9 Step Ergonomic Workplace Assessment of Nursing Environments

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9 Step Ergonomic Workplace Assessment of Nursing
Environments

• Step 7. Formulate Recommendations
• (continued)

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Step 7. Formulate Recommendations

• To Select Appropriate Interventions
• Match preferred
• interventions with
• dependency classifications

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Step 7. Formulate RecommendationsDependency
Status Key

• ADL Self-Performance Codes
• 0 Independent
• 1 Supervision
• 2 Limited Assistance
• 3 Extensive Assistance
• 4 Total Dependence

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Step 7. Formulate RecommendationsTotal
Dependence Class 4

• Minimize transfers if possible
• Mechanical full body sling lift
• Powered lateral assist device
• Friction reducing device

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Step 7. Formulate RecommendationsExtensive
Assistance Class 3

• Minimize transfers if possible
• Mechanical full body sling lift
• Powered lateral assist device
• Friction reducing device
• Stand assist lift

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Step 7. Formulate RecommendationsLimited
Assistance Class 2

• Stand assist lift
• Stand assist aid
• Gait/transfer belt with handles
• Sliding board

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Step 7. Formulate RecommendationsSupervision
Class 1

• Stand assist aid
• Gait/transfer belt with handles
• Sliding board

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Step 7. Formulate RecommendationsIndependent
Class 0

• Normally unassisted
• If condition is variable.. Do NOT categorize
  as Independent

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Lift Aid Equipment Determination
Grid (recommended example)
For a typical resident with the dependency status
classification as shown, this grid indicates
normal equipment requirements to conduct a safe
transfer. Some residents may have special
characteristics and not exactly match a typical
profile. In those situations, special
consideration will be required. (G. Fragala)
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Step 7. Formulate Recommendations

• Criteria for Selecting the Right Equipment
• Ease of use, availability
• Match with Patient characteristics
• Comfort, safety and dignity for Patients
• Exertion/safety for caregiver
• Space restrictions
• Cost and Durability
• Acceptance of staff

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• Now you know what program
  elements to include, risk control strategies, and
  what is equipment is available.
• Next Step
• Program Implementation

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Ergonomics Equipment alone are not magical
solutions

• To be effective, a well thought out system of
  implementation must be developed.

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Step 8. Implement Recommendations
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Step 8. Implement Recommendations

• Selling the SPHM Program at Your Facility

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Learning from History

• Over the past 35 years, efforts to reduce
  work-related injuries in nursing have been
  largely unsuccessful.

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Avoid Costly Mistakes

• Anxious to fix the problem, Administrators
  implement these known but largely ineffective
  strategies.
• Administrators lost money, saw no benefit, so
  its getting harder to convince them to spend
  more money

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Level of Evidence Needed!
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Previously Used Flawed Implementation Plans

• Pattern of implementing a strategy, finding
  positive results in 3 months, and then pulling
  out.
• Need for maintenance strategies to sustain
  positive effects.

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Failure to Market the Program Effectively

• Need for Buy-In at all levels
• Need for adequate Resource allocation
• Need to share success stories and best
  practices.

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Limited Involvement of Direct Care Providers

• Solutions didnt always fit unit
• Forced standardization
• Limited clinician buy-in

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Nurses are Worth it

• We cannot afford to lose 12 of our most
  experienced nurses each year due to injuries.
• Nursing should be focused on brains not brawn!
  

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Successful SPHM Implementation Strategies

• Use SPHM Implementation Team
• Use Goals Objectives as Implementation Drivers
  
• Use Existing Resources for Program Development
  ANA/OSHA/VA
• Use Social Marketing Strategies
• Be Aware of Barriers
• Utilize Change Strategies
• Know The Problem CAN be fixed!

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Step 8. Implement Recommendations

• Use Existing Resources for Program Development
  ANA/OSHA/VA

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ANA Ergonomic/Workplace MSD Campaign

• Released Position Statement asking to Eliminate
  Manual Patient Handling
• Partnering with researchers
• Sponsoring conference workshops
• Pursuing state legislation (federal?)
• Training and education among CMAs
• Incorporating safe patient handling education
  into schools of nursing

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ANA Ergonomic/Workplace MSD Campaign

• Handle with Care Training Program

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OSHA RESOURCES

• OSHA Ergonomic Guidelines for Nursing Homes
  www.osha.gov/ergonomics/guidelines/nursinghome/ind
  ex.html
• OSHA website www.osha.gov
• OSHA Compliance Assistance Specialists in OSHA
  area offices

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OSHA RESOURCES

• OSHA Regional Office in Atlanta, GA
• OSHA Training Institute (OTI) Educational
  Resource Center
• Cal/OSHA A Back Injury Prevention Guide for
  Health Care Providers (www.dir.ca.gov/dosh/dosh_p
  ublications/ backinj.pdf)

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VA RESOURCES

• This Training Program
• VA Patient Care Ergonomics Resource Guide
  Safe Patient Handling Movement
• VA Technology Resource Guide
• Bariatrics Resource Guide
• Website www.patientsafetycenter.com

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Step 8. Implement Recommendations

• Use Social Marketing Strategies

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Step 8. Implement Recommendations

• Social Marketing
• Identifies what angle will be most convincing to
  each group you need to target

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But Not all ideas can be marketed successfully!
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Step 8. Implement Recommendations

• Social Marketing Plan
• 1. Define Goal/s
• What are your goal/s?
• What are you wanting to change?
• Why?
• 2. Define Target Groups
• Who are you wanting to target?

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Step 8. Implement Recommendations

• Social Marketing Strategies
• Target Groups
• Patients
• Staff
• Organization

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Step 8. Implement Recommendations

• Marketing Strategies to Patients
• Use of Equipment increases Patient
• Comfort
• Security
• Dignity
• Safety - Seen as decreases in falls, skin tears,
  abrasions

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Step 8. Implement Recommendations

• Marketing Strategies to Patients
• Use of Patient Handling Equipment..
• Promotes Patient mobility and independence
• Enhances toileting outcomes and decrease
  incontinence
• Improves Quality of Life

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Step 8. Implement Recommendations

• Marketing Strategies to Staff
• Reduces of injuries
• Reduces severity of injuries
• Lost work days Light Duty days
• Keeps more able-bodied co-workers on unit
• Reduces direct costs
• Decreases musculoskeletal discomfort
• Decreases staff turnover

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Step 8. Implement Recommendations

• Marketing Strategies to Organization
• Employer of Choice
• Improve recruitment
• Staff satisfaction
• Retention
• Safety
• Enhances regulatory compliance

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Step 8. Implement Recommendations

• Marketing Strategies to Organization
• Improves Staff Efficiency
• Improves Patient Safety
• Fosters Culture of Safety

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Social Marketing Sample Grid
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Step 8. Implement Recommendations

• Social Marketing Plan
• 1. Define Goal/s
• What are your goal/s?
• What are you wanting to change?
• Why?
• 2. Define Target Groups
• Who are you wanting to target?
• Complete A B, A-1 Handout, Developing a SPHM
  Action Plan

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Step 8. Implement Recommendations

• Be Aware of Barriers to Successful
  Implementation

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Step 8. Implement Recommendations
Why isnt this problem fixed yet?

• Dont Know How
• Havent Figured Out That Training Isnt Working
• Still Blaming Staff Who Get Injured
• Lack of Time

• Dont Believe Published Findings
• Resource Impaired
• Not a Priority
• No One is Championing This

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Step 8. Implement Recommendations

• Barriers
• Staff Level
• Patient Level
• Organizational Level
• Nursing Unit
• Facility
• Organization

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Step 8. Implement Recommendations

• Staff Level Barriers?

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Step 8. Implement Recommendations

• Staff Level Barriers
• This is that way weve always done it.
• I dont have time.
• My way is better.
• This is just another fad.
• It wont work.
• Weve already tried, and it didnt work.

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Step 8. Implement Recommendations

• Response to
• Weve already tried, and it didnt work.
• BUT, previously
• Equipment
• quality was poor
• wasnt easy to use
• wasnt accessible
• wasnt maintained properly
• wasnt matched to Unit needs
• Staff werent trained adequately

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Step 8. Implement Recommendations

• Patient Level Barriers?

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Step 8. Implement Recommendations

• Patient Level Barriers
• Why cant we keep doing things like weve
  always done them?
• I like the personal touch.
• Im afraid of being lifted up.
• This is just another fad.
• Dignity Issues
• Loss of Independence
• Family Resistance

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Step 8. Implement Recommendations

• Strategies to Overcome Patient Barriers to
  Equipment Use
• Staff demonstrate equipment use
• Take advantage of snowball effect
• Patient Family Council
• Outlet for fears of family member
• Discuss pros/cons
• Testimony from Patients using equipment

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Step 8. Implement Recommendations

• Organizational Level Barriers?

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Step 8. Implement Recommendations

• Organizational Level Barriers
• Lack of Leader Support
• Lack of Understanding
• Not a Priority
• Lack of Incentives
• Outdated Policy
• Space
• Cost
• More

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Step 8. Implement Recommendations

• Utilize Change Strategies (Facilitators)

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Step 8. Implement Recommendations

• Facilitators of Change
• Knowledge All must be aware of the problem and
  the solutions
• Attitudes Those involved must agree with
  recommendations
• Behavior Culture must be in place to promote,
  support accept behavior changes
• Maintenance Reinforcement sustains changes

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Step 8. Implement Recommendations

• Change Strategies
• Transfer Knowledge (Educate Train)
• Involve Front-line Workers
• Use Unit Peer Leaders or Facility Expert
• Promote Costs/Savings Benefit
• Foster Change/Develop Action Plans

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Mechanisms of Knowledge Transfer

• Learning After
• Accident Review Boards (ARB)
• Root Cause Analysis (RCA)
• Safety Investigations (OSHA)
• Best Practices Systems
• After Action Review (AAR)

Human Action

• Learning Before
• Peer Leaders (BIRNS)
• Failure Mode Effect Analysis (FMEA)
• Best Practices
• AAR

• Learning During
• Individual Imprinting

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Making the Most of the Knowledge Transfer Process

• Ex You want to transfer knowledge related to
  injuries due to patient handling tasks

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Making the Most of the Knowledge Transfer Process

• 1. Identify what you need to know.
• Factors that place worker at risk for injury
• Factors that reduce the risk of injury

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Systematizing Knowledge Transfer

• 2. What do you already know about this issue?
  What is the target audience?
• Knowledge Patient handling tasks are frequent
  and risk is from both routine and non-routine
  aspects
• Target Audience Front line patient care staff
  at the unit level

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Systematizing Knowledge Transfer

• 3. Develop a dissemination plan
• Train peer leaders (Back Injury Resource Nurses)
  in After Action Review (AAR), face-to-face method
• Train staff in After Action Review (AAR), staff
  safety meeting
• Develop Distribute AAR brochure

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Systematizing Knowledge Transfer

• 4. Implement the dissemination plan
• Staff training and buy-in, dissemination of AAR
  brochure, in-services
• Implementation of After Action Review at the unit
  level by the Back Injury Resource Nurses.
  Consider staff needs, motivators, unit
  organization, etc.

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Systematizing Knowledge Transfer

• 5. Evaluate the knowledge transfer
  process/outcomes
• Monthly process logs completed by Back Injury
  Resource Nurses
• Is activity level of After Action Reviews related
  to incidence of back injuries?

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Knowledge Transfer

• Fosters a Culture of Safety
• Solves problems quickly
• Facilitates implementation of best practices
  effectively and efficiently
• Empowers staff by using the knowledge they possess

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Step 8. Implement RecommendationsUse Change
Strategies

• Change Strategy Educate and Train
• Education
• Present theory, philosophy and why Program is
  being implemented.
• Develop foundation to develop attitudes that will
  support the value of an ergonomics-based
  program.
• Training
• Develop skill and competency in use of equipment
  and utilization of program elements.
• Source An Ergonomic Based Back Injury
  Prevention Program for Healthcare Advisory Panel
  for Safe Patient Handing Movement June, 2000,
  Guy Fragala, PhD, PE, CSP

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Step 8. Implement Recommendations

• Educate, Educate, Educate
• Train, Train, Train
• Policy
• Program Elements
• Equipment
• Skills-based
• Give MORE than one or two times!
• Annual Refreshers
• Must show Competency in Use

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Step 8. Implement Recommendations

• A Comprehensive Training Program is CRITICAL!

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Step 8. Implement Recommendations
Change Strategy Involve Front-line Workers

• Use
• Brainstorming
• AAR
• Interviews
• Questionnaires
• Team Activities
• Focus Groups
• Group Discussions

• Get Staff Input on
• Unit Needs (storage/space/etc.)
• Unit Hazards/Risks
• Ergonomic Evaluation
• Equipment Selection
• More

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Step 8. Implement Recommendations

• Think for a minute.
• What do you think would be the best way to
  involve frontline workers in your patient care
  environment?

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Step 8. Implement Recommendations

• Change Strategy Use Unit Peer Leaders/ Facility
  Experts
• Back Injury Resource Staff
• Act as Resource, Coach, Trainer, Team Leader,
  Good Behavior Model
• Share/Transfer Knowledge/ Information
• Assist in building a Culture
  of Safety

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Step 8. Implement Recommendations

• Use past experiences.
• What has been your experience with similar
  (injury prevention) programs?
• How were you involved?
• What was the program approach/content?
• What barriers were encountered?
• What elements were successful?
• How effective was the overall program?
• Do you feel your approach was optimum?
• How would you improve in the future?

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Step 9. Monitor Results

• Outcome Measures - Ch. 11
• Incidence/severity of MS injuries (p.131 133)
• Intensity/duration/frequency of MS discomfort (C)
• Job Satisfaction (p. 139)
• Adherence to/Acceptance of Program (p.97 145)

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Step 9. Monitor Results

• Outcome Measures - Ch. 11
• Equipment Use (p.147)
• Competency (p. 119)
• Cost Cost Savings (p.129)
• Performance Measures (An Ergonomic Based Back
  Injury Prevention Program for Healthcare,
  Advisory Panel for Safe Patient Handing
  Movement June 1 2, 2000, Guy Fragala, PhD, PE,
  CSP)

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Conclusion

• There is a problem
• But know something CAN be done about the
  problem.
• Complex activity that takes a concerted effort
  from the many involved.
• Staff Management need to be motivated.
• Efforts are needed over time to sustain the
  change.

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BIRN Certification Training

• Back Injury Resource Staff
• The key to successful Safe Patient
  Handling and Movement Programs.

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• Never underestimate the ability of a small
  group of committed individuals to change the
  world. Indeed, it is the only thing that ever
  has.
• Margaret Meade

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Foster Change/Develop Action Plans

• Complete
• Developing a SPHM Action Plan
• Developing A SPHM Action Plan (A-1)