Transcript Preventing Back Injuries in Nurses: Safe Patient Handling

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
Decreased 31% (144 to 99 injuries)
150
100
50
0
PRE
POST
Results: Injury Rates*

Decreased from
24 to 16.9
25
20
15
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Difference was
significant at
0.036 level
10
5
0
PreIntervention
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
2500
2000
1500
1000
500
0
PRE
POST
Results: Lost Work Days
Decreased 18%, from 256 to 209 days
300
250
200
150
100
50
0
PRE
POST
Results: Job Satisfaction
•Pay
•Professional Status*
•Task Requirements*
•Autonomy
•Organization Policy
•Interaction
•Overall
*Denotes Significance
3.8
3.75
3.7
3.65
3.6
3.55
PRE
POST
Successful
Solutions
Overview of a Safe
Patient Handling
& Movement
Program
Safe Patient Handling &
Movement Program
For success, required infrastructure
MUST be in place prior to implementing
SPHM Program
• Management
Support
• Champion
• SPHM Team
• Program
Elements
• Equipment
• Knowledge
Transfer
Mechanisms
• Technical Support
SPHM Champion
 Clout
 Mover/Shaker
 Interest
 Nursing,
Therapy, Safety…
SPHM Team Responsibilities
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Implements Program
Writes Policy
Reviews/Trends Data
Ensures incidents/injuries are
investigated
Facilitates Equipment Purchases
SPHM Team Members
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Nursing Administrator
Nursing Staff (CNA,
LPN, RN)
Nursing Service Safety
Rep
Peer Leader (BIRN)
Risk Manager
Resident/Patient
Union
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Nurse Educator
Therapy Staff
(OT, PT, ST)
Purchasing
Engineering
Employee
Health/Safety
Others…
Safe Patient Handling &
Movement Program
Goals
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Reduce the incidence of
musculoskeletal injuries
Reduce the severity of
musculoskeletal injuries
Reduce costs from these injuries
Safe Patient Handling &
Movement Program
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 ___%
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Note: Best to NOT measure
success by # of reported
injuries…
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)
Safe Patient Handling &
Movement Program
SPHM Program Elements
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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
Safe Patient Handling &
Movement Program
BIRNS are the Key to
Program Success…
•Implement Program
•Continue Program
Back Injury Resource Nurses
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RN, LPN, CNA
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Informal Leader/
Respected

Safety Interest

Ergo Experience
Not Required
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Enthusiastic/
Out-going
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Good Time/
Mgmt Skills
Back Injury Resource Nurses
Roles/Responsibilities
1.
2.
3.
4.
5.
Implement/Continue SPHM Program
Act as Resource, Coach, and Team
Leader for Peers, NM, Facility
Share/Transfer Knowledge
Perform Continual Hazard/Risk
Monitoring
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.
BIRNS Roles & Responsibilities
2. Act as Resource, Coach, and
Team Leader
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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!!
BIRNS Roles & Responsibilities
3. Share/Transfer Knowledge
BIRNS-BIRNS
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Within Units, Facilities,
Organization…
With Others Organizations
Monthly Conference Calls
Outlook Email Groups
National Conferences
BIRNS Roles & Responsibilities
3. Share/Transfer Knowledge
BIRNS-STAFF
 AAR Meetings
 On-the-Job
• Co-workers
• New Employees
 Staff Meetings
 Skills Check-off Training/In-services
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
BIRNS Roles & Responsibilities
5. Monitor and Evaluate Program
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Assist in Collecting/Analyzing
Injury Data
Complete Checklists for Safe
Use of Lifting Equipment
Evaluate Ability to use
Algorithms & Complete Care
Plan
BIRNS Roles & Responsibilities
5. Monitor and Evaluate Program
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Weekly BIRN Process Log (p.89)
• BIRNS Activity Level
• BIRNS and Program Status
• Effectiveness
• Adherence
• Support
What Helps Make a BIRNS
Successful?
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Personality
•
•
•
•
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Natural Leader
Positive Outlook
Team Player
Proactive
Cooperation & Support
What Helps Make a BIRNS
Successful?
Cooperation & Support
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Nurse Manager
Nursing Administration
Facility Management
Facility Safety Champion
Engineering & Housekeeping
What Helps Make a BIRNS
Successful?
Management Support
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TIME to fulfill BIRNS role (especially
during implementation phase)
• Coverage during meeting times, staff
in-services & BIRNS training
• Lighter case-load
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TIME for Staff to attend In-Services
Back Injury Resource Nurses
Outcomes for Staff
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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
Back Injury Resource Nurses
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.
Safe Patient Handling &
Movement Program
BIRNS are the Key to…
•Implement SPHM Program
•Continue SPHM Program
Safe Patient Handling
& Movement
Program Elements
After Action Review Process
Chapter 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
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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
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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 faultfinding/blaming
Guidelines for AAR Use
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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
Guidelines for AAR Use
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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
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Minimal Training required
Staff In-service – review
purpose, need for trust,
benefits, etc.
Training Tools
• Handout A-2, AAR Brochure
• My AAR slides
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.
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.
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?
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 inservice. Then, I couldn’t find a sling, so I just
got him up myself. While I was lifting him I
kept thinking… ‘Don’t’ hurt yourself…’ I
guess I was lucky I didn’t!
So.. What happened was that I lifted Mr.
Walker without help, without using a lift.
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’s so frustrating to have all
of these new lifts but not have the slings
where you need them. I know I’ve had
trouble finding slings, too.
Others discuss their experiences related to
the lifts and slings.
What Accounts for the
Difference?
Nancy: Let’s see… What accounts for
the difference? Well... The sling
wasn’t available. For starters, the
sling should have been in the room
and on the bed side stand, where we
agreed to keep them.
What Accounts for the
Difference?
Ron: You’re right, but there's not
always room to put them there…
That’s where patients place their
things too… Because of that a lot of
times I put slings places where ‘I’ can
find them when ‘I’ come back in the
room, but I guess that makes it hard
for you guys to find them when I’m
not around….
What Accounts for the
Difference?
After more discussion, the group decides
that the problems of ‘inaccessible slings’
is caused by no good location for the
slings in patient rooms.
How can the same outcome be
avoided the next time??
Nancy: OK… We’re always running around
looking for slings. What do you think
about placing a sling ‘hook’ in every
patient room, right at the door, so you can
easily pick the sling up on entering and
put it back on leaving?
Fred: That’s a good idea! I also think it
would help if we had more slings… How
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
install the hooks and after they’re
installed I’ll make sure everyone gets
the message on the new procedure.
Ron: I’ll add the process to the new
employee orientation packet.
Fred: I’ll put in a request to order 6
slings.
What’s the Follow-up Plan?
Sue: Let’s see if I have all of our
recommendations… Put in a work order for
installation of the hooks, buy more slings,
spread the word, and the add process to the
unit orientation packet for new employees.
Brad: Since this has been a continual problem,
let’s see how we’re doing on the sling issue
at an AAR in one month.
After Action Review
Case Study
AAR Case Study
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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
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Break into groups
Think of a problem common
to your group
Perform an AAR using the
AAR questions.
Safe Patient Handling
& Movement
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 Patient
2. Determine what handling
activities you must perform
3. Follow the algorithms to
determine what equipment
and # of staff are needed
4. Complete the Care Plan
5. File for future use
What Tasks Do the Care Plan &
Algorithms Cover?
1.
2.
3.
4.
5.
6.
Transfer To and From: Bed to Chair, Chair
to Toilet, Chair to Chair, or Car to Chair
Lateral Transfer To and From: Bed to
Stretcher, Trolley
Transfer To and From: Chair to Stretcher,
Chair to Chair, or Chair to Exam Table
Reposition in Bed: Side to Side, Up in Bed
Reposition in Chair: Wheelchair or
Dependency Chair
Transfer a Patient Up from the Floor
What Tasks Do the Bariatric
Care Plan & Algorithms Cover?
1.
2.
3.
4.
5.
6.
7.
8.
Transfer To and From: Bed to Chair, Chair to
Toilet, Chair to Chair, or Car to Chair
Lateral Transfer To and From: Bed to Stretcher,
Trolley
Reposition in Bed: Side to Side, Up in Bed
Reposition in Chair: Wheelchair or Dependency
Chair
Tasks Requiring Sustained Holding of Limb/s or
Access to Body Parts
Transporting (stretcher, w/c, walker)
Toileting
Transfer Patient Up from Floor
Patient Assessment &
Care Plan – Page 71
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Completed on all patients
Takes into consideration:
• Patient Characteristics
• Patient Handling Task
• Equipment
Uses Algorithms
Algorithms - Page 73
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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?
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Developed by a group of nursing
experts
Tested with different patient
populations in a variety of
settings
When Should The
Algorithms be Used?
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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
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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 Assistance
Dependent
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
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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 Patient
2. Determine what handling
activities you must perform
3. Follow the algorithms to
determine what equipment
and # of staff are needed
4. Complete the Care Plan
5. File for future use
Algorithms Practice
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Break into groups
Have one person give a clinical
description of a recent patient
requiring moving/handling
Develop a patient handling Care
Plan using the assessment tool
and algorithms.
Safe Patient Handling
& Movement
Program Elements
Safe Patient Handling &
Movement Policy
Chapter 6
Safe Patient Handling &
Movement Policy
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
Safe Patient Handling &
Movement Policy
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
Safe Patient Handling &
Movement Program
BUT….
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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…
Safe Patient Handling
& Movement
Program Elements
9 Step Ergonomic Workplace
Assessment of Nursing
Environments
Chapter 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 Units
3. Obtain Pre-Site Visit Data
4. Identify High-Risk Tasks
5. Conduct Team Site Visit at each High-Risk Unit
6. Risk Analysis
7. Formulate Recommendations
8. 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 Care
Activity
Cause of
Injury
Sample:
Patient transfer
bed to
stretcher
Reaching
across
stretcher
for patient
Type of
Injury
Strain
Body
Part(s)
Location
Upper back Patient
bedside
Time of
Injury
09:30
Lost
Days
3
*Be sure to note which source is used on your Injury Log
Modified
Duty
Days
5
Step 1. Collect Baseline
Injury Data
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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.)
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Duration: Minimum of 1 year of data
Step 1. Collect Baseline
Injury Data

Collect by Unit
risk analysis)

(will also use later during
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
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Delete Tasks not usually performed on Unit
Completed by
• Each Staff member
• Collectively by Shift
Step 4. Identify High-Risk
Tasks
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)
Step 4. Identify 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?
Step 4. Identify High-Risk
Tasks
High Risk Task Ranking UNIT
Exercise
1. Have staff complete
2. Compare their perceptions
to yours
3. 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 highrisk 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
Step 5. Conduct Site Visit
Site Visit Walk-through
• Equipment
• Availability
• Use
• Storage
• Staff attitudes
Accessibility
Condition
Step 5. Conduct Site Visit
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
Step 6. Perform Risk
Analysis
Risk Identification/Breakdown
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
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
Step 6. Perform Risk
Analysis
What do we need to look at
to identify Specific RISKS
of ‘ELEMENTS’ of High Risk
Job TASKS?
Step 6. Perform Risk
Analysis
Element/Task Risk
Identification
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Task Intensity
Task Duration
Work Posture
General Design of Equipment
Space Characteristics
Where do you think problem
exists?
Step 6. Perform Risk
Analysis
Methods to Gather Risk Data
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General Observation
Staff Discussions
Staff Questionnaires
Review of Medical Data
Symptoms Surveys
Quantitative Evaluations
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Previous Studies
Job Consistency
& Fatigue
Brainstorming &
Group Activities
Job Safety
Analyses
Step 6. Perform Risk
Analysis
Job Safety Analysis (JSA)
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
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Break down job into steps
Identify hazards associated with
each step
Determine actions necessary to
eliminate or minimize hazards
Step 6. Perform Risk
Analysis
Job Safety Analysis (JSA)
Let’s try it!!!
See Job Safety Analysis Worksheet (Handout A-7)
Step 6. Perform Risk
Analysis
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??
Step 6. Perform Risk
Analysis
Risk can come from:
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
Patient Handling Tasks
Health Care Environment
Patient
Once risks are identified, steps can
be taken to protect Staff and
Patients!
Step 6. Perform Risk
Analysis
What Risk Factors are
related to the Health Care
Environment?
Step 6. Perform Risk
Analysis
Health Care Environment Risk Factors
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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
Step 6. Perform Risk
Analysis
Health Care Environment Risk
Factors


Space limitations
• Small rooms
• Lots of equipment
• Clutter
• Cramped working space
Poor placement of room furnishings
Step 6. Perform Risk
Analysis
Health Care Environment Risk Factors




Broken Equipment
Inefficient Equipment (non-electric, slowmoving, bed rails)
Not enough or Inconvenient Storage Space
Staff who don’t help each other or don’t
communicate
‘The Far Side’ Safety Humor…
Step 6. Perform Risk
Analysis
What Risk Factors are
related to Patients?
Step 6. Perform Risk
Analysis
Patient Risk Factors






Weak/unable to help with
transfers
Unpredictable
Vision or hearing loss
Hit or bite
Resistive Behavior
Unable to follow simple
directions
Step 6. Perform Risk
Analysis
Patient Risk Factors




Overweight
Experiencing Pain
Hearing or vision loss
No/little communication
between staff about Patient
or with Patient
Step 6. Perform Risk
Analysis
What Risk Factors are found in
Patient Handling Tasks?
Step 6. Perform Risk
Analysis
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
Step 6. Perform Risk
Analysis
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
Step 6. Perform Risk
Analysis
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.
Step 6. Perform Risk
Analysis
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)
Step 6. Perform Risk
Analysis
Risk Analysis includes review of…


Site Visit Information
• Site Visit Summary Data Sheet (p. 34)
Observations & Additional Information
from Site Visit
Step 6. Perform Risk
Analysis
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?
Step 6. Perform Risk
Analysis
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?
Step 6. Perform Risk
Analysis
Analyzing Unit Baseline Injury
Data
What does the unit injury
data tell you?
Step 6. Perform Risk
Analysis
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
Step 6. Perform Risk
Analysis
Information from the
Risk Analysis drives
formation of
Recommendations…
9 Step Ergonomic Workplace Assessment
of Nursing Environments
Step 7. Formulate
Recommendations
Step 7. Formulate
Recommendations
Solutions involve:
#1 Hazard Elimination
#2 Engineering Controls
#3 Administrative Controls
Step 7. Formulate
Recommendations
Hazard Elimination
Examples?
Step 7. Formulate
Recommendations
Hazard Elimination


Scale in sling lift
Transfer Bed
Step 7. Formulate
Recommendations
Administrative Controls
Examples?
Step 7. Formulate
Recommendations
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
Step 7. Formulate
Recommendations
Engineering Control
Examples?
Step 7. Formulate
Recommendations
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
Step 7. Formulate
Recommendations
Engineering Controls are the
keys to improving safety in
a health care environment….
Let’s see some examples.