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

Patient Care Ergonomics

Remember… Through Ergonomics

• Job can be redesigned• Jobs can be improved to be within

reasonable limits of human capabilities However, ergonomics is not a magical

solution…• To be effective, a well thought out system

of implementation must be developed

Here’s A Successful Solution using Patient

Care Ergonomics…

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)

Results: Incidence (#) of Injuries

0

50

100

150

PRE POST

Decreased 31% (144 to 99 injuries)

Results: Injury Rates*

Decreased from 24 to 16.9

Difference was significant at 0.036 level

0

5

10

15

20

25

Pre-

Intervention

Post

Intervention

*Defined as # reported injuries per 100 workers per year

Results: Light Duty Days

Decreased 70% (1777 to 539 days) Significant at 0.05 level

0

500

1000

1500

2000

2500

PRE POST

Results: Lost Work Days

0

50

100

150

200

250

300

PRE POST

Decreased 18%, from 256 to 209 days

Results: Job Satisfaction

3.55

3.6

3.65

3.7

3.75

3.8

PRE POST

•Pay•Professional Status*•Task Requirements*•Autonomy•Organization Policy•Interaction•Overall

*Denotes Significance

Successful Solutions

Overview of a Safe Patient Handling & Movement Program

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

SPHM Champion

CloutMover/Shaker InterestNursing, Therapy, Safety…

SPHM Team Responsibilities

Implements Program Writes Policy Reviews/Trends Data Ensures incidents/injuries are

investigated Facilitates Equipment Purchases

SPHM Team Members

Nursing Administrator

Nursing Staff (CNA, LPN, RN)

Nursing Service Safety Rep

Peer Leader (BIRN) Risk Manager Resident/Patient Union

Nurse Educator Therapy Staff

(OT, PT, ST) Purchasing Engineering Employee

Health/Safety Others…


Goals Reduce the incidence of

musculoskeletal injuries Reduce the severity of

musculoskeletal injuries Reduce costs from these injuries


Goals Create a safer environment &

improve the quality of life for patients/residents

Encourage reporting of incidents/injuries

Create a Culture of Safety and empower nurses to create safe working environments

SPHM Key Objectives

Reduce manual transfers by ___%

Reduce direct costs by ___% Decrease nursing turnover by

__% Decrease musculoskeletal

discomfort in nursing staff by ___%

SPHM Key Objectives

Reduce # of lost workdays due to patient handling tasks by ___%

Reduce # of light duty days due to patient handling tasks by ___%

Note: Best to NOT measure success by # of reported injuries…


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)


SPHM Program Elements Peer Leaders – BIRNS/Ergo Rangers After Action Review Process Patient Assessment, Care Plan,

Algorithms for Safe Patient Handling & Movement

SPHM Policy Ergonomic & Hazard Assessment of

Patient Care Environment Equipment

Safe Patient Handling & Movement

Program Elements

Back Injury Resource Nurses

Chapter 7


BIRNS are the Key to Program Success…

•Implement Program•Continue Program


RN, LPN, CNA

Informal Leader/ Respected

Safety Interest

Ergo Experience Not Required

Enthusiastic/ Out-going

Good Time/ Mgmt Skills


Roles/Responsibilities

1. Implement/Continue SPHM Program2. Act as Resource, Coach, and Team

Leader for Peers, NM, Facility3. Share/Transfer Knowledge4. Perform Continual Hazard/Risk

Monitoring5. Monitor and Evaluate Program

BIRNS Roles & Responsibilities

1. Implement/Continue SPHM Program

BIRNS activities and involvement depend on what program elements

are included in your Program.


2. Act as Resource, Coach, and Team Leader

Share expertise in use of Program elements

Motivate use of Program elements Listen to Ideas & Concerns Demonstrate Care & Concern for

Staff Well-Being Support and promote a “Culture of

Safety” Cheer on Safety Successes!!


3. Share/Transfer Knowledge

BIRNS-BIRNS Within Units, Facilities,

Organization… With Others Organizations Monthly Conference Calls Outlook Email Groups National Conferences


3. Share/Transfer Knowledge

BIRNS-STAFF AAR Meetings On-the-Job

• Co-workers• New Employees

Staff Meetings Skills Check-off Training/In-services


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


5. Monitor and Evaluate Program

Assist in Collecting/Analyzing Injury Data

Complete Checklists for Safe Use of Lifting Equipment

Evaluate Ability to use Algorithms & Complete Care Plan


5. Monitor and Evaluate Program

Weekly BIRN Process Log (p.89)•BIRNS Activity Level•BIRNS and Program Status

•Effectiveness•Adherence•Support

What Helps Make a BIRNS Successful?

Personality• Natural Leader • Positive Outlook• Team Player• Proactive

Cooperation & Support


Cooperation & Support Nurse Manager Nursing Administration Facility Management Facility Safety Champion Engineering & Housekeeping


Management Support TIME to fulfill BIRNS role

(especially during implementation phase)• Coverage during meeting times,

staff in-services & BIRNS training• Lighter case-load

TIME for Staff to attend In-Services


Outcomes for Staff Staff are empowered

•Channel to voice ideas/suggestions•Opportunity to have input in making work environment safer

Increased competence in performing job

Increased sharing of knowledge/best practices

Fosters Culture of Safety


Examples of Problems Identified 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.


BIRNS are the Key to…

•Implement SPHM Program

•Continue SPHM Program


Program Elements

After Action Review ProcessChapter 9

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)

AAR and Risk Reduction

Provides mechanism for whole team to learn from the experiences of one individual

Involves front line staff in identifying problems and SOLUTIONS

Guidelines for AAR Use

Used for injuries AND “near-misses” After an incident has occurred bring

staff together to discuss the incident No notes are taken Involve as many staff as possible Hold AAR in location of incident, if

possible Non-punitive approach with no fault-

finding/blaming


Keep meetings brief - less than 15 minutes

Staff-driven Assign one or two persons

to ensure corrective actions are taken

At next AAR, follow-up if needed


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?

Training Staff on AAR

Minimal Training requiredMinimal Training required Staff In-service – review Staff In-service – review

purpose, need for trust, purpose, need for trust, benefits, etc.benefits, etc.

Training ToolsTraining Tools• Handout A-2, AAR BrochureHandout A-2, AAR Brochure• My AAR slidesMy AAR slides

AAR Case Study

A nurse manager of a long term A nurse manager of a long term care unit decides to implement care unit decides to implement after action reviews after she after action reviews after she

notices an increase in notices an increase in musculoskeletal injuries musculoskeletal injuries

among the staff.among the staff.

AAR Case Study

After hearing an explanation of the After hearing an explanation of the process, staff decide to schedule process, staff decide to schedule

AAR meetings on Monday, AAR meetings on Monday, Wednesday, and Friday at 11 AM. Wednesday, and Friday at 11 AM.

This time was selected because most This time was selected because most of the morning care is completed by of the morning care is completed by 11:00 and it is before lunch time. 11:00 and it is before lunch time.

AAR Case Study

During the first meeting, group During the first meeting, group members ask staff to think about members ask staff to think about

what happened during the morning.what happened during the morning.

Did anything happen (near-miss or Did anything happen (near-miss or injury) that could have put them or injury) that could have put them or

their co-workers at risk of injury their co-workers at risk of injury that everyone could learn from? that everyone could learn from?

What Happened?

Sue, an LPN, begins. Sue, an LPN, begins.

I had to get Mr. Walker up because he was I had to get Mr. Walker up because he was lying in a wet bed.... I was late with my lying in a wet bed.... I was late with my meds and I knew I needed to get to the in-meds and I knew I needed to get to the in-service. Then, I couldn’t find a sling, so I service. Then, I couldn’t find a sling, so I just got him up myself. While I was lifting just got him up myself. While I was lifting him I kept thinking… ‘Don’t’ hurt him I kept thinking… ‘Don’t’ hurt yourself…’ I guess I was lucky I didn’t!yourself…’ I guess I was lucky I didn’t!

So.. So.. What happenedWhat happened was that I lifted Mr. was that I lifted Mr. Walker without help, without using a lift.Walker without help, without using a lift.

What Was Supposed to Happen?

Nancy: Nancy: OK.. So, OK.. So, what should have happenedwhat should have happened??

Sue: Sue: I should have found the sling and used I should have found the sling and used the lift, but I was in such a hurry. the lift, but I was in such a hurry.

NancyNancy: I know… It’s so frustrating to have all : I know… It’s so frustrating to have all of these new lifts but not have the slings of these new lifts but not have the slings where you need them. I know I’ve had where you need them. I know I’ve had trouble finding slings, too.trouble finding slings, too.

Others discuss their experiences related to Others discuss their experiences related to the lifts and slings. the lifts and slings.

What Accounts for the Difference?

Nancy: Nancy: Let’s see… Let’s see… What accounts for What accounts for the differencethe difference? Well... The sling ? Well... The sling wasn’t available.wasn’t available. For starters, the For starters, the sling should have been in the room sling should have been in the room and on the bed side stand, where and on the bed side stand, where we agreed to keep them.we agreed to keep them.


Ron: Ron: You’re right, but there's not You’re right, but there's not always room to put them there… always room to put them there… That’s where patients place their That’s where patients place their things too… Because of that a lot of things too… Because of that a lot of times I put slings places where ‘I’ times I put slings places where ‘I’ can find them when ‘I’ come back in can find them when ‘I’ come back in the room, but I guess that makes it the room, but I guess that makes it hard for you guys to find them when hard for you guys to find them when I’m not around…. I’m not around….


After more discussion, the group decides After more discussion, the group decides that the problems of ‘inaccessible slings’ that the problems of ‘inaccessible slings’ is caused by no good location for the is caused by no good location for the slings in patient rooms.slings in patient rooms.

How can the same outcome be avoided the next time??

NancyNancy: : OK… We’re always running OK… We’re always running around looking for slings. What do you around looking for slings. What do you think about placing a sling ‘hook’ in think about placing a sling ‘hook’ in every patient room, right at the door, so every patient room, right at the door, so you can easily pick the sling up on you can easily pick the sling up on entering and put it back on leaving? entering and put it back on leaving?

Fred: Fred: That’s a good idea! I also think it That’s a good idea! I also think it would help if we had more slings… How would help if we had more slings… How many more do you think we need? many more do you think we need?

How can the same outcome be avoided the next time??

Brad: I’ll request a work order to Brad: I’ll request a work order to install the hooks and after they’re install the hooks and after they’re installed I’ll make sure everyone installed I’ll make sure everyone gets the message on the new gets the message on the new procedure. procedure.

Ron:Ron: I’ll add the process to the new I’ll add the process to the new employee orientation packet.employee orientation packet.

Fred:Fred: I’ll put in a request to order 6 I’ll put in a request to order 6 slings.slings.

What’s the Follow-up Plan?

Sue: Sue: Let’s see if I have all of our Let’s see if I have all of our recommendations… Put in a work order for recommendations… Put in a work order for installation of the hooks, buy more slings, installation of the hooks, buy more slings, spread the word, and the add process to the spread the word, and the add process to the unit orientation packet for new employees. unit orientation packet for new employees.

Brad:Brad: Since this has been a continual Since this has been a continual problem, let’s see how we’re doing on the problem, let’s see how we’re doing on the sling issue at an AAR in one month.sling issue at an AAR in one month.

After Action Review Case Study

AAR Case Study BIRN noticed friction reducing devices

(FRDs) weren’t being used on her Unit Held staff AAR Determined FRD’s too narrow Solution: BIRN contacted manufacturer

who made new, wider FRD’s. Outcome: New, wider FRD’s used on

Unit

AAR Practice

Break into groupsBreak into groups Think of a problem common Think of a problem common

to your groupto your group Perform an AAR using the Perform an AAR using the

AAR questions.AAR questions.


Program Elements

Patient Assessment, Care Plan, & Algorithms for Safe

Patient Handling & Movement Chapter 5

Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling

& Movement

The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling

activities you must perform3. Follow the algorithms to

determine what equipment and # of staff are needed

4. Complete the Care Plan5. File for future use

What Tasks Do the Care Plan & Algorithms Cover?

1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

2. Lateral Transfer To and From: Bed to Stretcher, Trolley

3. Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table

4. Reposition in Bed: Side to Side, Up in Bed5. Reposition in Chair: Wheelchair or

Dependency Chair6. Transfer a Patient Up from the Floor

What Tasks Do the Bariatric Care Plan & Algorithms

Cover?

1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

2. Lateral Transfer To and From: Bed to Stretcher, Trolley

3. Reposition in Bed: Side to Side, Up in Bed 4. Reposition in Chair: Wheelchair or

Dependency Chair5. Tasks Requiring Sustained Holding of Limb/s

or Access to Body Parts6. Transporting (stretcher, w/c, walker)7. Toileting8. Transfer Patient Up from Floor

Patient Assessment & Care Plan – Page 71

Completed on all patients Takes into consideration:

•Patient Characteristics •Patient Handling Task•Equipment

Uses Algorithms

Algorithms - Page 73

Based on Specific Patient Characteristics (from Assessment)

Assists nurses in selecting• Safest Equipment • Safest Patient Handling

Technique Advises # of staff needed

How were these Algorithms Developed?

Developed by a group of nursing experts

Tested with different patient populations in a variety of settings

When Should The Algorithms be Used?

Use the Algorithms for every patient/resident who needs help moving

Remember….• The Algorithms provide general

direction• Caregiver must use their

professional judgment in applying Algorithms

How Do We Lift This Resident?

Let’s assess NH resident: Fred Veteran

80 year old resident of a VA Nursing Home. Weight: 156 lbs. Height: 5’ 9” Has dementia and a history of falls. Some days he is cooperative. Other days

he is combative and fearful. When he is cooperative, he can bear

weight. Otherwise, he resists standing. He is to be out of bed every day in a chair.

Assessing Fred V.

Take a few minutes and complete a Patient

Handling Care Plan for Fred Veteran.

(Use Handout A-3, Patient Assessment & Care Plan)

Assessing Fred V.

Level of AssistanceDependent

Can the resident bear weight?

No, because the resident is not cooperative

Does resident have upper extremity strength needed to support weight during transfers?

No, because resident is unreliable for using his upper extremity strength

Assessing Fred V.

Resident’s level of cooperation and comprehension

Unpredictable

Weight: 156 lbs. Height: 5’ 9”

Special circumstances?

History of Falls

Finishing Fred V.’s Care Plan

Although the resident can sometimes bear weight, he can be uncooperative.

The “No” answer to “Is the Resident cooperative?” leads you to: “Use full body sling lift and 2 caregivers”

Answer: Use full body sling lift and 2 caregivers

Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling

& Movement

The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling

activities you must perform3. Follow the algorithms to

determine what equipment and # of staff are needed

4. Complete the Care Plan5. File for future use

Algorithms Practice

Break into groupsBreak into groups Have one person give a clinical Have one person give a clinical

description of a recent patient description of a recent patient requiring moving/handlingrequiring moving/handling

Develop a patient handling Care Develop a patient handling Care Plan using the assessment tool Plan using the assessment tool and algorithms.and algorithms.


Program Elements

Safe Patient Handling & Movement Policy

Chapter 6


SPHM Policy Ties all Program Elements Together…

Based on UK Policy Implemented in high-risk units Focus on creating a safe

workplace for caregivers rather than on punitive action for mistakes


SPHM Policy Ties all Program Elements Together…

Says to avoid hazardous Patient handling tasks.

If can’t avoid, carefully assess hazard, & if possible, always use Patient handling equipment


BUT…. Patient Handling Equipment/Aids MUST

be in place first, before implementing a SPHM Program.

So, a systematic process is needed to ensure the right equipment is in place…


Program Elements

9 Step Ergonomic Workplace Assessment of Nursing

EnvironmentsChapter 3

Patient Care Ergonomic Hazard/Risk Evaluation

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

Patient Care Ergonomic Evaluation Process

Studies show ergonomic approaches• Reduced staff injuries from 20 - 80%• Significantly reduced workers

compensation costs• Reduced lost time due to injuries

Bruening, 1996; Empowering Workers, 1993; Fragala, 1993; Fragala, 1995; Fragala, 1996; Fragala & Santamaria, 1997; Logan, 1996; Perrault, 1995; Sacrifical Lamb Stance, 1999; Stensaas, 1992; Villaneuve, 1998; Werner, 1992)

Patient Care Ergonomic Evaluation Process

Patient Care Ergonomic Evaluation Process 1. Collect Baseline Injury Data 2. Identify High Risk Units3. Obtain Pre-Site Visit Data4. Identify High-Risk Tasks 5. Conduct Team Site Visit at each High-Risk Unit6. Risk Analysis7. Formulate Recommendations8. Implement Recommendations (Involve End Users)9. Monitor Results/Evaluate Program/Continuously

Improve Safety

Step 1. Collect Baseline Injury Data

PATIENT CARE INCIDENT/INJURY PROFILE

Patient CareActivity

Cause ofInjury

Type ofInjury

BodyPart(s)

Location Time ofInjury

LostDays

ModifiedDutyDays

Sample:Patient transferbed tostretcher

Reachingacrossstretcherfor patient

Strain Upper back Patientbedside

09:30 3 5

*Be sure to note which source is used on your Injury Log


Cause: Patient Handling Tasks Target Population/s: Nursing Staff

(Radiology, Therapy Staff – PT,OT,ST, Others?)

Type: Strains/Sprains (Struck, Fall..?) (Best to include all types of injuries, then analyze those of interest.)

Duration: Minimum of 1 year of data


Collect by Unit (will also use later during risk analysis)

Sources:• Risk Manager/Safety/Human Resources • Facility Injury Logs/Statistics, Unit

Records, OSHA 200/300 Logs • Patient Care Incident/Injury Profile

Note which source is used on your Injury Log

Step 2. Identify High-Risk Units

What units have the •Most Patient handling injuries/

incidents? •Most severe injuries/incidents?

(by lost time or modified duty days)

•Highest concentration of staff on modified duty?

Step 2. Identify High-Risk Units

Common Characteristics:•High proportion of dependent

patients/residents•High frequency of

patients/residents getting in & out of bed

•High frequency of transfers from one surface to another, e.g. w/c to toilet or bed

Step 4. Identify High-Risk Tasks

‘Tool for Prioritizing High Risk Tasks’ – p. 30 Rank Tasks from 1 to 10

1 = highest risk 10 = lowest risk When ranking, consider:

• Frequency & Musculoskeletal Stress Delete Tasks not usually performed on

Unit Completed by

• Each Staff member• Collectively by Shift


High Risk Task Ranking Exercise

1. Think of a high-risk unit. Complete Tools for Prioritizing High-Risk Patient Handling Tasks

(Complete Handout A-4, Prioritizing High Risk Tasks)


Let’s compare high risk tasks identified by you and others…

If there were differences… Why??

What factors play a role in ranking tasks?


High Risk Task Ranking UNIT Exercise

1. Have staff complete 2. Compare their perceptions

to yours3. Compare their and your

perceptions to Baseline Injury data

3. Obtain Pre-Site Visit Data on High-Risk Units

Use ‘Pre site Visit Unit Profile’ – p. 24• Space issues• Storage availability• Maintenance/repair issues• Patient population • Staffing characteristics • Equipment inventory/issues

Will use when performing site visit and for making recommendations

Step 3. Obtain Pre-Site Visit Data

Remember…Involve as many staff as possible and as much as

possible…

Step 3. Obtain Pre-Site Visit Data

Now… think of one of your high-risk units from your facility and complete a cursory “Unit Data Collection Tool” for that unit.

* Complete Unit Data Collection Tool Profile (Handout A-5)

Step 5. Conduct Site Visit

Site Visit Walk-through• Patient room sizes/configurations• Ceiling Characteristics/AC vents/TVs• Showering/bathing facilities• Toileting process


Site Visit Walk-through• Equipment

•Availability Accessibility•Use Condition•Storage

• Staff attitudes


After Site Visit… Organize data by entering into

Site Visit Summary Data Sheet (p. 34 and Handout A-6)

Use during Risk Analysis in order to make Recommendations

9 Step Ergonomic Workplace Assessment of Nursing

Environments

Step 6. Perform Risk Analysis


Risk Identification/Breakdown High Risk DEPARTMENT/AREA High Risk JOBS (RN, CNA, LPN, etc.)

• Specific TASKS of High Risk Jobs (p. 30)

• Specific ‘ELEMENTS’ of High Risk Job TASKS


What do we need to look at to identify Specific

RISKS of ‘ELEMENTS’ of High Risk Job TASKS?


Element/Task Risk Identification

Task Intensity Task Duration Work Posture General Design of Equipment Space Characteristics Where do you think problem

exists?


Methods to Gather Risk Data General Observation Staff Discussions Staff Questionnaires Review of Medical Data Symptoms Surveys Quantitative Evaluations

Previous Studies Job Consistency

& Fatigue Brainstorming &

Group Activities Job Safety

Analyses


Job Safety Analysis (JSA) Break down job into steps Identify hazards associated

with each step Determine actions necessary to

eliminate or minimize hazards


Job Safety Analysis (JSA)

Let’s try it!!!

See Job Safety Analysis Worksheet (Handout A-7)


Risk Analysis is used to find Risk Factors that may cause injury.

There are three categories of Risk Factors in a Patient Care

Environment...

What do you think they are??


Risk can come from: Patient Handling Tasks Health Care Environment Patient

Once risks are identified, steps can be taken to protect Staff

and Patients!


What Risk Factors are related to the Health Care Environment?


Health Care Environment Risk Factors

Slip, trip, and fall hazards Uneven work surfaces (stretchers, beds,

chairs, toilets at different heights) Uneven Floor Surfaces (thresholds) Narrow Doorways Poor bathing area design


Health Care Environment Risk Factors

Space limitations • Small rooms• Lots of equipment• Clutter• Cramped working space

Poor placement of room furnishings


Health Care Environment Risk Factors Broken Equipment Inefficient Equipment (non-electric, slow-

moving, bed rails) Not enough or Inconvenient Storage

Space Staff who don’t help each other or don’t

communicate

‘The Far Side’ Safety Humor…


What Risk Factors are related to Patients?


Patient Risk Factors Weak/unable to help with

transfers Unpredictable Vision or hearing loss Hit or bite Resistive Behavior Unable to follow simple

directions


Patient Risk Factors Overweight Experiencing Pain Hearing or vision loss No/little communication

between staff about Patient or with Patient


What Risk Factors are found in Patient Handling Tasks?


Patient Handling Tasks Risk Factors Reaching and lifting with loads far

from the body Lifting heavy loads Twisting while lifting Unexpected changes in load

demand during lift Reaching Long Duration


Patient Handling Tasks Risk Factors Moving or carrying a load

a significant distance Awkward Posture Pushing/Pulling Completing activity with

bed at wrong height Frequent/repeated

lifting & moving


Now, it’s time to tie…

Patient Handling Task Risks Health Care Environment Risks

Patient Risks to

Site Visit Data

This will show us what to consider in making recommendations.


Risk Analysis includes review of… Unit Baseline Injury Data

• Patient Care Incident/Injury Profile (p. 21)

Pre-Site Visit Data• Pre-Site Visit Unit Profile (p. 24)

High-Risk Tasks• Tool for Prioritizing High-Risk Patient

Handling Tasks (p. 30)


Risk Analysis includes review of… Site Visit Information

• Site Visit Summary Data Sheet (p. 34) Observations & Additional Information

from Site Visit


Analyzing Unit Baseline Injury Data • Will provide direction when making

ergonomic recommendations• Determine:

•#1 & 2 Causes of Injuries •#1 & 2 Activities being performed when staff are injured

•What’s going on? What trends are seen?


Analyzing Unit Baseline Injury Data Activity

Let’s try it… Use Injury Incidence Profile (Handout A-8)

1. For the NHCU, what are the:• #1 & 2 Causes of injuries?• #1 & 2 Activities involved in the injuries?

2. What trends do you see?


Analyzing Unit Baseline Injury Data

What does the unit injury data tell you?


Data to Direct Recommendations Incidence (# injuries per unit) Severity (defined by # of lost and

modified duty days) 1 - 2 Primary task/s involved in injuries 1 - 2 Primary cause/s of injuries on unit Patient Dependency Levels Number/configuration of rooms Whatever is significant to your needs


Information from the Risk Analysis drives

formation of Recommendations…

9 Step Ergonomic Workplace Assessment of Nursing Environments

Step 7. Formulate Recommendations


Solutions involve:#1 Hazard Elimination#2 Engineering Controls#3 Administrative Controls


Hazard Elimination Examples?


Hazard Elimination Scale in sling lift Transfer Bed


Administrative Controls Examples?


Administrative Controls Changes in Scheduling Minimizing # times transfers are required Job Rotation Redistribution of Workload Based on

Acuity Lifting Teams Procedures for repair/maintenance Allot Storage Space to make equipment

more accessible


Engineering Control Examples?


Engineering Controls Result: Caregivers conduct their

job in a new way• Physical Change to the way a

job/task is conducted• Utilization of an aid/equipment

to reduce the hazard• Modifications to the

Workplace


Engineering Controls are the keys to improving safety in

a health care environment….

Let’s see some examples.