Safe patient handling solutions

Safe patient handling solutions Simple Interventions. Extraordinary Outcomes.

How do we stop nurses from becoming patients? Nursing professionals incur more musculoskeletal (MSK) injuries/ nonfatal injuries on the job than any other occupation. 1 Nurses and nursing assistants are more likely to get injured on the job than any other occupation more than construction, manufacturing, transportation and warehouse employees. 1 The most common tasks that lead to injury are patient: 2 lifting transferring repositioning It s a costly problem n $15,800 Average compensation claim due to patient handling 3 n $37,000 Average direct costs associated with an occupational back injury of healthcare provider 4 n $27,000 to $103,000 Cost of nurse turnover 5 that may get worse n Patient obesity levels are increasing n Average age of nurses continues to rise 6 n Estimates project 260,000 unfilled nursing jobs by 2025 6 Who takes care of patients when healthcare workers are injured on the job? Many healthcare workers leave the profession early due to debilitating arm, back and shoulder injuries. More nurses are worried about getting a back injury than contracting an infectious disease. 7 And for good reason: n 56% of nurses reported shoulder, back, neck, or arm pain at work 7 n 80% continued to work despite having MSK pain 7 n 13.3 days of work are missed (on average) by healthcare workers due to overexertion in lifting/lowering patient 1 REFERENCES: 1. U.S. Bureau of Labor Statistics, www.bls.gov/news.release/osh3.nro.htm accessed March, 12, 2015. 2. Safe Patient Handling and Mobility: Interprofessional National Standards Across the Care Continuum. American Nursing Association, 2013. 3. AON Risk Solutions. Health Care Workers Compensation Barometer. December 2014. 4. AORN Position Statement on Workplace Safety. Dec 2009, reviewed March 2014. Available at: https://www.aorn.org/uploadedfiles/main_navigation/clinical_practice/toolkits/posstat%20workplace%20safety.pdf Accessed October 15, 2015. 5. Occupational Safety and Health Administration (OSHA) Safe Patient Handling Programs: Effectiveness and Cost Savings. Available at: https://www.osha.gov/publications/osha3279.pdf Accessed October 15, 2015. 6. Buerhaus, PI, Auerbach, DI, Staiger, The Recent Surge In Nurse Employment: Causes and Implications, Health Affairs July/August 2009 vol. 28 no. 4 w657-w668. 7. ANA Health and Safety Survey. American Nurses Association, 2011. 8. Occupational Safety and Health Administration (OSHA) Safe Patient Handling: Busting the Myths, Caring for our Caregivers Brochure. Available at https://www.osha.gov/dsg/hospitals/documents/3.1_mythbusters_508.pdf. Accessed October 15, 2015. 9. DuBose J, Donahue T, Taking the pain out of patient handling, American Nurse Today, December 2006;37-43. 10. Occupational Safety and Health Administration (OSHA) Safe Patient Handling: Safety and Health Topics. Available at https://www.osha.gov/sltc/healthcarefacilities/safepatienthandling.html. Accessed October 15, 2015. 11. Centers for Disease Control and Prevention. Occupational Traumatic Injuries Among Workers in Health Care Facilities United States, 2012-2014. MMWR 2015:64(15);405-410. 12. Association of perioperative Registered Nurses (AORN) Pocket Reference Guide: Safe Patient Handling and Movement in the Perioperative Setting. AORN Toolkit. 2014. 13. Occupational Safety and Health Administration (OSHA), Guidelines for nursing homes: ergonomics for the prevention of musculoskeletal disorders, 2009:13. 14. Pedersen J, Bill B, Call E, In vitro Measurement of the Impact of Transfer and Positioning Devices on Microclimate when Left in Place Following Use. Poster presented at SAWC 2013. 1 www.sageproducts.com

How is your hospital addressing safe patient handling? There is no such thing as safe manual lifting of patients, regardless of body mechanics. 8 n 30+ years of research and experience show this is not an effective way to reduce back and other MSK injuries. 8 n During an 8 hour shift, nurses can lift a cumulative weight of up to 1.8 tons! 9 n MSK injuries are often the result of repeated manual patient handling activities, such as transferring and repositioning patients. 10 Hospitals are investing in equipment but healthcare workers are still getting injured 82% of healthcare workers who sustained an MSK did not use facility lifting equipment. 11 Why aren t nursing staff using lifting equipment? In most cases, the equipment is not easily accessible it may be located away from patient care areas, moved to another floor, unavailable while being reprocessed, or worse yet, locked away in a closet. 11 states have already enacted Safe Patient Handling Laws Nurses can lift a cumulative weight of up to 1.8 TONS during an 8hr shift GUIDELINES & RECOMMENDATIONS American Nurses Association (ANA) 2 Safe Patient Handling and Mobility (SPHM) Interprofessional National Standards Across the Care Continuum 2.1.7 Reduce the physical requirements of high-risk tasks. The organization will focus on reducing the physical requirements of high-risk healthcare recipient transfer, repositioning, and mobilization, and other applicable tasks through engineering, safe work practice, and/or administrative controls. 4.1.5 Provide and strategically place SPHM technology for accessibility. The organization will develop a process for providing SPHM technology that ensures ease in accessibility. The quantity and type of SPHM technology will be sufficient to minimize risk for the healthcare recipient population served and the environment of care. AORN 12 Principles of the ANA Standards for SPHM, include: n Establish a culture of safety. n Implement and sustain a SPHM program. n Select, install and maintain SPHM technology. n Integrate patient- centered SPHM assessment, plan of care, and use of SPHM technology. n Create a systemized proactive approach that includes prevention considerations in all designs that affect individuals in the occupational environment. n Provide assistive tools at the point of care to facilitate SPHM.... Task Recommendations: n General lateral transfer Use lateral transfer device and 4 caregivers Destination surface should be slightly lower n Supine Anesthesiologist supports head and neck Weight < 157 lb Use lateral transfer device and 4 caregivers Weight > 157 lb Use mechanical lift with supine sling, mechanical lateral transfer device, or air-assisted lateral transfer device and 3 to 4 caregivers... OHSA 13 Lateral Transfer to and from: Bed to Stretcher, Trolley For patients who are partially able or unable to assist: If patient is <100 pounds: Use a lateral sliding aid and 2 caregivers. If patient is 100-200 pounds: Use a lateral sliding aid - or- a friction reducing device and 2 caregivers. If patient is >200 pounds: Use a lateral sliding aid and 3 caregivers - or- a friction- reducing device or lateral transfer device and 2 caregivers -or- a mechanical lateral transfer device.

Now is the time to implement a safe patient handling program utilizing equipment with proven results Sage Products provides a complete line of safe patient handling solutions for the entire continuum of care, from admittance through recovery, with clinically proven results. Sage s Prevalon solutions Liftaem, TAP, and SPS are designed to stay with the patient at the bedside for convenience and accessibility when needed, further promoting the use of SPHM equipment. Our solutions promote safety for staff and patients, and help reduce associated costs from healthcare workplace injuries. Prevalon Liftaem Mobile Patient Transfer System Safely and easily transfer patients n Helps reduce the risk of staff injury during patient transfers n Provides a safe and comfortable transfer experience for patients n Easy to use in a variety of care settings Prevalon Turn and Position System (TAP) Promotes safe patient handling n The only device proven compatible with all low air loss mattresses 14 n Helps staff more easily follow best practice prevention guidelines n Reduces exertion needed to turn and boost patients n Decreases strain on staff s hands, wrists, shoulders, and backs Prevalon Seated Positioning System (SPS) Glide patients without lifting n Secures patient to minimize the need for repetitive boosting and repositioning n Promotes proper ergonomics to improve posture and body mechanics n Designed to improve compliance to the seated position 800-323-2220 3

Disclosures: Program upon which results are based was created and implemented independently by SwedishAmerican Hospital. Poster to summarize program and results was written in collaboration with Sage Products, LLC and funded by Sage Products, LLC. References: 1. Occupational Safety and Health Administration. Caring for our Caregivers. Facts About Hospital Worker Safety. Available at: https://www.osha.gov/dsg/hospitals/documents/1.2_factbook_508.pdf. 2. Bureau of Labor Statistics. Case and Demographic Incidence Rates. Accessed March 30, 2015. 3. Aon Risk Solutions. 2012. 2012 Health Care Workers Compensation Barometer. 23100 1 Usage based on ordering history provided by manufacturer. November and December 2012 are based on usage rates for January and February 2013. November and December 2014 are based on usage from January 2014 through October 2014. 2Collected and provided by hospital. PROVEN RESULTS: Presented at the 2015 Safe Patient Handling and Mobility Conference, April 20-24, Glendale, AZ Reducing Healthcare Worker Injury: The Establishment, Implementation, and Results of an Evidenced-Based Protocol for Lateral Patient Transfer Ruth E. Chance, BSN, RN a, Karen K. Giuliano, PhD, RN b a Swedish American Hospital, Rockford, IL; b Sage Products LLC, Cary IL Prevalon Liftaem Mobile Patient Transfer System BACKGROUND According to the 2013 Bureau of Labor statistics, US hospitals recorded 58,860 work-related injuries and illnesses that caused employees to miss work in 2011, with nearly half of these injuries were caused by over-exertion. Hospitals are among the most hazardous places to work with 253,700 reported healthcare worker injuries (HCWIs) in 2011. 1 The incidence of non-fatal occupational injuries in HCWs was 6.8 per 100 full-time employees compared with 3.5 per 200 in all US industries combined. 2 The number of work-related injuries among HCWs surpasses injury rates in construction and manufacturing. 2 The average worker s compensation claim ranged from $15,860 to $22,300 per injury. 2 The average hospital incurs $0.78 in losses due to workers compensation claims for every $100 of payroll, equivalent to a total national annual cost of $2 billion. 1 Recommendations to reduce HCWIs include appropriate use of equipment, 4% 1% minimal-lift policies and patient assessment tools, and training 9% on proper use of equipment. 3 Overexertion and bodily 13% reaction 48% Slips, trips, and falls Contact with objects 25% Violence Exposure to substances All other causes OBJECTIVE To evaluate the impact of implementation of patient safe-handling protocols and a lateral patient transfer device on HCWI rates METHODS The study was conducted at SwedishAmerican Hospital, a 333-bed, full-service, hospital located in Rockford, IL. Evidence-based procedures were written to address safe patient handling, with these procedures implemented in all clinical units. The procedures addressed appropriate methods and equipment to meet needs to improve the safety of patients and HCWs during lateral patient transfers. The new lateral transfer procedures were incorporated into the policy and equipment guidelines of the hospital and disseminated to staff though education programs supplemented by written and verbal communications. Approximately 1,500 staff received training on the proper use of a lateral transfer device. Each employee was required to successfully complete a competency assessment to evaluate their knowledge and skills for appropriate use of the patient transfer device. HCWI rates were monitored following implementation of the evidence-based procedures and the lateral transfer device. Figure 1. Monthly HCWI rate prior to implementation of intervention to reduce injuries associated with patient lateral transfers RESULTS Healthcare worker injuries were summarized for 2011 and 2012 to establish a pre-intervention injury rate. The total number of HCWIs in 2011 was 41, with 37 HCWIs occurring in 2012 prior to implementation of the intervention of.the lateral transfer device in January 2013. The rate of HCWIs declined to 10 in 2013 and 8 in 2014, for an overall reduction in injuries of 76.9% (Figure 2). The average number of HCWIs declined to 0.83 in 2013 and 0.67 in 2014 (Table 1). Figure 2. Comparison of monthly HCWI rates pre- and post-implementation of evidence-based protocol and lateral patient transfer device Table 1. Comparison of monthly HCWI rate by frequency of use for the lateral patient transfer device Device Usage 1 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Quantity Used 2011 NA NA NA NA NA NA NA NA NA NA NA NA Quantity Used 2012 NA NA NA NA NA NA NA NA NA NA 153 153 Quantity Used 2013 190 110 200 120 170 140 170 140 150 150 140 160 Quantity Used 2014 200 120 130 170 130 150 300 80 160 180 164 164 Number HCWIs 2011 4 2 10 3 5 2 1 3 1 4 1 5 2012 3 1 7 3 3 2 5 4 3 4 1 1 2013 1 1 1 0 0 1 1 0 4 0 1 0 2014 0 0 1 0 0 3 0 2 0 0 0 2 DISCUSSION This study demonstrates the effect of an evidence-based educational The three injuries in June 2014 were due to: intervention and use of a device to assist with lateral patient transfers Two employees were injured when a patient lost their balance while on rates of HCWIs at a single institution. being weighed. Utilization of the device was maintained at a fairly consistent rate in 2013 One employee was shifting the patient s position on the table. and 2014, following implementation of the device in January 2013. Comments from hospital staff provide anecdotal support for the There were two notable spikes in HCWI rates in September 2013 (n=4) intervention, with employees commenting that it was easier and June 2014 (n=3). to move patients laterally from one surface to another. Hospital analysis of these injuries revealed that the September 2013 These results support that an institutional intervention based on staff injuries were due to: education, adherence to evidence-based protocols, and use of a One employee did not request assistance or use the lateral transfer lateral patient transfer device resulted in a clinically device when moving a patient. reduction in HCWIs. One employee did not take time to use the lateral transfer device, Additional research is suggested to determine the unique contributions although it was readily available in the patient s room. of each component of the intervention to the overall reduction in HCWIs. One employee was injured when a patient lost their balance while being weighed. One employee was providing care in a home setting and did not have access to the device or assistance from colleagues to move the patient. 77% reduction in healthcare worker injuries 1 Prevalon Turn and Position System (TAP) 58% reduction in employee injury 2 = $247,500 savings professional practice Prevalon Seated Positioning System (SPS) Repositioning Patients in Chairs An Improved Method by Guy Fragala, PhD, PE, CSP, CSPHP, and Maren Fragala, PhD, CSCSD Proper seated posture is important in health care settings because immobilized patients may be sitting for extended periods. In many situations, a caregiver is required to assist a slouching patient to a proper, more comfortable upright posture. The caregiver is at risk from exposure to the physical demands of this task. This study evaluated exertion and risk to the caregiver using three methods of repositioning patients in chairs in the health care setting. Through application of a new method employing an ergonomically designed device, exertion and risk were reduced. Results from this study indicate that the highrisk occupational activity of repositioning a slouching patient in a chair can be made safer for caregivers. [Workplace Health Saf 2013;61(4):141-144.] M aintaining proper sitting posture is important in health care settings because immobilized patients may be sitting for extended periods. The seated position is often more desirable than lying in bed because it can enhance healing and rehabilitation processes (Kleinpell, Fletcher, & Jennings, 2008; Powers, 2011). However, poor seated posture can not only lead to discomfort and pain but also result in digestive and respiratory problems ABOUT THE AUTHORS Dr. G. Fragala is Senior Advisor for Ergonomics, Patient Safety Center of Inquiry, The Villages, FL. Dr. M. Fragala is Assistant Professor, University of Central Florida, Sport and Exercise Science, Orlando, FL. The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank Julie Chirchirillo, RN, Clinical Educator, Intermediate Care Units, and Andrea Klosinski, RN, BSN, Cardiac Telemetry Unit, Rockford Memorial Hospital, Rockford, Illinois, for their help and support related to conducting this study in a clinical setting. E-mail: guyfragala@comcast.net. doi:10.3928/21650799-20130327-16 (Bauman et al., 2011; Markus, 2009; Sherwood, 2011; Watanabe, Eguchi, Kobara, & Ishida, 2008). Often, when seated, a patient may slide down in the seat of a chair to a slouching position because of chair design and the patient s compromised physical condition. The seated position places pressure on the ischial tuberosities from the patient s body weight. Because this area of the body is relatively small and the amount of pressure can increase with poor posture, a pressure ulcer can develop. Poor seated posture also makes the sacral region more prone to pressure ulcers (Katz & Kirr, 2012; Melter, 2011). For patients with existing pressure ulcers on the ischial or sacral areas, proper posture while sitting in a chair is essential to prevent further skin breakdown. Patients must be closely monitored so they maintain appropriate posture that will not aggravate existing pressure wounds (Wound, Ostomy, and Continence Nurses Society, 2010). Self-repositioning from a slouching posture to a proper upright seated position may not be possible for a physically limited patient. Hence, chair-bound patients must be repositioned with the assistance of a caregiver if they fall into a slouching posture to maintain comfort and avoid health risks such as pressure ulcers. However, when a caregiver is required to assist a slouching patient to a proper, more comfortable upright posture, the caregiver is at risk due to the physical demands of this task. Because of the weight of the patient and the posture the caregiver must assume to pull the patient up in the chair, forces on the musculoskeletal structure of the caregiver are beyond body tolerance; strain and sprain type injuries can result. Direct care providers continue to be one of the occupational groups most at risk for musculoskeletal injuries (Engkvist, Hagberg, Lindén, & Malker, 1992; Harber et al., 1985; Hedge, 2009; Hignett, 1996; Jensen, Nestor, Myers, & Rattiner, 1988; Khuder, Schaub, Bisesi, & Krabill, 1999; Ljungberg, Kilbom, & Hägg, 1989; Nelson, Fragala, & Menzel, 2003; Pheasant & Stubbs, 1992). The task of pulling a patient from a slouching position to a more desirable posture is one of the activities contributing to this high risk for occupational injuries. To date, repositioning solutions have been sparse. However, the field WORKPLACE HEALTH & SAFETY VOL. 61, NO. 4, 2013 141 Overall exertion was reduced 127% 166% less exertion in the lower back while repositioning a slouching patient 3 REFERENCES: 1.Chance RE, Giuliano KK, Reducing Healthcare Worker Injury: The Establishment, Implementation, and Results of an Evidenced-Based Protocol for Lateral Patient Transfer. Poster presented at the 2015 Safe Patient Handling and Mobility Conference, April 20-24, Glendale, AZ. 2.Way, H, Safe Patient Handling Initiative Results in Reduction in Injuries and Improved Patient Outcomes for Pressure Ulcer Prevention. Poster presented at 2014 Safe Patient Handling East Conference, March 27, 2014. 3. Fragala G, Fragala M, Repositioning Patients in Chairs An Improved Method, Workplace Health & Safety, 2013;61(4):141-4.

Simple Interventions. Extraordinary Outcomes. At Sage Products, we believe that evidence-based interventions lead to improved outcomes. Our market-leading products solve real problems in the healthcare industry and are backed by proven clinical evidence. We develop and manufacture these products to make it easier for you to deliver essential patient care, while helping to prevent infections, skin breakdown and staff injury. Help reduce the risk of heel pressure ulcers by continuously offloading the heel with Prevalon Heel Protector Provide comprehensive oral care with Q Care Oral Cleansing and Suctioning Systems Help reduce SSIs by addressing multidrug resistant organisms on your patient s skin prior to surgery with 2% Chlorhexidine Gluconate Cloth Comfort Bath Cleansing Washcloths eliminate the contamination risk from bath basins Comfort Shield Barrier Cream Cloths help clean, treat and protect your patient s skin after an incontinent episode Standardize patient hygiene protocol with a clean technique using M-Care Meatal Cleansing Cloths for the Foley Catheterized Patient Help your patients comfortably transition from hospital to home. The same quality Sage products you trust in your facility are available for family caregivers and patients after they leave your care. Receive more information at: www.shopsageproducts.com/htoh or call 800.323.2220 Sage Products LLC 3909 Three Oaks Road Cary, Illinois 60013 www.sageproducts.com 800.323.2220 23415 Sage Products LLC 2015