Effective Transportation Arrangement for Patients to and from Operation Theatre

Transcription

1 Service Priorities & Programmes 8. Staff Engagement and Wellness No. SPP8.1 Effective Transportation Arrangement for Patients to and from Operation Theatre Amy Chan Suk Wan Nursing Officer The Duchess of Kent Children s Hospital at Sandy Bay 精益改善計劃

2 Effective Transportation Arrangement for Patients to and from Operation Theatre An e-hospital project of DKCH in 2011 minor change makes great different

3 Seven Building Blocks Facilitating Patients Services

4 Staffs compliant Very long route for transport patients from Ward 1&2 to OT Higher physical demand for staff Red line is the route along Kwai Fong Corridor to & from Block A to G Kwai Fong Corridor a cover walk way build along Block B to G

5 Patients to and from Operation Theatre (Block A) W1&2 (Block G) up-hill / down-hill slope + along Kwai Fong Corridor ( 群芳走廊 ) W3&4 (Block F) lift + along Kwai Fong Corridor ( 群芳走廊 ) W5&6, HDU (Block B ) direct short route to Block A W7&8 (Block B) lift + short route to Block A

6 e-hospital Flow of HKWC 1. Reasons for Action 急需改善原因 2. Current Condition 現狀 3. Target for Perfection 完善指標 4. Gap Analysis 差距分析 5. Counter measures 改善措施 6. Preliminary Result 初步成效 7. Implementation Plan 推行計劃 8. Improvement Achieved 成效 9. Lesson Learned 總結

7 1. Reasons for Action 急需改善原因 Environment Passage between W1&2, W3&4 and O.T. contains many sharp turns and narrow steep slope with water drainages. manual force; occupational hazard; Staffs complaint difficult to wheel old stretchers - Complaint of frequent wrists pain Patient expressed uncomfortable frequent turns and unexpected pumping while transported by stretcher Habit 2 staffs to escort ; wasted manpower in the daily transfer activities between wards & O.T. sharp turns (red line) narrow steep passage

8 Environment outside W1&2 narrow sharp turn narrow door immediate uphill

9 2011 received New Stryker (5 wheels) x 4 Paramount x 2 Common Stretchers in DKCH >15 years?? X 2 Stryker (4 wheels) x 1 Techlem x 1 (Condemn)

10 2. Current Condition 現狀 Furniture stretchers ( over 15 years) heavy, old & not uniform risk of wrist pain Not adhere to guideline for patient transfer Staffs habit & knowledge deficit to decide when to use wheelchair, stretcher or patient walk to OT by themselves. Wastage Using stretcher to transfer patient, used twice amount of time and manpower. Heavy old stretcher HDU bed Worn and small wheel

11 Project Team From involved department Chan Suk Wan (leader) NO / Ward 5&6, HDU Sze Ka Man RN / Ward 5&6, HDU Yeung Yip Ki PCAII / Ward 5&6, HDU Lo Estella (co-leader) Chiu Sau Fun APN / OT RN / OT Li Lai Fong NO / Ward 1&2 Yuen Wan Ying RN / Ward 1&2 Cheung Tai Miu WA / Ward 1&2

12 3. Target for Perfection 完善指標 Ensure patient safety and comfort Enhance staff occupational safety Pull and Push force on wrist to eliminate wrist pain Streamline the patient transfer Update guideline & reinforce staffs to follow Save manpower and time / decrease wastage Effective allocation of new stretchers / resources Improvement of equipments Eliminate use of HDU beds / old stretchers / beds

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14 5. Counter measures 改善措施 Received 4 new stretchers with 5th steering wheel lighter in weight & better forward control Re-allocated new stretchers for patient transfer between wards, HDU & OT : 2 for W1&2, 1 for W5&6 and 1 park in OT Assessment for occupational and manual handling safety Evaluate and updated guideline on patient transfer Physical fit patients could walk by themselves Use of wheelchairs instead of stretcher if patient condition allowed. Educate and train staffs Use the new stretchers and re-enforce to follow updated guideline New stretcher 5th wheel Steering brake

15 Assessment for occupational and manual handling safety MHO Investigation Team Venue: Ward 1&2 群芳走廊 Outside Ward 5&6 Operation Theatre Involved Members: 13 From Nursing Division (10): 2 NO + 1APN Amy Chan, LF Li, Estella Lo 2 RN K M Sze, S F Chui 2 supporting staffs Ah Kei, Ah Ling 3 student nurses From OSH Committee (2): Mike Kwan, Kennis Ha From HK West OM team (1): Joyce Wong

16 Stretchers being tested: New Stryker (5 wheels) from Ward 1&2 Paramount (4 wheels) from Ward 5&6 Length: Width: 214 cm 75 cm Length: Width: 200 cm 68 cm Wheels Size: 8 Wheels Condition: Good Wheels Size: 8 Wheels Condition: Slightly Rusted

17 Instrument Used: 2 Chatillons From DKCH Chatillon (dynamometer) From QMH (OM Team) Chatillon Digital Force Gauge

18 preparing in W1&2 anchor at front & rear end

19 Test 1: New Stryker (5 wheels) Route: Ward 1&2 to OT Segment 1: Ward 1&2 to Uphill slope uphill slope Front (Pulling) Rear (Pushing)

20 Test 1: New Stryker (5 wheels) Route: Ward 1&2 to OT steering function not well adopted Segment 2: Level ground with steep along 群芳走廊 to OT Front (Pushing) Along Window of PT Rear (Pushing) Sharp turn outside W5 Turn to 1F/Blk B lobby

21 Test 1: New Stryker (5 wheels) Route: OT to Ward 1&2 Segment 2 : Downhill slope to Ward 1&2 Front (Pulling) Rear (Pulling) Downhill slope

22 Recommendation on using paramount stretcher from Ward 5&6 remain in use Length: 200 cm Width: 68 cm Wheels Size: 8 Wheels Condition: Slightly Rusted Short and slimmer size than other stretcher Ward 5&6 is same floor and near OT

23 Recommendation : Techlem Stretcher Not good for use Condemn item in Ward 1&2 Wider size than other stretcher more difficult for turning Heavier than other stretcher more force required for patient transfer Only one handle inefficient to use for 2 people.

24 Techlem Stretcher Narrow spacing & sharp turn One-ended handle, space limited Immediate uphill

25 Comment from OSH Committee I Four wheels design stretchers with a longer turning radius and with longer time for turning Less techniques required Five wheels design stretcher with a shorter turning radius & shorter time for turning Higher technique and cooperation required (via guideline & training)

26 Comment from OSH Committee II Inadequate distance turning and pushing uphills pulling and turning downhills Higher MHO demand in pushing/ pulling force to accelerate/ decelerate the stretcher

27 Comment from OSH Committee III The corridor outside ward 5&6 was relatively narrow for both pushing stretcher and walking width for the controller [only 124 cm] (with the sewage pipe and water drainage path) Stretcher Width: 75 cm Sewage pipe Steep slope - Stretcher easily go into the water drainage path also require higher MHO demand. Water drainage path

28 Short Term Solution Very long route for transport patients from Ward 1&2 to OT Higher physical demand for staff Suggest improve the cooperativeness between two controllers. Avoid jerky movement Maintain constant speed

29 Long Term Solution Suggest restructuring of wards to minimize long distance travelling of wards Renovate the cover walkway outside ward 1&2 to eliminate the sharp corner

30 6. Preliminary Result I 初步成效 Save manpower and time Patient walk to OT saved 50% manpower & less time required in escort compared with using stretcher Saved & eliminate procedures: cleansing of wheel chairs/ stretchers Enhanced MHO No more increase complain of wrist pain in patient transfer Saved manual force loading lighter stretcher Staffs were pleased with new stretchers. Updated guideline in patient transfer was followed by all staffs HDU & wards implemented with good result (less manpower needed for ward and OT staffs less time waiting for patient ) Justify decision of new stretchers allocation for transfer and condemnation of old stretchers Relocation of all 4 new stretchers to wards & OT Apply funding to replace all old stretchers (over 15 years)

31 6. Preliminary Result II 初步成效 walk wheelchair new stretcher old stretcher No. of staffs escort patient Time spend in minute for each patient transfer wheelchair & new stretcher Each patient transfer Before plan After plan Manpower x escort 2 staffs < 1.75 staff Time used (mins) 8.32min walk only min Old stretcher only min wheelchair only min wheelchair & new stretcher min New stretcher only

32 7. Implementation Plan 推行計劃 Assessment for occupational and manual handling safety Use of new stretchers and implemented updated guideline on patient transfer. Reinforced and increase communication between wards & OT on patient transfer. Training Stretcher & guideline education Use of new stretcher, enforce the function of the 5th wheel. Assessment of patient condition for choosing mode of transfer, e.g. patient walk / wheelchair / stretcher.

33 8. Improvement Achieved 成效 Use new stretchers for patient transfer acknowledge better equipment could facilitate daily activities; promote occupational safety & health to staffs. Staffs compliance to transfer guideline & understand new stretcher function, esp. the 5 th steering wheel: a) Patient safety with comfort was ensured. b) No new wrist pain since implementation Decrease wastage Man hour saved 25.45% from March to May 2011 Manpower saved 31.25% from March to May 2011 Man hour saved 58.68% from August to Sept.2011 Nursing manpower saved 75 % from August to Sept.2011 Saved manpower / man hour could be utilized in other nursing activities.

34 Survey Staffs W1&2 Save time and manpower No wrist pain increased W5&6 O.T. Extra logistic arrangement laundry bag in lobby Save time Patients Appreciate walk to OT and Wear trousers to OT take off in OT lobby

35 Manpower (person) 8. Improvement Achieved II 成效 Manpower used by transfer OT patient saved 31.25% saved 75% 125 1/3/11-31/5/11 1/8/11-30/9/11 Before Plan After Plan In March to May total OT patients were 364 with GA/ LA cases In August to Sept. total OT patients were 251 with GA / LA cases

36 manhour ( hrs) 8. Improvement Achieved III 成效 Manhour saved used by transfer OT patient saved 25.45% saved 58.68% 25.5 Before Plan After Plan 0 1/3/11-31/5/11 1/8/11-30/9/11 In March to May total OT patients were 364 with GA/ LA cases In August to Sept. total OT patients were 251 with GA / LA cases 2175 minutes saved in August & Sept, 2012

37 9. Lesson Learned 總結 Care for the carer Address the daily burden of staffs Welcome open discussion with all level of staffs to voice out their difficulties, hazard and idea in daily routine. Change mind/ guideline Patient can walk or use of wheelchair to transfer to OT & returned to wards if condition allowed Communicate among departments Smoothen logistics arrangement Add laundry bag in OT receiving area Patient can wear trousers to OT Facing environment constraints & limited resources We could improve our working condition and practice by implementing mutual agreed guideline

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39 Acknowledgement OSH Advisor Kwan Mike Ha Kennis Project Advisor Wong Isadora Wong Eliza SOT OT1 DOM WM Stretcher reallocate sponsor Leung Chung Shing NO / SOPD Addition effort contribute team OT staffs

40 Thank You