AORN GUIDANCE STATEMENT: SAFE PATIENT HANDLING
This is a preview of "AORN MAN-872B-2015". Click here to purchase the full version from the ANSI store.AORN GUIDANCE STATEMENT: SAFEPATIENT HANDLING AND MOVEMENT INTHE PERIOPERATIVE SETTINGEditor’s note: Ergonomic Tool #3 and related text inthis guidance statement were updated in September2011 to reflect the revised Ergonomic Tool #3 published in the AORN Journal (May 2011, Vol 93, No 5,page 591).Description of the ProblemPerioperative registered nurses and the perioperativeteam are routinely faced with a wide array of occupational hazards in the perioperative setting that placethem at risk for work-related musculoskeletal disorders.1-3 Musculoskeletal disorders are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, or spinal discs associated with actions such asoverexertion, repetitive motion, and bodily reaction.4,5 The US Department of Labor does not includeinjuries caused by slips, trips, falls, motor vehicleaccidents, or similar accidents in their definition ofmusculoskeletal disorders.4 Musculoskeletal disorders are one of the most frequently occurring andcostly types of occupational issues affectingnurses.2,6,7 More than a third (ie, 36%) of the musculoskeletal injuries that nurses reported requiring timeaway from work were back injuries. 8 Among thenurses working in the private sector, nearly 9,000 hadback injuries. 8,9 One study revealed that 12% ofnurses planning to leave the profession indicated thatback injuries were either a primary or contributingfactor to their decision.10 While back injuries are oneof the most common occupational injuries in thehealth care industry, injuries of the shoulder andneck were more likely to prevent nurses from performing their work than low back pain.10-13 The USDepartment of Health and Human Services report onnursing identified concern for personal safety in thehealth care environment as the reason given by18.3% of nurses for leaving the profession.14When the worker’s physical ability, task, workplace environment, and workplace culture are notcompatible, there is an increased risk of a musculoskeletal disorder.1,2,15 The connection between physical risk factors and musculoskeletal disorders isgreater when exposures are intense and prolongedand when several occupational risk factors are present at the same time.16 Examples of physical stressorsencountered in health care include forceful tasks, repetitive motion, awkward posture, static posture, moving or lifting patients and equipment, carrying heavy instruments and equipment, andoverexertion.1-3,11,12,14,17-26The perioperative setting poses unique challengesrelated to the provision of patient care and completion of procedure-related tasks. This highly technicalenvironment is equipment intensive and necessitatesthe lifting and moving of heavy supplies and equipment during the perioperative team member’s workperiod. Many of the patients having surgical or otherinvasive procedures are completely or partiallydependent on the caregivers due to the effects of general or regional anesthesia or sedation. Patients whoare unconscious cannot move, sense discomfort, orfeel pain, and they must be protected from injury.This may require the perioperative team to manuallylift the patient or the patient’s extremities severaltimes during a procedure. The following are amongthe high-risk tasks specific to perioperative nursesidentified that will be addressed in the following discussion of ergonomic tools: transferring patients on and off OR beds,2 repositioning patients in the OR bed,2 lifting and holding the patient’s extremities,2 standing for long periods of time,2 holding retractors for long periods of time,2 lifting and moving equipment,2 and sustaining awkward positions.Transferring, lifting, and handling patients hasbeen identified as the most frequent precipitatingtrigger of back and shoulder problems in nurses.2,27Certain patient handling tasks (eg, patient transfers)have been identified as high risk for musculoskeletalinjuries to health care workers.27 Lifting and movingpatients is a frequent activity in the perioperative setting; for example, caregivers transfer patients to andfrom transport carts (eg, stretchers) and the OR bedmany times during a typical work shift.Health care providers often reposition patientsonce they are on the OR bed to provide appropriateexposure of the surgical site. This high-risk activityrequires team members to physically lift and maneuver the patient or a patient’s extremity while simultaneously placing a positioning device. The patient’sweight may not be evenly distributed; the extremity’smass may be bulky and asymmetric, and it may bedifficult to hold the extremity close to the health careprovider’s body during positioning maneuvers. 28Additionally, concern for the patient’s airway, maintaining his or her body alignment, and supporting theextremities may make it difficult for team members toposition themselves in an ergonomically safe position, thus exacerbating physical demands.2015 Guidelines for Perioperative PracticeLast revised: November 2006. Copyright 2015 AORN, Inc. All rights reserved.733
This is a preview of "AORN MAN-872B-2015". Click here to purchase the full version from the ANSI store.SAFE PATIENT HANDLINGSeveral unique aspects of high-risk patient handlingtasks associated with prepping a patient’s limb havebeen identified.29 Preparing an extremity for surgerygenerally requires it to be elevated to allow completecircumferential skin preparation. The limb can be suspended by a person holding the limb or by placing thelimb in a holding device. In some instances, the limbmay be held manually during the entire skin prepwhile a second person performs the skin prep. Theperson performing the skin prep may also hold thelimb if the limb is small or if only the distal portionneeds to be prepped. To maintain asepsis, the personlifting the extremity is forced to hold the limbextended away from his or her body. The size of thelimb, length of prep time, posture necessary to holdthe extremity, and the physical capability of the personholding the limb all contribute to the ability of thecaregiver to safely suspend the limb for the requiredprep. The following questions should be consideredwhen determining how to safely raise and hold a limb. Does the limb need to be raised for the entire surgical skin prep? Does the limb need to be lifted by scrubbed orunscrubbed personnel? Is the person holding the limb strong enough toperform the task? Is there an alternative practice that can beadopted? Is there equipment that could be used to supportthe task? Is it possible to hold a heavy limb safely withoutrisk of injury to the nurse or the patient?29Perioperative registered nurses are prone to painand fatigue from static posture during surgical procedures. The entire perioperative team spends a significant amount of time on their feet during the course of ashift; however, sterile perioperative team membersmay be required to stand for much longer periods oftime. The sterile team members must maintain theintegrity of the sterile field, which precludes themfrom changing levels. They should not alternatebetween sitting in a chair that is lower than the sterilefield and a standing position. Acute and chronic back,leg, and foot pain are frequent complaints resultingfrom standing in one place for long periods of time.The following factors should be considered during surgical or other invasive procedures. Are the sterilemembers of the team at the appropriate height for the level of the ORbed? adopting awkward positions to work effectively? positioned in close proximity to the patient toperform required tasks? stretching and relaxing muscles regularly?29Perioperative nurses and other perioperative personnel are frequently required to push or pull heavy equipment (eg, OR beds, portable microscopes, video carts).This equipment is very expensive and often must beshared between several individual operating rooms.Unoccupied OR beds are very heavy and difficult toTask Force MembersAndrea Baptiste, MA (OT), CIEErgonomist/BiomechanistPatient Safety Center of InquiryJames A. Haley Veterans’ HospitalTampa, FlaEdward Hernandez, RN, BSNOR Nurse ManagerJames A. Haley Veterans’ HospitalTampa, FlaNancy Hughes, RN, MHADirector, Center for Occupationaland Environmental HealthAmerican Nurses AssociationSilver Spring, MdValerie KelleherInformation SpecialistPatient Safety Center of InquiryJames A. Haley Veterans’ HospitalTampa, FlaJohn D. Lloyd, PhD, MErgS, CPEDirector, Research LaboratoriesPatient Safety Center of InquiryJames A. Haley Veterans’ HospitalTampa, Fla734Mary W. Matz, MSPHVHA Patient Care Ergonomics Consultant and Industrial HygienistPatient Safety Center of InquiryJames A. Haley Veterans’ HospitalTampa, FlaKaren Moser, RN, BSN, CNOREducatorWilliam S. Middleton VA HospitalMadison, WisAudrey Nelson, PhD, RN, FAANDirector, Patient Safety Center ofInquiryJames A. Haley Veterans’ HospitalTampa, FlaKristy Robinson, RN, BSN, CNORPerioperative RNTampa General HospitalTampa, FlaManon Short, RPT, CEASInjury Prevention CoordinatorTampa General HospitalTampa, FlaPatrice Spera, RN, MS, CNOR,CRNFADirector of Clinical ServicesTampa Bay Specialty SurgicalCenterPinellas Park, FlaCarol Petersen, RN, BSN, MAOM,CNORPerioperative Nursing SpecialistAORN, IncDenver, ColoDeborah G. Spratt, RN, MPA,CNAA, CNORClinical SpecialistUniversity of Rochester MedicalCenterRochester, NYLori Plante-Mallon, RN, CNORPerioperative RNStrong Memorial HospitalUniversity of Rochester MedicalCenterRochester, NYThomas R. Waters, PhD, CPELeader of the Human Factors Ergonomics Research TeamNational Institute for OccupationalSafety and HealthCincinnati, Ohio
This is a preview of "AORN MAN-872B-2015". Click here to purchase the full version from the ANSI store.SAFE PATIENT HANDLINGmove. Moving an occupied OR bed is not recommended because the risk of injury increases for both theworker and the patient.Perioperative personnel and central processing personnel are frequently required to carry sets of surgicalinstruments. Instrument set weights vary and mayweigh as much as 40 pounds. Instrument trays arewrapped with impervious nonwoven material or contained in a ridged container system. Both packagingmethods can present lifting and carrying problems.Wrapped instrument sets that are too heavy may posean additional problem because they have no handlesand are awkward to carry. Rigid container systemsoften have handles that make carrying easier, but theweight of the container itself adds to the total weight ofa full tray. In an effort to keep costs down and conservestorage space, instrument trays may be inappropriatelyprepared and too heavy to lift or carry safely. Instrument sets that are flash sterilized require staff membersto aseptically remove the hot trays from the sterilizer.The weight of these trays and the height of the personremoving them from the sterilizer in relation to theheight of the sterilizer chamber contribute to thedegree of risk to that individual.The consequences of musculoskeletal disorders aresevere. Employees who experience pain and fatigue areless productive and attentive, more prone to make mistakes, more susceptible to further injury, and may bemore likely to affect the health and safety of others.Nurses suffering from disabling back injuries or the fearof getting injured have contributed to the number ofnurses leaving the profession, thus increasing the nursing shortage. Workplaces with high incidences of musculoskeletal disorders report increases in lost or modified workdays, higher staff member turnover, increasedcosts, and adverse patient outcomes.14,29,30Description of the ProcessThe 2005–2006 Workplace Safety Task Force wascharged by AORN President Sharon McNamara, RN,MS, CNOR, to prepare a guidance document for ergonomically healthy workplaces. In addition, the taskforce was charged with forming a collaborativearrangement with the National Institute for Occupational Safety and Health (NIOSH) and the AmericanNurses Association (ANA) to work together to discuss,design, and advance the agenda of healthy work sitesfor perioperative professionals, to include ergonomicsafety. This document was developed by AORN withthe assistance of a panel of experts from the PatientSafety Center of Inquiry, Tampa, Fla; the James A.Haley Veterans Administration Medical Center(VMAC); the NIOSH Division of Applied Research andTechnology Human Factors and Ergonomics ResearchTeam; and ANA.Members of the task force examined current research,literature, and patient care practices to evaluate andmake recommendations to promote patient and caregiver safety when performing activities in a perioperative setting. While there are several high-risk tasks specific to perioperative nurses, the task force identifiedseven key activities as the starting point for developingrecommendations. Some of these recommendations arebased upon current technology that can be immediatelyimplemented. Others, such as use of ceiling lifts inoperating rooms, are in development or are projectedpatient handling innovations. This group will continueto examine what is available and encourage manufacturers to develop new and innovative technologies toachieve the optimal safety of the patient and the caregiver. Development of this equipment is critical for successful implementation of these ergonomic tools.The ergonomic tools developed for this guidance document are based on previous work by Audrey Nelson,PhD, RN, FAAN; experts within the Veterans Administration (VA); and nationally recognized researchers.28The ergonomic tools for safe patient handling andmovement have been designed with the goal of eradicating job-related musculoskeletal disorders in perioperative nurses. The ergonomic tools and algorithmswere developed based on professional consensus andevidence from research. Plans are underway for pilottests in several facilities.Ergonomic Tool #1: Lateral Transfer FromStretcher To and From the OR BedTransferring a patient to and from the OR bed is one ofthe first actions of the perioperative team. The AORN“Recommended practices for positioning the patient inthe perioperative practice setting” recommends that the*Calculation of Design GoalTo accommodate the design goal of 75% of the US adult femaleworking population, maximum load for a one-handed lift is calculated to be 11.1 lb (5.0 kg), assuming a worst-case scenariowhere the patient load may be handled at full arm’s length. Thisis determined by calculating the strength capabilities for the 25thpercentile US adult female maximum shoulder flexion moment(25th percentile strength 31.2 Nm, based on mean of 40 Nmand standard deviation of 13 Nm, therefore 25th percentile 31.2 Nm)35 and the 75th percentile US adult female shoulder togrip length (75th percentile length 630 mm, based on mean of610 mm and standard deviation of 30 mm).36 Therefore, maximum one-handed lift is calculated as 31.2 Nm divided by 0.63 m,which equals 49.5 N, or 11.1 lb.Maximum load (for one person) for a two-handed lift (22.2lb/10.1 kg) is calculated as twice that of a one-handed lift. According to Rohmert, muscle strength capabilities diminish as a functionof time.37 Therefore, maximum loads for two-handed holding of bodyparts are presented for one-, two-, and three-minute durations. Afterone minute, muscle endurance has decreased by 48%; by 65%after two minutes; and after three minutes of continuous holding,strength capability is only 29% of initial lifting strength.735
This is a preview of "AORN MAN-872B-2015". Click here to purchase the full version from the ANSI store.SAFE PATIENT HANDLING736
This is a preview of "AORN MAN-872B-2015". Click here to purchase the full version from the ANSI store.SAFE PATIENT HANDLINGperioperative registered nurse perform a preoperativeassessment for patient-specific positioning needs. 31Based on that assessment and using Ergonomic Tool #1,the patient will be transferred to and from the OR bed inan ergonomically safe manner.Supine to Prone TransferAssuming that one caregiver or anesthesia care provider supports the patient’s head and neck duringsupine to prone transfers, the patient’s remaining bodymass equals 91.6% of his or her total body mass.32Using the approach for lifting and holding, a maximumtwo-handed load to achieve 75% US adult femaledesign goal equals 22.2 lb (10.1 kg).* Typically one ofthe four caregivers moving a patient is the anesthesiacare provider who maintains the airway and supportsthe patient’s head. Two caregivers plus the anesthesiacare provider can safely transfer a patient weighing upto 48.5 lb (22.0 kg) from supine to prone position.Three caregivers, plus an anesthesia care provider, cansafely transfer a patient weighing up to 72.7 lb (33.0kg). If the patient’s weight is greater than 73 lb, it isnecessary to use assistive technology and a minimumof three to four caregivers. Although this has beenidentified as a gap in technology, a mechanical deviceis preferable for this task and should be developed.Supine to Supine TransferThe desirable approach for lateral transfer of a patientinvolves use of a lateral transfer device (eg, frictionreducing sheets, slider board, and air-assisted transferdevice). If only a draw sheet is used without a lateraltransfer device, the care provider exerts a pull force upto 72.6% of the patient’s weight.33 Assuming that onecaregiver or anesthesia care provider supports thepatient’s head and neck to maintain the airway duringlateral transfers, the remaining mass of the patient’sbody equals 91.6% of his or her total body mass.32Research indicates that for a pulling distance of 6.9 ft(2.1 m) or less, where the pull point (ie, starting pointfor the hands) is between the caregiver’s waist and nipple line, and the task is performed no more frequentlythan once every 30 minutes, the maximum initial forcerequired equals 57 lb (26 kg) and the maximum sustained force needed equals 35 lb (16 kg).34 Therefore,each caregiver can safely contribute a pull forcerequired to transfer up to 48 lb (35 lb/0.726 as referenced above). For one caregiver, plus the anesthesiacare provider, maximum patient weight equals 52.6 lb(48 lb/0.916 as referenced above). Two caregivers plusthe anesthesia care provider can safely transfer apatient up to 104.8 lb ([48 x 2]/0.916 as referencedabove). Three caregivers plus the anesthesia care provider can safely transfer a patient up to 157.2 lb ([48 x3]/0.916 as referenced above). If the patient is 157 lb,use an appropriate mechanical lifting device—ie,mechanical lift with supine sling, mechanical lateraltransfer device, or air-assisted lateral transfer device—and a minimum of three to four caregivers.Ergonomic Tool #2: Positioning andRepositioning the Patient on the OR Bed Intoand From the Supine PositionThe AORN “Recommended practices for positioningthe patient in the perioperative practice setting”require that “the perioperative nurse should activelyparticipate in monitoring patient body alignment andtissue integrity based on sound physiologic principles.” It further states, “an inadequate number of personnel and equipment can re sult in patient injury.”31Ergonomic Tool #2 provides evidence-based guidelinesto assist the perioperative registered nurse and otherteam members to position and reposition the patient onthe OR bed in a safe manner for the patient and theteam.Moving the Patient Into andOut of a Semi-Fowler PositionThe mass of a patient’s body from the waist up, including the head, neck, and upper extremities, equals68.6% of the patient’s total body weight.32 Added tothis is the estimated weight of the equipment (20 lb/9.1kg). To accommodate at least 75% of the US adultfemale working population, the maximum load for atwo-handed lift is 22.2 lb (10.1 kg). This is determinedbased on 25th percentile US adult female shoulderstrength capabilities35 and 75th percentile US adultfemale arm length. 36 Therefore, t
Carol Petersen, RN, BSN, MAOM, CNOR Perioperative Nursing Specialist AORN, Inc Denver, Colo Lori Plante-Mallon, RN, CNOR Perioperative RN Strong Memorial Hospital University of Rochester Medical Center Rochester, NY Kristy Robinson, RN, BSN, CNOR Perioperative RN Tampa General Hospital Tampa,
AORN Resources AORN guidance statement: safe medication practices in periopera-tive settings across the life span. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2011:605-611. Watch for these new and updated AORN resources in spring and summer 2012 Safe Medication Administrati
Key words: AORN recommended practices, surgical attire, cover apparel, home laundering. T he revised AORN “Recommended prac-tices for surgical attire” document was published electronically in AORN’s . CNOR, Lisa Spruce, 3.6 Implementing AORN Recommended Practices for Surgical Attire) .
elections. For 2018 candidates, we have revised the AORN Statement on Campaigning to make you aware of what is and is not acceptable. Please read and return the AORN Revised 2017 Statement on Campaigning Acknowledgment on page 15 of this handbook by September 5, 2017. By mail to: AORN Attention: Hannah Campbell 2170 S Parker Rd, Suite 400
AORN Journal to explain the use of the clinical tools and provide assistance in implementing them in practice. AORN believes that increased knowl-edge and widespread acceptance of safe ergonomic practices will help to promote a safer perioperative work environment and protect peri-operative team members—as well as their
Braswell, M.L., Spruce, L. Implementing AORN Recommended Practices for Surgical Attire, AORN. (January 2012) 122-137. doi: 10.1016/j.aorn.2011.10.017 “It is recommended that perioperative personnel in the semi-restricted and restricted areas wear facility-approved, clean, freshly laundered, or
Association of periOperative Registered Nurses (AORN) 2017 AORN Guideline for Surgical Smoke Safety: AORN is a professional association based in Denver, Colorado that represents the interests of more than 160,000 perioperative nurses. The following are contained in Recommended Practices: Recommendation I
the AORN Foundation. Each grant awards a nurse 1,000 to assist in their career and educational advancement by attending Expo. A 10% fee is included for program administration costs. The AORN Foundation is a 501(c)(3) bona fide charitable organization. Gifts to the AORN Foundation are tax-deductible to the fullest extent of the law.
Designation D2996-88, Specification for Filament-Wound Reinforced Thermosetting Resin Pipe, 1988, American Society for Testing and Materials, 1916 Race Street, Philadelphia, PA 19103. (8) ASTM D3299-88 means American Society for Testing and Materials Designation D3299-88, Filament-Wound Glass-Fiber-Reinforced Thermoset Resin Chemical-Resistant Tanks, 1988, American Society for Testing and .
