1 Safe Patient Handling Program: Applied Ergonomics for Nurses and Health Care Workers This material has been possible by a grant from Oregon Occupational

1

Safe Patient Handling Program: Applied Ergonomics for Nurses

and Health Care Workers

This material has been possible by a grant from Oregon Occupational Safety and Health Division, Department of Consumer and Business Services 2004.

2

Session Objectives Identify activities at work or away from work that could put you at

risk of Musculoskeletal Disorders (MSDs).

Identify the primary risk factors that can contribute to the development of work related MSDs.

Define why manual patient handling tasks are unsafe.

Define health care ergonomics.

Define engineering, work practice and administrative controls.

Identify examples of work practice controls that can help reduce your risk of injury when performing patient handling and care tasks.

Describe the four action steps that can reduce your risk of injury.

3

Session Agenda

Background

The ABC Hospital Safe Patient Handling Program

Applied Ergonomics for Nurses and Health Care Workers Video: Section 1

Review Key Points from Video

Applied Ergonomics for Nurses and Health Care Workers Video: Section 2 – Case Studies

Case Studies: Discussion and Group Work

Quiz and Evaluations

4

Brand names mentioned or seen in the training video do not constitute endorsement of the device, equipment or product by the Oregon Occupational Safety and Health Division, Oregon Nurses Association, Bay Area Hospital, the University of Oregon's Labor Education and Research Center or other organizations who support this grant.

Equipment shown in this video may vary from the equipment used by your health care facility. Not all patient handling equipment available is shown in the video.

This training session is not a substitute for specific training on safe use of patient handling equipment.

Always follow the patient handling policy at your facility.

5

Background

Safe Patient Handling Program: Applied Ergonomics for Nurses and

Health Care Workers

6

The most common MSDs reported by nurses and nursing aides are strains or sprains and injuries due to overexertion (lifting, pushing or pulling) associated with patient handling tasks.

At risk Occupations for Strains and Sprains, 2000# 1 Truck Drivers# 2 Nursing aides, orderlies & attendants# 3 Laborers# 6 RN’s# 18 LPNs

Source: U.S. DOL, 2002

The Incidence of MSDs in Health Care

7

Why is Manual Patient Handling So Hazardous?

The Physical Demands of Work– Patient

• Weight (heavy load)• Shape (bulky and awkward)• Behavior (unpredictable, confused, fragile, in

pain)

– High repetition of tasks

Equipment and Facilities Design– Constricted work space– Poorly maintained equipment

8


Poor Work Practices– Adjustments on equipment (e.g., bed) not used

Personal Factors– Off the job activities e.g., Lifting and handling

children; trash; shopping, or performing yard work, etc

– Previous InjuryRemember: Using good bodymechanics is not

enough to prevent back injuries and other MSDs caused by manual patient handling.

9

The physical effort requiredto repeatedly lift and move patients manually is greater than your musculoskeletal system can tolerate.


The bottom line…….

There is No Safe method to lift and transfer patients manually

Compression

Shearing

Rotation

Arrows show direction of load or force on lower back (L5/S1) when manually lifting and moving patients

10

Risk Factors for MSDs


Health Care Workers

11

What are Musculoskeletal Disorders (MSDs)?

Chronic or Cumulative:

Injuries that occur over a period of time (months/years)

& are caused by a combination of risk factors

Acute:

A sudden or one-time traumatic event or incident, e.g., slip, trip, fall or car wreck

MSDs affect ligaments, muscles, tendons, cartilage, blood vessels & nerves & spinal discs

12

Some Common MSDs

Tendinitis & Tenosynivitis (upper extremities)

Epicondylitis (Tennis Elbow/Golfer’s elbow)

Rotator Cuff Tear (shoulder)

Bursitis (shoulder or knees)

Strains and Sprains(neck, back, shoulder)

Low Back Pain & Sciatica

Bulging or Herniated Spinal Discs

Carpal Tunnel Syndrome

13

TimeTimeAwkward & Static Postures

RepetitionRepetition

ForceForce

Primary Risk Factors For MSDs

At work and/or at home

14

Awkward Posture & MSDs

Definition:Position of the body when performing physical tasks

Awkward postures cause biomechanical stress to joints and surrounding soft tissues. Strength to the body part is decreased accelerating muscle fatigue and increasing risk of injury.

Awkward Postures include:

Bending Twisting Reaching overhead

Kneeling SquattingPinch grips

15

Awkward Posture & MSDs

Examples: Providing medical care or performing personal

hygiene tasks when the patient is in a chair or bed that is too low

Accessing medical equipment such as in-wall oxygen or suction equipment

Manually repositioning or transferring patients

16

Static or Fixed Postures & MSDs

Definition:Postures or work positions that are held for a period of time

Blood supply reduced to muscles muscle fatigue

17

Examples:

Prolonged standing or sitting

Performing patient care tasks or making a bed while bending forward at the waist for a few minutes or longer

Supporting a patients extremities or heavy instruments during a nursing task or medical procedure

Static or Fixed Postures & MSDs

18

Definition:Amount of physical exertion or muscular effort expended when performing a task or activity such as lifting, pushing, pulling, carrying or gripping tools or equipment

The greater the force exerted and/or sustained over time accelerates muscle fatigue and increases risk of injury

Force and MSDs

19

Force and MSDs

The amount of force exerted is influenced by the:– Weight, shape and condition of the patient or

equipment– Body posture used– Number of repetitions performed – Duration or length of time that task is performed

Examples: Load or patient shifts suddenly or unexpectedly Lifting bariatric or obese patients Pushing a stretcher with poorly maintained or

incorrect casters

20

Definition:Performing the same motion over and over again.

Example: Repeated positioning of patients in bed or

transfers to chairs

Repetitions and MSDs

21

The Cumulative Effect

When the musculoskeletal system is exposed to a combination of these risk

factors (too quickly, too often and for too long) without sufficient recovery or rest

time, damage occurs

Duration of Exposure to Risk Factors (Time)

Affected by:

Working through breaks Overtime Task variability

22

Fatigue

Discomfort

Pain

Injury

Disability

Continued Exposure to

Risk Factors

Time

The Cumulative Effect

23

Patient HandlingHigher Risk Tasks

Transfer from/to bed to chair or stretcher

Manually moving patient in bed

Manually lifting from floor

Attempting to stop falls

(Source:Hignett, 2003)

24

PreventionEmployee Safety=Patient Safety


Health Care Workers

25

Defining Health Care Ergonomics

The science of fitting the physical and cognitive demands of thejob to the worker to prevent injury, human error and improve

worker and patient comfortor

Capabilities ofPeople

Demands ofthe Job

“Fitting the Job to the Worker”

NOT

“Fitting The Person To The Job”

26

First Choice (or Method): Engineering Controls

Eliminate or reduce primary risk factorse.g., Use patient handling equipment, such as,

ceiling and portable floor lifts, air assist transfer devices and mechanical sit to stand lifts

Must match equipment with: - patient dependency

(physical and cognitive abilities), - the type of lift, transfer or movement - the number of staff available

Preventing MSDS

27

Second Choice: Work Practice Controls

Reduce employee exposure to primary risk factors by using best work methods, e.g.,

Plan work organization Use good housekeeping practices Use adjustments on equipment Get help Eliminate unnecessary movements Don’t use broken equipment

Preventing MSDS

Remember – it’s the employee’s responsibility to use good work practices and follow the organizations’ safe patient handling policy and procedures

28

Second Choice - Work Practice Controls

Use neutral or good body postures- Neutral postures reduce physical stress on

musculoskeletal structures and enable optimum blood flow to the musculoskeletal system.

- Your body is in the strongest and most balanced position.

Example:Work at proper heights & keep everything in easy

reach

Preventing MSDS

Using good body mechanics or postures is still important when using patient handling equipment and devices

29

Neutral Standing Posture

Neutral Posture for WorkPerformed in Standing Position

Stand with feet shoulder width apart Knees are flexed/unlocked Head upright Shoulders relaxed (not rolled forward) Chest up Back straight Elbows not locked or flexed more than 110

degrees Wrists straight Ears, shoulders, hips, knees and ankles

should be in straight alignment to maintain natural “S” curve of the spine (neutral position)

Ears

Shoulder

Hips

Knees

Ankles

30

Optimal Work Height & Reach Envelopes

Best

Good

Fair

Poor

Fair

Poor

Best

Fair

Poor

Primary

Secondary

31

Second Choice: Administrative Controls

Reduce employee exposure to primary risk factors, e.g.,

Ergonomics training Policy & procedures that define good work

practices Job rotation Staffing and overtime practices

Preventing MSDS

32

Preventing MSDS

Engineering +

Work Practice+

Administrative Controls

= Reduce the Risk of Injury for

Employees & Patients

Remember - back belts are ineffective in preventing back injuries

33

What Can You Do to Reduce Your Risk of MSDs?

34

Conduct a hazard or risk assessment

1. Assess the patient

2. Assess & prepare the environment

3. Get necessary equipment & help

4. Perform the patient care task, lift or movement safely

What Can You Do to Reduce Your Risk of MSDs?

Plan and Prepare – It only takes a minute but can save a career

35

1. Assess the Patient

Goal:

To assess if patient status (physical and cognitive abilities) has changed and to determine the safest method to transfer or move the patient.

Compare assessment with patient handling orders or instructions in the Patient's Care Plan and ensure that staff are alerted to changes in patient status.

36

1. Assess the Patient (continued)

This brief observation includes assessment of the patient’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 patient cannot assist with the transfer/ repositioning

37

2. Assess & Prepare the Environment

Ensure that the path for transfer or movement is clear and remove (using good body posture) obstacles and clutter that constrain use of good posture and access to the patient, 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

38

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

2. Assess & Prepare the Environment (continued)

39

3. Get Necessary Equipment & Help Get the correct equipment and supplies for the task as

determined in the Patient Care Plan and after the Patient 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 patient is wearing non-slip footwear if they are to be weight bearing

40

4. Perform the Patient Care Task, Lift or Movement Safely

Explain the task to the patient – 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, patient assessment and safe work

practices before handling patients

41

Coordinate the task as a team (nurses and patient)

Have the patient 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 patient handling policy and procedures

4. Perform the Patient Care Task, Lift or Movement Safely

(continued)

42

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 = Quicker Recovery

43

Case Studies

Case Study 1: Repositioning Patient in Bed

Case Study 2: Transfer from Chair to Bed

Case Study 3: Transfer from Bed to Stretcher

Case Study 4: Transfer from Wheel Chair to Bed

Case Study 5: Making a Bed & Repositioning Patient in Bed

Case Study 6: Patient Ambulation and Fall Recovery

44

Case Studies

Remember – What you are about to practice is not a substitute for specific training on safe use of patient handling equipment.

Not all patient handling equipment available is shown in the video.

Always follow the patient handling policy at your facility.

45

Case Study 1Repositioning Patient 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

46

Case Study 1Repositioning Patient in Bed

Task Risk Factors & Hazards Cause

Injection of medication

Back bent & twisted coupled with static posture

Trip Hazard

Bed too lowRail upBed table

obstructs access

Phone on bed – cord on floor

Dispose of needle

Back bent Neck bent backwardsLong reach (arm overhead)

Bed table obstructs access

47

Case Study 1Repositioning Patient in Bed (continued)

Task Risk Factors & Hazards

Cause

Reposition patient

Back bent & twisted

Neck bent backwards

Forceful exertion– back and shoulder

Bed too low

Rail up

Weight of patientPatient did not assist

48

Assess the Patient– 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

patient

Case Study 1Repositioning Patient in Bed:

The Safer Way

49

Get Necessary Equipment & Help– Friction reducing device (slippery sheet) & two

nurses or caregivers

Perform the Task Safely– Coordinate the move– Use good posture– Have patient assist

Case Study 1Repositioning Patient in Bed:

The Safer Way (continued)

50

Case Study 2Transfer from Chair to Bed

What Did You See?





51


Cause

Assisting patient from chair to bed

Forceful exertion – back

Back bent & twisted

Patient weight

Patient not capableof bearing full Weight

Patient notassessed

Chair too low

Case Study 2Transfer from Chair to Bed

52


Cause

Assisting patient onto bed

Forceful and suddenexertion – back

Back bent & twisted

Neck bent backwards

Patient not capable of full weight bearing

Patient not assessed

Repositioning in bed


Back bent & twisted

Neck bent backwards


Bed too low

Case Study 2Transfer from Chair to Bed (continued)

53

Assess the Patient– 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

Case Study 2Transfer from Chair to Bed:

The Safer Way

54

Get Necessary Equipment & Help– Powered Sit-to-Stand device– Only one caregiver needed

Perform the Task Safely– Apply equipment brakes when raising and

lowering patient – Raise bed before lifting patient’s legs– Use good posture– Have patient assist

Case Study 2Transfer from Chair to Bed:


55

Case Study 3Transfer from Bed to Stretcher

What Did You See?





56


Cause

Positioning stretcher in room

Back bent and twisted

Sharp corners or protruding edges on furniture (risk of soft tissue contusion)

Poor posture orbodymechanics

Moving furniture in constricted space

Preparing transfer

Back bent

Long reach (arm overhead)

Passing IV bag and tubing over bed

Case Study 3Transfer from Bed to Stretcher

57


Cause

Performing transfer

Extreme forceful exertion – back and shoulders

Back bent

Neck bent backwards

Extreme bending of knee (on bed) coupled with force

Extended reach to grasp drawsheet

Forceful grip (poor hand hold)

Patient weight and shape

Patient unable toassist

Stretcher higherthan bed height

Width of stretcher and bed

Use of drawsheet tomove patient

Case Study 3Transfer from Bed to Stretcher (continued)

58


Cause

Moving the stretcher

Forceful exertion - back and shoulder

Back bent and twisted

Neck bent backwards and twisted

Arms extended away from body

Pushing and Pulling stretcher oncarpeted surface

Lack of holder onstretcher foroxygen tank

Lack of steeringcontrol on stretcher

Stretcher too low

Case Study 3Transfer from Bed to Stretcher (continued)

59

Assess the Patient– This is a Bariatric patient who cannot assist

with the transfer

Assess the Environment– Move furniture from of work area before

bringing stretcher into room

Case Study 3Transfer from Bed to Stretcher:

The Safer Way

60

Get Necessary Equipment & Help– Air assisted friction-reducing device & three

caregivers– Pass IV bag around patient– Stretcher has holder for IV and Oxygen tank– Larger wheels and steering assist mechanism



61

Perform the Task Safely– Coordinate the preparation and transfer– Work heights equal and equipment/bed brakes

applied– Use good posture – Adjust stretcher height for movement to allow

good posture – 2nd person required to guide front of stretcher

only



62

Case Study 4Transfer from Wheel Chair to Bed

What Did You See?





63

Case Study 4Transfer from Wheel Chair to Bed


Cause

Preparing to Assist the Patient

Forceful exertion - back

Back bent

Neck bent backwards

Holding patient’s leg while adjusting foot rest

Adjusting leg supports/foot rests

Assisting patient from wheelchair to bed


Back bent & twisted


Patient weight

Patient not assessed

64


Cause

Assisting patient onto bed

Forceful and sudden exertion – back

Back bent & twisted

Neck bent backwards


Patient not Assessed

Wheel chair awayfrom bed

Case Study 4Transfer from Wheel Chair to Bed (continued)

65


Cause

Repositioning in bed

Forceful exertion -back

Back bent & twisted

Neck bentbackwards

Bed too low

Bed rail up

Head of Bed partially raised

Patient does not assist

Case Study 4Transfer from Wheel Chair to Bed (continued)

66

Assess the Patient– Partial weight bearing, cooperative, has upper

extremity strength and can sit unaided

Assess the Environment– Move bed table, raise bed, raise head of bed,

lower bed rail using good posture

Case Study 4Transfer from Wheel Chair to Bed:

The Safer Way

67

Get Necessary Equipment & Help– Gait belt; crutches and trapeze bar– Only one caregiver needed



68

Perform the Task Safely– Use good posture to apply gait belt and to

adjust wheel chair foot supports– Have patient assist to hold leg while adjusting

foot support– Do NOT lift but guide patient to a standing

position– Have patient transfer self to bed with stand-by

assist– Have patient reposition self on bed



69

Case Study 5Making a Bed and Repositioning

Patient in Bed

What Did You See?





70


Making the bed

Forceful exertion – back and shoulders (nurse turning & holding patient)

Back bent & twisted in static posture (nurse turning & holding patient)

Repetitive bending & twisting of back (nurse making bed)

Neck bent backwards (both nurses)

Weight of patient

Patient unable to assist

Bed too low

Bed Rails up


Patient in Bed (continued)

71


Making the bed

Forceful grip - Poor hand hold (nurse turning & holding patient)

Slip Hazard

Using drawsheet

Spill on floor

Repositioning patient up in bed

Forceful exertion – back and shoulder

Back bent & twisted

Neck bent backwards & twisted

Weight of patient

Patient unable to assist

Bed too low

Rail up


Patient in Bed (continued)

72

Assess the Patient– This is a semi-conscious patient who is unable

to assist

Assess the Environment– Clean up spill, have bed linens ready, raise bed

and lower rails


Patient in Bed: The Safer Way

73

Get Necessary Equipment & Help– Ceiling hoist and 2 nurses or caregivers

Perform the Task Safely– Coordinate lift and movement– Each nurse makes a side of the bed– Move bed and/or use ceiling lift to reposition

patient safely


Patient in Bed: The Safer Way (continued)

74

Case Study 6Patient Ambulation and Fall Recovery

What Did You See?





75


Ambulating patient

Trip hazards

Sharp corners or protruding edges on furniture (risk of soft tissue contusion)

Poor and unstable coupling (handhold)

Equipment in walkway

No safe way tosupport patient – holding wrist may cause softtissue trauma to patient during fall


76


Attempting to control the patient fall

Forceful exertion – backand shoulders

Back bent & twisted

Neck bent backwards

Forceful twisting of left forearm when attemptingto ‘hold’ patient during fall

Patient weight coupled with sudden motion

Location of patient at floor level

Poor coupling –no location to securely support patient and control the fall safely


(continued)

77


Lifting patient from floor

Forceful exertion – back and shoulder

Back bent

Neck bent backwards

Forceful grip - Poor coupling hand hold

Weight of patient

Patient unable toAssist

Location of patient- lift from floor level

No safe way to holdpatient’s arms and legs. Risk of softtissue trauma to patient


(continued)

78

Assess the Patient– Can weight bear with standby assist and is

cooperative– The patient cannot stand without assistance

after fall

Assess the Environment– Move IV pole and wheelchair in walkway

Case Study 6Patient Ambulation and Fall Recovery:

The Safer Way

79

Get Necessary Equipment & Help– Use gait belt for ambulation – Only one nurse or caregiver needed– Portable powered floor lift and two nurses or

caregivers to safely lift patient from floor using equipment



80

Perform the Task Safely– Improve coupling or handhold by using gait

belt with handles (less grip force required)– Control fall correctly using gait belt as aid (but

not to ‘lift’ patient)– Maintain good posture while controlling the fall

and supporting patient in floor lift sling– Use of portable powered floor lift reduces

injury risk for caregiver and patient



Documents

1 Safe Patient Handling Program: Applied Ergonomics for Nurses and Health Care Workers This material has been possible by a grant from Oregon Occupational