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Back Safety, Safe Patient Handling, & Assisted Mobility Skills PowerPoint Presentation
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Back Safety, Safe Patient Handling, & Assisted Mobility Skills

Back Safety, Safe Patient Handling, & Assisted Mobility Skills

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Back Safety, Safe Patient Handling, & Assisted Mobility Skills

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  1. Back Safety,Safe Patient Handling,& Assisted Mobility Skills Finger Lakes DDSO New Employee Orientation April 2012

  2. What is Back Safety/Safe Patient Handling(SPH)?1 • A set of policies and programs designed to decrease the strain and injury on staff while they move and care for consumers • Focuses on minimizing and eliminating manual lifting by using equipment instead of the caregiver’s body • Legislation in NYS is passed in the Assembly and is pending in the Senate to make SPH mandatory in all healthcare facilities.

  3. Why is Back Safety/Safe Patient Handling important? • Healthcare work is among the most hazardous occupations in NYS2 • Back injury is the 2nd leading occupational injury3 • Back injuries are expensive2 • Cost of medical care • Cost to pay overtime coverage • Significant time is lost with injury • Mandated overtime, training new staff • Safe body mechanics are not enough to prevent injury3,5 • Prior to SPH, stand pivot transfers were the #1 way FLDDSO staff were injured when caring for consumers

  4. Benefits to Staff2 • Decreases Injuries • Decreases Pain and Muscle Fatigue • Decreases Lost Work Days • Decreases Overtime • Increases Morale • Increases Job Satisfaction • “My company/supervisor/worksite cares about me!” • SPH is an investment in the employee

  5. Consumer Benefits of SPH2 • Improves quality of life • Lowers levels of depression and “behaviors” • Consumers feel more secure and less anxious when being transferred in a consistent manner • Improves urinary continence • Increases consumer participation in activities • Increases level of daytime alertness • Increases/maintains upper extremity ROM • Decreases fall risk • Decreases in fractures (spiral, compression) • Decreases skin tears and bruising

  6. What About the Consumers? • Bottom line: • We can not provide safe care for the consumers if we do not take care of ourselves!

  7. Back Safety Injuries Risk Factors Proper Lifting

  8. Healthy Spine Image from Image from

  9. Posture • Purpose of the spine: • Protects the spinal nerve • Demo: posture/curves • Muscles support the spine • Back muscles tend to be small in size • Lifting muscles are larger quads and gluts • Good posture relies on flexibility & core strength • Stretch your low back into extension • Strengthen your abs Image from:

  10. Risk Factors2,3,6,7,8,9 • Poor posture • Stretches & weakens key muscles • Examples: car seating, brushing teeth, washing dishes • Frequency of forward flexion • Typically 3,000-5,000 times/day • Previous injury • Known or unknown • Lack of exercise • Lack of social support • Low job satisfaction • Age • Lifting more than 35lbs • NIOSH safe weight limit • Lack of sleep • Less than 8 hours • Smoking • Decreases body’s ability to heal

  11. Microtraumas: “Unknown” Injuries • Mechanical processes • Compression • Shear • Rotation/Twist • Awkward Postures Image from

  12. Common Injury in Spine • Disc Herniation • Over time the outer layer of the disc weakens from repeated microtraumas • The inner jelly of the disc bulges out of position, usually toward the back where it can put pressure on the nerve Image from

  13. Other Common Injuries • Muscle Strain • Tear in muscle fibers • Pain • Inflammation • Tightness • Tendinopathy • Pain • Tenderness • Related to gradual wear & tear • Compression Fracture • Directly related to disc health • Various Locations • Shoulder • Rotator cuff, impingement • Knees • Torn cartilage, ligament issues • Neck • Nerve problems radiating down arm, stiffness

  14. Body Mechanics DO DO NOT • Get in the ready position • Wide base of support • One foot slightly forward • Firmly plant your feet • Soften your knees • Wear appropriate clothing and footwear • Per DDSO dress code, shoes must cover toes and have flat contact with ground • Make quick and jerky movements • Causes strain on back muscles • Twist when lifting • “Keep nose and toes pointed in the same direction” • Wear clothing that interferes with safe patient care • Large jewelry • Shoes with high heels, flip-flops

  15. Body Mechanics / Lifting • Assess the situation • Know your limitations • Is there equipment available to make this safer? • Plan ahead and prepare the environment • Clear pathway • Hold the load close and firm • Hips & shoulders square to load • If hold is not firm- start over! • With heavy objects, break up the load • Communicate with other staff member and consumer

  16. Chores Challenge • Laundry • Top loading washer & front loading dryer • Making beds • Shoveling snow • Push, squat, do not toss over shoulder • Yard work • Use wheelbarrows, kneel on knee pads • Carrying groceries & supplies • Divide up loads, use carts on wheels

  17. SPH & Assisted Mobility Skills

  18. Course Objectives • Given direction by a licensed physical or occupational therapy staff, the FLDDSO new employee/trainee will demonstrate their knowledge by performing the following: • General concepts for joint range of motion (not specific to a consumer) • General concepts to prevent and manage decubiti (pressure sores) • Safe and effective transferring and handling techniques including use of non-friction devices, rolling devices, mechanical floor lifts, sit/stand lifts and gait belts • Safe and effective positioning of consumers on support surfaces (wheelchairs, beds)

  19. Competencies • 4.17 Lifting & Transferring • 4.19 Range of Motion • 3.5 Blind Trailing-Mobility Techniques for consumers with Visual Deficits • Competencies get officially signed at the worksite. This class will give you the basics and will result in signature in the “Comments” section of these 3 competencies.

  20. Range of Motion (ROM) = The available movement at a joint ROM deficits are commonly seen in: • Consumers with cerebral palsy (high tone) • Consumers who have had a stroke (high tone) • Consumers with arthritis (cartilage less pliable) Benefits of Joint Movement • Increased comfort and flexibility • Increased circulation and nutrition to joint • Maintenance of ADLs (dressing, bathing, etc.) • Greater ease for staff to perform skin/hygiene care

  21. ROM Programs • ROM is performed by staff when muscle and/or joint tightness: • Interferes with cleanliness and hygiene care • Interferes with dressing • Causes pain and discomfort • Formal programs may be provided by OT/PT • Found in the IPOP • Require further consumer specific training by the therapist

  22. Keys to Remember • Your approach matters: • Quiet voice, dim lights, firm, but gentle touch, after a warm bath/shower • Always tell the consumer what you are doing • Surround the joint • One hand on each side of the joint • Only range one joint at a time • Full hand control • Keep fingers together, flat surface • Fingertips can bruise; avoid claw hands • Smooth and controlled • Never push into restrictions • Never bounce • Move slowly: fast jerks can increase tone and cause injury

  23. ROM Terms to Know • Flexion • To bend • Extension • To straighten • Abduction • Moving the body part away from midline • Abduct means to take away! • Adduction • Moving the body part towards midline • “ADD”ing to the body • Internal Rotation • Rotation towards the center of the body • External Rotation • Rotation away from the center of the body

  24. Flexion • Extension Images from

  25. Abduction • Adduction Images from

  26. Internal Rotation • External Rotation Images from

  27. Decubitus Ulcers“Pressure Ulcers” “Bed Sores” • Risk factors • Boney areas of the body • Tail bone, heel, ankle, hip, elbow, back • Prolonged pressure • Healthcare best practice requires repositioning at least every two hours! • Fragile skin • Decreased circulation • Diabetes, other vascular diseases • Poor nutrition • May have adequate intake, but poor absorption

  28. Decubitus Ulcers • Risk Factors continued… • Friction • Repeated movement across a surface • Shearing • Body tissue moves over top the skin which has adhered to the support surface • Example: bare legs on a vinyl car seat on a hot day • Moisture & heat • Sweat • Incontinence • Bowel and bladder • Caustic to skin

  29. Decubitus Ulcers • Most are preventable by • Keeping the skin clean and dry • Changing position at least every 2 hours • Properly using support surfaces that relieve pressure • seat cushions, mattresses… • Assuring clothing is not a risk factor • avoid jeans, avoid nylon pants, ensure footwear is ON when in wheelchair

  30. Discussion points on seating demo • Tell us about how you feel after being on improper seating during the short discussion • Remember that consumers sit in positions for up to two hours at a time • Make sure consumers are seated appropriately! • Fragility of consumer skin even before seating concerns

  31. Cushion 101 • Used for pressure relief, comfort, and positioning • Positioning cushions have: • Bump in front to separate legs • Soft well in the back for tailbone • Check to make sure they are in properly • Hand sweep to check front and back • Check the labels • Often labeled front and back • Do not assume the cover is on the cushion correctly

  32. Wheelchair parts Pelvic Positioning Belt Hand Rim Rear Anti-Tippers Front Castor

  33. All WCs used by consumers at the FLDDSO must have: • 2 working brakes (wheel locks) • Pelvic positioning belt (seat belt) • Rear anti-tippers • Arm rests • Foot rests • may be removed inside buildings for people who foot propel, must be replaced prior to transportation • Tilt chairs must have headrests *Any exceptions are found in the IPOP

  34. Wheelchair Maintenance & Care • Frequent cleaning necessary for function • Not just for night shift • Cleaning should occur as chair gets soiled • Especially following meals • Upholstery should be wiped down • More to come with Personal Care Skills course… • If the wheelchair is broken or missing parts, DO NOT bring consumer to day program or outings • Cannot be transported in that condition • Immediately contact OT, PT, house or program managers

  35. “Soft Goods” include: Wheelchair Cushion Covers Canvas and Mesh Slings Non-friction sheets for bed repositioning One-way (anti-slip) devices Gait belts Washing Hand wash Machine wash: lukewarm water & detergent Garment bag may be used **DO NOT USE BLEACH** Drying All soft goods MUST be hung or laid flat to dry **DO NOT PUT IN THE DRYER** Soft Goods Maintenance & Care

  36. Bed Mobilityand Positioning

  37. Keys to Bed Mobility and Positioning • COMMUNICATION • Always talk to the consumer to tell them what you are doing; ask them to help if they can assist • Always talk to the other staff person • Don’t forget good body mechanics • If the task is unsafe or difficult, is there equipment that would make it safer and easier? If you aren’t sure, ask a PT or OT!

  38. Supine positioning • Body position • laying on their back • Pressure points • Back, tail bone, heels, back of head, elbows • Use bed controls for positioning • Pillow/support placement • Under head • Under knees • Behind calves • Heels floating Image from

  39. Side-lying positioning • Body position • Head, neck, trunk, and hip aligned • Both legs bent at hips and knees • Pressure points • Shoulder, hip, knees, ankles • Pillow/support placement • Under head • Between knees • Supporting top arm • Behind back Image from Image from

  40. SPH Rolling • Communicate with the consumer and other staff • Equipment possibilities include: • Non-friction sheets • Positioning devices (Tri-turner, full body, split sheet) • Grab bars (side rails, bed assist bars) • Position the person for best mechanical advantage • Bend knee opposite the direction of the roll or cross leg over towards roll • Ensure their arms are out of the way

  41. Rolling With SPH Techniques & Devices • Top Sheet (“Split Sheet”) • Used with mechanical lifts • Used for wound care, pressure relief • Can be used with 1 or 2 staff members because it is for positioning & is not a transfer out of bed • Must be left on bed • Make the bed with the Top-Sheet on Images from

  42. More SPH Techniques & Devices • Non-Friction Sheets • Use: Repositioning up/down, side/side in bed, rolling for care in sidelying • Closed end of tube in the direction you are moving the consumer • Headfoot for up/down positioning • Sideside for lateral shift or rolling • Must be used with two staff • Must hold and use secondary sheet (draw sheet/cloth chux) atop NF sheet • Rules for Non-Friction Sheets • Hands are never on the NF sheet after it is under the person • Hands are driving DOWNWARD into the bed • Lunge/step to move, square body towards direction you are going • Arms/legs/trunk move as ONE unit • Place and remove without turning or rolling consumer • Tuck method in demo lab • Does NOT stay on bed Images from

  43. Transfers

  44. Gait belts Image from • Why • Consistent, firm grasping surface for staff • Provides a sense of security to the consumer • Protects both parties from injury when transferring or ambulating • When • Consumer requires assistance to maintain balance standing or ambulating as determined by PT/OT/RN with input from staff • Remember • NOT a lifting belt • Consumer must have good sitting balance • Consumer must be able to move their feet • Should not require lifting to maintain standing position • Not intended to prevent most falls • Always hold at the handle • Make sure belt is snug but not restrictive • Be aware of location of medical concerns (tubes)

  45. Assistance Levels • Contact Guard • Gait belt required • Hands on the gait belt • Used when consumer requires physical and/or directional guidance and verbal cueing • Stand-By Guard • Gait belt frequently required • Within an arms reach of the consumer, prepared to assist if needed • Used when consumer only needs occasional balance assistance or guidance • Range of Scanning • Visual supervision *Level of assistance determined by PT/OT/RN • Documented in IPOP

  46. Keys to Transfers with Mechanical Devices • COMMUNICATION • Always talk to the consumer to tell them what you are doing; ask them to help if they can assist • Always talk to the other staff person • Don’t forget good body mechanics • If the task is unsafe or difficult, is there equipment that would make it safer and easier? • If you aren’t sure, ask a PT or OT!

  47. Lifting Sling Sizing and Materials Sizing • Height • Mid-head to mid-buttock for full coverage • Width • 2-3 finger-width of material on either side of body • Weight • Slings will have weight as well as sizing restrictions • Check label • Color Coded (most) • Small= red, Medium= yellow, Large= green, XLarge= blue Materials • Canvas/Quilted • Dry transfers only (not for bathing) • Not left under consumer • Mesh • ANY transfer, including bathing • Typically best if IPOP requires sling to stay under consumer • Dries fastest

  48. Lifting Sling Check • When to NOT use sling: • Frayed material on loops (even if it’s not the loop you will be using) • Holes in any portion of sling • Cut-off loops • Evidence of previous repair (sewn) • Evidence of being shrunk in washer • Dusty residue from previous bleaching • Report to supervisor if you take sling out of use, clearly label concern on sling • Contact OT/PT

  49. Lifting Sling Types… • Split Leg Sling • Has full trunk and separate leg extensions to support each leg • Available with or without head support • Can be placed & removed with consumer in chair Images from and

  50. Lifting Sling Types… • Full Body Sling • Must stay under consumer • Ideally, it should be mesh • Head control • No separate pieces for legs Image from