Safe Patient Movement and Mobility Improving Outcomes for Patients and Employees. Objectives. Your Presenter. Vision

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1 Presented by: Janice Homola, ARM Senior Consultant Loss Prevention Services Workers Compensation Services Safe Patient Movement and Mobility Improving Outcomes for Patients and Employees Your Presenter Janice Homola, ARM Senior Consultant Loss Prevention Services Workers Compensation Services Coverys Objectives Understand how the environment today impacts mobility and injury Learn the two types of indicators to measure Understand causes of musculoskeletal disorders (MSDs) from providing care Understand possible solutions that can benefit patient and employee outcomes Vision Transfers and mobilization needs to be viewed in a new way, such that both the patient and caregiver remain safe at all times, while achieving quality mobility levels. Safe patient mobility involves a mental and behavioral shift, and takes time to fully embrace. The goal is not to immobilize all patients, but rather, enhance progressive mobility through use of technology. 1

2 The Perfect Storm Aging nurses, aging CNAs, aging patients larger patients, larger caregivers patients with higher acuity levels Caregivers working longer hours Bureau of Labor Statistics, December 16, 2014 IR = Incidence Rate per 10,000 FTEs in private industry. Calculation: No. of injuries & illnesses / total employee hours worked that year x 20,000,000 5 Our Nurses are Hurting 62% of RNs: suffering a disabling MSD is one of their top three safety concerns Taken on August 1, 2014 from ml 80% work despite frequent MSD pain Majority MSDs attributed to overexertion during repeated transfer, repositioning and ambulation Source: ANA s 2011 Health and Safety Survey, taken from the Safe Patient Handling and Mobility Standard ANA. 2

3 Our Nurses are Aging Why Focus on Safe Patient Movement? Eleven state safe patient handling acts ANA Safe Patient Handing Standard Injuries to employees are expensive Injuries to patients can be more expensive Moving patients are creating injuries Injured employees may not provide best care Program improvements can improve employee morale, turnover, patient satisfaction Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013 *Prevalence estimates reflect BRFSS methodological changes started in These estimates should not be compared to prevalence estimates before AK CA OR WA NV ID AZ UT MT WY NM CO ND SD NE TX KS OK MN IA MO AR LA WI IL MS IN TN MI AL KY OH GA WV SC FL PA VA NC NY VT ME NH MA RI CT NJ DE MD DC Left to themselves, injury costs will rise and fall from year to year. The true indication of a reduction in claims is effective interventions with results over the long term. HI GUAM PR 15% <20% 20% <25% 25% <30% 30% <35% 35% Obesity is a body mass index of > 30 Source: CDC,

4 Measure to Move Forward Lagging indicators Are historical Employee injury: OSHA logs, incident reports Benchmark against others, peers 2013: No. of Work-Related Injuries and Illnesses per 100 FTEs in US Hospitals Total recordable cases: 6.4 Cases involving days away from work, job restriction, or transfer: 1.5 Source: BLS, 2013 A Patient Focus Drives Change Lagging indicators Hospitals: Medicare is paying partly on patient satisfaction scores Medicare will not pay for falls, hospital acquired pneumonia, UTIs associated with catheters, and pressure ulcers. Measure and benchmark these outcomes, costs. Measure to Move Forward Leading indicators Are proactive Behaviors that lead to outcomes A culture of continuous improvement Turnover: Went from 30 of 45 positions filled to 1 in 6 months No. of Nurses Aides Replaced Wyandot County Nursing Home Annual Employee Turnover in 45 N.A. Positions Floor lifts added Ambul. lift added Mech beds added Ceiling lifts added 9 1 4

5 Develop Leading Indicators Understand challenges, reasons for at risk behavior - ask, observe Takes too long Too cluttered I m used to doing it this way Change can be scary My patients might not like it Not comfortable with use Change Takes too long to go get Patients need to move equipment Fear Battery is not charged Lift is being used by someone else I don t know how it feels The care of the patient is intimately interwoven with the abilities of the caregiver. Have to leave the room What Causes Back Injuries and Other Musculoskeletal Disorders (MSDs)? 1. A one-time heavy lift 2. Other factors Obesity Heredity Aging Etc. Disc Vertebrae 3. Most strains/sprains are from cumulative damage Ligaments and disks do not contain nerves, so we do not feel minor damage. The 3 Ergonomic Risk Factors Reducing any of these will reduce the potential for injury. 1. Awkward Posture 2. Force (Weight). The Effects of Awkward Posture Repetition (Frequency) 5

6 1. Bending and Reaching Better: Stay Close How do you stay close? Climb on the bed. Risk Factor 2: Force (Weight) What is a safe lift? No more than 35 pounds And Good grip Compact Not often At waist height Close to you No twisting No matter how much we try to lift properly, we are (no longer) superheroes. Combining Weight and Distance Risk Factor 3: Repetition Performing the same motion or series of motions continually or frequently. Source: DOL, Ergonomics for the Prevention of Musculoskeletal Disorders: Guidelines for Nursing Homes,

7 Factor 3. Repetition Step-down telemetry unit, 2 nd shift Ave. # of patients: 5-6 Ave. # of dependent patients: 3-5 Ave. # of lifts per depend. patient: 8 1. Reposition in bed 2. Turn on side to change sheets 3. Turn on side to change depends 4. From bed to cardiac chair (CNA) 5. From bed or chair to toilet/commode 6. From toilet/commode to chair or bed 7. Cardiac chair to bed (to rest/greet) 8. Reposition in bed. Total daily lifting & transferring of 3-5 dependent patents: If with a 2 nd person = lifts Push-Pull and Rotating Forces For a dependent 128 lb. and 170 lb. patient Rotating a patient from supine to sitting position on edge of bed exceeds the NIOSH criterion limit. Sling placement does not exceed NIOSH criterion limit (Note: Push away is better than pull towards) Study: Zhuang, Z., et al. Biomechanical Evaluation of Assistive Devices for Transferring Residents. Gait Belts Gait belts are for guiding, not manual lifting Gait belts provide a better grip, but: - Require use of elbows and shoulders - Place caregiver further away from patient, increase force - Slide up and result in patient bruises A gait belt is not a lifting device. Arun Garg,PhD, CPE Lifting with gait belts can shoulder pain and injury Reducing Falls When used in the falls prevention program, planned toileting with a lift can aid the patient in safe toileting rather than middle of the night falls. All high risk fall patients should stand/walk using equipment as the fall back up, not a caregiver. 7

8 The Sliding Patient The 30 bed angle reduces ventilator associated pneumonia, the risk of aspirating gastric content Moving bed to 45 increases patient migration 5-11 Increases friction and shearing Creates kyphosis, reduces deep breathing Prevention Methods Use knee gatch prior to raising bed Special mattresses and bedframes Source: Wiggerman, Neal PhD. The American Nurse Today. The Sliding Patient: How to Respond and Prevent Migration in Bed. Sept What We Want to Prevent 1. Manually lifting patients 2. Using incontinence pads to reposition 3. Using gait belts to lift 4. Lifting from under the patient s arms 5. Lifting a patient out of a geri-chair 6. Lifting from the floor 7. Lifting a patient to toilet, lift to wipe Enable Better Care 1. Use lifts and slings to turn dependent patients more frequently, prevent bedsores 2. Use sit-to-stands and walking slings for medium to high fall risk patients encourage weight bearing, prevent pneumonia, reduce falls 3. Use the bed to reduce bending 4. Use slippery sheets to reposition 5. Use lifts/slings to turn and clean patients 6. Use a lift to get a patient from the floor 7. Use lifts to assist from geri-chairs When the patient is up out of the bed, standing safely in a lift, deep breathing assists in decreasing pneumonia risk. 8

9 UTIs associated with catheterization In the bariatric patient (specifically) UTIs are usually a result of an inadequate sterile field while catheterizing the patient. A lift assists in mobility, holding legs while the caregiver does the catheterization Caring for a Patient on a Ventilator Residents on ventilators are at high risk for developing pressure ulcers, due to immobility and decreased tissue perfusion. Medical Intensive Care Unit Nursing on July 25, 2010 These patients need repeated, continuous mobility. It would be difficult if not impossible to safely conduct manual log rolls (turning) of these patients every two hours without the use of a lift. Pressure Ulcers Prevent through consistent turning with the use of ceiling lifts and repositioning slings, straps - Turn and position bed-bound clients every 2 hours if consistent with overall care goals. - Reposition chair- or wheelchair-bound clients on their own, every 15 min. with assistance, every hour Regular standing with a lift Use of slide sheets to reposition, 30 degree side lying positions Repositioning and Turning Mayo Clinic. Taken October 14,

10 Repositioning sheets Must be slippery! No log-rolling needed Immediately available near patient care zone Patient weight has little effect on the amount of spine loading due to low level of friction. Ceiling Lifts Source: Marras, et. al. Lumbar Spine Forces during Maneuvering of Ceiling-based and Floor-based Patient Transfer Devices. Ergonomics, 2009 Semi - Portable Ceiling Lifts Radiology Maxi Sky

11 Do Floor Lifts Reduce Lifting to Safe Levels? Capable of producing excessive loads on the lumbar spine, especially during patient turns 1 Friction Reducers Exceeds lower threshold for disc damage for some of the population even with large wheel, hard surface, and straight push 1 Turning dramatically increases Anterior/Posterior shear loading 1 Floor-based provide a benefit over manual patient lifting 1 Use of two caregivers does not compensate for the poorer performance of floor lifts 2 1. Marras, et. al. Lumbar Spine Forces during Maneuvering of Ceiling-based and Floor-based Patient Transfer Devices. Ergonomics, Dutta, et. al. A Biomechanical Assessment of Floor and Overhead Lifts Using One or Two Caregivers for Patient Transfers. Applied Ergonomics, May Fast Beds Fast beds reduced our turnover more than all the other equipment combined. - Joe Jolliff, Retired Nursing Home Administrator Lateral Transfers for Fragile Skin Barton Transfer Chair by Hill-Rom Motorized Stretch Chair by Transmotion Medical 11

12 High Fall Risk? Scenario One Scenario Two Scenario Three Full Lifts Equipment, not the back, needs to catch a patient if they fall. Slings Sit to Stands 12

13 Ambulation: Walking Vests Full or Ceiling Lift Sling Types Hospital Bed, Stretcher, and Wheelchair Movers Bariatric Care 13

14 Electric Transport Chair Basic, Bariatric Shower Chairs Arms move Caregiver grip means you can keep wrists straight Wheels are small Determine Adequate Technology Patient population: determine number and location on each unit: 1. Bariatric- number and location 2. Fully dependent 3. Partially to mostly dependent, but need mobility 4. Special needs: high fall risk, pain sensitive, amputee, other Once you know how many meet your criteria, you can determine your needs Job Hazard Assessment - Representative sample from each type, shift - Measures improvement How Much Lift Equipment Is Needed? What is your organization s goal? Goal: minimize manual lifting of patients by nurses and other direct patient care ; workers by using safe patient handling equipment. - MN Safe Patient Handling Act the acquisition of an adequate supply of appropriate safe patient handling equipment 14

15 1/15/2015 Equipment Recommendations Patient Movement Injury by Activity ; Success Requires Is Your Lift Equipment Available? Involvement at all levels Overcoming barriers Investments in time and money Evidence of effectiveness and cost benefits of interventions Continuous improvement 15

16 Safe Patient Handling and Mobility Standards 1. Establish a culture of safety 2. Implement and sustain a SPHM program 3. Implement ergonomic design principles 4. Select Install, and maintain SPHM equipment 5. Establish system for education, competence 6. Establish assessment guidelines and plan of care 7. Include use of equipment in reasonable accommodation and return to work. 8. Establish a comprehensive evaluation system Your challenge: Enlarge the scope to include employees and patients It is not right to sacrifice unnecessarily the backs of our caregivers to help others get well. It is a fixable problem. - Joe Joliffe, Retired Administrator 16