No Unsafe Lift. Workbook

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1 N Unsafe Lift Wrkbk

2 Cver and Sectin Break image prvided curtesy f Arj Canada Inc.

3 Table Of Cntents Purpse f this wrkbk... 2 Hw t use this wrkbk...3 SECTION ONE A Brief Review f the Literature...5 SECTION TWO Features fr an Effective Musculskeletal Injury Preventin Prgram in Healthcare Organizatins Feature One Management Cmmitment...17 Feature Tw Emplyee Participatin...32 Feature Three Crdinatin Feature Fur Risk Assessment Patient Handling Tasks...37 Risk Assessment Nn-patient Handling Tasks Feature Five Equipment Cnsideratins Feature Six Bimechanical Cnsideratins Feature Seven Training...60 Feature Eight Cmmunicatin Prcedures...64 Feature Nine Area Design Cnsideratins SECTION THREE Prgram Planning, Implementatin and Administratin...69 A. Develping a Budget fr a Safe Patient Handling Prgram...71 B. Planning fr Timelines and Accuntabilities...77 C. Implementatin Cnsideratins...80 D. Managing Change...83 E. Prgram Evaluatin Defining and Measuring Outcmes...86 F. Prgram Prgress Reprt References N Unsafe Lift WrkBk

4 N Unsafe Lift Participant Wrkbk Purpse f this wrkbk In 2002, Wrk Safe Alberta was established with the gal f reducing injuries t Alberta wrkers by 40%. While the majrity f industries in Alberta made significant prgress twards this injury reductin target, the Health Services Industry has imprved mre slwly. The majrity f injuries fr healthcare wrkers were musculskeletal injuries related t patient handling. Fr healthcare rganizatins, this cmes as n surprise. Patient handling tasks ften present unexpected difficulties and mvement that may increase the risk f verexertin fr the caregiver. Healthcare rganizatins have identified several challenges in trying t reduce injuries related t patient handling tasks. These include the fllwing: Lack f apprpriate numbers and types f patient lifting devices. Shrtage f direct caregivers that may result in inadequate lifting r transfer practices. Facility design issues that cmprmise the ability t prvide prper ergnmic slutins t lifting and transferring tasks. Reluctance f staff t emply mechanical lifting aids in patient handling tasks. Reluctance f patients r their families t supprt the use f lifting devices. Inadequate training f caregivers in bimechanics. Lack f cmmunicatin abut the status f patients (requirements fr specific lifting/transferring strategies). Higher acuity patients requiring a higher level f care. Increased weight f many patients, impacting the ability t use standard lifting devices. The N Unsafe Lift wrkbk is designed t prvide a prvincial framewrk fr healthcare emplyers t develp and implement cmprehensive musculskeletal injury preventin prgrams fr their facilities. While the framewrk is brad in scpe and des nt fcus slely n musculskeletal injury preventin, the recgnitin f the key rle f verexertin injuries deserves cncentrated effrt and resurces. This framewrk identifies critical cmpnents f a musculskeletal injury preventin prgram t ensure all factrs are ptimized t prevent injuries. N Unsafe Lift WrkBk

5 In Alberta, we recgnize the unique nature f emplyers in the healthcare industry. With challenges specific t the client ppulatin and varied rganizatinal cultures, a musculskeletal injury preventin prgram cannt be a ne size fits all slutin. Rather, awareness f the key features f an effective musculskeletal injury preventin prgram will enable healthcare emplyers t tailr a prgram t meet their specific envirnments. This wrkbk is designed t prvide a descriptin f these key features, templates t enable an rganizatin t custmize its apprach, and references t assist the rganizatin in further study and prgram develpment. There is an integral cnnectin between the health and safety f healthcare wrkers and the quality f services they can prvide. In these days, where the fcus is n patient safety, it is wrth nting that, t be effective, a culture f safety must encmpass bth the wrkers as well as the clients served in a healthcare envirnment. Hw t use this wrkbk This wrkbk has been designed fr yu t use as a tl fr reviewing yur current musculskeletal injury preventin prgram and/r develping r imprving yur prgram. Fr many rganizatins, sme f the cmpnents described in this wrkbk are already well-established parts f their injury preventin prgram. Fr thers, integrating many f these features int their current prgrams will prvide significant benefits. This wrkbk is nt meant t be prescriptive, but rather t present ideas, cncepts, references and examples t assist yu in develping, evaluating and maintaining yur prgrams. The selectin f the title N Unsafe Lift reflects the flexibility that is necessary in a prgram that must take int accunt variatins in risk, resurces, patient assessments, and rganizatinal culture. An rganizatin cmmitted t N Unsafe Lift is cmmitted t using prfessinal judgement in the assessment f all factrs that cntribute t the safety f the task. Sectin 1 f this wrkbk prvides the reader with a brief review f the literature as it pertains t musculskeletal injury preventin in the healthcare industry, with a particular fcus n patient handling tasks. N Unsafe Lift WrkBk

6 Sectin 2 identifies the majr features t be cnsidered in the framewrk fr a N Unsafe Lift Prgram plan. These majr features include: Management Cmmitment Plicies and Prmtin Emplyee Participatin Crdinatin Risk Assessment Equipment Bimechanical Cnsideratins Training Cmmunicatin Area Design Cnsideratin Sectin 3 cvers prgram requirements, including: Preparatin f a multi-year budget fr the prgram, Identificatin f timelines and accuntabilities fr prgram cmpnents, Implementatin and enfrcement strategies, Change management, and Examples f utcme measures and prgram evaluatin prcesses. Each feature will include examples f ptins that address each f the features and templates t assist the participant in identifying/selecting desired prgram cmpnent details that are feasible and cnsistent with the rganizatin s culture. Peridically, material will include shrt self-assessment questins t help identify rganizatinal issues. Ideally, this wrkbk will be used by a prgram planning team frm the healthcare rganizatin. As any prgram f this nature requires the input and effrt f many peple and is multidisciplinary in nature, representatives frm grups mst directly impacted shuld be included n the planning team. These may include representatives frm Human Resurces, Educatin/ Training, Occupatinal Health and Safety, frntline patient care management, supprt services, and frntline wrkers. It may be useful t include thers specific t functins in yur rganizatins as well. This wrkbk can be used by reviewing the material and cmpleting the templates in the rder in which they are presented, r sub-grups may chse t wrk n specific framewrk features. T btain the maximum benefit, attempt t answer all questins and cmplete the templates fr each sectin. These have been designed t guide yu thrugh prgram develpment and implementatin planning. N Unsafe Lift WrkBk

7 Sectin 1 Table Of Cntents Purpse f this wrkbk... 2 A Brief Review f the Literature Hw t use this wrkbk...3 SECTION ONE A Brief Review f the Literature...5 SECTION TWO Features fr an Effective Musculskeletal Injury Preventin Prgram in Healthcare Organizatins Feature One Management Cmmitment...17 Feature Tw Emplyee Participatin Feature Three Crdinatin Feature Fur Risk Assessment Patient Handling Tasks...37 Risk Assessment Nn-patient Handling Tasks Feature Five Equipment Cnsideratins Feature Six Bimechanical Cnsideratins Feature Seven Training...60 Feature Eight Cmmunicatin Prcedures...64 Feature Nine Area Design Cnsideratins SECTION THREE Prgram Planning, Implementatin and Administratin...69 A. Develping a Budget fr a Safe Patient Handling Prgram...71 B. Planning fr Timelines and Accuntabilities...77 C. Implementatin Cnsideratins...80 D. Managing Change...83 E. Prgram Evaluatin Defining and Measuring Outcmes...86 F. Prgram Prgress Reprt

8 References

9 SECTION ONE A Brief Review f the Literature 1 There have been numerus reviews cnducted t identify causes and slutins fr the high prevalence f musculskeletal injuries (MSIs) 2 in the healthcare industry sectr. In a cmprehensive review f Evidence-Based Practices fr Safe Patient Handling and Mvement, authrs Audrey Nelsn and Andrea S. Baptiste reviewed ver 130 studies and papers t summarize evidence f successful interventins t reduce injuries t caregivers. Their findings indicate that strategies such as classes in bdy mechanics, training in safe lifting techniques, the use f back belts, and manual resident lifting prcedures have nt been successful in reducing resident-handling injuries, thugh they remain the mst cmmn interventins used in many lngterm care rganizatins. Althugh it is widely accepted that classes n bdy mechanics and/r training in lifting techniques prevent jb-related injuries, thirty-five years f research reveal that these effrts have cnsistently failed t reduce the jb-related injuries in patient care settings. This cmprehensive review paper suggests a need fr a majr paradigm shift twards evidencebased practices that incrprate the extensive use f lifting devices, imprved resident/patient care ergnmic assessment tls, true n lift plicies, effective and required training n the use f lifting devices, and the use f lifting teams where pssible. The article als encurages the use f unit-based peer leaders and clinical tls (including algrithms and assessment tls). An industrial hygiene apprach cnsiders the use f several levels f cntrls. Audrey Nelsn and Andrea S. Baptiste suggest that evidence indicates effectiveness f engineering, administrative and behaviural cntrls. Engineering cntrls have been shwn t be extremely effective in reducing risk at the surce and creating a mre permanent slutin. Engineering cntrls reviewed include changes t the wrk envirnment, layut, and equipment (such as lifting devices, lateral transfer aids, r electric beds). Administrative cntrls discussed included the mdificatin f jbs and prcedures t incrprate mre rest perids, jb rtatin and shift length adjustments, and training f wrkers t apprpriately assess risk. Examples are a safe lift plicy, resident assessment prtcls and the use f decisin trees, algrithms, etc. Behaviural cntrls included emplyee training in the prper use f lifting devices and the use f unit-based peer leaders Mdified and adapted frm a prject dcument written by GMS & Assciates, Ltd. fr the Cntinuing Care Safety Assciatin in September 2006 entitled Musculskeletal Injury Preventin in Alberta s Lng Term Care Wrkplaces Status f Prgrams, Issues and Recmmendatins Evidence-Based Practices fr Safe Patient Handling and Mvement, Audrey Nelsn, Andrea Baptiste, Online Jurnal f Nursing Issues - September 2004; MainMenuCategries/ANAMarketplace/ ANAPeridicals/OJIN/TablefCntents/ Vlume92004/Number3September30/ EvidenceBasedPractices.aspx N Unsafe Lift WrkBk sectin 1

10 In An evaluatin f a best practices musculskeletal injury preventin prgram in nursing hmes 3, the authrs cnducted an extensive literature review and identified the fllwing best practices that have been determined t be successful features f an effective musculskeletal injury preventin prgram: Mechanical lifting equipment and repsitining aids. Training n the use f lifts. Medical management prgram. Written plicy. The authrs designed a six year interventin trial in six nursing hmes cvering 552 beds and facilities ranging in size frm 60 t 120 beds, and invlving 1728 nursing persnnel. Implementing a preventin prgram emplying these selected best practices resulted in a decrease frm 5.8 t 2.0 lst time injuries per 100 nursing persnnel, and a decrease in ttal lst wrk days frm 488 t 229. At this time, there was n decrease in ther types f injuries in the facilities. Interestingly, the study als fund that there was a decline in injuries assciated with resident vilence twards staff during resident handling. The authrs suggested that using mechanical equipment t lift residents increases a resident s cmfrt and feeling f security when cmpared t manual methds The physical separatin frm the caregiver and the resident affrded by the use f a lift, particularly thse with a knwn histry f vilence, culd als explain the reductin in assaults n caregivers while using mechanical lifts. 3. An evaluatin f a best practices musculskeletal injury preventin prgram in nursing hmes; JW Cllins, L. Wlf, J Bell, B Evanff; Injury Preventin 2004;10: Lifting Patients/Residents/Clients in Healthcare; Washingtn State 2005; Reprt t the Washingtn State Legislature Huse Cmmerce and Labr Cmmittee January Many healthcare rganizatins have develped musculskeletal injury preventin prgrams targeting the healthcare industry sectr. In develping these prgrams, mst have cnducted an initial review f the literature t determine critical success factrs. Fr example, a Lifting in Healthcare Task Frce 4 cllabrated with the Washingtn State Department f Labr and Industries t address the increasing frequency and severity f musculskeletal injuries in healthcare rganizatins in the state. Their study included site visits, surveys, and interviews t learn abut the issues, as well as identify barriers and successes in addressing the issues. The findings were cnsistent with thse f ther studies and included the fllwing: The meaning f n lift varied cnsiderably frm site t site, with n cnsistent understanding r applicatin f the principles. N Unsafe Lift WrkBk sectin 1

11 Management cmmitment was ften lw, with incnsistent enfrcement f plicies and inadequate supprt fr the prgram (thrugh the prvisin f time, training, equipment, etc.). There was ften little evidence f reinfrcement r f cnsequences (unless a resident was injured). Mst staff in the nursing hmes (80%) believed that mre mechanical equipment wuld reduce the ptential fr injury; hwever, 50-60% felt this wuld require mre help frm c-wrkers and take mre time t use this equipment. There was an increased need fr specialized equipment t handle bese residents. Ceiling lifts have been shwn t be cst-effective and well received by mst nursing hme staff. Older facilities presented barriers t the installatin f ceiling lifts. Psitining the slings under the resident is a physically demanding prcess, smetimes requiring awkward pstures and frceful exertins. There has been a greater recgnitin f the value f leaving slings in place t reduce this effrt. Sme facilities have expanded their prgram t include supprt staff rather than slely care giving staff. Cnclusins in this reprt were that the hazards f manually handling residents culd be reduced by a prgram that includes: Plicies fr risk assessment and cntrl, Having adequate equipment, Having adequate staffing, Onging resident handling training, Management cmmitment, Staff invlvement, and Incident investigatin, fllw-up and cmmunicatin. A survey in eight healthcare rganizatins which had implemented zer lift prgrams (n manual resident lifting) was cnducted by Dr. Arun Garg 5 at the University f Wiscnsin Milwaukee (spnsred by the Natinal Institute fr Occupatinal Safety and Health). This study reviewed the cmpnents f successful prgrams, particularly fcusing n the participatry apprach t the prgram develpment and implementatin. Findings shwed significant imprvement in number f injuries, Wrkers Cmpensatin Bard (WCB) csts, lst wrk days and restricted wrk days. 5. Lng-Term Effectiveness f Zer-Lift Prgram in Seven Nursing Hmes and One Hspital; Arun Garg; University f Wiscnsin Milwaukee; August N Unsafe Lift WrkBk sectin 1 9

12 Data shwed: 62% decrease in patient transfer injuries, 32% decrease in all injuries. 86% decrease in wrk days lst frm patient transfers, 62% decrease in all lst wrk days. 64% decrease in mdified wrk days frm patient transfers, 6% decrease in all wrk days lst. 84% decrease in wrkers cmpensatin csts frm patient transfers; 55% decrease in wrkers cmpensatin csts fr the entire facilities. This study als revealed intangible benefits such as lder and pregnant nursing aids cntinuing t wrk lnger, staff reprting less fatigue and pain fllwing their shifts, imprvement in emplyee mrale, and imprved patient care. In the cmprehensive Patient Care Ergnmics Resurce Guide 6 develped in 2001 by the Patient Safety Center f Inquiry (Tampa, FL), Veterans Health Administratin and Department f Defense, the authrs reviewed many studies and made knwn the fllwing myths abut safe patient handling and mvement by prviding evidence that the facts d nt supprt these widely held beliefs: 6. Patient Care Ergnmics Resurce Guide: Safe Patient Handling and Mvement; Patient Safety Center f Inquiry (Tampa, FL), Veterans Health Administratin and Department f Defence, USA, 2001 Educatin and training are effective in reducing injuries Twelve reviewed studies led t the cnclusin that traditinal injury preventin prgrams based primarily n training and attempts t mdify behaviur f wrkers have nt demnstrated widespread success. The authrs summarize that There are several reasns why training alne is nt effective, including the fllwing: (1) bdy mechanics training is based n research that is nt likely generalizable t nursing practice, (2) it is difficult fr nurses t translate classrm cntent t direct patient care, (3) experts d nt agree n what prper bdy mechanics include, and (4) manual patient handling tasks are intrinsically unsafe because they are beynd the capabilities f the general wrkfrce. Back belts are effective in reducing risks t caregivers Fur studies were cited, including the extensive review by the NIOSH Back Belt Wrking Grup, which indicate that there is n evidence that these belts are effective. On the basis f available evidence, the ptential effectiveness f back belts in reducing the ccurrence f lw back injuries remains unprven. There has been sme cncern that wearing a back belt may increase the ptential fr injury in that they may prvide a false sense f cnfidence t the lifter which may lead t lifting mre weight than they are capable f handling. 10 N Unsafe Lift WrkBk sectin 1

13 Mechanical lifts are nt affrdable Nine studies reviewed indicate that the benefits (bth financial and ther) f having mechanical lifts balance r exceed their csts. Use f mechanical lifts eliminates all the risk f manual handling Human effrt is always required t mve, steady, r psitin the patient. In using sme equipment, the resident must first be rlled ver in rder t insert a sling. High risk tasks in nursing are restricted t lifting patients Tw studies cited identified the fllwing stressful tasks: (1) transferring patient frm tilet t chair, (2) transferring patient frm chair t tilet, (3) transferring patient frm chair t bed, (4) transferring patient frm bed t chair, (5) transferring patient frm bathtub t chair, (6) transferring a patient frm chair lift t chair, (7) weighing a patient, (8) lifting a patient up in bed, (9) repsitining a patient in bed side t side, (10) repsitining a patient in a chair, (11) changing an absrbent pad, (12) making a bed with a patient in it, (13) undressing a patient, (14) tying supprts, (15) feeding a bedridden patient, (16) making a bed while the patient is nt in it. If yu buy equipment and devices fr safe patient handling and mvement, staff will use them Fur cited studies indicated that even thugh equipment may have been purchased, there is a reluctance t use the equipment by many caregivers. The reasns fr this include: equipment that is nt user-friendly r patient-friendly, unstable equipment, lack f strage that wuld make the equipment easily available, and prly maintained equipment. If yu institute a n lift plicy, nurses will stp lifting In rder t institute a n lift plicy successfully, the infrastructure must first be shaped t supprt the plicy, including the prvisin f sufficient quantities f apprpriate technlgical slutins. Many rganizatins that have tried t institute n lift plicies have failed withut this necessary supprt. Varius lifting and handling equipment and devices are equally effective Three studies were cited that indicate that sme types f equipment may pse increased caregiver injury. Examples given include differences in spinal crd lading prvided by using different frictin reducing devices, lifting devices requiring pumping resulting in shulder strains, and sme specialty mattresses that increase required exertin by caregivers. N Unsafe Lift WrkBk sectin 1 11

14 Nurses wh are physically fit are less likely t be injured Twenty-tw studies were cited that identified a variety f caregiver characteristics that affect risk. These included: level f fitness, besity, genetics, muscular strength, age, stress, previus histry f back injury, with cnfunding factrs f drug/alchl cnsumptin and cigarette smking. Observatins at the Tampa VA Hspital indicated that a better predictr might be the scial relatinships n the unit....nurses that were well integrated n a unit were able t secure assistance frm peers easier and mre quickly than staff members wh were marginally accepted. In additin t staff wh were nt well-liked r respected by peers, ther staff that had difficulty securing assistance included new staff and staff wh flated t the unit. Once an injury ccurred, staff that had psitive relatinships with their nurse manager was mre likely t return t wrk sner than staff with prer relatinships with management. Many f these myths are held as beliefs in healthcare rganizatins. In sme cases, the myths are seen as fact, in thers, they have prven t be untrue. In the develpment f a musculskeletal preventin prgram, it may be imprtant t recgnize and discuss these assumptins early in the cmmunicatin f a prgram. The relatinship f healthcare wrker injuries t patient safety is being evaluated and penly discussed in the literature. With the increased imperative t imprve patient safety, the understanding f the crrelatin f healthcare wrker safety t patient safety has led t a call fr greater resurces t imprve wrker safety. In the Nvember AAOHN Jurnal, the authrs suggest that high rates f injury are linked t the natinal nursing shrtage and als t the high turnver rates experienced in bth acute and lng-term care facilities. An American Nurses Assciatin website 8 article Safe Staffing/Patient Outcmes states An area f mre recent research is that f nurse fatigue and patient utcmes. As mandatry vertime plus the use f vluntary vertime became an issue fr practicing nurses, the questin arse fr researchers as t the effect f prlnged nursing wrk hurs and the impact fatigue might have n patients and the nurses themselves. Grundbreaking wrk by Dr. Ann Rgers, RN, PhD and Dr. Linda Sctt, RN, PhD and their team demnstrated that as wrked hurs increase past 8 hurs, but mst dramatically past 12.5 hurs, the prbability f errrs and near misses rise. In additin, the rate f the nurses having accidents r near misses when ut f wrk increases. 12 N Unsafe Lift WrkBk sectin 1

15 It is becming well recgnized that healthcare wrker injuries are nt a simple cause and effect relatinship. Numerus studies have evaluated the impacts f staffing levels, nursing skill mix, and wrk schedules n healthcare wrker injuries. Any prgram that will be successful must invlve all aspects f the wrk envirnment. Hwever, prviding an effective musculskeletal injury preventin prgram is an excellent first step t imprving healthcare wrker safety. In an attempt t psitively impact the injury rates in healthcare rganizatins, many assciatins and regulatry bdies wrldwide have develped prgrams and training materials t assist healthcare rganizatins. In sme cases, there has been pressure t ensure that the prgrams in use are cnsistent in their details, as this allws fr greater applicability acrss rganizatins, particularly imprtant when many rganizatins share a cmmn pl f emplyees. Fr this wrkbk, best practices that are cmmn features f many f these prgrams are discussed and templates are prvided t assist Alberta healthcare rganizatins in chsing suitable ptins fr implementing each cmpnent. In particular, best practice features were chsen based n their inclusin in several effective prgrams including: LITEN UP The LITEN Up apprach is described in the New Zealand Patient Handling Guidelines. Tampa VA Prgram The Patient Care Ergnmics Resurce Guide Safe Patient Handling and Mvement was develped by the Veterans Health Administratin and the Patient Safety Center f Inquiry in Tampa, Flrida. Handle With Care - Ontari This prgram has been designed by the Ontari Safety Assciatin fr Cmmunity and Healthcare (OSACH). Handle with Care - BC This prgram was develped by Wrk Safe BC. 7. Nursing Injury Rates and Negative Patient Outcmes Cnnecting the Dts, by William Charney and Jseph Schirmer, AAOHN Jurnal, Nvember 2007, Vl. 55, N Categries/ThePracticefPrfessinalNursing/ wrkplace/wrkfrce/shrtagestaffing/ Staffing/SafeStaffingPatientOutcmes.aspx N Unsafe Lift WrkBk sectin 1 13

16 These prgrams are nly examples f cmprehensive guidelines develped by varius rganizatins and this list is nt t be cnsidered exhaustive. Hwever, it is nted that these prgrams, as well as many thers, have sme cmmn critical features. These features include: Management Cmmitment Plicies and Prmtin Emplyee Participatin Crdinatin Risk Assessment Equipment Bimechanical Cnsideratins Training Cmmunicatin Area Design Cnsideratins In the next sectin, we will delve int each f these features in greater detail and prvide tls t assist yu in identifying hw these features can be incrprated int yur rganizatin s prgram. 14 N Unsafe Lift WrkBk sectin 1

17 N Unsafe Lift Participant Wrkbk Purpse f this wrkbk Sectin 2 In 2002, Wrk Safe Alberta was established with the gal f reducing injuries t Alberta wrkers by 40%. While the majrity f industries in Alberta made significant prgress twards this injury reductin target, the Features Health Services fr Industry an Effective has imprved Musculskeletal mre slwly. The majrity Injury f Preventin injuries fr healthcare Prgram wrkers in were Healthcare musculskeletal Organizatins injuries related t patient handling. Fr healthcare rganizatins, this cmes as n surprise. Patient handling tasks ften present unexpected difficulties and mvement that may increase the risk f verexertin fr the caregiver. Healthcare rganizatins have identified several challenges in trying t reduce injuries related t patient handling tasks. These include the fllwing: Lack f apprpriate numbers and types f patient lifting devices. 2 Shrtage f direct caregivers that may result in inadequate lifting r transfer practices. Facility design issues that cmprmise the ability t prvide prper ergnmic slutins t lifting and transferring tasks. Reluctance f staff t emply mechanical lifting aids in patient handling tasks. Reluctance f patients r their families t supprt the use f lifting devices. Inadequate training f caregivers in bimechanics. Lack f cmmunicatin abut the status f patients (requirements fr specific lifting/transferring strategies). Higher acuity patients requiring a higher level f care. Increased weight f many patients, impacting the ability t use standard lifting devices. The N Unsafe Lift wrkbk is designed t prvide a prvincial framewrk fr healthcare emplyers t develp and implement cmprehensive musculskeletal injury preventin prgrams fr their facilities. While the framewrk is brad in scpe and des nt fcus slely n musculskeletal injury preventin, the recgnitin f the key rle f verexertin injuries deserves cncentrated effrt and resurces. This framewrk identifies critical cmpnents f a musculskeletal injury preventin prgram t ensure all factrs are ptimized t prevent injuries. N Unsafe Lift Wrkbk

18 In Alberta, we recgnize the unique nature f emplyers in the healthcare industry. With challenges specific t the client ppulatin and varied rganizatinal cultures, a musculskeletal injury preventin prgram cannt be a ne size fits all slutin. Rather, awareness f the key features f an effective musculskeletal injury preventin prgram will enable healthcare emplyers t tailr a prgram t meet their specific envirnments. This wrkbk is designed t prvide a descriptin f these key features, templates t enable an rganizatin t custmize its apprach, and references t assist the rganizatin in further study and prgram develpment. There is an integral cnnectin between the health and safety f healthcare wrkers and the quality f services they can prvide. In these days, where the fcus is n patient safety, it is wrth nting that, t be effective, a culture f safety must encmpass bth the wrkers as well as the clients served in a healthcare envirnment. Hw t use this wrkbk This wrkbk has been designed fr yu t use as a tl fr reviewing yur current musculskeletal injury preventin prgram and/r develping r imprving yur prgram. Fr many rganizatins, sme f the cmpnents described in this wrkbk are already well-established parts f their injury preventin prgram. Fr thers, integrating many f these features int their current prgrams will prvide significant benefits. This wrkbk is nt meant t be prescriptive, but rather t present ideas, cncepts, references and examples t assist yu in develping, evaluating and maintaining yur prgrams. The selectin f the title N Unsafe Lift reflects the flexibility that is necessary in a prgram that must take int accunt variatins in risk, resurces, patient assessments, and rganizatinal culture. An rganizatin cmmitted t N Unsafe Lift is cmmitted t using prfessinal judgement in the assessment f all factrs that cntribute t the safety f the task. Sectin 1 f this wrkbk prvides the reader with a brief review f the literature as it pertains t musculskeletal injury preventin in the healthcare industry, with a particular fcus n patient handling tasks.

19 SECTION TWO Features fr an Effective Musculskeletal Injury Preventin Prgram in Healthcare Organizatins Feature One Management Cmmitment Fr every prgram r initiative f an rganizatin, success is clsely tied t the level f management cmmitment. In healthcare rganizatins, management has an extensive scpe f respnsibilities, and must respnd t critical patient-related situatins (such as bed shrtages, utbreaks, etc.) as well as scietal pressures (such as labur shrtages, the aging wrkfrce, etc.). Internal prblems related t physical structure and emplyee health and safety issues must als be dealt with. Fr healthcare rganizatins, staffing represents a majr cst and ften impacts the number f beds that can be kept pen and the quality f patient care. Keeping staff healthy and safe is a legal, mral and business respnsibility. Fr this reasn, management cmmitment is the pre-requisite fr a successful musculskeletal injury preventin prgram. The key aspects f management cmmitment that will be discussed in this wrkbk include: Understanding the scpe f the prblem, Defining bjectives, Establishing the plicies, Rles, respnsibilities and accuntabilities, and Fllw thrugh attentin and evaluatin. Understanding the scpe f the prblem (lcally) There is a general cnsensus that the mst cstly wrkplace injuries in healthcare are musculskeletal injuries. Recvery time is ften prlnged, and injured emplyees are mre susceptible t re-injury. Resumptin f regular wrk after an injury is a gradual prcess, requiring a build-up t full duties. T assist in btaining management supprt fr musculskeletal injury preventin effrts, it is useful t identify the impacts f this type f injury. While WCB data is clearly related t wrkplace incidents, shrt and lng-term disability data can als reveal the impacts f musculskeletal injuries t the rganizatin. Increased patient acuity, increased weights f patients, and the aging wrkfrce all cntribute t the ptential fr greater ergnmic stress and musculskeletal injury (bth at wrk and ff the jb). Creating an effective cmprehensive musculskeletal injury preventin prgram will prvide psitive impacts affecting prductivity and the health and wellbeing f staff and patients. This template may be used t summarize the impact f musculskeletal injuries in yur rganizatin. N Unsafe Lift WrkBk sectin 2 17

20 Impacts f Musculskeletal Injuries Infrmatin available? Y r N Parameter Result Number f lst time injuries in the last year Number f lst time injuries in the last year related t verexertin, sprains, strains r lifting Number f immediate mdified wrk pprtunity/ prgrams in in the last year related t verexertin, sprains, strains r lifting % f lst time injuries in the last year related t verexertin, sprains, strains r lifting cmpared t all lst time injuries Ttal csts t date f lst time injuries in in the last year related t verexertin, sprains, strains r lifting Average cst f lst time injuries in in the last year related t verexertin, sprains, strains r lifting Average number f days/hurs missed in in the last year due t verexertin, sprains, strains r lifting (cded WCB) Ttal csts f lst time injuries in in the last year related t verexertin, sprains, strains r lifting divided by number f full time equivalents (FTE) Ttal cst f immediate mdified wrk pprtunity/plans in the last year related t verexertin, sprains, strains r lifting divided by number f FTEs Ttal number f hurs cded WCB fr lst time injuries in in the last year related t verexertin, sprains, strains r lifting divided by 2000 (equals time lss stated as number f FTEs ) Ttal WCB premium csts in the last year Emplyer s WCB lst time injury frequency rate Emplyer s WCB lst time injury severity rate Trends in lst time injury rates (increasing/decreasing) Trends in lst time severity rate (increasing/decreasing) Cmparisn f Emplyer s WCB lst time injury frequency rate with industry average Cmparisn f Emplyer s WCB lst time injury severity rate with industry average Number f shrt and lng-term disability claims related t musculskeletal injuries in the last year Csts related t shrt and lng-term disability claims related t musculskeletal injuries in the last year 18 N Unsafe Lift WrkBk sectin 2

21 Summary f impact: Number f FTEs equal t time lst fr musculskeletal injuries Direct csts f musculskeletal injuries (WCB) and STD, LTD T prevent injuries, it is imprtant t identify what causes the injuries t target preventin effrts accrdingly. In many cases, insufficient infrmatin abut hw the incident ccurred r investigatin t determine rt causes results in nly a vague perceptin f what needs t be dne t prevent similar injuries. T fully understand the scpe f emplyee incidents related t musculskeletal stresses, a system must be in place t investigate the incidents fully. When management is aware f the impacts f musculskeletal injuries n the rganizatin (bth financial and prductivity impacts), there is greater impetus t reduce injuries. But t ensure that any interventin is successful, a clear understanding f what causes these injuries shuld direct the interventins. Fr many years, it was assumed that the cause f nurses patient handling injuries was lack f training n prper bimechanics. The majrity f healthcare rganizatins instituted training prgrams t address the perceived prblem. Hwever, fr mst, the incidents cntinued, with greater number f nurses injured each year. It became apparent that a clser lk at the causal factrs f incidents was warranted. The fllwing templates may assist with incident investigatin infrmatin gathering. Questin 1.1 Des yur rganizatin track WCB claims and assciated csts related t musculskeletal injuries? Questin 1.2 Are yu able t summarize the direct csts f musculskeletal injuries and translate this cst int the number f FTEs it represents? N Unsafe Lift WrkBk sectin 2 19

22 Rt Causes f Musculskeletal Injuries Rt causes check as many as applicable Inadequate training Imprper wrk area design Inadequate enfrcement f rules Lack f plicy r prcedure Unreslved wrklad issues Cnflicting demands Imprper strage/dispsal Unsafe prcedure Inadequate risk assessment New equipment r materials psing hazard Defective equipment Lack f emergency respnse planning r training Inadequate maintenance Pr cmmunicatin Unavailable cntrls (assistive devices) Inadequate staffing Lack f cntrls identified Other 20 N Unsafe Lift WrkBk Wrkbk sectin 2

23 Gathering Infrmatin frm Incidents Gathering Infrmatin frm Incidents Transferring patient : bed t stretcher Rushing t perfrm service Transferring patient: bed t wheelchair Wrker with previus injury Transferring patient: wheelchair t tilet/ cmmde Unavailable equipment Assisting falling/fallen patient Defective equipment Bathing patient Insufficient lighting fr task Repsitining patient in bed Inadequate space t maneuvre arund patient Assisting patient t stand Patient unable t supprt bdy weight Used a lifting device Patient ver 200 punds Used transfer device Patient ver 400 punds Used 2 persns fr lift/transfer Unaware f status f patient vis-à-vis lift/ transfer requirements Used mre than 2 persns fr lift/transfer Status f patient changed Unavailable staff member t assist Patient uncperative Uncrdinated lift with mre than 1 caregiver Aggressive patient Heavy items placed abve shulders Inapprpriate/inadequate strage space Extensive bending required Cluttered area Repetitive mtin required Unexpected weight f item t be mved Inadequate/inapprpriate technique used Other: N Unsafe Lift WrkBk sectin 2 21

24 Questin 1.3 Des yur incident reprting prcess require a descriptin f the activities being perfrmed when the incident ccurred? Defining Objectives Management indicates the imprtance f specific issues by setting gals and bjectives related t that issue. When it cmes t injury preventin, gals and bjectives must be carefully determined t ensure that they: Are realistic and achievable, Are relevant t the issue, Have measurable utcmes, and Identify accuntabilities. Questin 1.4 Des yur rganizatin have an incident investigatin prgram in place that requires investigatin f ALL incidents where there is an emplyee injury? Questin 1.5 Identifying a gal such as reducing WCB claims by 50% with the intrductin f a training prgram is an example f an bjective that DOES NOT meet many f the criteria listed abve. First, it is nt likely t be realistic, as the training prgram is nt likely t crrect many f the rt causes that led t the incidents. Secnd, the fcus shuld be n reducing injuries, nt claim numbers. A fcus n reducing claim numbers may discurage reprting f incidents, which prevents the cllectin and analysis f infrmatin pertinent t injury preventin effrts. The number f claims can be reduced by immediate mdified wrk pprtunities fr injured emplyees, but this will nt assist in reducing the injuries in the first place. Hlding supervisrs and frnt line managers accuntable fr their injury rates is apprpriate if they can cntrl the wrk envirnment. This means ensuring they have the prper tls, equipment, prcesses and staff in place t perfrm ptimally and ensure adequate injury preventin is in place. Gals are critical tls fr prgram success. If well designed, they fcus attentin and effrt t the desired bjectives. The fllwing table lists sme bjectives that meet the criteria listed abve. Des yur incident investigatin prgram require the identificatin and crrectin f rt causes f incidents? 22 N Unsafe Lift WrkBk sectin 2

25 Examples f Musculskeletal Injury Preventin Objectives All wrk areas perfrm risk assessments fr musculskeletal injuries and determine required equipment t reduce injuries. All musculskeletal injuries are fully investigated, with rt causes identified and crrective actin taken. All new r transferred emplyees receive rientatin t the Safe Patient Handling Prgram and understand their rles and respnsibilities. Cmpetency assessments are perfrmed fr all new hires r transferred wrkers and include assessments n all available equipment using a practical return demnstratin, as well as an annual educatin fr all wrkers. Questin 1.6 D yu have current gals related t musculskeletal injury preventin? If s, what are they? All perfrmance appraisals include an element f fllwing the Safe Patient Handling Plicy and Prgram. Fr example, prvide the pprtunity t explre barriers t safe patient handling. Cmmunicatin strategies regarding assessment f patient status are cnsistent thrughut the rganizatin, reviewed and updated regularly, and include cmmunicatin t all apprpriate staff. Mdified wrk will be ffered t all emplyees wh have sustained wrk injuries t allw fr a gradual wrk hardening t prevent re-injury. Questin 1.7 Identify bjectives that may be feasible in yur rganizatin. Fr each, identify: Wh is accuntable? These examples can be assessed frm the perspective f % cmpleted, with the gal set at 100%. If bjectives are tied t prgram elements rather than final impacts, a greater fcus n implementing the prgram elements will ccur, and this fcus will ultimately drive the activities that will alter the utcmes. What will be measured? What are the targets? N Unsafe Lift WrkBk sectin 2 23

26 Establishing Plicies, including Rles and Respnsibilities Mst rganizatins indicate the imprtance f tpics by creating a plicy which clearly defines management cmmitment, the gals, expectatins, rles and respnsibilities related t the tpic. Frm a due diligence perspective, emplyers indicate the rganizatin s apprach t ensuring certain behaviurs are identified and enfrced thrugh the develpment and cmmunicatin f plicies. When it cmes t health and safety, plicies are critical management tls t ensure that all wrkplace parties wrk tgether t create and maintain a safe wrking envirnment. Plicies are ften structured t clearly identify rles and respnsibilities fr each wrkplace party, identify expected actins, and indicate ramificatins f nt fllwing plicy. A plicy generally cntains the fllwing sectins: Statement f cmmitment/ Purpse Statement f cnsistency with legislated standards Gals & Objectives Definitins Required actins Rles and Respnsibilities Available resurces Enfrcement /Accuntabilities In develping a Safe Patient Handling Prgram, each rganizatin shuld select wrding apprpriate t the culture f the rganizatin and ensure that definitins are clearly understd. Ideally, the plicy will be develped by a multidisciplinary grup and be reviewed in draft stages fr cmments prir t being accepted. The fllwing examples are prvided t assist healthcare rganizatins in drafting specific plicy cmpnents. Examples f statements f cmmitment/purpse: ABC Hspital Centre is cmmitted t prviding a healthy and safe envirnment fr all staff and patients. We demnstrate that cmmitment by putting int place a Safe Patient Handling Prgram aimed t ensure that all lifts, transfers r repsitining tasks are perfrmed as safely as pssible. This rganizatin will prvide the training, equipment, and prcesses t ensure that n unsafe lifts are undertaken. As a healthcare rganizatin, we recgnize the need fr a practive apprach t injury preventin. We greatly value the health and safety f all staff and patients. 24 N Unsafe Lift WrkBk sectin 2

27 ABC Hspital is cmmitted t prviding a Safe Patient Handling Prgram with the supprt, training, and equipment t enable staff t perfrm lifting tasks with n adverse effects n themselves r the patients. We have recgnized the human and financial tll f wrkplace injuries related t ergnmic verexertin in the healthcare industry and are cmmitted t reducing the risks assciated with ur wrk. ABC Hspital Centre is cmmitted t excellence in patient care and recgnizes the imprtance f staff health and safety in attaining ur gals. Given the human and financial cst f wrkplace injuries, ABC Hspital Centre has develped a Safe Patient Handling Plicy t reduce the risk f injuries related t patient handling as well as ther lifting activities in the wrkplace. We demnstrate ur cmmitment t the principles embdied in the Safe Patient Handling Prgram by prviding the equipment, resurces, and training required fr the prgram s success. We greatly value the health and wellbeing f ur staff and ur patients. Examples f statements f cnsistency with legislated standards Our Safe Patient Handling Prgram is designed t meet r exceed legal requirements (Alberta OHS Cde, part 14) by ensuring the prvisin f apprpriate lifting devices, identifying hazards and cntrls related t lifting tasks, and investigating and taking actin when emplyees reprt symptms f musculskeletal injuries sustained at wrk. ABC Hspital Centre will meet r exceed legislated requirements related t lifting and handling lads and will demnstrate due diligence by fully dcumenting all prcedures. Our Safe Patient Handling Prgram will meet r exceed all applicable legislated standards and strive t demnstrate that it is cnsistent with best practices in the healthcare industry. Examples f statements f Gals & Objectives T create a safety culture in which all wrkplace parties cnsider staff and patient safety as an underlying value that drives all actins. T reduce the number and severity f musculskeletal injuries sustained by wrkers as a result f patient handling tasks. T ensure that cnsistent lifting, transferring and repsitining techniques are used thrughut the facility. T assign specific respnsibilities that will ensure that the Safe Patient Handling Prgram is fully peratinalized and maintained. N Unsafe Lift WrkBk sectin 2 25

28 T ensure that all emplyee injuries are reprted, investigated, and analyzed fr crrective actin aimed at reducing musculskeletal injuries. T ensure that all emplyees receive the apprpriate training in all aspects f the Safe Patient Handling Prgram. T ensure the effective assessment and cmmunicatin f patient status related t ergnmic requirements fr safe lifting by staff. T ensure that all staff are able t assess risks related t lifting and transferring tasks and respnd with apprpriate cntrls. T ensure the prvisin f apprpriate tls, equipment and training t all implicated staff in a timely manner. Examples f definitins 9 9. These definitins are excerpted frm infrmatin prvided by the Patient Care Ergnmics Resurce Guide: Safe Patient Handling and Mvement; Tampa Veteran s Administratin and Department f Defense; Patient Safety Center f Inquiry; Octber High-Risk Patient Handling Tasks: Patient handling tasks that have a high-risk f musculskeletal injury fr staff perfrming the tasks. These include but are nt limited t transferring tasks, lifting tasks, repsitining tasks, bathing patients in bed, making ccupied beds, dressing patients, turning patients in bed, and tasks with lng duratins. High-risk Patient Care Areas: Inpatient hspital wards with a high prprtin f dependent patients, requiring full assistance with patient handling tasks and activities f daily living. Designatin is based n the dependency level f patients and the frequency with which patients are encuraged t be ut f bed. These areas include Spinal Crd Injury Units, Nursing Hme Care Units, and ther specified areas. Manual Lifting: Lifting, transferring, repsitining, and mving patients using a caregiver s bdy strength withut the use f lifting equipment/ aids t reduce frces n the caregiver s musculskeletal structure. Mechanical Patient Lifting Equipment: Equipment used t lift, transfer, repsitin, and mve patients. Examples include prtable base and ceiling track munted full bdy sling lifts, stand assist lifts, and mechanized lateral transfer aids. Patient Handling Aids: Equipment used t assist in the lift r transfer prcess. Examples include gait belts with handles, stand assist aids, sliding bards, and surface frictin-reducing devices. Culture f Safety: Describes the cllective attitude f emplyers and emplyees taking shared respnsibility fr safety in a wrk envirnment and by ding s, prviding a safe envirnment f care fr themselves as well as patients. 26 N Unsafe Lift WrkBk sectin 2

29 Examples f statements f Required Actins ABC Hspital Centre will ensure that equipment needs will be identified t supprt the Safe Patient Handling Prgram in each area and that a system will be put in place t maintain the equipment. ABC Hspital Centre is cmmitted t meaningful emplyee invlvement in the prcess f selecting equipment, identifying risk, develping cmmunicatin strategies and implementing the Safe Patient Handling Prgram. A Safe Patient Handling Steering Cmmittee will be established t assist in designing prgram details and implementatin plans. This Steering Cmmittee will include representatin frm impacted wrkplace parties (frntline supervisrs, managers, emplyees, maintenance, Human Resurces, Occupatinal Health & Safety (OH&S), educatin, etc.). Training is required fr emplyees n the use f all lifting devices prir t their use. The use f mechanical lifts is expected wherever pssible, based n risk assessments. Algrithms fr patient handling will be designed and cmmunicated t all staff fr cnsistency in interpretatin f lifting requirements. Any staff member experiencing a disabling injury related t lifting shall be reassessed fr fitness prir t assuming full duties. Where pssible r indicated, a mdified return t wrk will be ffered. All emplyee incidents will be reprted and investigated. Rt causes will be identified and crrective actin implemented t prevent further incidents. Examples f Rles and Respnsibilities 10 FACILITY SENIOR MANAGEMENT shall: Supprt the implementatin f this plicy. Supprt a Culture f Safety within this health regin. Furnish sufficient lifting equipment/aids t allw staff t use them when needed fr safe patient handling and mvement. Furnish acceptable strage lcatins fr lifting equipment/aids. Prvide fr the rutine maintenance f equipment. Prvide staffing levels sufficient t cmply with this plicy. 10. These definitins are excerpted frm infrmatin prvided by the Patient Care Ergnmics Resurce Guide: Safe Patient Handling and Mvement; Tampa Veteran s Administratin and Department f Defense; Patient Safety Center f Inquiry; Octber N Unsafe Lift WrkBk sectin 2 27

30 SUPERVISORS shall: Ensure high-risk patient handling tasks are assessed prir t being undertaken and they are cmpleted safely, using mechanical lifting devices and ther apprved patient handling aids and apprpriate techniques. Ensure mechanical lifting devices and ther equipment/aids are available, maintained regularly, in prper wrking rder, and stred cnveniently and safely. Ensure emplyees cmplete initial and annual training, and prvide training as required if emplyees shw nn-cmpliance with safe patient handling and mvement r equipment use. Maintain training recrds fr a perid f three (3) years. Refer all staff reprting injuries due t patient handling tasks t Occupatinal Health and Safety. Maintain incident/accident reprts and injury statistics as required by the facility. Supprt a Culture f Safety within their facility. EMPLOYEES shall: Cmply with all parameters f this plicy. Use prper techniques, mechanical lifting devices, and ther apprved equipment/aids during perfrmance f high-risk patient handling tasks. Ntify their supervisrs f any injury sustained while perfrming patient handling tasks. Ntify their supervisrs f the need fr re-training in use f mechanical lifting devices, ther equipment/aids and lifting/mving techniques. Ntify their supervisrs f mechanical lifting devices in need f repair. Supprt a Culture f Safety within their facility. 28 N Unsafe Lift WrkBk sectin 2

31 ENGINEERING SERVICES shall maintain mechanical lifting devices in prper wrking rder. Examples f statements identifying available resurces ABC Hspital Centre will prvide patient lifting devices/assistive devices as required based n a determinatin f risk which will include the nature f lifting tasks, the level f hazard presented t bth the patient and the caregiver, the lcatin and area design, and available ptins. ABC Hspital Centre will prvide a cmprehensive rientatin and training related t the Safe Patient Handling Prgram fr all emplyees when it is first implemented and t all new emplyees prir t starting regular wrk requiring lifting. The OH&S Department will prvide statistics n incidents t each department. A Safe Patient Handling Prgram crdinatr will be appinted t crdinate the design and implementatin f all prgram cmpnents. Examples f statements defining enfrcement/cmpliance accuntabilities All wrkplace parties are accuntable fr their delegated respnsibilities under this prgram. Failure t fllw prgram prcedures will be nted n perfrmance appraisals and may result in disciplinary actin. All wrkers have the right and respnsibility t refuse lifting r transfer wrk they cnsider t be imminently dangerus t their health. Supervisrs are respnsible fr immediately investigating any situatin believed by wrkers t present imminent danger. Any nn-cmpliance with this plicy will result in a dcumented nte in the emplyee s persnnel file. Wrkers fund in nn-cmpliance may be subject t disciplinary actin. The abve statements are examples nly. Use the fllwing template t assist in develping yur Safe Patient Handling Plicy. N Unsafe Lift WrkBk sectin 2 29

32 Template - Safe Patient Handling Plicy Plicy Title: Plicy Number: Apprved By: Date: Applicable t: Review date: Purpse f Plicy Gals & Objectives Definitins Requirements Rles and Respnsibilities Senir Management Directrs Managers Supervisrs Wrkers Steering Cmmittee OHS Department Educatin Department Available Resurces Accuntabilities/cmpliance issues 30 N Unsafe Lift Wrkbk sectin 2

33 Fllw Thrugh Attentin and Evaluatin Management cmmitment des nt end with establishing plicies and prviding resurces and accuntabilities. T be effective, management needs t actively prmte the Safe Patient Handling Prgram and set up prcesses t cntinually evaluate and imprve the Prgram. The adage what gets measured gets dne applies in this case, as unmeasured prcesses ften becme paper prcesses that n ne fllws r cmplies with. Sme examples f actins senir management can undertake t demnstrate nging cmmitment include: Attending Steering Cmmittee meetings, Prviding pening remarks and encuragement at training sessins, Sending ut mems r newsletters identifying the equipment that has been purchased, Reinfrcing the plicy at numerus pprtunities, Assigning a prgram crdinatin rle t a well-respected senir team member, Scheduling walk-arunds t speak abut the prgram at the unit level r t bserve the prgram in actin, and Celebrate successes. T measure prgram implementatin, it is imprtant t identify what parameters will be measured early in the prgram design. Where pssible, cllecting befre and after data shuld be attempted. Types f infrmatin that may be used t gauge prgress may include: Emplyee perceptin survey results, Number f lifts where lifting devices have been used, Number f emplyees attending training sessins, Number f senir management cmmunicatins issued regarding the prgram, Percentage f incident investigatins that have led t crrectin f rt causes, and Percentage f injured wrkers ffered mdified wrk in a return t wrk prgram. The critical cmpnent f any effective OH&S Management System Prgram is management cmmitment and leadership. Once management demnstrates its intent and cmmitment t take this prgram seriusly, the fundatin is set t fully develp and implement an effective Safe Patient Handling Prgram. N Unsafe N Lift Unsafe Wrkbk Lift Wrkbk sectin 2 31

34 Feature Tw Emplyee Participatin A majr feature f a successful prgram is the active participatin f emplyees in the develpment, implementatin and review f the prgram. In a NIOSH-spnsred study 11, authr Arun Garg prvides a fcused and detailed discussin n the merits f a participatry apprach t MSI preventin. The fllwing are sme f the reasns why wrker participatin is imprtant in a nursing hme envirnment: Wrker participatin in all phases f the prgram (prblem identificatin, cntrl develpment, evaluatin and selectin, training, cntrl implementatin and evaluatin) reduces resistance t change. This is especially true in nursing hmes as engineering cntrls (patient transferring devices) take lnger t make a transfer (90 secnds) than manual lifting methds (12 secnds). This increased time has been mentined as a majr cncern fr nn-cmpliance with engineering cntrls The average turnver rate fr nursing assistants is 80%. Thus, training the new staff is a majr prblem. The nursing assistants play a crucial rle in prviding nging training t the c-wrkers. Emplyee-management advisry Cmmittees lead t much better cmmunicatin between management and nursing aides. Withut effective cmmunicatin between administrative staff, nurses and nursing assistants, management is ften nt aware f prblems encuntered by the caregivers in implementing cntrls. Prblems cited included resident/family refusal t use specific equipment r techniques, changes in resident physical r mental cnditins requiring a change in equipment r techniques, equipment break dwn, equipment strage and battery charging requirements. 11. Lng-Term Effectiveness f Zer-Lift Prgram in Seven Nursing Hmes and One Hspital; Arun Garg; University f Wiscnsin Milwaukee; August Frm The New Zealand Patient Handling Guidelines, 2004, used with permissin. 13. Handle with Care; available at Thugh this study fcused n the nursing hme envirnment, the findings can easily be extraplated t an acute care envirnment. It is wellacknwledged that greater buy-in fr the prgram will be achieved with multi-stakehlder invlvement. In additin t frnt line emplyees and supervisrs, facility ergnmists, designers, purchasing agents, trainers, infectin preventin and cntrl prfessinals and OH&S staff can have valuable input. In the New Zealand LITEN UP Prgram dcumentatin, the fllwing pprtunities t invlve emplyees and ensure tw-way cmmunicatins are identified N Unsafe Lift WrkBk sectin 2

35 Staff need t be invlved and have a sense f wnership frm the start. Effective tw-way cmmunicatin can help achieve this. Here are sme suggestins: Seek staff input befre drafting the plicy and prcedures circulate drafts fr cmments and feedback. Set up a frmal feedback prcess, but als use infrmal means such as suggestin bxes and talking t staff n the jb. Questin 2.1 Des yur current OH&S Cmmittee (s) deal with prgram develpment and implementatin? Include staff representatives in the review, plan and actin cycle. Seek staff input befre making big changes such as buying equipment r altering facilities. Maintain a regular stream f cmmunicatin abut what s happening and make sure results are cmmunicated t everyne. Encurage regular staff meetings t review prgress, and use frums like training sessins t gain staff views and suggestins. Seek cmment n issues using means such as feedback frms in newsletters, questinnaires and plls. Many prgram manuals highlight the advantages f emplyee participatin in all aspects f prgram design and implementatin. Anther gd example f this is in the WrkSafe BC manual Handle with Care 13. Several cnsultatin mdels are discussed, as the style f cnsultatin shuld fit in with the culture f the rganizatin and take int accunt cnsultatin prcesses already established, as well as lcatins f wrkers, size f facilities, and available resurces. Sme cnsultatin mdels include using the regular jint ccupatinal health and safety Cmmittee t develp, implement and mnitr the prgram. An expert will be designated t be respnsible fr drafting the prgram guidelines and the implementatin strategy. The expert will als: cnsult with the jint ccupatinal health and safety Cmmittee fr input, establish a specific Safe Patient Handling Prgram team t undertake the design implementatin and mnitring f the prgram, and prvide pprtunities thrugh the use f a series f input sessins where emplyee input is sught. Questin 2.2 Are there any ther frmal mechanisms in place that culd be used fr emplyee input in this prgram develpment? Questin 2.3 Wh needs t be invlved in yur facility t ensure the apprpriate peple are invlved? Fr specific elements f the prgram, emplyee input and participatin will greatly assist in gathering accurate infrmatin as well as btaining buy-in and prgram wnership by all. In particular, emplyee input int risk assessments, equipment selectin, training and cmmunicatin aspects shuld be slicited. N Unsafe Lift WrkBk sectin 2 33

36 The fllwing is an example f Terms f Reference fr a Prject Steering Cmmittee. Terms f Reference Safe Patient Handling Prgram Prject Steering Cmmittee Purpse: T prvide guidance in the develpment and implementatin f ABC Hspital Centre s Safe Patient Handling Prgram. Membership and structure: Members f the Prject Steering Cmmittee will include management representatives frm Nursing Operatins, Supprt Services, Maintenance, Educatin, Human Resurces and Occupatinal Health and Safety. In additin, there will be at least 4 emplyee representatives frm departments impacted by this prgram (nursing, Supprt Services). This Prject Steering Cmmittee shuld ideally have 6-12 members. The Cmmittee chair will be appinted by senir management. The Cmmittee will meet as required and at the call f the chair. Initially bi-weekly meetings are anticipated. Functins f the Cmmittee: 1. T develp r review majr cmpnents f the Safe Patient Handling Prgram including: Readiness assessment Review f incident data Plicy develpment Patient mbility assessment prcedures, including cmmunicatin tls Equipment needs assessment Equipment evaluatin Lifting & transfer techniques bimechanical guidelines Area design cnsideratin Orientatin and training prgrams 34 N Unsafe Lift WrkBk sectin 2

37 T assist in frmulating and implementing change management prcesses relative t this prgram. T identify issues impacting implementatin f the prgram and develp slutins. T receive regular reprts n the status f prgram develpment and implementatin. Cmmittee Cmmunicatins: Minutes will be maintained fr all meetings. The Cmmittee will prduce a quarterly reprt f the current prgress/ status f the prgram implementatin effrts and disseminate the reprt widely. The Cmmittee chair will reprt quarterly r mre ften, as required, t senir management. Feature Three Crdinatin Many studies indicate that a prgram with accuntability designated fr prgram crdinatin is mre likely t be successful. The Veterans Health Administratin and Department f Defense Prgram Safe Patient Handling and Mvement states that T be successful, the implementatin f any new prgram necessitates a knwledgeable persn with enthusiasm and leadership capabilities t direct the charge. Often, a crdinatr is chsen frm a grup f peers and may be any staff member interested in the subject and cnsidered t be infrmal leaders in their units. Crdinatrs shuld receive special training that includes hw t effectively train, cach and mtivate c-wrkers, and they must be assured f administrative supprt t enable them t be successful. In many healthcare rganizatins, new endeavurs becme added n t already busy schedules. While it may seem reasnable t add n the crdinatin f the Safe Patient Handling Prgram t ne f the rganizatin s educatrs, r t the OH&S manager, it is recmmended that the crdinatr be appinted as a full time psitin until the prgram is up and running smthly. This will ensure that adequate time is available t crdinate the varius aspects f the prgram and ensure that there are n gaps in the cmprehensiveness f the prgram. T facilitate the wrk f the crdinatr, a clse reprting relatinship t senir management is recmmended, as this serves t ensure that issues are prperly addressed and t raise the perceived level f imprtance f the prgram t frnt line staff. N Unsafe Lift WrkBk sectin 2 35

38 Questin 3.1 D yu currently have a crdinatr fr yur prgram? All levels f management and staff shuld have designated accuntabilities fr the prgram, but these must be crdinated t ensure the greatest effectiveness. Designating a crdinatr ensures that n prgram element falls thrugh the cracks withut clear accuntabilities assigned. A crdinatr shuld have a perfrmance appraisal that includes the majr accuntabilities f the psitin. Crdinatrs shuld be required t keep regular lgs f activities and reprt regularly t senir management n the status f the prgram. An example f a jb prfile fr a Safe Patient Handling Prgram Crdinatr is prvided here. Questin 3.2 What is/shuld be the jb descriptin fr the crdinatr? Jb prfile Crdinatr f the Safe Patient Handling Prgram This psitin is a full time psitin reprting t the Vice President f Nursing Services. Qualificatins and desired qualities fr this psitin include: Frmal/infrmal leadership experience. Effective cmmunicatin skills (bth written and ral). Enthusiastic mtivatr. Gd prblem slving abilities. Questin 3.3 Des the crdinatr prvide regular status reprts? If s, t whm? Training and caching experience. Wrks well in a team envirnment. Awareness f wrk unit pressures, activities and timetables. Duties include: Crdinating the develpment and implementatin f patient assessment tls, algrithms, patient handling plans. 14. Tampa Veteran s Administratin and Department f Defense; Patient Safety Center f Inquiry; Octber 2001 Crdinating the area risk assessment prcess. Maintaining and analyzing incident reprts related t patient handling tasks; assisting in incident investigatin f these incidents. Prviding n-site supprt services fr the implementatin f the Safe Patient Handling Prgram, including site visits t assess status f prgram implementatin effrts. Meeting with emplyees wh sustained wrk injuries related t patient handling tasks prir t their return t wrk t assess prcesses and the ptential fr mdified wrk. 36 N Unsafe Lift WrkBk sectin 2

39 Crdinate the develpment f rientatin and training materials related t the prgram. Prvide encuragement and supprt fr supervisrs in the implementatin f all prgram elements. Cmplete a mnthly lg f activities, issues arising and slutins. Meet with and regularly update the Safe Patient Handling Steering Cmmittee. Prvide quarterly reprts f prgram status and utcme measures. Questin 4.1 D yu have a prcess in place t evaluate risks related t patient handling? Feature Fur Risk Assessment Patient Handling Tasks Alberta OH&S legislatin requires the assessment and cntrl f wrkplace hazards. Fr patient handling tasks, the assessment is nt a ne-time static assessment, but changes cnstantly t cnsider caregiver, task, equipment, envirnment, and patient variables. An effective Safe Patient Handling Prgram will assist in prviding a systematic apprach t assess risk. Five key risk assessments are required t determine what prcedures r equipment shuld be used fr patient handling. These include a self-assessment by the caregiver, a patient assessment, a wrkplace assessment (including equipment and envirnment), and a task assessment. Healthcare wrkers rarely cnsider themselves first; hwever, in rder t prtect the patient s safety, they must ensure their wn safety. A self-assessment fr the caregiver shuld include: Assessment f whether the task can be dne safely while prtecting bth the patient and the caregiver, Questin 4.2 Des it include assessing wrkplace, patient and task related risks? Questin 4.3 Wh des the risk assessment? Whether additinal assistance frm anther caregiver is required, Level f cmmunicatin between caregivers assisting in the task, Level f awareness abut the prper use f equipment, and Physical readiness t perfrm the task (prperly warmed up, prper ftwear, etc.). Fr envirnment and equipment, key cnsideratins include: The staff t patient rati Types f patients Individual needs f patients Equipment availability and accessibility N Unsafe Lift WrkBk sectin 2 37

40 Questin 4.4 Hw wuld yu develp/change yur risk assessment prcess? Questin 4.5 Hw frequently are the risks re-assessed? Bed lcks and adjustable heights Psitin f bed rails needed The existence f patient care plans that include handling requirements Languages required fr effective cmmunicatin Wrklad issues Wrkers wearing apprpriate clthing and ftwear Cmmunicatin prtcls fr patient status infrmatin Emergency respnse patient lifting and transfer plans Trained staff Preventive and reparative maintenance prgrams fr equipment in place Sufficient space t perfrm tasks, including use f mechanical lifts Walkways free f clutter and patient equipment mved ut f the way Flr surfaces in gd rder Stable, suitable furniture Electric, adjustable beds Adequate lighting fr tasks Fr patients, key factrs include: Capability t bear weight, assist and cperate with the task, and tlerate basic tasks. Level f understanding and ability t cperate in the task. Assessment f bed mbility and patient factrs including lying t sitting capability, sitting balance, and strength f quadriceps. Any changes in transfer status. Patient cnditins that may impact risk such as histry f falls, impaired mvement, pain, lss f sensatin, skin issues, cmmunicatin issues, medical equipment used, surgical cnditins, sensry deficiencies, mental state (cnfusin), aggressin, etc. Types and frequency f transfers, lifts, repsitining required. 38 N Unsafe Lift WrkBk sectin 2

41 Fr a task assessment, cnsideratin shuld be given t whether the task needs t be dne, as well as the risks assciated with the tasks. These may include: Static psitins that may be required Duratin f task Questin 4.6 Hw d yu ensure risks are cmmunicated t all caregivers? Equipment required A planned rute f mvement Awkward pstures fr caregivers Task requiring extended reach Restrictins psed by prtective equipment Inflexibility f time fr task Each rganizatin may develp risk assessment prcedures cnsistent with the risk management prcess in place. The examples prvided here are examples nly and may be used t btain ideas abut the types f risk infrmatin that may be imprtant t cllect. In sme prgrams, detailed algrithms are designed t assist in decisin making related t required patient handling strategies. In the VA Prgram 15, six general algrithms and seven algrithms specific t bariatric patients are prvided. An example f ne f the algrithms is reprduced here. Questin 4.7 Des yur plicy and Safe Patient Handling Prgram include guidance t effectively integrate and utilize the risk assessment t reduce musculskeletal injuries? 15. Patient Care Ergnmics Resurce Guide: Safe Patient Handling and Mvement; Tampa Veteran s Administratin and Department f Defense; Patient Safety Center f Inquiry; Octber 2001 N Unsafe Lift WrkBk sectin 2 39

42 Algrithm 1: Lateral Transfer t and frm: Bed t Stretcher, Trlley Start Here Partially able r nt at all able Can patient assist? Partially able r nt at all able > 200 punds: Use a frictin reducing device and 3 caregivers < 200 punds: Use a frictin reducing device Yes Caregiver assistance nt needed: Stand by fr safety as needed. Surface shuld be even fr all lateral patient mves. Fr patients with Stage III r IV pressure ulcers, care must be taken t avid shearing frce. During any patient transferring task, if any caregiver is required t lift mre than 35 punds f a patient s weight, then the patient shuld be cnsidered t be fully dependent and assistive devices shuld be used fr the transfer. * In develping and using algrithms fr Alberta prgrams, the Alberta Occupatinal Health and Safety (OHS) Act, Regulatin and Cde must be utilized. 40 N Unsafe Lift WrkBk sectin 2

43 The New Zealand Patient Handling Guidelines 16 prvides excellent templates fr each type f risk assessment. The authrs graciusly permitted reprductin f the fllwing risk assessment frms: WORKPLACE PROFILE ORGANIZATION: YOUR NAME: WARD OR UNIT: MANAGER/ADVISER: EMPLOYEE REPRESENTATIVE: PART 1: WORKPLACE DETAILS LOAD: Patients Number f patients: Staff-patient rati: Ward r unit specialty: Age range: Nenates Paediatric Adult (16-64) Geriatric (65+) Type f care: Acute Lng-term Residential Cmmunity Number needing specialized handling: % (fr example due t weight beynd equipment tlerances, medical cnditin r ther) Special prgrammes in place: Calm and restraint Falls Specialized cmmunicatins Other INDIVIDUAL: Caregivers TASK: Task and equipment Build an inventry f equipment available fr the tasks perfrmed in yur ward r unit. 16. New Zealand Patient Handling Guidelines The LITEN UP Apprach, 2003; cmplete prgram details and frms available at safer-industries/health/resurces/index.htm N Unsafe Lift WrkBk sectin 2 41

44 TASK LIST EQUIPMENT AVAILABLE NO. REQUIRED COMPONENTS REQUIRED CONDITION ACCESSIBILITY STORAGE Standing and sitting Gd Pr Gd Pr Gd Pr Walking Gd Pr Gd Pr Gd Pr Rlling in bed Gd Pr Gd Pr Gd Pr Sitting up in bed Gd Pr Gd Pr Gd Pr Mving in bed Gd Pr Gd Pr Gd Pr Sitting t edge f bed Gd Pr Gd Pr Gd Pr Sitting t sitting transfers Gd Pr Gd Pr Gd Pr Nn-weightbearing Gd Pr Gd Pr Gd Pr Repsitin fallen patient Gd Pr Gd Pr Gd Pr Assisting fallen patient Gd Pr Gd Pr Gd Pr Transfer lying t lying surfaces Gd Pr Gd Pr Gd Pr Other tasks Gd Pr Gd Pr Gd Pr ENVIRONMENT: Facilities Number f beds per unit Type f flring Number f bath/shwer rms Adequate access fr equipment? Number f tilets Adequate strage fr equipment? Specialized FACILITIES: 42 N Unsafe Lift Wrkbk sectin 2

45 PART 2: WORKPLACE RISK ASSESSMENT In this part f the prfile, the questins help yu rate yur current psitin and identify issues and pririties fr actin. Please scre each questin n a sliding scale with 1 being the lwest risk (always dne r actin cmpleted) and 5 the highest risk (never r n actin taken). LOAD: Patients ALWAYS DONE NO ACTION 1. D all patients (and families) receive infrmatin n patient handling? D yur admissin prcedures cver safe patient handling? Is yur patient handling plicy displayed in the ward r unit? Are patient prfiles/safe patient handling plans cmpleted? Are cpies f patient prfiles/handling plans available t all caregivers? D the patient prfiles accmpany patients when mved? Can caregivers cmmunicate with patients in languages ther than English? Ntes: Sub-ttals INDIVIDUAL: Caregivers ALWAYS DONE NO ACTION 8. D yu always have a full cmplement f staff? D staff have a cmprehensive level f clinical experience? D caregivers take regular breaks? Are wrklads manageable and the pace f wrk reasnable? D all staff knw the plicy and fllw the defined prcedures? Are patient handling respnsibilities included in emplyment cntracts? Are patient handling perfrmance measures included in appraisals? D yu have prcedures fr nn-cmpliance? D yu have prcedures fr emergency situatins? Have all caregivers cmpleted basic patient handling training? N Unsafe Lift Wrkbk sectin 2 43

46 INDIVIDUAL: Caregivers ALWAYS DONE NO ACTION 18. D yu prvide extra training fr specialized needs? D new caregivers receive basic patient handling training during inductin? D all caregivers attend annual refresher training? D yu have access t a patient handling adviser? D all caregivers knw where t get advice n cmplex handling situatins? D caregivers wear suitable clthing that desn t restrict mvement? D caregivers wear suitable nn-slip ftwear? Are caregivers invlved in planning and feedback fr patient handling? Are all caregivers able t cmmunicate clearly in and understand English? D yu recrd and review all incidents and injuries? D yu encurage early reprting f cnditins that limit handling ability? D yu prvide mdified wrk fr caregivers with limiting cnditins? Ntes: Sub-ttals TASK: Task and Equipment ALWAYS DONE NO ACTION 30. D caregivers always cnsider patient prfiles befre starting handling tasks? Are nly apprved safe patient handling techniques used fr tasks? D yu always have enugh caregivers t carry ut handling tasks? D yu stagger handling tasks? e.g. bathing patients ver different shifts Is sufficient time allwed t carry ut handling tasks? D yu rtate handling tasks between caregivers? N Unsafe Lift WrkBk sectin 2

47 TASK: Task and Equipment ALWAYS DONE NO ACTION 36. D yu have prcedures fr preparing patients befre handling tasks? Are patient self-help techniques used t reduce handling requirements? D all caregivers knw hw t check and use the equipment prperly? D caregivers rutinely check equipment and cmpnents befre use? D yu regularly reassess yur equipment needs? D yu have sufficient equipment fr the staff and tasks in yur wrk area? Is equipment easy t stre and retrieve d yu have enugh strage space? D yu regularly check, repair and replace equipment and cmpnents? D yu get staff input and arrange trials befre acquiring new equipment? D yu have sufficient resurces t buy r hire new items when required? Ntes: Sub-ttals ENVIRONMENT: Facilities 46. Is there sufficient space in handling areas t perfrm tasks and maneuvre equipment arund beds? ALWAYS DONE NO ACTION Is there gd lighting and clear visibility fr tasks? Have yu made special lighting prvisins fr night staff? Are flrs nn-slip, stable and even? Are flr surfaces in handling areas in gd rder? D all wet areas have nn-slip flring? Can equipment be easily mved ver flring? Are steps and slpes well lit and prperly designed? Are wrk areas free f trip hazards? e.g. trailing crds, rugs N Unsafe Lift WrkBk sectin 2 45

48 ENVIRONMENT: Facilities ALWAYS DONE NO ACTION 55. D yu have prcedures fr preparing patients befre handling tasks? Are patient self-help techniques used t reduce handling requirements? D all caregivers knw hw t check and use the equipment prperly? D caregivers rutinely check equipment and cmpnents befre use? D yu regularly reassess yur equipment needs? D yu have sufficient equipment fr the staff and tasks in yur wrk area? Is equipment easy t stre and retrieve d yu have enugh strage space? D yu regularly check, repair and replace equipment and cmpnents? D yu get staff input and arrange trials befre acquiring new equipment? D yu have sufficient resurces t buy r hire new items when required? Ntes: Sub-ttals Ttal scre 1. The ranking fr each questin The ranking fr each questin identifies areas where yu culd take actin t imprve patient handling in yur rganizatin. The lwer the scre the better in terms f managing patient handling risks. A ranking f 1-2 indicates a lwer level f risk. A ranking f 2-3 indicates a medium and pssibly imprtant risk. A ranking f 3-5 indicates a higher and pssibly substantial risk. 2. The ttal scre Yur ttal scre gives an verall picture f yur current psitin. It is a simple measure, but cvers the issues imprtant t building an effective patient handling prgram. Even if yur ttal scre is lw, any individual item ranked 3-5 shuld be addressed immediately. This risk assessment and scre is a guide nly. Testing n reliability and validity will be undertaken in cnjunctin with the healthcare industry. 46 N Unsafe Lift Wrkbk sectin 2

49 Patient Prfile ORGANIZATION: COMPLETED BY: WARD OR UNIT: LAST REVIEW DONE: / / NEXT REVIEW DUE: / / PATIENT DETAILS Name: Preferred name: Height: Weight: Date f birth: Relevant medical cnditins past and current Capabilities Patient: Can mve nrmally Can bear weight Can assist with task Can balance Is stable Can tlerate basic activity PATIENT HANDLING RISK (cmplete checklist verleaf first) 1. Falls risk 5. Skin at risk 9. Medical equipment 13. Visin needs 2. In pain 6. Incntinence 10. C-peratin issues 14. Hearing needs 3. Impaired mvement 7. Medical needs 11. Cmmunicatin issues 15. Ftwear needs 4. Lss f sensatin 8. Surgical needs 12. Barriers 16. Mbility aids used HANDLING PLAN REQUIRED? NO YES COMPLETE TASK ELIMINATE, ISOLATE OR MINIMIZE? Circle One TECHNIQUE TO BE USED EQUIPMENT TO BE USED SUITS CARE PLAN? NOTES CHECKLIST Standing and sitting E I M Walking E I M Rlling in bed E I M Sitting up in bed E I M Mving in bed E I M Sitting t edge f bed E I M Sitting t sitting E I M Nn-weight bearing transfers Repsitin in chair Assisting fallen patient Transfer lying t lying surfaces E I M E I M E I M E I M Other tasks N Yes attach task analysis sheet Befre starting task check: Lighting: Is lighting adequate? Flrs: Are flrs nn-slip, stable, n trip hazards? Equipment: Is it in gd wrking rder? Equipment: Are all cmpnents in place and wrking? Access: Are rute and access ways clear? Destinatin: Is it unccupied/ready? eg. tilet/bath Clutter: Is there enugh clear space fr the task? Nise: Is clear cmmunicatin pssible? Assistance: Are all caregivers ready and available? Weather: Will rain, wind etc. have an impact? Any changes: Is handling plan still apprpriate? Attach cmpleted task analysis t patient prfile N Unsafe N Lift Unsafe Wrkbk Lift Wrkbk sectin 2 47

50 NO EFFECT ON MOBILITY 1. Falls N risk Falls risk management 2. Pain Pain free In pain describe POSSIBLE EFFECT ON MOBILITY (Please cmplete then nte brief details n frnt f frm) 3. Mvement Nrmal Impaired muscle strength Abnrmal reflex Unstable Jint needs prtectin Impaired muscle tne Decreased activity tlerance N balance Other: 4. Sensatin Nrmal Lss f sensatin r bdy awareness Hypersensitive areas: Other: 5. Skin Nrmal Integrity impaired Wet/slippery skin likely 6. Cntinence Cntinent Cntinent with frequent tileting management: At risk f impairment Wund needs prtectin Incntinent 7. Medical treatments r medicatins N/n effect Treatments r medicatins affect: Perceptin Activity tlerance Prpriceptin Balance 8. Surgical interventin N/n effect Prtectin f wund required Restricted mvement required Describe lcatin, severity and implicatins fr mbility: 9. Medical equipment Nne IV catheter xygen Mnitrs Drain Chest tube Tractin Other: 10. C-peratin C-perative Unwilling/unable t c-perate Refuses equipment/best practice Aggressive Abusive 11. Cmprehensin Gd Reduced hearing Difficulty fllwing simple cmmands 12. Barriers Nne Islatin chemical bilgical hazards Behaviural Pr hygiene Cultural/ religius Family/ friends bese 13. Visin Gd Needs glasses Ttally impaired and uses devices 14. Hearing Gd Uses hearing aid Uses sign language Impaired visin but wn t wear glasses Impaired hearing but wn t wear hearing aid 15. Ftwear Gd Specialized ftwear Inapprpriate ftwear 16. Mbility aids Nne Orthtics/prsthetics Walking stick Grab rail Hip prtectr Walking frame Standing frame Wheelchair Crutches Other: 48 N Unsafe Lift WrkBk Wrkbk sectin 2

51 Handling Equipment Needed Slidesheet Other: Transfer bard Prfiling bed Hist TASK ANALYSIS Can the task be eliminated? N Yes attach task analysis sheet WHAT ARE THE RISK FACTORS? Please check all that apply. HOW CAN THE RISK BE CONTROLLED? Eliminate Islate Minimize Repetitin required Lng duratin f task Static psture required such as supprting a limb r patient Awkward psture required such as twisted r bent pstures due t space cnstraints r equipment in use Requires extended reach fr example reaching ver a bedrail Perfrmed ver distance fr example frm bed t chair in anther rm Lack f space fr task and equipment Staff fatigue r stress fr example due t staff shrtages r emergencies Hazardus weights Unpredictable mvements are likely Restrictins f prtective gear such as glves, surgical gwn r bties Inflexibility fr instance inflexible schedules that cause time pressures Other cntributing risks please describe: TECHNIQUE TO BE USED EQUIPMENT REQUIRED COMMENTS N Unsafe Lift WrkBk sectin 2 49

52 Risk Assessment - Nn-patient Handling Tasks Nt all lifting and transferring tasks in healthcare are related t patient handling. A cmprehensive Safe Patient Handling Prgram addresses risks fr all wh handle lads. Fr this reasn, the Safe Patient Handling Steering Cmmittee shuld include a member f the Supprt Services r materials management grup. This will ensure that issues specific t thse nt invlved in patient handling are als addressed. The fllwing template/checklist may be useful in identifying wrkplace ergnmic risks related t handling nn patient-related lads. Risk Assessment fr Lifting and Mving Tasks (fr nn-patient areas) Task N Yes If yes, suggest cntrl D tls weigh mre than 5 kg.? Des the task invlve frequent lifting f lads? Des the task require repeated bending at the waist? Is lifting r lwering lads a significant part f the task? Des the task invlve mving lads while n a ladder? Des the task invlve mving lads up r dwn stairs? Des the wrk require the use f ne specific hand nly? Des the wrk invlve sustained muscle cntractin fr a perid f time Are wrkplace flrs slippery? Are wrkplace flrs uneven? Is there sufficient space t perfrm the required tasks safely? Is prper ftwear wrn by wrkers? Is the task repetitive, using the same muscles fr extended perids? Is the view f the task bstructed? Are wrkers wrking withut prper training? 50 N Unsafe Lift WrkBk sectin 2

53 Task N Yes If yes, suggest cntrl Are mechanical devices available t assist in lifting r mving items? Are wrkers trained in the use f mechanical devices? Are cntainers f the size that enables easy handling? Are tasks rtated t reduce physical stress? Are tasks able t be perfrmed with tw hands? Is assistance available frm ther wrkers? Is equipment adjustable? Is persnal prtective equipment available if needed? Are wrkers trained in prper wrk prcedures? D wrkers reprt any injuries r near misses? In healthcare rganizatins, handling lads may be necessary tasks in several areas including: Fd Services Laundry Maintenance Materials Management Bimedical Engineering Purchasing Labratries Ensure that these areas are als invlved in the Safe Patient Handling Prgram. Infrmal Pre-Task Risk Assessments In additin t frmal risk assessments, mre regular infrmal risk assessments shuld be cnducted by emplyees whenever they apprach a lifting task. The fllwing example may serve t remind emplyees f issues t cnsider: N Unsafe Lift WrkBk sectin 2 51

54 Emplyee Pre-Lift Scan Cnsideratin if true Suggested plan/slutin The patient is unable t assist with the mvement. The patient is likely t be uncperative r aggressive. The patient is very heavy. Medical equipment used with the patient may impact the mvement. The nn-patient lad is awkward t handle (size, shape). The nn-patient lad is heavy. The lcatin f the lad may make mvement difficult. The task will require prlnged use f specific muscle grups. The task must be perfrmed quickly. There is insufficient space arund the patient r lad t enable the use f mechanical handling devices. Lifting and transfer assistive devices are nt available. I am currently experiencing back r shulder pain r have ther cnditins that may make the task higher risk fr myself r the patient. 52 N Unsafe Lift WrkBk sectin 2

55 Feature Five Equipment Cnsideratins One f the critical cntrls fr reducing patient handling injuries is the prvisin f mechanical devices t assist in patient lifts, transfers and repsitining tasks. Successful musculskeletal injury preventin prgrams in healthcare facilities are thse that reduce the use f manual lifting techniques and increase the use f technlgical advances that limit the bimechanical stress n emplyees. A variety f equipment is available and includes heightadjustable beds, electric beds, mbile resident lifts, ceiling lifts, repsitining devices, lateral transfer and turning aids, etc. Chsing apprpriate equipment can be quite challenging, as the need fr flexibility in the healthcare envirnment is significant. There are ptential wrkplace health and safety risks assciated with equipment as well as advantages and disadvantages f specific pieces f equipment. There has been a desire in many facilities t standardize the lifting devices available. Advantages f standardizing the equipment include interchangeability f slings and parts, easier maintenance, and ptential discunts in cst because f vlume purchasing. Hwever, a balance shuld be struck between standardized lifting devices acrss the site and the variety f devices needed t meet the spectrum f needs. An inventry f equipment and evaluatin f equipment needs are imprtant first steps. Several tls are available t make this task mre systematic. A simple inventry 17 can be created frm the fllwing template. Fr an excellent review f mst types f patient handling equipment prepared as part f New Zealand s Patient Handling Guidelines 18, access prgram materials at health/resurces/index.htm. The equipment sectin describes each piece f equipment, identifies safety and wrksite issues t cnsider in its use, and describes ptential risks f the equipment and the equipment uses and limitatins. 17. Frm Patient Care Ergnmics Resurce Guide: Safe Patient Handling and Mvement; Tampa Veteran s Administratin and Department f Defense; Patient Safety Center f Inquiry; Octber 2001; used with permissin. 18. New Zealand Patient Handling Guidelines The LITEN UP Apprach, N Unsafe Lift WrkBk sectin 2 53

56 Type f equipment Brand Name/ Mdel Unit/Ward # f devices In wrking rder? Current usage Recmmended changes, purchases 54 N Unsafe Lift Wrkbk sectin 2

57 Emplyee invlvement in chsing equipment mtivates greater emplyee buy-in and cmpliance with the requirement t use equipment. Mst manufacturers permit an n-site trail f equipment prir t purchase, with a training prgram prvided fr thse wh will trial the equipment. Emplyees shuld be prvided with an appraisal frm t recrd their impressins f the equipment nting any ptential prblems, strng pints, risks, and ther cmments. As with any equipment, in additin t evaluating and chsing equipment, a preventive as well as reparative maintenance plan is imprtant fr the prgram s success. Maintaining lg sheets fr each piece f equipment and scheduling regular preventive maintenance will assist in detecting r preventing any prblems befre they cause an incident. Anther excellent plan is t develp an nging equipment replacement prgram, which can ensure that utdated equipment is replaced n a regular basis. Emplyees are smetimes reluctant t make use f mechanical lifting devices because they are nt trained r experienced in their use. The equipment can appear intimidating and emplyees smetimes cnsider it t be dehumanizing as an alternate t manual lifts and transfers. Emplyers shuld nt assume that if the equipment is there and there is a plicy requiring its use, emplyees will use the equipment. Rather, it is imprtant t respect and address an emplyee s insecurity in using mechanical devices by prviding thrugh training n their use and ensuring that emplyees are cmpetent t use each device. The prper use f mechanical lifting devices reduces physical injuries t wrkers as well as risk f patient injuries that may ccur in manual lifting. While general mechanical patient handling devices have greatly reduced risk and imprved safety fr bth patients and emplyees, the use f these devices is nt risk-free. In 1997, a ntice 19 frm Health Canada t hspital administratrs and lngterm care facilities warned f certain risks assciated with mechanical lifting devices and prvided recmmendatins t reduce the risk. 9.http://www.hc-sc.gc.ca/index-eng.php N Unsafe Lift Wrkbk sectin 2 55

58 March 20, N. 109 TO: Hspital and nursing hme administratrs and hme care prviders. T the attentin f: nursing, CCU/ICU, bimedical engineering, maintenance, ccupatinal health and safety, materiel management, husekeeping and laundry staff. SUBJECT: Incidents Invlving Patient Lifts Since 1981, Health Canada has received reprts f 11 deaths and ver 50 injuries related t the malfunctin, failure, r misuse f patient lifts in Canada. In the United States, there have been ver 41 deaths and 443 injuries reprted t the US Fd and Drug Administratin since In 1996 alne, Health Canada received reprts f seven incidents resulting in injury invlving the malfunctin r misuse f six different brands f mbile flr patient lifts. The injuries included ne death, ne skull fracture, and five cases f less serius injuries invlving mstly minr bruising. Fur f the incidents invlved the release f the sling frm the lift r the failure f the sling itself. In three f thse fur incidents, an unbalanced lad caused by an imprperly psitined patient leaning t ne side r mving arund was cnfirmed r suspected as the cause. Further investigatins f these incidents revealed the fllwing scenaris fr the varius brands: The patient fell t the flr when straps attached t the hygiene sling released r the sling ripped at the strap. The patient was drpped frm the lift when the gravity-activated lcking clip which hlds the sling nt the bar apparently failed. The clip may pen when the lad becmes unbalanced, allwing the strap t slip ut f the bar. The sling slipped ut f the spreader bar during use; the patient was reprted t be mving while in the lift. The tileting sling used was t large fr the patient, and the patient s arms were nt placed utside the sling as indicated in the sling s instructins. The patient fell thrugh the pening f the sling, hitting her head n the flr. The patient fell when a leg frm the base f the lift separated frm the rest f the lift after a split pin hlding the leg pivt brke. A failure f the lift s hydraulic mechanism used t raise and lwer the patient resulted in a sudden drp f the jib. 56 N Unsafe Lift WrkBk sectin 2

59 In view f these incidents, Health Canada recmmends that hspitals, nursing hmes and hme care prviders take the fllwing safety measures: 1. Ensure staff are adequately trained and receive regular reviews n the safe use f patient lifts, fllwing the manufacturer s directins. 2. Examine befre each use, all lift supprt systems t ensure that they are structurally sund. Examine cmpnents including slings and chairs fr any signs f wear. Fr example, examine slings fr frayed material r weak stitching, and check straps, chains and hks used t attach the sling t the lift. If wear is nticed, replace the cmpnent immediately. Als examine all hks t ensure that they will nt unhk during use, even if the lad is unstable. Nte that hlding r supprting the patient while in the sling r chair may allw straps r hks t disengage. Als check that the lift can be prpelled in a nrmal manner, making sure that the castrs are in gd cnditin and are free in their mvements. Check that all external fittings are secure and that all screws and nuts are tight. Ensure that all safety labels are firmly attached and in gd readable cnditin. Questin 5.1 What type f equipment inventry des yur rganizatin currently have? Questin 5.2 Has yur rganizatin cmpleted and dcumented an equipment needs assessment? Fllw the manufacturer s maintenance instructins at the required intervals and as required by the health facility s maintenance prcedures fr that device. Fllw the manufacturer s cleaning instructins fr slings and chairs. Strng bleaches r ther disinfecting agents may weaken fabrics and cleaning prducts may als weaken the base f permanently munted lifting devices. Use slings and ther lift accessries that are either riginal equipment r cmpatible with the brand and mdel f lift being used. Ensure that the accessry is suitable fr the applicatin and is f the apprpriate size and strength fr the weight f the patient. Als make sure nt t exceed the verall maximum rated lad fr the lift. When using a sling, ensure that the patient s limbs are prperly placed as per the manufacturer s instructins in rder t help secure the patient. Ensure that any belts and/r restraining devices used t secure the patient are sufficiently tight. N Unsafe Lift WrkBk sectin 2 57

60 Questin 5.3 D yu have a cmprehensive equipment preventive maintenance prgram in place fr patient handling devices? Never leave the patient unattended in a lift. Instruct the patient t remain mtinless while being lifted t reduce the chance f lift instability. Ensure that the base f the lift is kept as wide pen as pssible t maintain its verall stability. If the width f the base must be reduced in rder t g thrugh a drway, ensure it is re-pened afterwards. Nte that sme lifts may becme unstable if they are pushed and pulled by the jib r mast; always use the device s handles designed fr this purpse. D nt mve the lift with a patient in it ver a threshld. In such a case, mve the patient in a wheelchair r stretcher. Take care when mving an unladed lift ver raised threshlds r unevenness in the flr s as nt t damage its base r tip it. Questin 5.4 D yu have an effective reparative maintenance prgram fr any patient handling devices that need repair? Questin 5.5 D emplyees knw hw t reprt defective equipment t ensure that it is nt used (which may create a hazard t bth wrker and patient)? 13. D nt use the lift t transprt the patient fr lng distances. If mving the patient ver shrt distances, ensure that the patient is kept in the lwest psitin pssible t help maintain the lift s stability. Health Canada has cntacted the manufacturers invlved in the abve reprts in rder t discuss crrective actins. Health Canada is als participating n a Canadian Standards Assciatin (CSA) Cmmittee drafting a standard t imprve the safety f lifts and their use. Inquiries cncerning these incidents and reprts f similar prblems shuld be addressed t the Directr, Drugs and Medical Devices Directrate, Health Canada, Tunney s Pasture, Address Lcatr 0301H1, Ottawa, Ontari, K1A 0L2. Telephne: (613) , Fax: (613) Medical device prblems may als be reprted thrugh the tll free Medical Devices Htline at N Unsafe Lift WrkBk sectin 2

61 Feature Six Bimechanical Cnsideratins A psitive apprach t bimechanical cnsideratins encurages flexibility, thinking and prblem slving skills at the caregiver level. Rather than have a specific set f rules that are strictly applied, the prgram shuld encurage caregivers t fcus n several key aspects f the situatin befre determining the mst effective technique t use fr mving r repsitining a resident. These aspects are key cmpnents f New Zealand s LITEN UP Prgram and include: Questin 6.1 Are bimechanics a part f yur current training prgram? A fcus n the lad; reviewing lad characteristics that may impact the handling risk. These may include age, gender, diagnsis, dependency, neurlgical status, size, weight, ability t cperate, and fall risk fr patients; size, shape and weight fr ther lads. A fcus n the individual wrker capabilities; these may include language, educatin, training, physical limitatins, stress, and fatigue. A fcus n the specific task; the nature f the task, what has t be dne, hw, and when. Different tasks have different requirements, each needing assessment and a unique apprach. A fcus n the envirnment, including cnsideratin f the facility design, staffing levels, culture and resurces. Questin 6.2 Des yur training incrprate the cncepts f fcusing n the lad and wrker capabilities? Bimechanical cnsideratins shuld be a majr factr in designing a musculskeletal injury preventin prgram. A cnsistent apprach using standard, well-accepted gd bdy mechanics is preferable t an apprach which attempts t teach cmpletely new theries f mvement that may be useful in sme specific instances, but may be cunter-intuitive r incnsistent with basic techniques used frm site t site. This is particularly imprtant when staff are shared between varius sites r emplyers. Staff shuld be encuraged t systematically scan the situatin, evaluating each f these cmpnents. Anther imprtant factr in ensuring that bimechanics are well cnsidered is planning fr a crdinated mve r transfer using several caregivers. Prir t attempting a tw, three r fur persn transfer, a plan shuld be discussed s that all participants are aware f the rle they play in the mve. Ideally the patient will als understand hw the mve will be undertaken, as this will prevent any unexpected respnses frm the patient that might have negative cnsequences n the mvement. Incident reprt reviews suggest that a lack f crdinatin has smetimes played a majr factr in caregiver injuries. This factr may be effectively eliminated with gd planning and cmmunicatin. N Unsafe Lift WrkBk sectin 2 59

62 Questin 7.1 Des yur rganizatin currently have a dcumented training prgram fr safe lifts & transfers? Questin 7.2 Hw des yur rganizatin ensure that all thse wh shuld have this training attend the sessins? Questin 7.3 Des yur training include a cmpetency assessment that is dcumented? Questin 7.4 Feature Seven Training Back injury preventin training has lng been the staple (and ften the nly cmpnent) f a musculskeletal injury (MSI) preventin prgram fr many healthcare rganizatins. Hwever, training n prper lifting techniques alne has nt been shwn t be effective in reducing MSIs. As a best practice, training must be fcused n prper patient assessment, prper envirnmental evaluatin, prper use f apprpriate patient handling devices, effective cmmunicatin, and the management cmmitment t enfrce the plicy. Increasingly successful is the practice f using peer leaders r trainers, with many prgrams ffering advanced training t trainers. Training must ccur befre the emplyee starts regular wrk as well as reinfrced regularly thrugh required refresher training. Successful prgrams encurage big picture thinking and prblem slving skills which enable the emplyee t cnsider all relevant aspects f the situatin in a timely manner t determine the best technique t use. Training shuld be designed t educate staff t evaluate the risks assciated with resident handling tasks and make apprpriate decisins t reduce risk. This prvides the knwledge that allws flexibility t meet the challenges f specific situatins that arise in daily wrk activities. Training shuld include bth theretical and hands-n cmpnents, with cmpetency assessed and dcumented. Training shuld als be develped fr supprt staff wh d nt perfrm patient handling tasks. Cmpetency evaluatin shuld incrprate manual patient handling tasks as well as the use f equipment. Training recrds shuld be maintained t demnstrate due diligence. The fllwing checklist may be used t develp/assess the training cmpnent f yur Safe Patient Handling Prgram. What additinal elements are needed in yur training prgram t imprve it? 60 N Unsafe Lift Wrkbk sectin 2

63 Training Checklist Patient Handling Training prgram aspect In place Actin/slutin t cnsider Training is prvided fr all new staff prir t assuming full respnsibilities n the Unit. New hire training includes a theretical cmpnent and a hands-n cmpnent. There is a cmpetency assessment in the new hire training prgram. Additinal training is prvided fr thse wh d nt pass the cmpetency assessment. New hire training is dcumented. Refresher training is required n an annual/biannual basis fr all staff. There is a system t flag when refresher training is required. Refresher training includes a theretical cmpnent and a hands-n cmpnent. There is a cmpetency assessment in the refresher training prgram. Refresher training is dcumented. Training includes bimechanical principles. Training includes patient risk assessment prcedures. Training includes an envirnmental r pre-lift scan t identify risks. Training includes a hands-n use f patient lifting devices. Training includes cmmunicatin prcedures. Training includes all aspects f the Safe Patient Handling Plicy and Prgram guidelines. Remedial training/assessment is prvided fr emplyees returning t wrk after sustaining a patient-handling related incident. Training requirement cmpliance is evaluated fr supervisrs, managers and all emplyees. N Unsafe Lift Wrkbk sectin 2 61

64 Training Checklist Nn -Patient Handling Training prgram aspect In place Actin/slutin t cnsider Training is prvided fr all new staff prir t assuming full respnsibilities in the Department. New hire training includes a theretical cmpnent and a hands-n cmpnent. There is a cmpetency assessment in the new hire training prgram. Additinal training is prvided fr thse wh d nt pass the cmpetency assessment. New hire training is dcumented. Refresher training is required n an annual/biannual basis fr all staff. There is a system t flag when refresher training is required. Refresher training includes a theretical cmpnent and a hands-n cmpnent. There is a cmpetency assessment in the refresher training prgram. Refresher training is dcumented. Training includes bimechanical principles. Training includes an envirnmental r pre-lift scan t identify risks. Training includes a hands-n use f any lifting r mving devices. Training includes all aspects f the Safe Patient Handling Plicy and Prgram guidelines. Training requirement cmpliance is evaluated fr supervisrs, managers and all emplyees. 20. New Zealand Patient Handling Guidelines The LITEN UP Apprach, 2003; cmplete prgram details and frms available at Assessing cmpetency is an imprtant functin t ensure that training is successful. A shrt cmpetency assessment frm may be useful during the hands-n rientatin f staff t using patient handling devices. Different levels f cmpetencies may be required fr caregivers, advisrs and instructrs. The fllwing chart f cmpetencies is available in the New Zealand LITEN UP 20 prgram materials (mdified and reprduced here with permissin). 62 N Unsafe Lift Wrkbk sectin 2

65 Cmpetency All caregivers, advisrs and instructrs Extra requirements fr advisrs/supervisrs Extra requirements fr instructrs Organizatinal and planning issues Understand legal respnsibilities Knw & fllw plicy and prcedures Cntribute t decisinmaking and reviews Help with plicy develpment and implementatin Gain management supprt fr implementatin Organize a prcess t mnitr and review patient handling practices Maintain up t date resurces Ensure emplyees are up t date with guidelines and legislatin Ensure training fllws guidelines Update training t keep current Ensure training cvers plicy and prcedures Operatinal Issues Understand principles f safe patient handling Act as advcate fr patient needs Identify and assess risks as per prcedures Use prper handling techniques and equipment Seek help when needed Reprt incidents, cncerns, and unsafe practices r tasks Suggest imprvements Mentr staff and supervise perfrmance Ensure cmpliance Prmte evidence-based research t imprve practice Review prgress and identify areas fr imprvement Cmmunicate and cnsult with staff Prvide slutins fr cmplex handling situatins Mnitr training and evaluate utcmes Identify & eliminate unnecessary tasks Manage testing & evaluatin f new equipment Be invlved with facility design issues Teach and advise staff and mnitr their perfrmance Attend relevant meetings and pass n infrmatin thrugh training Recrd keeping Keep accurate and up t date recrds f risk assessments Reprt and/r recrd safety issues Keep reprts f meeting utcmes Keep central registry f patient handling dcuments and recrds, including training recrds Ensure adequate equipment and maintenance recrds are kept Keep a training register shwing attendees, curse cntent, and assessment details Prfessinal develpment Take persnal respnsibility fr cntinued prfessinal develpment Increase skills and knwledge t stay up t date with best practice Share skills and knwledge with thers Maintain cntact with prfessinal bdies t gain advice and guidance n latest research and best practice Take and act n advice frm the patient handling advisr N Unsafe Lift Wrkbk sectin 2 63

66 Questin 8.1 Hw des yur rganizatin cmmunicate the status f the patient s handling needs requirements? Questin 8.2 Wh is respnsible fr updating the risk assessment and changing it n the cmmunicatin tl? Feature Eight Cmmunicatin Prcedures The success f any prgram intrduced int a healthcare envirnment is dependent upn cmmunicatin f expectatins and prcedures and the prvisin f a fllw-up mechanism t ensure that issues that arise are dealt with in a timely manner. In Feature One, management cmmunicatin f cmmitment and plicy highlighted its imprtance in implementing a successful Safe Patient Handling Prgram. Cmmunicatin abut the details f the prgram will ensure that all thse invlved are aware f specific requirements. Risk assessment is a critical factr in determining the safest apprach t cnducting a patient lifting, transfer, r mvement task. Hwever, having a patient risk assessment prperly dne des nt in itself ensure that the tasks will be dne safely. Cmmunicatin f the results and f the risk assessment will ensure that all emplyees are aware f the risks and safe handling prcedures. A variety f mechanisms currently exist fr cmmunicating patient risk assessments in an efficient and effective manner. These can be bth frmal (written int care plans) and infrmal (mentin at daily reprt); hwever, the infrmatin is nt always readily available t all thse wh shuld have access t it. Time may nt permit checking the care plan, and varius schedules may leave sme wrkers withut the verbal briefing. Patient status may change gradually r suddenly, and reliance n a previus risk assessment may be insufficient. Sme healthcare rganizatins have develped quick visual cues t indicate the patient handling requirements fr each patient. Frm a prgram perspective, cnsistency in the use f the cues is needed. An example f effective cmmunicatin f patient handling requirements is the use f lg cards develped by OSACH 21. Their prgram manual describes each lift in great detail, with accmpanying phtgraphs. Using this type f cmmunicatin aid near the bedside will prvide immediate infrmatin fr the caregiver. A prcess must be in place t ensure that the assessment (and any cmmunicatin tl used fr the assessment) is updated regularly t reflect the mst up t date infrmatin abut the patient. 21. OSACH Planning Guide Implementatin f Client Mechanical Lifts, 2nd editin, Available fr rder at 64 N Unsafe Lift WrkBk sectin 2

67 Feature Nine Area Design Cnsideratins 22 As we increase the experience and knwledge f the impacts f ergnmics in the wrkplace, it becmes apparent that many f the lder facilities cannt be easily mdified t incrprate gd ergnmic principles. As a result, retrfitting is smetimes undertaken, but mre ften, caregivers must wrk arund pr area design t accmplish patient handling tasks. Even in newly designed facilities, attentin t best ergnmic practices in patient handling are smetimes nt cnsidered. A Safe Patient Handling Prgram must address area design issues and shuld include a practive cnsultative apprach in the design f new r renvated facilities. The fllwing criteria shuld be cnsidered in area design/cnfiguratin t assist in reducing patient-handling injuries t patients and caregivers: Ceiling lifts, where patient ppulatin warrants them, and the facility s physical structure can supprt them; ensure ceiling lifts track all the way int the bathrm. Furniture in patient rms t include adjustable beds, under-bed clearance t accmmdate patient lifting devices, castrs n furniture legs fr easier mving f beds, and chairs with armrests t assist in standing. Questin 8.3 Des yur cmmunicatin plan include cmmunicatin acrss all shifts and include all apprpriate staff? Questin 8.4 Hw wuld yu imprve current cmmunicatin prcedures in yur facility? Sufficient electrical utlets arranged t reduce the need fr lng electrical crds r extensin crds. Call systems with easy access fr patients t btain help if necessary. Sufficient clearance beside, at the ft f, and n the transfer side f the bed t allw fr tw caregivers and equipment as necessary (equipment may include a stretcher, wheelchair, lifting device, etc.). In bathrms, drway entrances shuld accmmdate wheelchairs, lifts and up t tw caregivers in additin t the patient; cnsider equipment such as bariatric equipment. (Fr example, cnsult the Arj Guidebk fr architects and planners, which prvides specific clearances fr rm designs.) In bathrms, space frm the tilet bwl t the wall shuld accmmdate ne r tw caregivers. In bathrms, tilet height shuld take int accunt types f cmmde chairs. In bathrms, grab rails near tilets, sinks and baths; baths shuld have sufficient area t accmmdate access by wheelchairs r lifting devices; access frm bth sides f the bathtub. 22. Infrmatin fr this sectin has been adapted frm the New Zealand Patient Handling Guidelines The LITEN UP Apprach, 2003 and used with permissin; cmplete prgram details and frms available at acc.c.nz/injury-preventin/safer-industries/ health/resurces/index.htm N Unsafe Lift WrkBk sectin 2 65

68 Clearance arund sinks shuld accmmdate caregivers and equipment. Shwer areas shuld be withut curbs t enable wheelchair access; adequate drainage t prevent pls f water frm frming; a seat in the shwer are fr the patient with a grab rail psitined clsely t the seat; detachable shwer hse and head; sufficient area t dry ff. Handrails in crridrs; unbstructed crridrs f sufficient width t allw patient equipment/furniture t be mved. Drways that are wide enugh t accmmdate patient equipment. Hard, smth flring (n carpet), that allws fr easy mvement f patient wheeled equipment; permanently sealed jints in flring t reduce tripping; nn-slip flring in bathrms. Sufficient strage space fr patient handling equipment and supplies t ensure they are readily available. Building Cdes and a variety f best practice guidelines 23 are useful in prviding mre specific details in the design f new facilities r in a renvatin prject. While cnsideratin f these factrs may be pssible in determining new area design r renvatin f existing facilities, making d with the current situatin is ften required. The New Zealand Patient Handling Guidelines ffers the fllwing suggestins fr Immediate changes t imprve patient handling safety. Immediate changes t imprve patient handling safety Patient rms Keep rms tidy and free f clutter. 23. New Zealand Patient Handling Guidelines The LITEN UP Apprach, 2003; cmplete prgram details and frms available at OSACH Handle With Care; Ontari Safety Assciatin fr Cmmunity & Healthcare; Resurce Manual; Secnd editin, May Can be rdered frm the OSACH website Create a permanent clear passage frm the ft f the bed t the dr, s there is always clear access t mve equipment frm the dr t the bed. In small rms, and where space is at a premium, attach castrs t the furniture s it can be easily mved ut f the way during patient handling tasks. Make sure beds are height adjustable. Make sure chairs have armrests t help patient transfers. Try t lcate patients wh need t be assisted with wheelchairs as near t day r dining rms as pssible, t minimize the distance they have t travel. 66 N Unsafe Lift WrkBk sectin 2

69 Prvide plenty f electrical sckets, t prevent trailing leads. Maintain a plicy regarding acceptable furniture fr patients t bring int the facility (e.g. lng-term care facilities), t avid clutter and heavy lifting fr wrkers. Tilets, shwers and bathrms If tilets are small, inaccessible and in difficult places in which t perfrm patient handling tasks safely, cnsider using ther tileting methds such as cmmdes, pans r bttles. Questin 9.1 Has yur rganizatin reviewed facility space issues with a view t ptimizing them fr safe patient handling? Cnsider the lading weight f the tilets, especially fr bariatric patients. If the shwer r bathrm is t small and inaccessible fr large patient handling equipment, cnsider: Bed bathing the patient until an alternative is fund, r Using a shwer chair that can be pushed int the shwer r bathrm. Crridrs, drs and flring Check crridrs and access rutes are free f items that restrict minimum recmmended widths. Questin 9.2 Have yu cnsidered strage requirements fr new equipment purchased? Check that: Crridr drs swing in the directin f the exit, Dr swings d nt restrict recmmended minimum crridr widths, Tilet drs d nt swing inwards, and Questin 9.3 Items are nt stred behind drs that can restrict them fully pening. Check flr cverings are tightly fixed t the flr, and permanently seal all gaps and lse edges. Check carpet edging strips are bevelled and nt mre than 10mm abve the flr. Are wrker and patient safety related t patient handling tasks cnsidered in the priritizatin list fr capital expenditures? N Unsafe Lift WrkBk sectin 2 67

70 Questin 9.4 Are yu planning n building a new facility in the near future? If s, are experts in patient handling tasks and ergnmics invlved in the design f the new facility? Patient handling equipment Ensure patient handling equipment is well maintained, and repaired r replaced when damaged. Use temprary ramps fr wheeled equipment t eliminate the risks assciated with lifting equipment ver threshlds. Install grab rails in tilets, shwers and bathrms t encurage patients t stand and sit independently. Install cntinuus handrails alng crridrs and stairs. Cnsider installing ceiling tracks and wall-hung r gantry hists because these require less rm t mve patients than mbile hists. Strage Ensure yur strage area is well rganized with clearly defined areas fr patient handling equipment. Questin 9.5 Are yu planning renvatins f patient care units in the near future? If s, are experts in patient handling tasks and ergnmics invlved in the design f the new facility? Lcate strage areas in the ward r unit, preferably within 20 meters f handling areas and within 10 meters f the nurses statin. It is advisable t ensure thse with expertise and experience in patient handling tasks are included n the design team fr new facilities r n the renvatin design team. 68 N Unsafe Lift WrkBk sectin 2

71 Sectin 2 identifies the majr features t be cnsidered in the framewrk fr a N Unsafe Lift Prgram plan. These majr features include: Management Cmmitment Plicies and Prmtin Sectin Emplyee Participatin 3 Crdinatin Risk Assessment Prgram Planning, Implementatin and Administratin Equipment 3 Bimechanical Cnsideratins Training Cmmunicatin Area Design Cnsideratin Sectin 3 cvers prgram requirements, including: Preparatin f a multi-year budget fr the prgram, Identificatin f timelines and accuntabilities fr prgram cmpnents, Implementatin and enfrcement strategies, Change management, and Examples f utcme measures and prgram evaluatin prcesses. Each feature will include examples f ptins that address each f the features and templates t assist the participant in identifying/selecting desired prgram cmpnent details that are feasible and cnsistent with the rganizatin s culture. Peridically, material will include shrt self-assessment questins t help identify rganizatinal issues. Ideally, this wrkbk will be used by a prgram planning team frm the healthcare rganizatin. As any prgram f this nature requires the input and effrt f many peple and is multidisciplinary in nature, representatives frm grups mst directly impacted shuld be included n the planning team. These may include representatives frm Human Resurces, Educatin/ Training, Occupatinal Health and Safety, frntline patient care management, supprt services, and frntline wrkers. It may be useful t include thers specific t functins in yur rganizatins as well. This wrkbk can be used by reviewing the material and cmpleting the templates in the rder in which they are presented, r sub-grups may chse t wrk n specific framewrk features. T btain the maximum benefit, attempt t answer all questins and cmplete the templates fr each sectin. These have been designed t guide yu thrugh prgram develpment and N Unsafe Lift Wrkbk

72 implementatin planning.

73 SECTION THREE Prgram Planning, Implementatin and Administratin This sectin will cver prgram planning, implementatin and administratin activities t supprt a Safe Patient Handling Prgram. T btain the maximum benefit fr the resurces prvided t reduce injuries related t handling f patients and bjects, a cmprehensive apprach is necessary. Understanding the key features f a gd prgram will assist in planning effrts. Identifying key stakehlders t participate in planning will facilitate buy-in and participatin. Develping a budget t address initial and n-ging funding requirements will reduce the likelihd f surprises and supprt sustainability f the prgram. Being aware f implementatin issues and bstacles will enable identificatin f prblems and slutins early in the prgram. Defining accuntability will prvide the necessary criteria fr evaluating perfrmance. Designing a prgram evaluatin plan will prvide the building blcks fr cntinuus imprvement effrts and prvide the necessary feedback t assess prgress. This sectin prvides templates t assist yu in develpment and implementatin planning. A. Develping a Budget fr a Safe Patient Handling Prgram Cnsideratins fr a multi-year budget fr this prgram will need t include: Initial Csts Prgram planning and develpment csts Staff time Steering Cmmittee, equipment inventry taking, emplyee surveys, plicy develpment, prcedures, analysis f accident data, etc. Crdinatr Salary & benefits Recruitment csts Office equipment and supplies N Unsafe Lift WrkBk sectin 3 71

74 Initial purchase f equipment Staff time fr evaluatin/pilt Equipment purchase (capital) Installatin csts (ceiling lifts) Accessries purchase Lifting devices fr materials handling Cmmunicatins Prductin f frms, lg cards r equivalent, psters Training Develpment time fr training material Equipment and equipment strage fr hands n training Rms/lcatins fr training Selectin/training f trainers Develpment f cmpetency assessment criteria/frms, etc. Scheduling time fr staff t attend training Staff time t attend training (initial blitz) Trainer time Training equipment prjectr(s), laptp(s) Csts f dcumentatin/handbks prduced fr distributin, etc. Maintenance Redesign f strage space Time fr develpment f preventive maintenance prgram Time fr repair f current equipment Evaluatin-related csts Infrmatin systems capable f recrding accident data Staff time fr develpment f perfrmance appraisal criteria Staff time fr emplyee surveys On-ging Csts Prgram crdinatin Crdinatr Salary & benefits Office equipment and supplies 72 N Unsafe Lift WrkBk sectin 3

75 Staff time Steering Cmmittee versight, nging review f prgram Equipment-related csts Planned replacement f equipment (capital) Additinal equipment related t expansin Accessries (slings, ther transfer aids) Cmmunicatins Onging prductin f frms, lg cards, psters, etc. Training Onging training f trainers Scheduling time fr staff t attend training (new and refresher) Staff time t attend training (new and refresher) Trainer time Csts f dcumentatin/handbks, etc. Time fr specific training fr emplyees returning t wrk pst patient handling injury Maintenance Preventive maintenance staff time Reparative maintenance staff time Parts Csts f sending equipment t supplier (when necessary) Evaluatin-related csts Staff time fr emplyee surveys Staff time t cllect, analyze and reprt n utcme data Future facilities planning Time t prvide input n renvatin and building prjects The fllwing template may be useful in determining yur budget needs. It is nt designed t fllw any specific rganizatin s frmat, but shuld prvide prmpts s that items are nt frgtten when develping yur budget. Remember t figure in equipment replacement csts ver time, and any new equipment expected when expansin is planned. N Unsafe Lift WrkBk sectin 3 73

76 Safe Patient Handling Prgram Budget Categry # Item cde Item Apr. May June July Aug. Sept. Oct. Nv. Dec. Jan. Feb. Mar. Ttal Expenditures Labur Crdinatr 1 FTE Crdinatr benefits Cmmittee member hurs/$ Trainer hurs/$ Staff hurs t attend training/$ Management hurs/$ Return t wrk ergnmist time/$ New facility/ renvatin OHS advisr time/$ Equipment Lifts Type Lifts Type Labur Lifts Type Lifts Type Lifts Type Slings Types/ sizes Transfer belts Transfer bards Other lifting aids Pellet jacks, etc. (fr materials) 74 N Unsafe Lift Wrkbk sectin 3

77 Categry # Item cde Item Apr. May June July Aug. Sept. Oct. Nv. Dec. Jan. Feb. Mar. Ttal Spare parts Training equipment Lifting devices prjectr Laptp Office supplies - furniture Desk Chair Office supplies - cmputer cmputer phtcpier Printer laminatr sftware Office supplies Paper Binders Printing csts Binders Frms Lg cards handbks Training materials Surveys Facilities/ maintenance Preventive maintenance time/$ N Unsafe Lift Wrkbk sectin 3 75

78 Categry # Item cde Item Apr. May June July Aug. Sept. Oct. Nv. Dec. Jan. Feb. Mar. Ttal Repair time/$ Shipping csts Cntracted services Cst ffset (recveries) Funding Health & Wellness Funding Emplyment & Immigratin WCB Rebate r Discunt Net 76 N Unsafe Lift Wrkbk sectin 3

79 Activity Accuntability Timelines/Target Dates Deliverables Participate in WHS Wrkshp Establish Steering Cmmittee and apprve Terms f Reference Determine budget Cllect and analyze past incident data Identify required imprvements in incident cause tracking Define bjectives Identify utcme measures and develp measurement systems Identify and dcument rles and respnsibilities Develp a Safe Patient Handling Plicy Cmplete inventry f current equipment Ensure equipment cleaned and repaired as necessary Determine strage spaces fr equipment B. Planning fr Timelines and Accuntabilities In sectin tw f this wrkbk, nine key features f a cmprehensive Safe Patient Handling Prgram were described. In prgram planning and implementatin, each f these features ideally wuld be cvered in the rganizatin s strategy. As with any activities, thse related t the develpment and implementatin f this prgram shuld be clearly identified, with accuntabilities fr the actin and estimated timeframes fr cmpletin. The fllwing template may assist the rganizatin in develping its actin list fr prgram develpment and implementatin. N Unsafe Lift Wrkbk sectin 3 77

80 Activity Accuntability Timelines/Target Dates Deliverables Identify equipment needs Apprve equipment requests Participate in selectin f equipment Determine crdinatr f prgram Develp jb prfile fr crdinatr If necessary, recruit and rient crdinatr Identify change management requirements Lead and implement change management prcesses Develp risk assessment tls patient handling tasks wrkplace assessment Develp risk assessment tls patient handling tasks patient assessment Develp risk assessment tls patient handling tasks task assessment Develp tls fr cmmunicatin f risk assessment (charting, lg cards, etc.) Develp risk assessment tls materials handling tasks 78 N Unsafe Lift Wrkbk sectin 3

81 Activity Accuntability Timelines/Target Dates Deliverables Develp risk assessment prtcls and accuntabilities Develp emplyee pre-lift r task specific scans r assessments Identify training plans Identify trainers Purchase training equipment Prduce training materials Schedule staff fr training Determine equipment and space needs fr training Identify training tracking prcess Prvide input n new cnstructin r renvatin prjects Prduce reprts f prgram implementatin status Prduce reprts f prgram utcme measures Develp actin plans based n utcme reprts In mst cases, it is a gd idea t cnfirm with thse wh are assigned accuntabilities t ensure that the deliverables are well understd and the timelines are feasible. In additin, if there are any resurce requirements t enable the cmpletin f activities, it is imprtant t identify these and arrange t have them prvided. Once the planned activities and accuntabilities are utlined, regular status checks shuld ccur t ensure that activities are n schedule and n unfreseen issues have develped which impact the cmpletin f activities. Regular reprting n the prgress f prgram develpment and implementatin is a useful mechanism t ensure that management is kept up t date. N Unsafe Lift Wrkbk sectin 3 79

82 C. Implementatin Cnsideratins Many rganizatins will chse t trial the implementatin f the prgram t identify any issues that may arise, find and crrect any prgram deficiencies, and shw impacts t encurage greater buy-in. In chsing a lcatin in which t implement the prgram as a pilt, cnsider the fllwing: Chse a lcatin with sufficiently high injury rates related t patient handling s that impacts will be clearly seen. Chse a lcatin where the supervisrs and managers are enthusiastic abut the prgram and will actively participate. Ensure that a lcal implementatin team is chsen and includes all levels f staff in the area (unit, site, etc.). Define a time perid fr the pilt that is sufficiently lng t enable the prgram t be well-integrated int peratins and t enable the cllectin and analysis f impact data. Analyze all incidents fr the previus year t determine causes and activities being undertaken when the incident ccurs. At the end f the trial, cnduct the pst-implementatin emplyee survey, analyze utcme data and reprt n results prir t expanding the prgram. Whether yu chse t implement a prgram as a pilt in ne area, r implement the prgram acrss all areas, cnsider the fllwing: Send ut a pre-implementatin emplyee survey t enable cmparisn with a pst-implementatin survey. Prvide supprt in the area t answer questins and prvide caching and reinfrcement. Discuss the prgram at regular staff meetings t identify any issues that need reslutin. Determine what data will be cllected and prvide a mechanism t ensure that it is dne (see sectin E). Ensure any incident reprts are cmpleted and prvide a detailed analysis f causal factrs. A survey such as the fllwing (r ne f yur wn design) can be cmpleted by emplyees prir t prgram implementatin and after the prgram has been implemented (n a trial basis r acrss the entire rganizatin). 80 N Unsafe Lift Wrkbk sectin 3

83 Safe Patient Handling - Emplyee Survey Unit: Name (ptinal) Date: Psitin: Strngly Agree Agree Disagree Strngly Disagree 1. I am aware f the plicy related t patient handling. 2. Senir management actively supprts safe patient handling prcedures. 3. I have been invlved in a wrkplace risk assessment with regards t patient handling. 4. I am regularly invlved with determining patient handling risks fr each patient. 5. We discuss patient handling risks n my unit regularly. 6. We have a frmal prcess t identify the apprpriate handling requirements fr patients. 7. Patient handling requirements are always well cmmunicated amng staff. 8. We have sufficient types f patient handling equipment t ensure tasks are handled safely. 9. The patient handling equipment is readily available. 10. Equipment accessries (slings, etc.) are readily available. 11. There is a prcess in place t label and reprt equipment needing repair. 12. There is a regular preventive maintenance prgram fr patient handling equipment. 13. Equipment is repaired in a timely manner. 14. I have never used defective equipment. N Unsafe Lift Wrkbk sectin 3 81

84 Strngly Agree Agree Disagree Strngly Disagree 15. There is enugh space arund the patient s bed t maneuvre with equipment. 16. When mre than ne persn is needed fr a safe lift, I always find smene t assist. 17. I never perfrm unsafe lifts. 18. The patient handling devices n my unit are easy t use. 19. I have been trained in the use f all patient handling devices n my unit. 20. I feel cmfrtable and cmpetent t use all lifting devices n my unit. 21. I have had hands-n training in prper lifting techniques. 22. I have been regularly assessed fr my cmpetence in handling patients. 23. My supervisr/manager actively supprts safe patient handling practices and reinfrces this ften. 24. Management slicits and listens t ur suggestins t imprve patient handling tasks t make them safer. 25. We d nt have patient handlingrelated injuries n my unit. 26. The wrklad n the unit is manageable. 82 N Unsafe Lift Wrkbk sectin 3

85 Strngly Agree Agree Disagree Strngly Disagree 27. Staffing n the unit is apprpriate. 28. Enugh time is allwed fr patient handling tasks. 29. Patient handling tasks are rtated with ther activities fr a wrk balance. 30. C-wrkers are willing t assist when I need them fr patient handling tasks. 31. I am willing t assist c-wrkers in patient handling tasks. 32. All patient handling-related injuries are reprted t the supervisr. 33. All patient handling related incidents are cmpletely investigated. 34. All patient handling incidents are discussed with staff t prevent similar incidents. 35. My safety perfrmance is part f my perfrmance appraisals. D. Managing Change Adpting a Safe Patient Handling Prgram may require a change in the rganizatin s view f ccupatinal health and safety. Healthcare rganizatins are generally fcused n patient safety issues. Thugh many see the cnnectin between emplyee safety and patient safety, attentin is ften directed at actins that can be demnstrated t directly impact patient safety (diagnstic errrs, medicatin errrs, etc.). This fcus n actins tends t diminish the perceived imprtance f cnditins and attitudes (unsafe wrking cnditins, staffing issues, lng wrking hurs, etc.) n patient safety. Many healthcare rganizatins are tracking patient-related incidents and analyzing cntributing factrs t identify needed imprvements. In sme cases, wrker health and safety issues are identified as cntributing factrs. A clser analysis f wrker injuries and illnesses wuld likely result in identified risks t the quality and utcmes f patient care. The develpment f a cmprehensive safety culture (fr bth patients and wrkers) is needed t imprve safety and reduce errrs and injuries. 24. Mdified frm the wrk f Jhn Ktter, A Frce fr Change: Hw Leadership Differs frm Management, 1990 (Free Press) and frm an article in strategy-business slutins magazine 10 Principles f Change Management by Jhn Jnes, DeAnne Aguirre and Matthew Calderne, April 15, N Unsafe Lift Wrkbk sectin 3 83

86 The change in safety culture has already begun. Patient safety issues are brught frward and discussed frankly. Incident reprting is encuraged and mandated t ensure that all pprtunities are taken t discver system issues that need slutins. Patient safety agencies publish vlumes f data abut patient safety statistics, accreditatin bdies lk fr patient safety systems in place, and hspital departments have been established t fcus n patient safety issues. This change did nt happen vernight. The basic principles 24 f intrducing change in an rganizatin were fllwed: Obtaining management cmmitment and leadership; define the visin; creating a sense f urgency, Creating a team t lead the change prcess, Identifying the current status; csts and benefits, Assigning accuntabilities; creating wnership; facilitate input, Cmmunicating the change prcess, Defining accuntabilities and invlving all layers f the rganizatin, Addressing the human side t ensure a cnstructive (nn-blaming) apprach, Identifying shrt and lng-term gals, and Making changes permanent and incrprated in the rganizatin s culture. The current challenge is t extend this safety culture t encmpass wrker safety. Once again, this change will nt happen vernight. The develpment and implementatin f a Safe Patient Handling Prgram may be an excellent building blck fr evlving t a cmprehensive (patient and emplyees) safety culture. As the key cmpnents f successfully intrducing change are necessary t meet this challenge, use the fllwing template t assist in develping yur change management plan t intrduce the Safe Patient Handling Prgram. 24. Mdified frm the wrk f Jhn Ktter, A Frce fr Change: Hw Leadership Differs frm Management, 1990 (Free Press) and frm an article in strategy-business slutins magazine 10 Principles f Change Management by Jhn Jnes, DeAnne Aguirre and Matthew Calderne, April 15, N Unsafe Lift WrkBk sectin 3

87 Issue Actin/Slutin Accuntability/Timelines Obtaining/Demnstrating management cmmitment t this change Identifying scpe f issue; reviewing ptins; making the case Identifying supprters and leaders fr this change Asking fr vlunteers; using a multidisciplinary apprach; establishing a Steering Cmmittee Determining scpe Deciding n a pilt apprach t trial the prgram; scheduling implementatin phases Getting buy-in frm all levels f staff Cmmunicating needs and desired utcmes; prviding extensive pprtunities fr input; invlving emplyees in prgram planning and implementatin Assigning rles and respnsibilities Asking fr vlunteers; discussing with all levels f staff Determining shrt term gals Determining lng-term gals Cmmunicatin f prcess Measurement f utcmes Cmmunicatin f utcmes Evaluatin and feedback Reinfrcement In Leading Change 25, Jhn Ktter identified the fllwing eight cmmn errrs made by rganizatins during their change management prcess. Allwing t much cmplacency Failing t create a sufficiently pwerful guiding calitin Underestimating the pwer f visin Undercmmunicating the visin Permitting bstacles t blck the new visin Failing t create shrt-term wins Declaring victry t sn Neglecting t anchr changes firmly in the crprate culture 25. Leading Change, Jhn P. Ktter, Harvard Business Schl Press, N Unsafe Lift WrkBk sectin 3 85

88 Each healthcare rganizatin will need t determine if the Safe Patient Handling Prgram will be an add n prgram, a revisin r updating f its current prgram, r if it will be a building blck twards a change t a cmprehensive safety culture. E. Prgram Evaluatin Defining and Measuring Outcmes Will yur prgram be successful in reducing injuries related t handling patients, equipment and materials? T assess success, a mechanism must be in place t identify utcme measures, cllect and analyze data, and reprt results. At the beginning f this wrkbk, yu were asked t identify bjectives f the prgram. Gd bjectives had these characteristics: Are realistic and achievable, Are relevant t the issue, Have measurable utcmes, and Identify accuntabilities. Determining what data t cllect, where t btain it, hw t interpret it, and hw t reprt n it is the first step. Using the framewrk identified by Reginal Health Authrities t prvide benchmarking capabilities thrugh cnsistent applicatin f data cllectin, analysis and reprting methds, yu can design yur measurement tls t prvide an accurate evaluatin f yur prgram s utcmes. This includes lking at bth lagging (Tiers 1 and 2) and leading indicatrs (Tier 3) f prgram perfrmance. Tier 1 Metrics Implementing the N Unsafe Lift Framewrk shuld impact the rates f injuries related t unsafe lifts. T determine what thse rates are, hwever, it is imprtant t have infrmatin related t the incident which caused the injury. Infrmatin frm the Wrkers Cmpensatin Bard (WCB) will indicate the part f bdy injured (e.g., back, shulder, etc.) and the nature f the injury (verexertin), but will nt identify if this ccurred while handling a patient r a lad f sme srt, r whether it was assciated with anther actin. The Safe Patient Handling Prgram is targeted t lifting, transferring and mving tasks and is nt likely t impact ther activities that may cause injury. 86 N Unsafe Lift WrkBk sectin 3

89 Therefre it is necessary t understand mre fully what activities were being perfrmed at the time f the incident. Fr this, ne wuld need t review a detailed incident investigatin reprt. If yur rganizatin has a cmprehensive incident investigatin prcess in place, btaining accurate pre-prgram data will be relatively easy. If it des nt have a prcess in place t identify activities being cnducted when an injury ccurs, the data btained frm the WCB may be used as a rugh apprximatin, thugh its limitatins must be clearly understd. If yu have access t incident reprts, it is advisable t review thse filed ver the past 1-2 years and tabulate the number that appear t be related t patient r materials handling activities. If yu identify that, fr example, 50% f all back injury (r verexertin, r shulder/back/multiple parts, etc.) WCB claims are related t patient handling activities, yu can use this as a rugh apprximatin when yu analyze WCB data. This way, yu will nt ver r underestimate the impacts f yur prgram by including injuries that are nt addressed by the prgram. Fcus n identifying the categries f yur WCB reprts that reflect injuries that culd be sustained as a result f unsafe lifting. Fr example, if yu had 100 lst time injuries last year, and 60% f these culd be reasnably attributed t lifting tasks (based n bdy part injured, nature f injury and supplemented by yur review f incident reprts), then 100% reductin (=eliminatin) f injuries related t lifting wuld result in a lst time injury number f 40 (all ther things remaining unchanged) fr this year. Hwever, the likelihd f 100% reductin f injuries is very slim, s it wuld be mre reasnable t cnsider a mre realistic, achievable target (particularly given the phasing in f the prgram, the awareness f all prcess related t the prgram, and the cmmunicatin f prgram details). A mre realistic target may be a 40% reductin in the first year fllwing prgram implementatin. This wuld prvide a target fr lst time injuries related t lifting t g frm 60 t 36 (60% f 60) lst time injuries related t lifting tasks. The ttal lst time injuries wuld then be (ther types f injuries) equalling 76. The reductin f 24% verall lst time injuries in the year after the prgram was implemented wuld accurately reflect a 40% reductin in the specific incidents the prgram is directed t impact. A wrd f cautin d nt utilize the reprting f all incidents (nn claim) as a Tier 1 metric, as a gd reprting system will encurage reprting f incidents. This will be cvered in mre detail when we discuss Tier 3 measures. N Unsafe Lift WrkBk sectin 3 87

90 Yu may chse t use the fllwing template t assist in reprting Tier 1 befre and after prgram implementatin measures. (Data used here is fictitius and is nly used as an example.) Pre-Prgram Year 1 f prgram Year 2 f prgram A. Number f WCB claims B. % f WCB claims assessed t be ptentially caused during lifting/handling tasks 60% 50% 50% C. Number f WCB claims assessed t be ptentially caused during lifting/handling tasks (AxB) r actual numbers (if knwn frm incident investigatins) With the table abve, yu can prvide infrmatin n the estimated impact f the prgram in reducing injuries ptentially caused during lifting/handling tasks. Yu can readily see that if yu cnsidered ttal WCB claims, yu nly have a reductin f 10% f claims after year 1 and 20% after year 2; whereas, if yu specify thse claims which may be impacted by a Safe Patient Handling Prgram, yu will nte that there is a 25% decrease in claims after year 1 and a 33% decrease after year 2. Prgram perfrmance targets shuld be established fr measures that are impacted by the prgram. The fllwing table is an extensin f the table abve, but this time perfrmance targets are established and reprted n. The perfrmance targets (rws D and E in the fllwing table) reflect targets fr reducing injuries specifically targeted by the Safe Patient Handling Prgram. Actual number f specific claims (rw C) is cmpared t the targets established the year befre t calculate perfrmance in a given year (target established in 2007 used t assess perfrmance in 2008). A cumulative perfrmance assessment cmpares all future years with the pre-prgram year data. 88 N Unsafe Lift WrkBk sectin 3

91 Pre-Prgram Year 1 f prgram Year 2 f prgram A. Number f WCB claims B. % f WCB claims assessed t be ptentially caused during lifting/handling tasks 60% 50% 50% C. Number f WCB claims assessed t be ptentially caused during lifting/handling tasks (AxB) r actual numbers (if knwn frm incident investigatins) D. Target fr next year % reductin in lift-related claims 30% 30% 50% E. Target fr next year number f lift-related claims (C - (CxD)) F. Perfrmance = (E/C) x100 with E frm last year, C frm current year 93% f target reached in % f target reached in 2009 G. verall cumulative impacts (C pre-prgram) - (C current year) / C pre-prgram x =15 15/60 x 100= 25% injury reductin 60-40=20 20/60 x 100= 33% injury reductin This perfrmance measure can be used fr the entire rganizatin, individual sites r departments, r fr the pilt study grup selected. Nte that this representatin f infrmatin des nt take int accunt the ttal number f staff and assumes a relatively steady state fr emplyee numbers. If yur rganizatin is expanding r annexing ther facilities, r if yu are expanding after the pilt prject, yu may cnsider expressing the WCB claim number relative t FTEs (e.g. 4 claims per 100 FTEs, etc.) fr a mre accurate cmparisn. Tier 2 Metrics Tier 2 metrics are still lagging indicatrs, but prvide much mre infrmatin that can be used t target preventin effrts r t fcus attentin n specific areas/units. This data centers upn the csts per WCB claim and allws yu t see the financial impact f preventin effrts. T access this infrmatin, yu will need t access yur wn rganizatin s WCB data using the WCB s elink electrnic system. N Unsafe Lift WrkBk sectin 3 89

92 Fr thse wh have participated in the OH&S Leaders Cuncil Benchmarking Prject, yu wuld fllw the directins under Tier 2 Fifth Measure Csts Related t Type f Injury and run yur pivt table reprt lking specifically at number and csts f inflammatin f jints/muscles and strains/ sprains tgether by year. Yu can then either run a new pivt reprt r use the data t cmplete the fllwing template: Type f injury (unless there is knwledge frm incident investigatins f incidents related t lifting) Number Pre-Prgram Year 1 f prgram Year 2 f prgram Ttal Cst Number Ttal Cst Number Ttal Cst Strains/sprains Inflammatin f jints/muscles Ttal If yu knw exactly which f the claims were related t lifting incidents, yu can create anther clumn n yur template t include this, and srt by this infrmatin (rather than the general strains/sprains/ inflammatin infrmatin). This gives yu infrmatin mre specific t incidents knwn t be targeted by the Safe Patient Handling Prgram. Keep in mind the limitatins f this data claims made in later years may nt yet be clsed and present a lwer than accurate estimate f ttal accident csts; this may lead ne t believe the prgram is mre effective than it might be. It may be prudent t fcus n numbers f claims rather than csts if using recent year data. 90 N Unsafe Lift WrkBk sectin 3

93 Fr thse withut experience in the OH&S Leaders Cuncil Benchmarking Prject, the fllwing infrmatin is reprduced with permissin frm the Guidelines 26. Fifth Measure Csts Related t Nature f Injury As mst Healthcare Organizatins must fcus n the bttm line, it is imprtant t identify what types f accidents/incidents are currently psing the greatest financial risk. This enables a business case t be made t intrduce methds t reduce these csts. Csts f incidents by type r by cause are mre difficult t btain, as this requires crss referencing infrmatin prvided by the WCB (Claims summary mnthly) and the rganizatin s wn incident tracking prgram. In additin, it requires maintaining histrical infrmatin abut WCB claims, as the mnthly reprts nly cntain currently active claims infrmatin. In the fllwing chart, a breakdwn f WCB claims by nature f injury (fr Lst Time Claims LTC and fr Medical Aid Claims MA) is prvided with accmpanying csts t date. This will allw management t understand csts and enable the business case t be made fr crrective actin. It als allws the emplyer t identify the mst cmmn and mst cstly injuries t help priritize preventin effrts. 26. OH&S Perfrmance Measures Data Cllectin, Analysis and Reprting Guidelines; GMS & Assciates, N Unsafe Lift WrkBk sectin 3 91

94 LTC LOST TIME r MA NATURE OF INJURY Number f Claims TOTAL COSTS TO DATE LTC Cunt MA MA Cunt Burns Fracture/Dislcatin/Nerve Damage Inflammatins f Jints/Muscles Intracranial Injures Multiple Trauma Injuries Open Wund Oth System Diseases Oth Traumatic Injuries Sprains/Strain Superficial Wunds Abnrmal Symptms/Cnditins Burns Inflammatins f Jints/Muscles Open Wund Oth System Diseases Oth Traumatic Injuries Peripheral Nerve damage/ Carpal Tunnel Sprains/Strain Superficial Wunds Grand Ttal 92 N Unsafe Lift Wrkbk sectin 3

95 Where t Find the Data The WCB n-line reprting system currently ffers a Yearly claims summary that can be requested at any time in a csv (cmma separated values) frmat by emplyers. This can be imprted int an Excel spreadsheet fr manipulatin and reprts can be prduced using the pivt reprt functin in Excel. The abve reprt is an example f a reprt that can be btained this way. It breaks up all claims fr a specific perid as either a Lst Time Claim (LTC) r a Medical Aid nly (MA) claim; further, it prvides the numbers f each type f claim by nature f injury as well as the ttal cst f claims by nature f injury. The Excel template prvided fr this prject can be used when transferring the csv reprt. This is hw it is dne: first, request the emplyer s yearly claims summary in the csv frmat. Save it t yur desktp. Click n the desktp icn fr the saved file and chse t dwnlad it int Excel (NOT text ). Next, nce yu have it, pen it. Highlight all the clumns except fr the first tw (A & B, which are the accunt and industry numbers) and the last ne (R). While in the highlighted area, right click n the muse and press cpy. Next pen the new Excel template prvided and put yur cursr n A 2, right click n the muse, and press paste. Nw yur data is ready t be wrked with. First, rename yur file by selecting Save As under the File Tab. Type in a descriptive Title (e.g. Reprt f WCB csts 2007 incidents) and save the file. Next, under the Data tab n yur Excel Template, select Pivt Table and Pivt Chart Reprt ; The Pivt Table and Pivt Chart Wizard Appears: N Unsafe Lift Wrkbk sectin 3 93

96 Press next. The next default is t include the whle wrksheet as yur selectin, which is what yu want t d: Press next t cntinue; then select the default new wrksheet by pressing Finish. Yur new wrksheet shuld have this sectin in the upper left crner: The Pivt Table Field List appears in a bx n the right hand side. It includes the Clumn headings frm the WCB Excel template. Frm yur Pivt Table Field List, drag the Nature f Injury item and drp it int the left-mst bx ( Drp Rw Fields Here ) smewhere belw A4. Yu will see the nature f injury breakdwns in the first clumn. Next, click n the Ttal Cst t Date item and drag it and drp it int the large Drp Data Items Here Bx; 94 N Unsafe Lift WrkBk sectin 3

97 Ttal csts are nw in the secnd clumn. Third, t see the breakdwn f lst time and n lst time claims, in the Pivt Field list, click n the Lst Time r MA item and drag it t the Drp Clumn Fields Here (place it in B3, right with the Ttal heading) Yur wrksheet nw lks like this (except that it includes all yur cst infrmatin): Next, t create the pivt reprt, we will use a standard pivt reprt frmat. First put yur cursr n any bx in the data field (where yu csts are). Then, g t the pivt table tl bar, which lks like this: and click Pivt Table with the drp dwn bx. Select Frmat Reprt, and chse the sample reprt frmat #2. Click n it, press OKAY and yur data will be summarized as a printable reprt. T make the data even clearer, nce yu have the reprt, highlight the clumn f csts and press the $ sign in the Excel tlbar t express the numbers as csts. The nice thing abut the pivt table is that as yu change r update numbers in the riginal database, they will be updated in the Pivt Tables als. This WCB data can be used as the basis fr many reprts, including capturing the data quarterly in the current year t date infrmatin. N Unsafe Lift WrkBk sectin 3 95

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