Transcript Ergonomics in hospital

IN THE NAME OF GOD
Ergonomics in Hospital
Department of Industrial Engineering
Professor
Jubin Ghayoor
Gathered by:
Zoha Zargham & Zahra Modarres Yazdi
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December 2006
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Introduction
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Hospital is a highly symbolic world where
the comedy and tragedy of human exist.
Hospitals are characterized by a
heterogeneous mix of professional and nonprofessional staff who may share only the
most abstracted aims.
One of the major differences in practicing
ergonomics in a hospital, compared with
other industries, is the treatment of patient.
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Why hospital ergonomics is so
important?
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Hospital employees are at particularly high risk
for work-related musculoskeletal disorders
(WRMSD).
The hospital industry reported the second highest
absolute number of injuries and illnesses with an
incidence rate of 8.8 per 100 full-time equivalent
workers compared to 5.7 for all industries
combined.
both physical and psychosocial stressors are
recognized contributors to overall injury risk.
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poor ergonomics characteristics not only
result in higher levels of absenteeism and
WRMSD, but also may lead to lower levels
of patient safety as well.
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Who is at Higher Risk?
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Nurses
Hospital workers; workstations,
housekeeping, maintenance and food
service workers.
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Nurse
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Nursing work is often physically heavy,
involving lifting weights.
Stressful job.
physically dirty, involving tasks such as
washing soiled bodies.
highly repetitive.
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Measuring the physical
workload on the job
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Physical load is typically assessed
through the analysis of posture,
movement, and peak force or
cumulative load over time, velocity,
acceleration, frequency and duration.
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The REBA
Rapid entire body assessment
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REBA is a postural targeting method for
assessing the risks of work-related
disorders. It provides a mechanism for
recording postures of virtually all parts of
the body, excluding the position of the foot
and ankle.
REBA can record simultaneously occurring
risk factors. static, repetitive, and awkward
postures.
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How Does The Algorithm
Work?
 For every Posture some points are considered
varying from 0 to 7. if any support is provided some
points will be reduced.
 The sum of these points represents the harm the
situation causes.
 It’s weighting algorithm to postures penalizes
extreme or unsupported postures with higher
ratings.
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REBA
Upper Extremity score:
Shoulder + Elbow + Wrist + Coupling + Arm Support.
Total possible range: 4 to 57.
Trunk/lower extremity score :
Trunk + legs + knees + foot support + leg position +
static + rapid.
Total Possible range: 4 to 103
Small range of motion (ROM) movements(>4 minute)
:+3 points
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REBA
 Mouse:+1 point for left handed and +2 for right handed
person
 Upper Quadrant Score: upper Extremity + Neck + small ROM
+ Mouse .
Total Possible Range is :-4 to 67.
 One or more body parts static for 41 min (static): +5.
 Rapid large changes in position or an unstable base (rapid):
+8.
 TOTAL Range of REBA :
0 To 170
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Example
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Most Common task for a
Nurse/hospital worker
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Pushing meal/medication cart
Transferring patients to chairs
Pushing wheelchairs
Transferring patients to and from beds
Lifting the patient up to headboard
Repositioning patient in bed side to side
Changing IV bags
Carrying trays and assistance with eating
Sitting and standing at computer workstation
Help with dressing/undressing
Weighing the patient
Washing Toilets / bathtubs
Tying supports
Feeding a bed ridden patient
Making the bed with the patient not in it
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Changing IV Bag
REBA Evaluation
Trunk: 2, Neck: 2 ,Legs: 1, Upper Arms: 5, Lower Arms: 2
Wrist: 1
Recommendations:
 Use a chair-like foot pump
to raise to the height
of the IV bag.
 Install an up and down
button for adjusting height.
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computer workstation
POTENTAL Problems :
Trunk, Neck, Legs, Arms, Wrist
Recommendations:
 Users eyes 2”-3”below top of monitor casing, facing keyboard
and monitor straight on.
 Monitor placed approximately at arm’s length.
 Computer stand placed 28”-30” above floor.
 Use laptop to minimize space.
 Foot rests would allow people with longer
or shorter legs to extend them with support.
 It is important that no clutter is under the
desk to make this possible.
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Pushing & Pulling Carts
REBA Score: 10 High risk
POTENTAL Problems:
Wrist: deviation & flexion
Arm & Shoulder: abduction
Neck & Back: twisting & flexion
Recommendations:
 Reduce weight of cargo
 Only one cart at a time
 Push instead of pull
 Ergonomic wheels
 Handles
 Motorized carts
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Mopping Under Beds
REBA Score: 8 (High Risk Level)
POTENTIAL PROBLEMS:
Back: flexion
Neck: flexion & twisting
Shoulder: fatigue to trapezius muscle
Upper Arm: repetition of abduction & adduction
Recommendations:
 Use Ergonomic Mop
 Longer handles
 Switching hand positions
 Frequent breaks to relieve
stress to trapezius muscle & elbow
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Scrubbing Toilets & Beds
REBA Score: 12
POTENTIAL PROBLEMS:
Wrist: flexion & extension
Shoulder: abduction & twisting
Back: flexion greater than 65 degrees
One-handed task
Recommendations:
 Use scrubbing tool rather than a rag
 Adjustable handle angles could prevent wrist deviation.
 Toilet placement: Accessible from all sides.
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Ergonomic tools for patient aid
Most common tasks have high risks
REBA: ranges from 9 to 13
High Risk to very high risk
Using Ergonomics tools will tremendously
reduce the harm
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Gait belt/Conveyer belt
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A gait belt with handles can be used during a stand pivot
transfer, guiding a patient along a transfer board and during
seated transfers.
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Lifting a patient
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Height-adjustable Electric Beds
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Have height controls to allow for easy transfers
from bed height to wheelchair height. These beds
can be kept low to the ground for patient safety
and then raised up for interaction with staff.
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Slip sheets
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Help to reduce friction while laterally transferring
patients or repositioning patients in bed and reduce
the force workers need to exert to move the
patient.
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Lateral Transfer Device
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The use of lateral transfer devices could eliminate
the risks of back injury caused by lifting patients
during lateral transfer procedures.
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Anti-fatigue mats
Reduce fatigue and discomfort in legs and back
 Increase blood flow and amount
of oxygen reaching the heart
 Polypropylene stain-resistant
surface for ease of maintenance
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Layout - Radial layout
Everything is centrally located
 Minimal movement because of central proximity to patient
areas and work areas with visual access to all rooms.
 Core area contains:
nurses station, charting,
lab, clerical, supplies
 Increases efficient of space
utilization and traffic flow
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Stress in Hospital
Workplace stress
amongst nurses has been associated
with high absenteeism, low work
satisfaction and poor retention rates.
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Stressors specific to Nurses
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Death and Dying
Conflict with Doctors
Inadequate preparation to deal with the
emotional needs of patients and their
families
Uncertainty concerning treatment
Conflict with other nurses and supervisors
Workload
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Survey
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A study attempted to evaluate the effectiveness of
a one-day stress management program on reducing
a rage of nurses stress.
8-hour face-to-face workshop.
Nurses were also given a self-directed manual to
exercises and use post the workshop.
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Work-shop
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Defining stress and the stress response
Primary working on Rational Emotive Behavior
Therapy ( REBT)
The importance of Beliefs, Thoughts and Attitudes.
Common stress related Beliefs, Thoughts and
Attitudes.
The importance of Rational thinking.
Recognizing unhealthy thinking patterns.
The link between thoughts and feelings.
Learning to be adaptable.
Challenging stress causing Beliefs, Thoughts and
Attitudes.
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The ABC’s of REBT
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A: Activating event. What happened.
Something that we can define clearly.
B: Beliefs about the event. What you
thought & said to yourself about it.
Your evaluations and judgments about
the event, yourself and others.
C: Consequences. How you felt in
response. What you did.
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Method
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Nurses were assessed before and at 6
weeks post the workshop, using the
Nurse Stress Scale
Nurses were also asked to rate their
level of stress at work, out side work
and overall stress.
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Results
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Results
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Results
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Design Case study
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Hospital bed
Hospital meal cart
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Transportation with
Hospital Beds:
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A common task for nurses in acute
hospital wards is the transportation of
patients in beds to different medical
specialties.
The aim of the study was to explore
the influence of different bed wheel
arrangements on the effort and
difficulties experienced by personnel
when transporting patients.
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Testing conditions:
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19 nurses, 2 men and 17 women
Four test beds:
Bed 1 was a standard hospital bed with
four castor wheels used without the
direction lock being activated. So the bed
could move in all directions.
Bed 2 was a standard hospital bed with
four castor wheels. The swivel function of
one castor at the foot part of the bed was
locked so that the foot part could only
move in the longitudinal direction.
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Testing Conditions:
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Bed three was an experimental bed with two
wheels attached to a common fixed axle at the
head part of the bed and two castor wheels at
the foot part. The head part of the bed could
only move in the longitudinal direction while the
foot part could move in all directions.
Bed four was an experimental bed with four
wheels attached to fixed axles positioned near
the center of the bed and with short distance
between the axles this bed could only move in
the longitudinal direction.
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Testing Conditions:
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Test situations:
Transport the bed along a straight corridor
Transport the bed around a corner
Maneuver the bed into a patient room
Maneuver the bed to a bed space in a
patient room
The testing order of the beds was
randomized in order to avoid effects such as
the subjects becoming tired, more skilled or
being influenced by the performance of the
first bed tested, when comparing the beds.
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Results and Suggestions:
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Beds 3 and 4 were experienced as easier and requiring less
effort to transport in straight corridors.
Beds 1 and 2 were easier to maneuver in limited spaces.
In limited spaces the bed must be turned and moved
sideways. Therefore, castor wheels are the natural solution to
the maneuvering problem in the patient’s room.
Suggested design: a bed with four castors completed with a
movable two-wheel axle placed in the center of the bed.
When the bed is propelled in corridors, the movable axle is
activated to carry the main load of the bed. In limited spaces,
the axle is raised so that the bed can move freely on the four
castors.
The bed must be equipped with an easily handled control
mechanism to activate the middle axle.
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Ergonomics Evaluation and
Redesign of a Hospital Meal
Cart
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The ergonomic, design and other problems of a
conventional hospital meal cart were evaluated with
a view to redesign a hospital meal cart,
incorporating ergonomic principles and data.
The operators encountered difficulty in setting the
cart in motion, seeing over the cart, turning the
cart and stopping it while in motion.
The operators expressed postural discomfort in the
shoulder, neck, back, lower back, knee and leg,
ankle and foot.
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Ergonomic and Other
Design Problems:
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Maneuverability (pushing, pulling and
turning)
Cart handle height and placement
Vision or eye height above the cart
Opening and closing of cart doors
Ease of stopping the cart
Size of meal tray
Provision of hot meals
Pushing versus pulling the cart
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Thanks for your
time & attention
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Questions and Comments ?!
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