Patient Care Ergonomics

1
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

2

• Heres A Successful Solution using Patient Care
  Ergonomics

3
Successful Solution using Patient Care Ergonomics

• VISN 8 Patient Safety Center Research Project
• VISN-Wide Deployment of a Back Injury Prevention
  Program for Nurses
• Safe Patient Handling and Movement
• (2001-2002)

4
Results Incidence () of Injuries

• Decreased 31 (144 to 99 injuries)

5
Results Injury Rates

• Decreased from 24 to 16.9
• Difference was significant at 0.036 level

Defined as reported injuries per 100 workers
per year
6
Results Light Duty Days
Decreased 70 (1777 to 539 days) Significant at
0.05 level
7
Results Lost Work Days
Decreased 18, from 256 to 209 days
8
Results Job Satisfaction

• Pay
• Professional Status
• Task Requirements
• Autonomy
• Organization Policy
• Interaction
• Overall
• Denotes Significance

9
Successful Solutions

Overview of a Safe Patient Handling Movement
Program
10
Safe Patient Handling Movement Program
For success, required infrastructure MUST be in
place prior to implementing SPHM Program

• Equipment
• Knowledge Transfer Mechanisms
• Technical Support

• Management Support
• Champion
• SPHM Team
• Program Elements

11
SPHM Champion

• Clout
• Mover/Shaker
• Interest
• Nursing, Therapy, Safety

12
SPHM Team Responsibilities

• Implements Program
• Writes Policy
• Reviews/Trends Data
• Ensures incidents/injuries are investigated
• Facilitates Equipment Purchases

13
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

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Safe Patient Handling Movement Program

• Goals
• Reduce the incidence of musculoskeletal
  injuries
• Reduce the severity of musculoskeletal
  injuries
• Reduce costs from these injuries

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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

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SPHM Key Objectives

• Reduce manual transfers by ___
• Reduce direct costs by ___
• Decrease nursing turnover by __
• Decrease musculoskeletal discomfort in nursing
  staff by ___

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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

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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)

19
Safe Patient Handling Movement Program

• 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

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Safe Patient Handling MovementProgram
Elements

• Back Injury Resource Nurses
• Chapter 7

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Safe Patient Handling Movement Program

• BIRNS are the Key to Program Success
• Implement Program
• Continue Program

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Back Injury Resource Nurses

• RN, LPN, CNA
• Informal Leader/ Respected
• Safety Interest

• Ergo Experience Not Required
• Enthusiastic/ Out-going
• Good Time/ Mgmt Skills

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Back Injury Resource Nurses

• Roles/Responsibilities
• 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

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BIRNS Roles Responsibilities1.
Implement/Continue SPHM Program

• BIRNS activities and involvement depend on what
  program elements are included in your Program.

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BIRNS Roles Responsibilities2. 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!!

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BIRNS Roles Responsibilities3.
Share/Transfer Knowledge

• BIRNS-BIRNS
• Within Units, Facilities, Organization
• With Others Organizations
• Monthly Conference Calls
• Outlook Email Groups
• National Conferences

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BIRNS Roles Responsibilities3.
Share/Transfer Knowledge

• BIRNS-STAFF
• AAR Meetings
• On-the-Job
• Co-workers
• New Employees
• Staff Meetings
• Skills Check-off Training/In-services

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BIRNS Roles Responsibilities4. 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

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BIRNS Roles Responsibilities5. 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

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BIRNS Roles Responsibilities5. Monitor and
Evaluate Program

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

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What Helps Make a BIRNS Successful?

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

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What Helps Make a BIRNS Successful?

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

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What Helps Make a BIRNS Successful?

• 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

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Back Injury Resource Nurses

• 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

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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.

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Safe Patient Handling Movement Program

• BIRNS are the Key to
• Implement SPHM Program
• Continue SPHM Program

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Safe Patient Handling MovementProgram
Elements

• After Action Review ProcessChapter 9

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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)

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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

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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/blamin
  g

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Guidelines for AAR Use

• 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

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Guidelines for AAR Use

• 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?

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Training Staff on AAR

• Minimal Training required
• Staff In-service review purpose, need for
  trust, benefits, etc.
• Training Tools
• Handout A-2, AAR Brochure
• My AAR slides

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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.

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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 1100 and it is
  before lunch time.

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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?

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What Happened?

• Sue, an LPN, begins.
• I had to get Mr. Walker up because he was lying
  in a wet bed.... I was late with my meds and I
  knew I needed to get to the in-service. Then, I
  couldnt find a sling, so I just got him up
  myself. While I was lifting him I kept thinking
  Dont hurt yourself I guess I was lucky I
  didnt!
• So.. What happened was that I lifted Mr. Walker
  without help, without using a lift.

48
What Was Supposed to Happen?

• Nancy OK.. So, what should have happened?
• Sue I should have found the sling and used the
  lift, but I was in such a hurry.
• Nancy I know Its so frustrating to have all
  of these new lifts but not have the slings where
  you need them. I know Ive had trouble finding
  slings, too.
• Others discuss their experiences related to
  the lifts and slings.

49
What Accounts for the Difference?

• Nancy Lets see What accounts for the
  difference? Well... The sling wasnt available.
  For starters, the sling should have been in the
  room and on the bed side stand, where we agreed
  to keep them.

50
What Accounts for the Difference?

• Ron Youre right, but there's not always room to
  put them there Thats 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 Im not
  around.

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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.

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

• Nancy OK Were 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 Thats a good idea! I also think it would
  help if we had more slings How many more do you
  think we need?

53
How can the same outcome be avoided the next
time??

• Brad Ill request a work order to install the
  hooks and after theyre installed Ill make sure
  everyone gets the message on the new procedure.
• Ron Ill add the process to the new employee
  orientation packet.
• Fred Ill put in a request to order 6 slings.

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Whats the Follow-up Plan?

• Sue Lets 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,
  lets see how were doing on the sling issue at
  an AAR in one month.

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After Action Review Case Study

• AAR Case Study
• BIRN noticed friction reducing devices (FRDs)
  werent being used on her Unit
• Held staff AAR
• Determined FRDs too narrow
• Solution BIRN contacted manufacturer who made
  new, wider FRDs.
• Outcome New, wider FRDs used on Unit

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AAR Practice

• Break into groups
• Think of a problem common to your group
• Perform an AAR using the AAR questions.

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Safe Patient Handling MovementProgram
Elements

• Patient Assessment, Care Plan, Algorithms for
  Safe Patient Handling Movement Chapter 5

58
Patient Assessment, Care Plan, Algorithms for
Safe Patient Handling Movement

• The Assessment, Algorithms , Care Plan go hand
  in hand...
• Assess the Patient
• Determine what handling activities you must
  perform
• Follow the algorithms to determine what equipment
  and of staff are needed
• Complete the Care Plan
• File for future use

59
What Tasks Do the Care Plan Algorithms Cover?

• 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

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What Tasks Do the Bariatric Care Plan
Algorithms Cover?

• 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

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Patient Assessment Care Plan Page 71

• Completed on all patients
• Takes into consideration
• Patient Characteristics
• Patient Handling Task
• Equipment
• Uses Algorithms

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Algorithms - Page 73

• Based on Specific Patient Characteristics
  (from Assessment)
• Assists nurses in selecting
• Safest Equipment
• Safest Patient Handling
  Technique
• Advises of staff needed

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How were these Algorithms Developed?

• Developed by a group of nursing experts
• Tested with different patient populations in a
  variety of settings

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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

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How Do We Lift This Resident?
66
Lets 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.

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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)

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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

69
Assessing Fred V.

• Residents level of cooperation and
  comprehension
• Unpredictable
• Weight 156 lbs.
• Height 5 9

• Special circumstances?
• History of Falls

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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

71
Patient Assessment, Care Plan, Algorithms for
Safe Patient Handling Movement

• The Assessment, Algorithms , Care Plan go hand
  in hand...
• Assess the Patient
• Determine what handling activities you must
  perform
• Follow the algorithms to determine what equipment
  and of staff are needed
• Complete the Care Plan
• File for future use

72
Algorithms Practice

• 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.

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Safe Patient Handling MovementProgram
Elements

• Safe Patient Handling Movement Policy
• Chapter 6

74
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

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Safe Patient Handling Movement Policy

• SPHM Policy Ties all Program Elements Together
• Says to avoid hazardous Patient handling tasks.
• If cant avoid, carefully assess hazard, if
  possible, always use Patient handling equipment

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Safe Patient Handling Movement Program

• 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

77
Safe Patient Handling MovementProgram
Elements

• 9 Step Ergonomic Workplace Assessment of Nursing
  Environments
• Chapter 3

78
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

79
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)

80
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

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Step 1. Collect Baseline Injury Data
Be sure to note which source is used on your
Injury Log
82
Step 1. Collect Baseline Injury Data

• 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

83
Step 1. Collect Baseline Injury 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

84
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?

85
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

86
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

87
Step 4. Identify High-Risk Tasks

• High Risk Task Ranking Exercise
• Think of a high-risk unit.
  Complete Tools for Prioritizing
  High-Risk Patient Handling Tasks
• (Complete Handout A-4, Prioritizing
  High Risk Tasks)

88
Step 4. Identify High-Risk Tasks

• Lets compare high risk tasks identified by you
  and others
• If there were differences
• Why??
• What factors play a role in ranking tasks?

89
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

90
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

91
Step 3. Obtain Pre-Site Visit Data

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

92
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)

93
Step 5. Conduct Site Visit

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

94
Step 5. Conduct Site Visit

• Site Visit Walk-through
• Equipment
• Availability Accessibility
• Use Condition
• Storage
• Staff attitudes

95
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

96
9 Step Ergonomic Workplace Assessment of Nursing
Environments

• Step 6. Perform Risk Analysis

97
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

98
Step 6. Perform Risk Analysis

• What do we need to look at to identify Specific
  RISKS of ELEMENTS of High Risk Job TASKS?

99
Step 6. Perform Risk Analysis

• Element/Task Risk Identification
• Task Intensity
• Task Duration
• Work Posture
• General Design of Equipment
• Space Characteristics
• Where do you think problem exists?

100
Step 6. Perform Risk Analysis

• 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

101
Step 6. Perform Risk Analysis

• Job Safety Analysis (JSA)
• Break down job into steps
• Identify hazards associated with each step
• Determine actions necessary to eliminate or
  minimize hazards

102
Step 6. Perform Risk Analysis

• Job Safety Analysis (JSA)
• Lets try it!!!
• See Job Safety Analysis Worksheet (Handout A-7)

103
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??

104
Step 6. Perform Risk Analysis

• Risk can come from
• Patient Handling Tasks
• Health Care Environment
• Patient
• Once risks are identified, steps can be taken to
  protect Staff and Patients!

105
Step 6. Perform Risk Analysis

• What Risk Factors are related to the Health Care
  Environment?

106
Step 6. Perform Risk Analysis

• 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

107
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

108
Step 6. Perform Risk Analysis

• Health Care Environment Risk Factors
• Broken Equipment
• Inefficient Equipment (non-electric, slow-moving,
  bed rails)
• Not enough or Inconvenient Storage Space
• Staff who dont help each other or dont
  communicate

109
The Far Side Safety Humor
110
Step 6. Perform Risk Analysis

• What Risk Factors are related to Patients?

111
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

112
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

113
Step 6. Perform Risk Analysis

• What Risk Factors are found in Patient Handling
  Tasks?

114
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

115
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

116
Step 6. Perform Risk Analysis

• Now, its 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.

117
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)

118
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

119
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
• Whats going on? What trends are seen?

120
Step 6. Perform Risk Analysis

• Analyzing Unit Baseline Injury Data Activity
• Lets 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?

121
Step 6. Perform Risk Analysis

• Analyzing Unit Baseline Injury Data
• What does the unit injury data tell you?

122
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

123
Step 6. Perform Risk Analysis

• Information from the Risk Analysis drives
  formation of Recommendations

124
9 Step Ergonomic Workplace Assessment of Nursing
Environments

• Step 7. Formulate Recommendations

125
Step 7. Formulate Recommendations

• Solutions involve
• 1 Hazard Elimination
• 2 Engineering Controls
• 3 Administrative Controls

126
Step 7. Formulate Recommendations

• Hazard Elimination
• Examples?

127
Step 7. Formulate Recommendations

• Hazard Elimination
• Scale in sling lift
• Transfer Bed

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Step 7. Formulate Recommendations

• Administrative Controls
• Examples?

129
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

130
Step 7. Formulate Recommendations

• Engineering Control
• Examples?

131
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

132
Step 7. Formulate Recommendations

• Engineering Controls are the keys to improving
  safety in a health care environment.
• Lets see some examples.