Mechanical L ifts in Schools

Who? When? Why? What? Where?

Adrianne “A.J.” MoffittMSPT, PCS

Physical TherapistBoard Certified Pediatric Clinical Specialist

Fairfax County Public SchoolsDepartment of Therapy Services

The presenter has no affiliation with any of the products or manufacturers discussed in this presentation, nor any other conflict of interest.

Objectives 1. Identify the complex factors that must be considered when creating a student specific safe “ lift” vs.“ transfer” plan.

2. Choose a lift ing device depending on student, environmental, and staff needs.

3. Build an evidenced-based case to support the lift ing decisions and overcome barriers.

4. Embed a therapeutic lift ing/ transfer plan into a student’s IEP to maximize safety and independence throughout the lifespan.

Why is this I mpor tant?

�Work related MS disorders are the leading occupational health problem plaguing the nursing workforce…little data available in the school setting.

�According to the US Department of Labor (2002), compared to other occupations, nursing aids/ orderlies/ attendants rank 2nd in “at risk” occupations. Nurses rank 6th.

�NIOSH has identified back injury as the second leading occupational injury in the US and the most common reason for filing workman’s compensation claims.

Concerns for Suppor t Staff?�Lost work days

�Burn out

�Decreased retention/ high turnover

�Threatened recruitment

�Training time commitment

What is Currently Available?

�In the US, there is no national legislation in the area of lifting.

In November 2000, OSHA issued a final ergonomics rule to protect healthcare workers. This was overturned in 2001 as it was thought to be “costly and an unnecessary burden to industry.”

In 2004, OSHA published an industry related guideline for nursing home personnel.

Handle with Care, ANA

National campaign established in 2003

�Supports a “No Lift Policy”

Handle With Care: No L ift Pol icy

No lifting except in life threatening situations

Patients should be encouraged to assist in their own transfers

Proper infrastructure:

Management commitment

Equipment

Maintenance of equipment

Employee training

A culture of safety.

NI OSH L ift ing Recommendations

�Recommend that the average worker lift no more than 51 lbs.

�Based on ideal conditions of lifting a stable box from the ground to waist height.

�When lifting people, NIOSH recommends using either an equation with multipliers for additional variables OR a 35 lbs. weight limit.

NI OSH L ift ing Equation

RWL= LC x HM x VM x DM x AM x FM x CM

RWL= Recommended weight limit

LC= Load constant (51 lbs.)

HM= Horizontal multiplier

VM= Vertical multiplier

DM= Distance multiplier

AM= Asymmetric multiplier

FM= Frequency Multiplier

CM= Coupling Multiplier

OSHA L ift ing Recommendations

Patient care ergonomic assessment protocols

�Patient “Lift Teams”

“Although these guidelines are designed specifically for nursing homes, OSHA hopes that employers with similar work environments, such as assisted living

centers, homes for the disabled, homes for the aged, and hospitals will find this information useful.”

OSHA.gov, 2005

Haglund, 2009•Program implemented in children’s hospital in response to state law and staff survey

•To determine understanding of safe patient handling and frequency of lifting tasks

•Pre/post prospective study

•Purchased lifts, slings, repositioning sheets

•Minimal lift policy

•Lift/transfer algorithm developed for transfers

•Implemented Ergo Coaches to act as peer leaders

Haglund, 2009

Before Program After Program

Average # incidents per year 14 4

Lost work days 12 9

Workers Compensation costs $17,883.00 - $ 35,586.00 $4,959.00 - $ 99,918.00

71.4% reduction in incidences of injuries

Campo, 2008

•Rates of injury among PT’s

•Members of the APTA (n=887) completed questionnaire in 2005 and 2006

•57.5% reported work related aches, pain, discomfort in 678 body regions

•Impacts: •Need to consult physician (n=115)•Change work setting (n=18)•Leave profession (n=11)•Loss of time at work (n=62)

Lift ing Policies in 11 states (California, I llinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, Washington, & Hawaii)

...but nothing for schools

10 states have comprehensive programs for their health care facil it ies (i.e. hospitals & nursing homes).

Hawaii: resolution to support SPH policies of the ANA

Only true emergencies warrant the use of manual lift ing a patient.

Several states offer grants or funding to assist with following their SPH including purchasing of equipment and training of staff.

What about public schools?

So, What about Public Schools?

ANA and some state initiatives started with hospitals then progressed to include nursing homes.

Should there be a move to include public schools or would this be limiting our treatments and the progress of our students?

Other Barriers: Cost/ budget & staff behavior change

Approaches from 3 different states/ school distr icts

Maryland-MD State Steering Committee for OT and PT School-based Programs

A forum for OT/PT school-based and early intervention specialists and other stakeholders to meet and problem-solve regarding statewide issues in the assessment and implementation of OT/PT services in Maryland public schools and early intervention programs.

High Deser t Education Service Distr ict, Oregon

Serves 8 districts as a regional entity

All special education directors & PTs in the districts agreed:

no 2-person lifts

use of transfer equipment if a child is > 30 lbs

standing pivot transfers only when they can be done reliably, cooperatively, and easily

High Deser t Education Service Distr ict, Oregon

Partner with administration

Perform environmental assessments

Prioritize high risk classes

Consider district budget/ budget cycle

Provide targeted employee training

Partner with vendors & schedule demo trials

Early involvement with new buildings and remodels

Integrate into the IEP/ 504 plan

Fair fax County Public Schools, Virginia

Virginia Department of Education Handbook for PT and OT:

-outlines school based practice and roles of OT’s and PT’s but does not delineate any lifting guidelines-FCPS “guidelines” are based on the NIOSH safe lifting

-FCPS Therapy Services department (OT and PT) provides all equipment

-Therapy Services department is a centrally located department funded by the department of special services (special education) with it’s own budget for equipment

-Collaborative initiative to have safe and effective personal care spaces in all buildings

-Incentive to attend lifting trainings

FCPS Safe Patient Handling Survey

● October 2009

● Purpose: to determine training needs, use of equipment and barriers

How comfor table do you feel training others?

Not comfortable at all (%)

Somewhat comfortable (%)

Comfortable (%) Extremely comfortable (%)

In performing transfers...

11 24 39 26

In the use of lifting equipment...

39 27 23 11

Reasons school staff do not use l ift ing equipmentYes (%) No (%)

Space 5 47

Interface between equipment

38 62

Storage 36 64

Time to use 42 58

Time to locate/get 25 75

Not enough slings 0 100

Availability 57 43

Staff resistance 57 43

Decision making tree for transferr ing students with disabil it ies

Minimal L ift Policy vs. No L ift Policy

Does it make sense for districts to have a “no lift” policy with preschoolers and emerging skills?

May need to target neediest schools, programs (i.e. ID severe), students (i.e. PD/ OI)

Purpose of the L ift ing Guidelines

• Safety of students

• Safety of caregivers

• Promote maximal independence for students

• Promote communication among team members

• Increase statewide or districtwide awareness of safe lift ing principles

• Provide tools for team decision making

I ntroducing Mechanical L ifts:

Who, When, Why, What, & Where?

How is this a Par t of Your Decision Making Process?

Who

? Consider the use of the mechanical lift at any point from PS through HS when the student’s or staffs safety may be compromised, Examples:

A PS student with global delay who is 70 lbs.

A HS student with advanced Duchennes MD

An elementary level student with spastic quadriplegic CP

Who

Els

e? Consider the staff availableEducational background

Physical condition

Learning styles

Number of staff available

Training of staff: What is I nvolved?

Identify designated trainees (staff in need of training):

Consider identifying “ lift teams.”

Identify back-up personnel that need to be trained to provide coverage when a team member is not present and the substitute is not trained.

Trainees could include but are not limited to paraeducators, personal care assistants, special education teachers, regular education teachers, PE teachers, health room staff, therapists.

Documentation of Training?

Whe

n? When efficiency and access to the environment could be improved

When student independence could be improved

When multiple toileting transfers or changes need to be performed at school

To provide more position change opportunities

Why

? Safety of student

Safety of staff

Student dignity and FAPE

Access to school environment and LRE

Physical disability and needs should not be a factor in educational placement

Whe

re? Consider the student’s educational

placement

Self contained vs. general education setting

Consider the environment

Bathrooms (student or staff), building layout and age

Consider the family and what they do at home ie: can they carry this over?

Whe

re E

lse? General Education

Field trips

Community based instruction

Bus

Emergency Evacuations

Physical Education

Wha

t? Choosing the device…..

Considerations

Dependent transfer?

Partial body weight transfer?

Assisted standing?

Assisted walking?

Toilet transfer?

Changing table transfer, floor transfer, stander transfer, chair to chair transfer

Part of a mobility plan?

As a mobility support or adaptive equipment? Or both?

Resources/ L ifts

Who?

When?

Why?

Where?

Resources/ L ifts

Who?

When?

Why?

Where?

Resources/ L ifts

Who?

When?

Why?

Where?

Resources/ L ifts

Who?

When?

Why?

Where?

Resources/ L ifts

Who?

When?

Why?

Where?

Mechanical L ifts and the I EP

Process

The mechanical l ift as an I EP goal???? Really?

As part ial body weight support for standing transfers: student participates by standing, using controls, instructing adults, self advocacy

For dependent l ift : student to control head when asked, use controls, self advocacy, behavior goal: ie keep hands in sling etc.

Prepar ing to be l ifted: students can shift weight in chair to don sling/ vest, lock brakes, don sling/ vest, park power chair in proper position etc...

Example I EP Goals

To improve independence at school, Mary will stand up from her chair and maintain standing using the mechanical lift for physical support to transfer, and adult supervision and support to operate mechanical lift, twice daily on 3 out of 4 opportunities measured quarterly.

Using the mechanical lift, Dean will participate in transfers once he is placed in the lift sling by an adult, by accurately using the up/ down controls on the lift to move his body from his chair to the changing table to improve his independence at school twice daily on 3 consecutive data probes quarterly.

Example I EP Goals

Cole will demonstrate improved self advocacy skills by requesting caregivers use the mechanical lift to transfer and suggesting modifications/ adaptations to mechanical lift transfer as needed for personal care needs 70% of the time on 3 out of 4 data days sampled.

Example I EP Goals

More Examples!

Murray will improve his safety and participation in mechanical lift transfers at school by consistently placing and maintaining his hands/ arms in the lift sling with verbal prompting only on 3 out of 4 opportunities sampled monthly.

More examples!

Danielle will improve her participation in transfers at school by safely and accurately positioning her power wheelchair appropriately in order to support mechanical lift transfer to changing table on 3 out of 4 opportunities sampled over a 9 week period.

I f not a goal, then what?

-When using a mechanical lift is not a goal for a student, and will be used as a mobility support, consider:

➔ adding it as a part of the student’s present level of performance on the IEP

➔ as an “other accommodation” on the student’s IEP , or listed in the supplementary aids and services portion of the IEP

➔ within your POC

➔ as a documented mobil ity plan for staff to access and for you to document in the student file

Sell ing your program to administrat ion

Agree as a PT/ OT team

Insurance carriers have safety consultants that can assist with gathering injury data

Present the evidence of SPH vs. manual transfers and injuries/ potential injuries

Calculate the total # of pounds lifted each day by classroom staff

Use the injury/ time lost/ cost argument

Make short and long term plans for SPH

Address the barriers to the use of mechanical lifts and intervene at multiple levels:

Collaboration with admin both central admin. ( facilities/ADA specialists, HR, occupational health) and local admin. (principals)

Education, data collection as it relates to barriers and needs, establish policies within the therapy services department

Train building staff, educate building staff, students, parents

Case Studies

What would your school distr ict do now...and how should it be done?

Case Study: Sammy

5 y.o. with quadriplegic CP

self-contained class

not potty trained

working on standing, walking, & transitioning between positions

transfers 7-8 times during the school day

How do we decrease the amount of physical l ifts dur ing his school day?

When do we consider mechanical l ifts for such a young student?

Case Study: Oscar

8th grad student with incomplete SCI

General education

Now using wheelchair as primary means of mobility

Requires 2 people to transfer to toilet

How do we consider Oscar ’s pr ivacy needs when making decisions regarding l ift ing and transferr ing?

How would we respond to the parents concerns of using a mechanical l ift?

How would be respond to school staff concerns regarding t ime missed from instruction for toilet ing?

Case study: Kal ina

18 year old high school student

enrolled in her neighborhood high school’s community based vocational training program (job site is the airport)

spastic diplegic cerebral palsy

GMFCS level IV

proficient power wheelchair driver

recent surgery has limited weight bearing transfers

How can PT support and collaborate with the student and job site?

Questions

References and Resources

1. Barrett, J. (2015). Adopting safe patient handling policy in school: An interview with Jill Barrett, MS, PT.

2. Campo, M., Rockefeller, K., Harwood, K. (2009). Body Mechanics is Not Enough. From: CSM, APTA, Feb. 11, 2009; Las Vegas, NV.

3. Campo, M., Weiser S, Koenig, KL, Nordin M. Work-Related Musculoskeletal Disorders in Physical Therapists: A Prospective Cohort Study with 1- Year -Follow -Up. Phys Ther 2008; 88:608-619.

4. Cromie J E, Robertson VJ Best MO. Work-related musculoskeletal disorders and the culture of physical therapy. Phys Ther 2002; 82; 459-472.

5. Collins J W, Wolf L, Bell J , Evanoff B (2004). An evaluation of a “best practices” musculoskeletal injury prevention program in nursing homes. Injury Prevention 10: 206-211.

6. Engkvist IL . Evaluation of an intervention comprising a no lift ing policy in Australian hospitals (2006). Applied Ergonomics 37: 141-148.

7. Haglund K., Kyle J , F inkelstein M (2009). P ediatric safe patient handling. Journal of Pediatr ic Nursing.

8. Holder NL, Clark HA, DiBlasio J M, Hughes CL, Scherpf J W, Harding L, Shepard KF. Cause, P revalence, and Response to Occupational Musculoskeletal Injuries Reported by P hysical Therapists and P hysical Therapists Assistants. Phys Ther 1999; 79:642-652

9. Knibbe NE, Hanneke J , Knibbe J , Crist J (2008). Special approaches for safe handling of disabled children in the netherlands. Rehabi li tation Nursing 33, 1: 18-21.

10. Kutash M, Short M, Shea J , Martinez M (2009). The lift team’s importance to a successful safe patient handling program. Journal of Nursing Administration 39,4: 170-175.

11. Li J , Wolf L, Evanoff J (2004). Use of mechanical patient lifts decrease musculoskeletal symptoms and injuries among health care workers. Injury Prevention 10: 212-216.

12. Occupational Health and Safety Administration. Guidelines for Nursing Homes. Ergonomics for the prevention of musculoskeletal disorders. Accessed on September 1, 2016 at http:/ / osha.gov/ ergonomics/ guidelines/ nursinghome/ final_nh_guidelines.pdf.

13. Marras WS, Davis KG, Kirking BC, Bertsche P K. A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics 1999; 42(7):904-926.

14. Waters TR. When is it safe to manually lift a patient? Am J Nurs 2007; 107(8):53-58

15. Centers for Disease Control. Accessed 3.18.2009 at http:/ / www.cdc.gov/ niosh/ docs/ 94-110/ .

Resourceswww.nursingworld.org/ mainmenucategories/ policy-advocacy/ state/ legislative-agenda-

reports/ state-safepatienthandling, ANA,Inc. (2016).

http:/ / www.rifton.com/ adaptive-mobility-blog/ blog-posts/ 2015/ june/ safe-patient-handling-special-education-schools.

http:/ / www.who.int/ classifications/ icf/ icfbeginnersguide.pdf?ua= 1