Patient Care Ergonomics

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• Patient Care Ergonomics

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The First Ergonomist
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What is Patient Care Ergonomics?

• Use of Ergonomic Principles in the Health Care
  Environment
• Jobs should fit the workers
• Jobs should fit within workers capabilities
• Through Patient Care Ergonomics...
• Jobs can be redesigned
• Jobs can be improved to be within reasonable
  limits of human capabilities

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Ergonomics Biomechanics 101
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Patient Care Ergonomics Biomechanics

• John D. Lloyd, PhD, CPE
• Associate Director, Technology
• VA Patient Safety Center
• Mary W. Matz, MSPH
• Patient Care Ergonomics Translational Specilaist
• Andrea Baptiste, MA, CIE
• Ergonomist/Biomechanist
• VISN 8 Patient Safety Center of Inquiry
• James A. Haley VA Hospital Tampa, Florida

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An Ergonomic Approach

• Provides a step-by-step process to ensure the
  appropriate technology is in place to reduce
  stress strain on nursing staff, thus reducing
  the risk of injury.

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A Simple Look at an Ergonomic Approach

• 1. Identify jobs and job tasks which stress body
  parts beyond limits (using Biomechanical and/or
  Job/Task Analysis)
• 2. Develop solutions to change these task
  demands.
• 3. Review the design of the physical work
  environment to reduce risk, remove barriers,
  minimize travel, etc.
• 4. Consider other factors that affect work
  performance, such as lighting spatial
  relations.
• 5. Implement these changes in the work place.

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Studies Show Patient Care Ergonomic Approaches.

• Reduce staff injuries from 20 - 80
• Significantly reduce workers compensation costs
• Reduce lost time due to injuries
• (Evanoff et al, 2003 Nelson et al, in press
  Collins et al, in press 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)

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Institute of Medicine Report 11/4/04

• Characterizes the aging nursing workforce as a
  risk to patient safety
• The loss of strength agility that often
  accompanies aging affects the ease with which
  nurses can perform patient care activities that
  require them to turn, lift, or provide
  weight-bearing support to patients.

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Institute of Medicine Report 11/4/04

• Continued.
• Ergonomic patient staff furniture and work
  tools will be needed to decrease the risk of
  injuries to patients (and
  nurses as well).

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Derivation of Ergonomics
ERGO NOMOS Laws of Work

• Phrase derived from two Greek words
• Coined by a Polish Naturalist circa 1870
  (Wojceich Bogumil Jastrebowski)

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Ergonomics Defined

• "Ergonomics is the scientific study of the
  relation between people and their occupation,
  equipment and environment" (Shackel)
• "In simple terms, Ergonomics is designing for
  human use" (McCormick and Saunders)

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Ergonomics Principles

• Design for human use
• Fits the task to the worker
• People are different
• People have limitations
• People age
• Utilize a multi-disciplinary approach to problem
  solving

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A Multi-Disciplinary Approach to Problem Solving
MEDICINE
MATHEMATICS
ENGINEERING
PHYSICS
BIOMECHANICS
PHYSIOLOGY
PSYCHOLOGY
ERGONOMICS
Ergonomics encompasses all aspects of human
'fit', not just the physical factors
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Factors which Affect Injury Potential in the
Workplace
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History of Ergonomics

• Young science
• Born during World War II out of the need to
  better accommodate military personnel in aviation
  design
• Now applied to reduce occupational injuries
  illnesses
• Uses NIOSH Lifting Equation

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History of Ergonomics

• NIOSH Lifting Equation was developed for
• Manual materials (box) handling
• Vertical lifts

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History of Ergonomics

• NIOSH Lifting Equation takes into account these
  variables
• Vertical distance being lifted
• Horizontal distance held from body
• Coupling characteristics
• Body Rotation
• Weight
• Frequency of lifts

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NIOSH Lifting Equation Applied to Patient
Handling Activities

• When experts attempted to apply the lessons of
  the NIOSH Lifting Equation to patient handling
• The result were
• MORE biomechanical stress on the spine and
  upper extremity joints.
• Increased Risk of Injury

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NIOSH Lifting Equation Applied to Patient
Handling Activities

• Teaching patient care providers to lift and move
  patients like they are lifting and moving boxes
  does NOT work!
• WHY?

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NIOSH Lifting Equation Applied to Patient
Handling Activities

• Safe lifting rules dont apply (Horizontal
  rather than vertical lifting)
• Patients
• are asymmetric bulky
• cant be held close to the body
• have no handles
• Patient assistance varies
• Patient handling tasks are unpredictable

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NIOSH Lifting Equation Applied to Patient
Handling Activities

• Even using the NIOSH Lifting Equation, the
  threshold limits for injury are exceeded when
  performing patient handling tasks.

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Spinal Loading Stress

• Two forces act on the body when lifting and
  moving patients
• Compressive forces
• Lifting heavy loads
• Lifting load for a sustained period of time
  (feeding, bathing, dressing change, etc.)
• Shear forces
• Twisting
• Reaching

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Spinal Loading Stress

• They both result in
• Micro-fractures to the spine
• Damage to discs
• Over time, these accumulate and serious harm is
  done cumulative trauma injury

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Spinal Loading Stress

• Injurious forces change from Compressive to Shear
  when going from 1 to 2 caregivers performing a
  task

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Spinal Loading Stress

• One of the main contributors to spinal loading
  stress is the distance a load is carried
  away from the body.
• If the load isnt close, the
  pressure is gross!

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Spinal Loading Stress

• Lifting Force Distance x Weight
• In other words, the force or pressure that is
  acting on your lower back is equal to the weight
  of the object you are carrying multiplied by the
  objects distance from your body.

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Spinal Loading Stress

• Lifting Force includes two factors
• The force required to move the upper torso (body)
• The force required to move the load

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Spinal Loading Stress Lifting Forces Far Lift

• The force required to move the upper torso

Center of Gravity
140 lb female Upper torso weight 100 lb Lever
length 10 in F Wt x Dist 100 lb x 10 in
1000 in lb
Lever Length
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Spinal Loading Stress Lifting Forces Far
Lift

• 2. The force required to move the load

140 lb female Load 44 lb Lever length 16
in F Wt x Dist 44 lb x 16 in 704 in lb
Center of Gravity
Lever Length
Total Force Torso Load 1000 704 1704
in lbs
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Spinal Loading Stress Lifting Forces Near
Lift

• The force required to move the upper torso

Center of Gravity
140 lb female Upper torso weight 100 lb Lever
length 0.8 in F Wt x Dist 100 lb x 0.8
in 80 in lb
Lever Length
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Spinal Loading Stress Lifting Forces Near
Lift

• 2. The force required to move the load

140 lb female Load 44 lb Lever length 12
in F Wt x Dist 44 lb x 12 in 528 in lb
Center of Gravity
Lever Length
Total Force Torso Load 80 528 608 in
lbs
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Spinal Loading Stress Reducing Forces Acting
on the Body
Keep arms close to body
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Spinal Loading Stress

• Patient handling tasks are primarily tasks with
  loads (patient body/limbs) held far from the body
  
• These body positions cannot be altered
  (as compared to boxing a
  product differently, etc.)

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Spinal Loading Stress

• For this reason, the only alternative is to
  provide engineering controls, such as lifting
  other patient handling equipment, to decrease or
  take the load off of the caregiver.
• Two examples of ergonomically hazardous postures
  follow.

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Example 1 Pull up in Geri-Chair

• Risk Factors
• Back posture, forces
• Shoulder high load
• Elbow high load
• Interventions
• Mechanical lifting aid
• Friction reducing device
• Two person task
• Not recommended

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Example 2 Transfer to Stretcher

• Risk Factors
• Back posture, force
• Shoulder high load
• Elbow high load
• Interventions
• Friction reducing device
• Mechanical Lateral
• Transfer Aids

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We Need Solutions

• What Prevention Programs are out there?
• What do you think can be done about this problem?

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Unsuccessful Solutions

• Over the past 20 years, efforts to reduce
  injuries have been largely unsuccessful
• Interventions have focused on
• body mechanics education
• training in lifting techniques

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Successful Solutions Needed

• Patient Safety Center other Researchers saw the
  need to redesign these patient handling tasks
• So, we designed developed the research
  project.
• Redesigning Patient Handling Tasks

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Successful Solutions

• Redesigning Patient Handling Tasks Research
  Project
• Biomechanically evaluated High Risk Resident
  Handling Activities using a
  3-D Body Tracking System

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Redesigning Patient Handling Tasks Research
Project

• Results Proved
• Resident Handling Tasks are beyond the physical
  capabilities of normal workers
• Tasks need to be redesigned using principles of
  Ergonomics

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Redesigning Patient Handling Tasks Research
Project

• Redesign requires
• Ergonomic Evaluation
• Use of Resident Handling Equipment Aids
• Mechanisms of support

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Successful Solutions

• Led to
• VA Safe Patient Handling Movement Research
  Project
• Safe Patient Handling Movement Program
• Patient Care Ergonomics Resource Guide Training