safe patient handling, reuban daniel. c
TRANSCRIPT
SAFE PATIENT HANDLING- AN ART TO LEARN & A SAFETY MEASURE TO
FOLLOW
REUBAN DANIEL.C
Sr.Faculty of Caregivers & Sr.Program
Manager-Spinal Injury Rehab
-The Association of People With Disability,
Bangalore
SAFE PATIENT HANDLING(SPH)-AN OVERVIEW
SPH is an important factor that determines the work
productivity of any health caregiver both in the hospitals and
community
SPH is inversely proportional to the cause of Musculoskeletal
Disorders(MSD) in care givers
MSD is generally a result of long term cumulative physical effort
during improper patient transfer
MSD also develops from “PEAK LOAD” of patient handling
In NUTSHELL- such adverse injuries in this most vulnerable
group can be prevented by drawing SPH plans
Ergonomics & Patient
handling
The best ergonomic postures in safe patient handling
plays a key role in engaging the workforce efficiently .
The best ergonomic practice has 2 components
1)PATIENT TRANSFER & 2) PATIENT LIFTS. The work
force should know about these two which would give
them a fair idea when to use/demand either one of it.
1)Patient Transfer: Is a dynamic effort in which the patient
aids in the transfer and is able to bear weight on at least
one leg
2)Patient Lifts: Is an effort by the workforce/workforces
where the patient cannot bear weight on at least
one leg
SPH –Decision making
Tree
Assessment of the patient
Weight bearing capacity on at least 1 leg/Upper body Strength
YES
Patient Transfer
NO
Patient Lift
SPH –Decision making
factors
Weight bearing capacity
Upper body strength
Co-operation & Cognitive level
Physical characteristics
Other special characteristics like
presence of tubes,IV,HOF,splints should
be considered.
Manual handling
In Growing Health care sectors its not possible to avoid
manual handling
At least Polices/ SOP’s should be developed so the
principle of Protection Using Safe Handling (PUSH) is
prioritised
PUSH –should be realistic & reflect Actual practice
A Robust Risk Management process including
Hazard Identification
Risk Assessment
Implementation of Controls
Performance Monitoring
Auditing & Review of the management
Can Gadgets make the
trick???
o Manual Handling too needs basic ,cost effective
equipments to deliver the task with great impact.
o Proper Ergo+coupling of handling gadget+PUSH
Coupling the manual
handling
Coupling the manual
handling
Coupling the manual
handling
Factors contributing safe handling
Safe
handling
Managem
ent's
commitm
ent
Employees
Participato
ry level
Ergonomic
approach
& Proper
work place
Design
System of
Investigat
ing
incident
Sufficient
Human
Resource
trained for
this Mx
Program
Developing SPH to sensitize the Work
Force
Manual Handling Training
Incident Reporting &
Investigation
Resources and competencies
Communication
Manual handling guides
Mechanical Handling
Mechanical handling is one of the safest Patient handling in the
developed countries as reported by CDC in the year 1999
In Developing countries like ours due to the fear of high investments
and lack of system to capture the details of ROI discourages the
organisations to use the effective Mechanical hoists & Lifts
Statutory bodies like NIOSH, VHA encourages care giving employees
to use the Mechanical lifts
o Having indicators for outcome at initial point of introduction
o Would measure the benefits-Tools like REBA,NIOSH,Physical Demand
Description (PDD) checklist tool can be used
ZERO LIFT-Is it
possible?
Hypothetical but still could be explored
Transferring & Re positioning using new technologies could be
the way out
ZERO LIFT would increase the quality care
Components include Technical caregivers, Customised lifts and
hoists with adequate hydraulic system
……All these would make at some point of time ZERO LIFT
Possible
Few Mechanical
technologies
Few Mechanical
technologies
Myth Breakers-Manual
Handling
MYTHS FACTS
Training workers to use
proper body mechanics
avoids injuries
It takes less time to
move the patient
manually
This alone is not effective .Along
with training commitment of
management ,implication,auditing
& maintaining the SOP aids better
delivery
It takes much time to gather the
team for a manual lift .Rather it
takes very less time while using
mechanical lift as the key
personnel involvement is less
Myth Breakers-
Mechanical Handling
MYTHS FACTS
Lifting Equipments are not
affordable to get/ not cost
effective
Employees will not use the
equipments if invested for
lifting
Use of mechanical lifts
eliminates all the risk of MSD
Several studies have shown that initial
capital investment in the policies and
equipments needed to SPH can be recovered
in 2 -5 years if effective implementation is in
process
According to the survey of 2011 among 3500
employees 76% fairly used the equipments
and 31% of frequent usage of the equipments
were reported in the first 1 year of
implementation
It reduces the risk, but doesn’t eliminate.
B’cos most of the MSD are
accumulative/Repetative .
SPH Team’s responsibilities
Implements Program
Writes Policy
Reviews/Trends Data
Ensures incidents/injuries are investigated
Facilitates Equipment Purchases
SPHM Team Members
Nursing Administrator
Nursing Staff
Nursing Service Safety
Rep
Risk Manager
Resident/Patient
Nurse Educator
Therapy Staff
(OT, PT, ST)
Purchasing
Engineering
Safe Patient Handling –Goals &
Algorithms
Goals Reduce the incidence & severity musculoskeletal injuries
Reduce costs from these injuries
To create Care Plan & Algorithms
Algorithms Based on Specific Patient Characteristics (from Assessment)
Assists nurses in selecting
• Safest Equipment
• Safest Patient Handling Technique
• No.of staff needed for the task
Lifting guidelines-OSHA
Lift loads close to the body
Never transfer when off the balance
Limit no.of lifts less than 20
Avoid heavy lifting while spine rotated
Never Lift alone
Try using /educate using the mechanical assistance
whenever possible
Avoid repetitive actions
Get guided by effective body mechanic
techniques
Case Discussion
80 year old patient named XYZ
Weight: 85 KGs Height: 5’ 9”
Has dementia and HOF.
Some days he is cooperative. Other days he is combative and fearful.
When he is cooperative, he can bear weight. Otherwise, he resists standing.
He is to be out of bed every day in a chair.
Assessing XYZ
Level of Assistance
Dependent
Can the resident bear weight?
No, because the resident is
not cooperative
Resident’s level of cooperation
and comprehension
Unpredictable
Weight: 85Kgs
Height: 5’ 9”
Does resident have upper extremity strength needed to support weight during transfers?
No, because resident is unreliable for using his upper extremity strength
Special circumstances?
History of Falls
Care Plan-XYZ
Although the resident can sometimes bear weight, he can
be uncooperative.
The “No” answer to “Is the patient cooperative?” leads
you to: “Use full body sling lift and 2 caregivers”
Answer: Use full body sling lift and 2
caregivers
To draw a SOP for a SPH
Program
Collect the following Baseline Data Target Population/s: Nursing Staff (Radiology, Therapy Staff – PT,OT,ST, Others?)
Type: Strains/Sprains (Struck, Fall..?) (Best to include all types of injuries, then analyze
those of interest.)
Duration: Minimum of 1 year of data
Rank Tasks from 1 to 10
1 = highest risk 10 = lowest risk
When ranking, consider:
• Frequency & Musculoskeletal Stress
Delete Tasks not usually performed on Unit
Completed by
• Each Staff member
• Collectively by Shift
Baseline data of a Pre-Site
Visit on High-Risk Units
Acquire the following • Space issues
• Storage availability
• Maintenance/repair issues
• Patient population
• Staffing characteristics
• Equipment inventory/issues
Will use when performing site visit and for making recommendations
Formulating
Recommendations
Hazard Elimination Scale in sling lift
Transfer Bed
Recommending apt coupling equipments/gadgets
Administrative Controls Changes in Scheduling
Minimizing # times transfers are required
Job Rotation
Redistribution of Workload Based on Acuity
Lifting Teams
Procedures for repair/maintenance-Engineering control
Allot Storage Space to make equipment more accessible
Wishing you to facilitate a Happy work place!!!!!
Thank you!!!!
WAKE UP!!!!