Pakosh Safe Patient Handling WNotes.ppt
10/20/2016Safe Patient HandlingWhat We’ll Talk About Injury Risk Myths vs. Facts Musculoskeletal Disorders Body Mechanics/Ergonomics Using a Patient Lift Proper Lifting TechniquesPPT-075-021PPT-075-02Patient HandlingInjury Risk“Manual handling has been a job expectation forcaregivers since Florence Nightingale’s time,despite advances in other industries (e.g.,manufacturing and shipping) that rely ontechnology not physical strength to do the heavylifting. However, some healthcare facilities havebeen slow to adopt new patient-handlingtechnologies and still rely on old-fashioned manualhandling.”**Nelson, A., Motacki, K., Menzel, N. (2009). The illustrated guide to safepatient handling and movement. New York, NY: Springer Publishing CompanyPPT-075-022 Rates of musculoskeletal (MSD) injuries fromoverexertion in healthcare occupations areamong the highest of all U.S. industries. Bureau of Labor Statistics (BLS) on average: rateof overexertion injury across all industries is 38per 10,000 full time workers. Rate for hospital workers twice the average (76per 10,000); Nursing home workers 3x theaverage (132 per 10,000); ambulance workers6x the average (238 per 10,000) Single greatest risk factor: manual patienthandling3PPT-075-02More Risks4Some Statistics*o Rising obesity rates in the U.S. have increasedphysical demands on caregiverso Aging workforce: average age of registered nursein U.S. 47o Ongoing shortage of nurses/other caregiverso Healthcare organizations cutting workforceo Longer work schedules 52% of Nurses experience chronic back pain12% leave nursing because of back pain20% transfer to a different unit due to back painBack pain is the leading cause of disability tonurses under 45 years of age*American Nursing Association,“Handle with h/handlewithcare/hwc.aspxPPT-075-025PPT-075-0261
10/20/2016Moving Patients-Myths vs. FactsMore Statistics*Myth: We can train workers to use proper bodymechanics and avoid injuries.Fact: More than 30 years of research andexperience shows relying on proper body mechanicsor manual lifting alone is not effective to reduceback/other MSD’s.Myth: Patients are not as comfortable or safe withmechanical lifting.Fact: Patient education can reinforce that the lift isfor the patient’s safety as well as the caregivers.Patient handling equipment can prevent falls,bruises, and skin tears.According to national statistics, six of the top tenprofessions with the greatest risk of back injuriesare: Registered Nurses, Nursing Assistants, Licensed practical Nurses, Health Aides, Radiology Technicians, and Physical Therapists.*http://www.bls.gov/iif/ Accessed August 18, 2011PPT-075-027Moving Patients-Myths vs. FactsPPT-075-028Manual Patient LiftingMyth: It takes less time to manually move patientsthan to use lifting equipment.Fact: It can actually take much longer to get ateam of co-workers together to manually lift apatient than to find and use lifting equipment.Attempting to lift a patient by only one person putsthat caregiver at risk of injury. Using mechanicaldevices takes fewer personnel and about 5 minutesless.*Dr. William Marras from Ohio University, who isleading the research on Bio mechanics and liftingstates that there is “no safe way to manually lift apatient.”*Massachusetts Nurses Association, Safe Patient ToolkitPPT-075-029PPT-075-0210Joints, Muscles, Tendons, etc.Musculoskeletal Disorders (MSDs)Injury or disorder of the: MusclesNervesTendonsJointsCartilageSpinal DiscsPPT-075-0211PPT-075-02122
10/20/2016Musculoskeletal DisordersStages of MSD’sEarly stage – pain may disappear after a rest awayfrom workIntermediate stage – body part aches and feelsweak soon after starting work and lasts until wellafter finishing workAdvanced stage – body part aches and feels weakeven at rest, sleep may be affected, light tasks aredifficult on days offMSD’s do not include injuries causedby slips, trips, falls, or other similaraccidents.MSD’s can differ in severity frommild periodic symptoms to severechronic and debilitating conditions.PPT-075-0213PPT-075-02MSD’s-Signs & SymptomsMSD’s-Common Causes of Back InjuriesDo not ignore signs & symptoms!o Achingo Paino Burningo Swellingo Crampingo Stiffness14 Heavy lifting from above theshoulders. Heavy lifting from below the knees. Twisting while lifting/carrying. Bending over at the waist. Carrying objects to one side.o Loss of Color o Tinglingo Numbnesso WeaknessPPT-075-0215PPT-075-02MSD Risk Factors - Avoid16Before Patient HandlingWear the right clothes: Make sure your clothing and footwearare appropriate – clothes should allow free movement and shoesshould be non-slip, supportive and stable. Know your limits: Know your own capabilities and don’t exceedthem – for instance, if you need training in the technique to beused, tell your Supervisor. Do one thing at a time: Don’t try to do two things at once – forinstance, don’t try to adjust the patient’s clothing during thetransfer. Prepare for the task: Make sure everything is ready before youstart – for instance, check other care givers are available ifneeded, equipment is ready and the handling environment isprepared. Apply safe principles: Always use safe body mechanics – anduse rhythm and timing to aid the task. Bent wrists Twisting at the waist Rolled shoulders Leaning forward Bending at the waistPPT-075-0217PPT-075-02183
10/20/2016Patient Handling MethodsPatient Handling vs. Other Lifting The load is often unstableMost common taught are body mechanics and theprinciples of ergonomics Patients do not have handles A patient’s weight is distributed unevenly A patient may be combativePPT-075-0219Important Principles-Body Mechanics20Important Principles-Body MechanicsApply safe body mechanics and maintain the natural curve of your spine tominimize the force on your joints and discs. Here’s the safe way to hold yourbody: Stand in a stable position: Your feet should be shoulder width apartwith one leg slightly forward to help you balance – you may need to moveyour feet to maintain a stable posture. Avoid twisting: Make sure your shoulders and pelvis stay in line witheach other. Bend your knees: Bend your knees slightly, but maintain your naturalspinal curve – avoid stooping by bending slightly at the hips (buttocksout). Elbows in: Keep your elbows tucked in and avoid reaching – thefurther away from the body the load is, the greater the potential for harm. Tighten abdominal muscles: Tighten your abdominal muscles tosupport your spine. Head up: Keep your head raised, with your chin tucked in during themovement. Move smoothly: Move smoothly throughout the technique and avoidfixed holds.PPT-075-02PPT-075-02When handling/moving patients:1) Maintain a wide, stable base with your feet2) Put the bed at the correct height (waist levelwhen providing care; hip level when moving apatient)3) Try to keep the work directly in front of you toavoid rotating the spine4) Keep the patient as close to your body aspossible to minimize reachingCAUTION: Body mechanics alone is not sufficient!21PPT-075-02Ergonomics22Ergonomic Risk FactorsErgonomics: The science of fitting jobs to people.Encompasses the body of knowledge about physicalabilities and limitations as well as other humancharacteristics relevant to job designErgonomic design: The application of this body ofknowledge to the design of the workplace (tasks,equipment, environment) for safe and efficientworker useGood ergonomic design: Makes the most efficientuse of worker capabilities while ensuring jobdemands do not exceed those capabilitiesPPT-075-0223In patient care occupations:oooooooForceful and Heavy ExertionsHigh Frequency/Repetitive TasksAwkward PosturesWork DurationUneven work floorsUnpredictable patientsDependence level of patientsPPT-075-02244
10/20/2016Ergonomic Risk FactorsRisk Factors-Awkward PosturesTwo Types:Static non-movingDynamic body in motionIn patient care occupations:o Lifting heavy loadso Excessive pushing/pullingo ReachingStress increases if any weight isadded by tools or other objects.Factors include: Time Repetition Body condition Health Range of motionPPT-075-0225Use CautionPPT-075-0226Team LiftingThere are lifting tasks that are so stressful to thebody even if proper body mechanics and ergonomicsare used a person can still suffer an injury!o More than one person required to lift a load: teamof folks; one person “calls” directions and liftingsteps so everyone will move at the same pace.o Can be used when the patient is very large oroverly obese.o Team members must still use caution to ensureproper body mechanics and ergonomic issues areaddressed.PPT-075-0227Prepare for Safe Patient HandlingPPT-075-0228When & Why to Use Lifting Devices Know what equipment is available and how it works Assess the patient and the environmentPatient Benefits: Gather appropriate equipment and staff neededo Patient comfort Coach Patiento Respects a patient’s sense of dignityo Promotes patient independence and rehabilitationPPT-075-0229PPT-075-02305
10/20/2016When to Use a LiftEconomic Benefits of Lifting DevicesDecreases occupational injuries and indirect costsincluding: Employee replacement Additional training Loss of productivity LiabilityFor most patient-lifting tasks – maximum weightlimit is 35 pounds.*Patient characteristics that add risk:o Heighto Weighto Body Shapeo Dependency*Waters, Thomas R. PhD. (2007). When Is It Safe to Manually Lift a Patient?. AJN, Vol. 107, No. 8. 53-59.PPT-075-0231When to Use a LiftPPT-075-0232Employee Responsibility Know the characteristics of an unsafe lift Know the help that is available – both coworkersand equipment Know your employer’s lift policies If unsure about the safety of a lift, ask yourinstructor/directorPPT-075-0233Risk FactorsPPT-075-0234Sitting a Patient Up in BedWhat do you see?Patient may havedifficulty supportingfull weightCan nurse supportfull weight of patientby herself?If patient beginsto fall what willthe nurse do? Move the person's legs over the edge of the bedwhile pivoting his or her body so the person endsup sitting on the edge of the bed.Is the patientwearing non-slipfootwear; floorslippery?PPT-075-02 If the person is not strong enough to push upwith his or her hands to a sitting position, placeone of your arms under the person's legs andyour other arm under his or her back. Keep your feet shoulder-width apart, your kneesbent and your back in a natural straight position.35PPT-075-02366
10/20/2016To Assist with Standing upTo Assist with Sitting Downo Position the person's feet on the floor and slightlyapart.o The patient's hands should be on the bed or onyour shoulders.o Place your arms around the person's back andclasp your hands together.o If the patient is wearing a lifting belt make sureit is fastened around their waist.o Grasp the belt when lifting the patient.o Hold the person close to you, lean back and shiftyour weight.PPT-075-02Into a chair, wheelchair, on a bed:Pivot toward the chair, bend your knees, andlower the person into the chair.The person should have both hands on the armsof the chair before lowering him/her down.37PPT-075-02Types of TransfersTransfers from a Vehicle Place the wheelchair at an angle in front of the car door and as close to thecar as possible. Open the car door. Make sure the brakes on the chair are locked before attempting a transferand double check the brake locks on the wheelchair before attempting avehicle transfer. Apply a “gape/safety belt” before any other steps are completed. Belt should be applied to the hip area of the individual to allow a safe wayto lift the user from the chair. To allow a clean transfer from wheelchair to a car, you should if possible,swing away or remove the footrests to enable a clear path of transfer. Slide the car seat as far back as possible to allow optimal room to engagethe transfer. Bed Chair Commode/toilet Lateral transfers Floor VehiclePPT-075-0239Transfers from a VehiclePPT-075-0240Transfer from Wheelchair to Toilet Assist the patient while they move towards the edge of the wheelchair seat and afterthey’re close to the edge of the seat, they can lean forward towards the caregiver The caregiver should be in position at all times to prevent a fall or any type ofaccident To prevent an accident the patient should hold on to the armrests of the chair insteadof holding onto the caretaker which can be dangerous While holding the armrests, the patient should be able to push up with minimal effortto begin the transfer Caregiver should get a solid grip on the individual (if a safety belt was applied thecaregiver should grip their hands onto the belt for necessary precautions If the patient has weak knees the caregiver will need to line up their knees with thepatient’s knees in order to provide extra support while lifting. Caretaker should guide the individual to shift their body towards the opened car doorfacing the caregiver Once next to the car door the patient should bend their knees to allow the caregiverto assist in getting them into the vehiclePPT-075-02381. Starting Transfer From Wheelchair To Toilet:When the patient is ready, make sure the brakes areengaged on both sides of the chair before attemptinga transfer.2. Remove Footrests & Clearing a Path To Transfer:41Remove any type of components of the chair that arein the way of an easy transfer includeing footrests (ifthey are removable), leg rests, and/or any extraaccessories or components that are removablePPT-075-02427
10/20/2016RepositioningTransfer from Wheelchair to Toilet4. Wheelchair User Shifting:The patient should be positioned at the edge of the wheelchairseat with some minimal momentum building towards the front ofthe chair. When patient is at the edge of chair ensure their legsare level with the ground and feet positioned straight underneaththe seat so they are ready to stand up. Chair Bed5. Standing & Transfer GurneyWhen the patient is in position and ready to stand, thecaregiver’s hands should be on patient’s hip area with patient’sarms positioned on top of the armrests to provide stability andsupport. Patient should lean towards the front of the chair andpush themselves upward and out of the chair with their armspositioned on the armrests, and their feet level with the ground. Diagnostic tablesPPT-075-0243PPT-075-0244PatientTransfer & Repositioning Factors Medical condition – history Patient Mental status – cooperative, follows directionsetc. Personnel Equipment Functional status- strength, balance, coordination& stamina EnvironmentPPT-075-0245Combative Patients*46Combative Patients* Speak softer than you think is necessary. You want to be heard, but youcan talk softer than you want to and still communicate just fine. When we wantto be heard, our instinct is to talk louder. However, when we drop our voicepeople tend to become quiet and focus on our words more intently. Speaksoftly and the volume of all communication on scene will like follow suit. Use the patient's name. If you know the patient's name, use it. And explainwhat you are doing. Bob, we need to lay still. Help us take care of you Bob. Themore personal you can make it the better. Using the patient's name sends anunspoken message to the patient that their identity is important to us. It alsoreminds everyone involved in the encounter that there is a real human being onthe opposite end of all of this conflict. PPT-075-02Use the jury test. Now that we have a calm person speaking softly and usingthe patients name. What should they say? Imagine that your care for thispatient was called into question and a jury was allowed to watch a video of youwrestling with your patient. Their job is to decide if your care was appropriate.Imagine that the volume on the video were turned down and you were allowedto explain to the jury what you were doing and why. What would you say? Take your time: Whether you're caring for a stranger orloved one, the urge to "take care of business" and "getthings done" can be very strong. Try taking the time togently guide the patient, maybe opening with chitchat orexplaining what the next activity will be. Be Patient: If the patient is always combative during acertain activity, take steps to make the environment ascomfortable and attractive as possible. Playing soothingmusic in the background may be helpful. If bathingprovokes combativeness, for example, try gently remindingthe patient how clean and comfortable he or she will beafterward.* “How to Deal with Combativeness” by Gilbert Guide, www.caring.com*“The Art of Ems” by Steve Whitehead; EMS1.comPPT-075-0247PPT-075-02488
10/20/2016EnvironmentPersonnel Design of the room Education/Training Furniture Competency Medical equipment Compliancy Lighting Teamwork Climate/temperature CommunicationIs there anything wrong with this? Traffic/activityPosture of care giver could lead to an injuryPPT-075-0249PPT-075-02Equipment50Before the Task, Remembero Bedo Ceiling lifto Total mechanical lifto Sit to stand lifto Transfer belto Non-Friction device/Air assistive deviceo Assistive devices (cane, wheelchair, etc.)PPT-075-0251Order of OperationPPT-075-0252Types of Patient Care Slings* Ceiling lift/Total mechanical lift Sit to stand lift Transfer/gait belt Non-Friction device/Air assistive device IndependentGoing from thebottom up thepatient requiresmore assistancePPT-075-02Check patient profile: Decide if the task is still necessary and that thehandling plan is still appropriate.Seek advice: Talk to your manager or the patient handling adviser if youneed advice on the techniques and equipment you should be using.Check equipment: Ensure equipment is available in good condition with allcomponents in place and ready to use. Always follow the manufacturer’sinstructions.Prepare handling environment: Position furniture correctly, check routeand access ways are clear, and check the destination is available.Explain the task: Explain the task to the patient and other care givers whomay be helping.Prepare the patient: Ensure the patient’s clothes and footwear areappropriate for the task, and they have any aids they need. Adjust theirclothes, aids and position – for instance, encourage the patient to lean forward.Give precise instructions: Give clear instructions. This helps the care giver(s)and patient to work together.53 Standing slings assist healthcare workers withtoileting or dressing patients, as well as for verticaltransfers. Supine slings assist healthcare workers inperforming lateral transfers (transfer in a supineposition from bed to stretcher), making occupiedbeds, bathing patients, repositioning patients in bed,or assisting patients who have fallen on floor. Seated slings enable healthcare workers to transferand lift patients in a sitting position, or repositionpatients in a chair. Hygiene slings are made of mesh fabric and can beused for showering patients.*(Nelson, et al. 2009)PPT-075-02549
10/20/2016Safety TipsSafety TipsIf bending over for a long period of time:If standing for an extended period:ooooooooStand with feet shoulder width apartPlace one foot slightly behind otherShift weight from foot to footRe-position your body if possiblePPT-075-02Stand uprightPlace your hands on your lower backBend backward slowlyCome back to upright position55Stretching ExercisesPPT-075-0256Stretching ExercisesNote: Before doing anyexercises check withyour physician toensure you’re able todo them safely!Note: Before doing anyexercises check withyour physician toensure you’re able todo them safely!o Stand or sit and place right hand on leftelbowo With left hand, pull right elbow acrosschest toward left shoulder and hold 10 to15 secondso Repeat on other side Sit or stand with arms hanging loosely atyour sides Turn head to one side, then the other Hold for 5 seconds, each side Repeat 1 to 3 timesPPT-075-0257Stretching Exerci
been slow to adopt new patient-handling technologies and still rely on old-fashioned manual handling.”* *Nelson, A., Motacki, K., Menzel, N. (2009). The illustrated guide to safe patient handling and movement. New York, NY: Springer Publishing Company PPT-075-02 4 I
Safe Patient Handling Point of Contact, Minneapolis VA Health Care System, Minneapolis, MN *Charlotte Lynch, MS, CNS, CSPHP, Safe Patient Handling Coordinator, Dayton VA Medical Center, Dayton, OH Marie Martin, Ph.D., Acting National Program Manager, Patient Care Ergonomics (10P3D) and Industrial Hygienist/Safe Patient Handling Facility .
experience with high-risk patient handling tasks, general patient mobility status for their unit and special patient needs. sAfe LIft component specific Action(s) sAfe LIft Audit Questions safe patient handling policies and practices are in place which address any gaps identified during the assessment process and include, at a minimum:
Safe Patient Handling Policy POLICY 1.1.3 Environment of Care Safe Patient Handling Program Issued: February 2013 Revised: July 2014 Page 4 of 7 d. Avoid high-risk patient handling tasks whenever possible. If unavoidable, assess the situation carefully and plan to minimize risks as best possible prior to initiating task. e.
Safe Patient Handling Program – Gap Analysis Checklist 2014 INSTRUCTIONS: This comprehensive Safe Patient Handling Program (SPH) program Gap Analysis . potential safety issue related to patient handling has been identified by staff Notes (timelines, responsibilities, etc.)
“Safe Patient Handling” refers to Safe Patient Handling and Mobility that is, the use of technology such as powered lifts and evidence based work practices and processes that are used to facilitate movement of a patient with the goal of reducing the risk of injury to both the healthcare employee and the patient.
in safe patient handling and mobili-ty (SPHM) to better define the problem, clarify risk factors, and identify risk-reduction strategies. Panel members reached a consen-sus that the term patient handling injury (PHI) is an accurate, well-Patient-handling injuries: Risk factors and risk-reduction strategies
Types of patient-handling activities In this guide, “patient handling” refers to the lifting, lowering, holding, pushing, or pulling of the patient using bodily force of the care provider. The term “patient” is used to describe a client or resident. Patient handling can be divided into two objectiv
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