combined presentation WHCRMS-2015 final 2€¦ · • Education and Training • Program Evaluation / Process Improvement Year One • Transformation into “One System” • Policy

5/18/2015

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Learning Objectives

• The Participant will understand the requirements for a successful program of injury prevention in a healthcare organization.

• The participant will be able to reference industry standards and legal requirements for healthcare organizations regarding general injury prevention, Safe Patient Handling and Healthcare Ergonomics.

• The participant will formulate a perspective of the broad spectrum between research and practical application and how the two are integrated.

Swedish Medical Center

First Hill Cherry Hill Ballard

Issaquah ACC’s: Mill Creek & Redmond Edmonds

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Alaska•Prov. Alaska Med. Center Anchorage

Montana•Prov. St. Patrick’s Medical Center Missoula•Prov. St. Joseph’s Medical Center PolsonProv. Alaska Med. Center Anchorage

•Prov. Kodiak Medical Center•Pro. Valdez Medical Center•Providence Seward Medical Center Oregon

•Prov. Portland Medical Center Portland•Prov. St. Vincent’s Portland•Prov. Seaside Hospital•Prov. Willamette Med. Center•Prov. Milwaukie Hospital•Prov. Medford Med. Center•Prov. Willamette Falls Med. Center•Prov. Hood River Memorial Hospital

•Washington•Prov. Regional Med. Center Everett•Prov. St. Peters Olympia•Prov. St. Mary’s Walla Walla•Prov. Sacred Heart Spokane•Prov. Holy Family Spokane•Prov. Centralia•Prov. Mt. Carmel•Prov. St. Joseph’s ChewelaSwedish Medical Center – 5 hospitalsKadlec Medical Center – RichlandPac‐Med

California•Prov. Tarzana Medical Center•Prov. Holy Cross Medical Center•Prov. Little Company of Mary Torrance•Prov. Little Company of Mary San Pedro•Prov. St. Joseph’s Med. Center Burbank•Prov. St. John’sFacey Medical Group

34 hospitals76,000 employees

Team Structure

HR : Operations ‐ Benefits

Employee Health & Injury Prevention

Alaska

Injury Management (Work Comp) Wellness Compliance Health & Welfare

Plans

Western WA

EWA/MT

Oregon

Calif.

Building a Team

• Limited Team Size – 9.5 FTE’s = 1:8000

• Team Background:– 2 Physical Therapists

– 1 Occupational Therapist1 Occupational Therapist

– 2 RN’s

– 2 Exercise Physiologists

– 1 PhD (Engineering / Research / Ergo)

– 1 MBA

– 1 ED Tech.

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Key Componentsfor Success

• Top Management Support and Involvement

• Worker Motivation / Participation

• Risk Identification and Assessment

• Risk Control

• Education and Training

• Program Evaluation / Process Improvement

Year One

• Transformation into “One System”

• Policy formation for

– Safe Patient Handling

– Ergonomics

– Blood and body fluid exposure

– TB Surveillance

– Respiratory Protection

Workers’ Compensation Board of B.C. Handle with Care

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Legal Duties

• Joint Commission for Accreditation on Healthcare Facilities

• Safe Patient Handling Legislation in 2 of the 5 regionsregions.

• Facilities Guideline Institute (FGI)

• Americans with Disabilities Act (ADA)

• OSHA General Duty Clause

Joint Commission Report ‐ 2012

•High Reliability Organization•“Culture of Safety”

•Calls out the relationship between worker and patient f tsafety.

•Values the input of Human Factors and Ergonomics in reducing error.

•Use of Safety Coaches, Champions and Unit Peer Leaders.

•Integration of Safety in Design.

Prevalence* of Self‐Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013

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State Policy Committee Hazard Assess Procedure Training RTR Yr. Assess Design Monetary

Texas (2005) X X X X X X X

Ohio (2005) X

Hawaii (2006)

Washington (2006) X X X X X X X X X

Rhode Island(2006) X X X X X X

State Law Comparison Chart-10 Laws / 2 other (12 total)

13

New Jersey (2007) X X X X X X X

Maryland (2008) X X X X X X

Minnesota (2011) X X X X X X

Illinois (2011) X X X X X X X

Missouri (2011) X X X X X X X

California (2011) X X X X X

New York (2014) X X X X X X X X

http://www.nursingworld.org/MainMenuCategories/Policy‐Advocacy/State/Legislative‐Agenda‐Reports/State‐SafePatientHandling

FGI Guidelines 2010 / 2014

• 2010 included Safe Patient Handling

– Patient Handling and Movement Assessment (PHAMA) Inadequate(PHAMA)

– Bariatric Considerations

Inadequate Equipment

Lack of Empathy

Avoid Patient

Fear of Injury

2010 ‐ PHAMA

1. An interdisciplinary approach to identify patient handling and movement equipment for each service area.

2. Definition of space requirements and structural and other architectural design considerations to accommodate incorporation of patient handling and movement equipment. (2010: 1.2‐5/A1.2‐5)

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2014 FGI guidelines

Major Revisions:

• The PHAMA is incorporated into the guidelines to address the patient handling and movement needs. (1.2‐3.3.1.1)patient handling and movement needs. (1.2 3.3.1.1)

• Safety Risk Assessment: Multidisciplinary (1.2‐3.3.2)

• Bariatric ‐ Specific Design Considerations(1.2‐5.4)

• Accommodations to encourage patient mobility (A2.1‐2.1)

• Design Criteria for Acoustic Surfaces (A1.2‐5.1.3)

Safety Risk Assessment (1.2‐3.3.2)‐2014

• All health care facility projects shall be designed and constructed to facilitate the safe delivery of care.

• To support this goal, an interdisciplinary team shall develop a safety risk assessment.

• Identify hazards and potential risks.

• Evaluate hazards and risks.

• SRA Report– Patient and caregiver safety hazards and risks identified by the safety

risk assessment. Design features that contribute to the identified hazards and risks

– Design strategies to reduce, mitigate, or eliminate identified hazards and risks

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Americans with Disabilities Act

Requires everyone to have equalaccess to medical care:

• Medical Clinics• Dental Offices• Dental Offices• Access to exam tables and other equipment

Free On‐lineADA Standards for Accessible Design –ADA – Access to Medical Care for Individuals with Mobility Disabilities –

WA. Ergo Rule / OSHA General Duty Clause

• Washington State Ergonomics Rule

– Implemented May 26, 2000

– Repealed November 2003

• Each Employer shall furnish to each of his employees employment and a place of employment which is free from recognized hazards that are causing or likely to cause death or serious physical harm to his employees.

Risk Identification

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Linen

Ergonomics

Housekeeping

Purchasing SeniorLeadership

Physicians/Surgeons

All staff/ unitswho handle patients

Mangers Workman’sCompensation/Return to Work

SPHCommittees

Leadership /

Linen

Ergonomics

Workman’sCompensation/

Leadership /Managers

Physicians/Surgeons

BiomedLearningCenter

EMR / IS

ProjectManagers

Facilities /Carpentry

InjuryInvestigation

InjuryInvestigation

Purchasing

Housekeeping


p /Managers

p /Return to Work

Linen / Co‐op Laundry

EMR / IS

Safety /Fire

Remodel/Construction

gProjectManagers

NEO

Clinical Education

Fall / SkinPrevention

Linen

Ergonomics


SeniorLeadership

Physicians/Surgeons


EMR / IS

ProjectManagers


Nursing/TherapySchools

InjuryInvestigation

InjuryInvestigation

Purchasing

Housekeeping

EMT’s

DepartmentOf

Health

StateLabor Code

VendorsNursing /Therapy/

SurgeonRecruits

Other Hospitals

OSHA, L & I,ADA, FGI

Magnet Status


Mangersp /

Return to Work


EMR / IS

Safety /Fire


gProjectManagers

NEO

Clinical Education


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Linen

Ergonomics


SeniorLeadership

Physicians/Surgeons


EMR / IS

ProjectManagers


Nursing/TherapySchools

InjuryInvestigation

InjuryInvestigation

Purchasing

Housekeeping

EMT’s

DepartmentOf

Health

StateLabor Codes

VendorsNursing /Therapy/

SurgeonRecruits

Other Hospitals

OSHA, L & I, ADA, FGI

Magnet Status


Mangersp /

Return to Work


EMR / IS

Safety /Fire


gProjectManagers

NEO

ClinicalEducation


HAPUReduction

Fall reduction

Poor patienthandling experience Poor

staff satisfaction

Injuriesreduction

Risk Assessments

• Center for Health Design:https://www.healthdesign.org/chd/learning_tools_and_resources/safety_risk_assess

ment_toolkit

Infection Control

Patient Handling

Falls

Medication Safety

Behavioral Health

Security

Education and Training

• Three hours of New Employee Education for Safe Patient Handling.

• Two hours of yearly training for annual refresher.

• Unit Safety Champions: combination of Safety Coaches, Safe Patient Handling Champions and

Wellness Advocates.

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Program Evaluation

• Employee involvement!

– Safety and Safe Patient Handling Committees.

R t l i f i j• Root cause analysis of injury.

• Good data trending.

– Challenges with data.

Ram Maikala, PhD

My Transition

Hopkinton, MA(12.9 years)

Everett, WA(since Sept 29’2014)

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Liberty Mutual’s Contribution

• Knowledge Transfer and Exchange (from Research to Reality) has been a Liberty Mutual differentiator since 1954.

• Nothing proprietary; all research published in the lit topen literature.

• Many examples over the years in Vehicle Safety, Machine safety (safe distance openings), Ergonomics, and Slips, Trips and Falls.

• As safety practitioners we rely on evidence based research to help sell our interventions!

Thanks to Wayne Maynard, Liberty Mutual

Knowledge Transfer & Exchange

Liberty Mutual Research Institute for

Liberty Mutual Research Institute for SafetySafety

Risk Control ServicesClaims & Case Management

Risk Control ServicesClaims & Case Management


Examples of Research


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Manual Materials Handling• Snook & Ciriello 1991, Ciriello,

Ciriello et al., 1999, 2001, 2005, 2007, 2008, 2009

Research??

….Research got to know its limitations!

Researchers say…… Practitioners say……

Research Vs. Reality (Practice)

I need more time I need the answer yesterday

I need more money I need the answer yesterday

Modified from text of Dr Patrick Dempsey, CDC-NIOSH, Pittsburgh, PA

You don’t understand the implications of my findings!

“Give me something I can use” (Wayne Maynard, LM)

More research is needed! Do your findings have any implications??

I published a Journal article on that!

Yeah, whatever!! “Give me something I can use”

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My Transition

Everett, WA(since Sept 29’2014)

Epidemiologic Trend in Health

86% 65%37%

(hypertension, heart disease, diabetes, cancer)

5/18/2015 38Global Health and Aging, WHO (2011)

• A shift in the leading causes of death and illness from infectious and parasitic diseases to noncommunicable diseases and chronic conditions!

• Aged above 60 years ‐ noncommunicable dieases account for more than 87% of the burden in low, middle and high‐income countries!

• Obesity is associated with increased risk of hypertension, heart disease, diabetes!

National Trend of Caregivers

• AGING - One-third of Nursing workforce is older than 50 (National Center for Health Workforce Analysis 2013)!

• OBESITY - Almost 54% Nurses are overweight or obese (Miller et al. 2008).

The biggest problem: Aging and Obese Workforce Vs Caring for Aging and Obese Patients

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Patient Handling

• Total Transfers

• Repositioning

• Limb Holding

• Lateral

• Falls on same level

• Fall from elevation

• Manipulating Needle in Patient

• Disposal‐Related Causes

• Handling /Passing • Cleanup

Exposures Falls

• Lateral Transfer

• Fall –Prevention

• Push‐Pull

• Assaults?

• Trip but no fall

• Slip but no fall

p• Improper Disposal • IV Line‐Related Causes • Collision with

Caregiver or Sharps • Recapping• Handling/ Transferring

Specimens

Injury* Definition

• Any unintentional (e.g., accidents) OR intentional(e.g., violence or assaults) damage to the body resulting from acute exposure to thermal, mechanical, electrical or chemical energy OR , gyfrom the absence of such essentials as heat or oxygen!

*CDC, National Center for Injury Prevention and Control, Department of Health and Human Services

Haddon Matrix*

Host Vector Environment

Pre-eventPre event

Event

Post-event

*Dr William Haddon, First Director of NHTSA

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Haddon Matrix*Factors contributing to injury process

Phases at which

HOST AGENT/VEHICLE ENVIRONMENT

• Person at risk for an injury

• Energy that is transmitted to the host through a vehicle (inanimate object) OR vector (person or animal)

• Characteristics of the setting in which the injury event takes place (e.g., roadway, playground)

• Social and legalCHANGE would have its effect

Pre‐Event

Event

Post‐Event

animal)• That is causing energy

transfer

• Social and legal norms and practices (e.g., policies)

Haddon MatrixFactors contributing to injury process

Phases at which CHANGE would have its effect

HOST AGENT/VEHICLE ENVIRONMENTPhysical and/or Social

Pre‐Event( i f

PRIMARYIntervention

• Conditions necessary for the transfer of energy• What leads to an injury?(time frame –

Seconds to Years)

Event(time frame –Fraction of Second to Minutes)

Post‐Event(time frame –Seconds to Years)

Intervention

SECONDARY Intervention

TERTIARY Intervention (to lessen long‐term adverse effects)

• What leads to an injury?• Time before the event occurs OR the period before release of

injury‐causing energy• (What are) Events that influence likelihood of an injury

• Given the Event occurrence, what leads to an injury• Release of uncontrolled energy• Events affect transmission of energy

• Period after injury

Exploring Strategies for Injury Prevention*

Hierarchy of Controls

(from Most Effective to Least Effective)

*The Hierarchy of Hazard Controls (http://creativesafetypublishing.com/the‐hierarchy‐of‐hazard‐controls/ )

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SUMMARY

• Injuries are predictable and preventable.

• Specific injuries have similar characteristics of: person, place, and time.

d di i j ( h i )• By understanding an injury (mechanism), interventions can be developed and implemented to prevent or limit the extent of a given injury!

Thank You!

Leslie pickett@providence [email protected]

[email protected]

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NPR Report on ADA Clinic Access

http://www.npr.org/templates/story/story.php?storyId=14362338

Documents

combined presentation WHCRMS-2015 final 2€¦ · • Education and Training • Program Evaluation / Process Improvement Year One • Transformation into “One System” • Policy