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Patient Care Ergonomics

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When experts attempted to apply the 'lessons' of the NIOSH Lifting Equation to patient handling... Lifting heavy loads. Lifting load for a sustained period ... – PowerPoint PPT presentation

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Title: Patient Care Ergonomics


1
  • Patient Care Ergonomics

2
The First Ergonomist
3
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

4

Ergonomics Biomechanics 101
5
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

6
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.

7
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.

8
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)

9
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.

10
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).

11
Derivation of Ergonomics
ERGO NOMOS Laws of Work
  • Phrase derived from two Greek words
  • Coined by a Polish Naturalist circa 1870
    (Wojceich Bogumil Jastrebowski)

12
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)

13
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

14
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
15
Factors which Affect Injury Potential in the
Workplace
16
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

17
History of Ergonomics
  • NIOSH Lifting Equation was developed for
  • Manual materials (box) handling
  • Vertical lifts

18
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

19
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

20
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?

21
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

22
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.

23
(No Transcript)
24
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

25
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

26
Spinal Loading Stress
  • Injurious forces change from Compressive to Shear
    when going from 1 to 2 caregivers performing a
    task

27
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!

28
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.

29
Spinal Loading Stress
  • Lifting Force includes two factors
  • The force required to move the upper torso (body)
  • The force required to move the load

30
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
31
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
32
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
33
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
34
Spinal Loading Stress Reducing Forces Acting
on the Body
Keep arms close to body
35
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.)

36
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.

37
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

38
Example 2 Transfer to Stretcher
  • Risk Factors
  • Back posture, force
  • Shoulder high load
  • Elbow high load
  • Interventions
  • Friction reducing device
  • Mechanical Lateral
  • Transfer Aids

39
We Need Solutions
  • What Prevention Programs are out there?
  • What do you think can be done about this problem?

40
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

41
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

42
Successful Solutions
  • Redesigning Patient Handling Tasks Research
    Project
  • Biomechanically evaluated High Risk Resident
    Handling Activities using a
    3-D Body Tracking System

43
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

44
Redesigning Patient Handling Tasks Research
Project
  • Redesign requires
  • Ergonomic Evaluation
  • Use of Resident Handling Equipment Aids
  • Mechanisms of support

45
Successful Solutions
  • Led to
  • VA Safe Patient Handling Movement Research
    Project
  • Safe Patient Handling Movement Program
  • Patient Care Ergonomics Resource Guide Training
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