? Brown, 1972 Dehlin, et al, 1976 Anderson, 1980 Daws, 1981 Buckle, 1981 Stubbs, et al, 1983 St. Vincent & Teller, 1989 Owen & Garg, 1991 Harber, et al, 1994 Larese & Fiorito, 1994 Lagerstrom & Hagberg, 1997 Daltroy, et al, 1997

49. What is Patient Care Ergonomics?