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Patient Care Ergonomics Remember l Through Ergonomics Job can be redesigned Jobs can be improved to be within reasonable limits of human capabilities

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Patient Care Ergonomics Remember l Through Ergonomics Job can be redesigned Jobs can be improved to be within reasonable limits of human capabilities l However, ergonomics is not a magical solution To be effective, a well thought out system of implementation must be developed Slide 2 Heres A Successful Solution using Patient Care Ergonomics Slide 3 Successful Solution using Patient Care Ergonomics VISN 8 Patient Safety Center Research Project: VISN-Wide Deployment of a Back Injury Prevention Program for Nurses: Safe Patient Handling and Movement (2001-2002) Slide 4 Results: Incidence (#) of Injuries Decreased 31% (144 to 99 injuries) Slide 5 Results: Injury Rates* l Decreased from 24 to 16.9 l Difference was significant at 0.036 level *Defined as # reported injuries per 100 workers per year Slide 6 Results: Light Duty Days Decreased 70% (1777 to 539 days) Significant at 0.05 level Slide 7 Results: Lost Work Days Decreased 18%, from 256 to 209 days Slide 8 Results: Job Satisfaction Pay Professional Status* Task Requirements* Autonomy Organization Policy Interaction Overall *Denotes Significance Slide 9 Successful Solutions Overview of a Safe Patient Handling & Movement Program Slide 10 Safe Patient Handling & Movement Program Management Support Champion SPHM Team Program Elements Equipment Knowledge Transfer Mechanisms Technical Support For success, required infrastructure MUST be in place prior to implementing SPHM Program Slide 11 SPHM Champion l Clout l Mover/Shaker l Interest l Nursing, Therapy, Safety Slide 12 SPHM Team Responsibilities l Implements Program l Writes Policy l Reviews/Trends Data l Ensures incidents/injuries are investigated l Facilitates Equipment Purchases Slide 13 SPHM Team Members l Nursing Administrator l Nursing Staff (CNA, LPN, RN) l Nursing Service Safety Rep l Peer Leader (BIRN) l Risk Manager l Resident/Patient l Union l Nurse Educator l Therapy Staff (OT, PT, ST) l Purchasing l Engineering l Employee Health/Safety l Others Slide 14 Safe Patient Handling & Movement Program Goals l Reduce the incidence of musculoskeletal injuries l Reduce the severity of musculoskeletal injuries l Reduce c osts from these injuries Slide 15 Safe Patient Handling & Movement Program Goals l Create a safer environment & improve the quality of life for patients/residents l Encourage reporting of incidents/injuries l Create a Culture of Safety and empower nurses to create safe working environments Slide 16 SPHM Key Objectives l Reduce manual transfers by ___% l Reduce direct costs by ___% l Decrease nursing turnover by __% l Decrease musculoskeletal discomfort in nursing staff by ___% Slide 17 SPHM Key Objectives l Reduce # of lost workdays due to patient handling tasks by ___% l Reduce # of light duty days due to patient handling tasks by ___% l Note: Best to NOT measure success by # of reported injuries Slide 18 Safe Patient Handling & Movement Program What goals do you want to achieve for yourself, your co-workers, and your unit? What specific Program Objectives do you want to attain? (Complete A & B of Handout A-1, Developing a Safe Patient Handling & Movement Action Plan) Slide 19 Safe Patient Handling & Movement Program SPHM Program Elements l Peer Leaders BIRNS/Ergo Rangers l After Action Review Process l Patient Assessment, Care Plan, Algorithms for Safe Patient Handling & Movement l SPHM Policy l Ergonomic & Hazard Assessment of Patient Care Environment l Equipment Slide 20 Safe Patient Handling & Movement Program Elements Back Injury Resource Nurses Chapter 7 Slide 21 Safe Patient Handling & Movement Program BIRNS are the Key to Program Success Implement Program Continue Program Slide 22 Back Injury Resource Nurses l RN, LPN, CNA l Informal Leader/ Respected l Safety Interest l Ergo Experience Not Required l Enthusiastic/ Out-going l Good Time/ Mgmt Skills Slide 23 Back Injury Resource Nurses Roles/Responsibilities 1. Implement/Continue SPHM Program 2. Act as Resource, Coach, and Team Leader for Peers, NM, Facility 3. Share/Transfer Knowledge 4. Perform Continual Hazard/Risk Monitoring 5. Monitor and Evaluate Program Slide 24 BIRNS Roles & Responsibilities 1. Implement/Continue SPHM Program BIRNS activities and involvement depend on what program elements are included in your Program. Slide 25 BIRNS Roles & Responsibilities 2. Act as Resource, Coach, and Team Leader l Share expertise in use of Program elements l Motivate use of Program elements l Listen to Ideas & Concerns l Demonstrate Care & Concern for Staff Well-Being l Support and promote a Culture of Safety l Cheer on Safety Successes!! Slide 26 BIRNS Roles & Responsibilities 3. Share/Transfer Knowledge BIRNS-BIRNS l Within Units, Facilities, Organization l With Others Organizations l Monthly Conference Calls l Outlook Email Groups l National Conferences Slide 27 BIRNS Roles & Responsibilities 3. Share/Transfer Knowledge BIRNS-STAFF l AAR Meetings l On-the-Job Co-workers New Employees l Staff Meetings l Skills Check-off Training/In-services Slide 28 BIRNS Roles & Responsibilities 4. Perform Continual Hazard/Risk Monitoring Two Levels of Hazard/Risk Evaluations Formal Ergonomic Hazard Evaluation Ch. 3 Ongoing Workplace Hazard Evaluations Of the Environment Of Patients/Residents Of Patient Handling Tasks Slide 29 BIRNS Roles & Responsibilities 5. Monitor and Evaluate Program l Assist in Collecting/Analyzing Injury Data l Complete Checklists for Safe Use of Lifting Equipment l Evaluate Ability to use Algorithms & Complete Care Plan Slide 30 BIRNS Roles & Responsibilities 5. Monitor and Evaluate Program l Weekly BIRN Process Log (p.89) BIRNS Activity Level BIRNS and Program Status Effectiveness Adherence Support Slide 31 What Helps Make a BIRNS Successful? l Personality Natural Leader Positive Outlook Team Player Proactive l Cooperation & Support Slide 32 What Helps Make a BIRNS Successful? Cooperation & Support l Nurse Manager l Nursing Administration l Facility Management l Facility Safety Champion l Engineering & Housekeeping Slide 33 What Helps Make a BIRNS Successful? Management Support l TIME to fulfill BIRNS role (especially during implementation phase) Coverage during meeting times, staff in-services & BIRNS training Lighter case-load l TIME for Staff to attend In-Services Slide 34 Back Injury Resource Nurses Outcomes for Staff l Staff are empowered Channel to voice ideas/suggestions Opportunity to have input in making work environment safer l Increased competence in performing job l Increased sharing of knowledge/best practices l Fosters Culture of Safety Slide 35 Back Injury Resource Nurses Examples of Problems Identified l Lifts not being used on night shifts. Why? Batteries were being charged on night shifts because no back-up batteries. Solution: Buy extra battery packs so lifts can be used 24 hours per day. Slide 36 Safe Patient Handling & Movement Program BIRNS are the Key to Implement SPHM Program Continue SPHM Program Slide 37 Safe Patient Handling & Movement Program Elements After Action Review Process Chapter 9 Slide 38 After Action Review An After Action Review is for transferring knowledge a team has learned from doing a task in one setting, to the next time that team does the task in different setting. (Dixon, 2000) Slide 39 AAR and Risk Reduction l Provides mechanism for whole team to learn from the experiences of one individual l Involves front line staff in identifying problems and SOLUTIONS Slide 40 Guidelines for AAR Use l Used for injuries AND near-misses l After an incident has occurred bring staff together to discuss the incident l No notes are taken l Involve as many staff as possible l Hold AAR in location of incident, if possible l Non-punitive approach with no fault- finding/blaming Slide 41 Guidelines for AAR Use l Keep meetings brief - less than 15 minutes l Staff-driven l Assign one or two persons to ensure corrective actions are taken l At next AAR, follow-up if needed Slide 42 Guidelines for AAR Use l The AAR group asks (1) What happened? (2) What was supposed to happen? (3) What accounts for the difference? (4) How could the same outcome be avoided the next time? (5) What is the follow-up plan? Slide 43 Training Staff on AAR l Minimal Training required l Staff In-service review purpose, need for trust, benefits, etc. l Training Tools Handout A-2, AAR Brochure Handout A-2, AAR Brochure My AAR slides My AAR slides Slide 44 AAR Case Study A nurse manager of a long term care unit decides to implement after action reviews after she notices an increase in musculoskeletal injuries among the staff. Slide 45 AAR Case Study After hearing an explanation of the process, staff decide to schedule AAR meetings on Monday, Wednesday, and Friday at 11 AM. This time was selected because most of the morning care is completed by 11:00 and it is before lunch time. Slide 46 AAR Case Study During the first meeting, group members ask staff to think about what happened during the morning. Did anything happen (near-miss or injury) that could have put them or their co-workers at risk of injury that everyone could learn from? Did anything happen (near-miss or injury) that could have put them or their co-workers at risk of injury that everyone could learn from? Slide 47 What Happened? Sue, an LPN, begins. I had to get Mr. Walker up because he was lying in a wet bed.... I was late with my meds and I knew I needed to get to the in- service. Then, I couldnt find a sling, so I just got him up myself. While I was lifting him I kept thinking Dont hurt yourself I guess I was lucky I didnt! So.. What happened was that I lifted Mr. Walker without help, without using a lift. Slide 48 What Was Supposed to Happen? Nancy: OK.. So, what should have happened? Sue: I should have found the sling and used the lift, but I was in such a hurry. Nancy : I know It

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