Elements of a Successful Patient Handling & Movement Program:

Why and How

Dana Root, MS, PT, CPE, CSPHPRoot.dana@dol.gov414.297.3315

Why? • Risks which could potentially

cause musculoskeletal injury:– Force

• Lifting own body weight plus patient’s weight

– Awkward posture• Prolonged forward bending• Twisting• Holding a position• Tight or awkward locations

– space restrictions

Why? – Repetition

• Number of transfers per shift• Number of repositionings per shift• Helping other staff with their patient

– Duration• Length of shift

– overtime• Shifts per week• Longevity in profession

Why? 1. Transfer from toilet to chair2. Transfer from chair to toilet3. Transfer from chair to bed4. Transfer from bed to chair5. Transfer from bathtub to chair6. Weighing patient7. Lift patient up in bed8. Reposition patient from side to side in bed9. Reposition patient in chair10. Change absorbent pad11. Make bed with patient in it12. Undress patient13. Feed bed ridden patient

– The resident/patient is not a box• Difficult to keep the load close because the load is a

person• There are varied body sizes & shapes and the

“handles” don’t always stay put• End result – more likely to have greater stresses the

shoulder & spine– NIOSH recommends for most patient lifting

tasks:• maximum weight limit is 35 pounds under IDEAL

lifting conditions– Using good body mechanics to protect the

back is a myth!

Why?

Why?Healthcare Provider Safety

Manual lifting of residents be minimized in all cases and eliminated when feasible

The Process:– Evaluate Injury and Illness costs

• Obtain funding– Establish a lifting committee– Resident/Family notification– Training– Coordination with all staff– Evaluate & select equipment

• Receive and prep equipment– Resident assessment– Enforcement– Performance measurement

How to Establish a SPH Handling Program?

How: The Program

For success, required

infrastructure MUST be in place prior to

implementing SPHM Program

http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp

RHIR & RHSR for Past Three Years

• Resident Handling Incident Rate

= # OF RH CASES WITH DAYS AWAY FROM WORK JOB TRANSFER DAYS OR RESTRICTED DAYS x 200,000 Resident Handling Hours worked

• Resident Handling Severity Rate

= (DAYS AWAY FROM WORK + ON JOB TRANSFER DAYS OR RESTRICTED DAYS) x 200,000 Resident Handling Hours worked

• MSD days away rate: 9.6 for 20109

The Process: Champions

• Management commitment– Quality assurance

• Competent in equipment usage• Enforcement/discipline of facility policy and

procedures• Employee involvement

– The REAL Champions for the process

• Establish a Lifting Committee– Select outgoing CNAs– Meet weekly– Food, fun & praise– Leader

• Has budget authority• Motivator

The Process: Champions

The Process: Policy & Notification

• Admission policy statement– Resident right issues: use of equipment

depending on functional abilities• Resident’s Council

– Notify residents of change• Deal with resident refusals

– Notify family of change• Introduce new equipment and use

The Process: Training

• One-on-one training for each employee• Employees competency checked on

each piece of equipment• Competency check signed off by aide• Not use equipment until competency

checked• Discipline for not using lift properly or at

all

The Process: Staff Coordination

• Maintenance– Preventive maintenance schedule

• Wheels, etc.• Battery charge

• Laundry– Sling inspection & cleaning– Infection control

• Rehab staff– Need to be trained on use of equipment

• Lifts require use of resident’s muscles• How can use in treatment goals

The Process: Equipment

• Evaluate– Hold vendor open houses

• Try out different equipment– CNAs test equipment

• Provide feedback• Consider types of devices

– Overhead– Floor based total lift– Lateral assist– Sit to stand– Slide sheet

• Select for resident population• Facility constraints

• Evaluate Type of Slings–Seated–Supine–Standing–Ambulation–Position Support

The Process: Equipment

• Get feedback evaluations from CNAs– Equipment– Slings

• Decision meeting with Lifting Committee

• Get budget approval and purchase• Set date for initiation of program

The Process: Equipment

• Right number of lifts • Appropriate locations

– Lifts need to be easily available to CNA– With sling– Battery storage

The Process: Equipment

• Copy manufacturer instructions, laminate, and attach to equipment

• Attach a warning sign that each lift and sling must be checked prior to use

• Develop competency checklist on use of equipment

• Who will charge the battery?

The Process: Equipment

The Process: Resident Assessment

• Type of equipment – Resident needs– Staff safety

• Manual lifting of residents be minimized in all cases and eliminated when feasible

• Develop assessment sheet– Algorithms– MDS

• ADL self assessment• ADL support provided

– FIMS• Communication

• Functional Independence Measure (FIM)– 7 level functional assessment scale of resident's actual

performance• Evaluates the amount of assistance required to perform

basic life activities• Need for assistance from another person or a device• Measures what the resident actually does

Independent7 Complete Independence8 Modified independence – requires assistive device, …..

Modified Dependence – resident expends 50% or more of the effort

9 Supervision (setup) – without physical contact by helper, or applies assistive device

4 Minimal Contact Assistance – resident expends 75% of effort3 Moderate Assistance – resident expends between 50% to 75% effort2 Maximal Assistance – resident expends between 25% to 50% of effort1 Total Assistance – resident expends less that 25% of effort

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Fresh Eyes: Resident Assessment

• Floor surfaces– Ramps– Carpet

transitions– Wet

• Equipment storage• Battery charging

• Size and configuration– Resident room– Bathroom – Shower room – Clutter

The Process: Workplace Assessment

The Process: Enforcement

• Policed by Lifting Committee members– Empowered to recommend suspensions– # of days suspension

• Pick suspension days for best use of facility resources

• Less impact on employee's paycheck

Resource Guides

http://www.visn8.med.va.gov/patientsafetycenter/safePtHandling/default.asp

http://www.cdc.gov/niosh/topics/ergonomics/

http://www.aohp.org/About/documents/GSBeyond.pdf www.osha.gov/SLTCergonom

ics/index.html