Educational Design (Day Three) Safe Patient Handling and Mobility Conference, Orlando, FL April 16-20, 2018

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1 Educational Design (Day Three) Safe Patient Handling and Mobility Conference, Orlando, FL April 16-20, 2018 Guy Fragala Objectives (Learner Outcomes in completion learner will be able to: Subject Matter (Topic Outline & Content As It Corresponds to the Objectives 2-3 examples for each References (3-5 evidencebased When Over 1,200 RNs Talk: Why We Should Listen! Field Results and Lessons Learned from SPHM Audits of 50 Hospitals Representing Over 12,000 Beds and Over 1,200 Nurses Wilson, Wawzyniecki, Fragala Insights from over 1200 RN s in 50 hospitals along with other SPHM assessment data will be presented in the first half of this session. Practical recommendations for attendees to consider implementing based on evidence from these audits will then be presented. Other summary data will include findings about the work environment, equipment levels and accessibility, injury data and W/C costs as well as tasks that contribute to the most injuries and where these injuries are occurring most often. Methods to prioritize and implement solutions to close program gaps, based on the audit findings will be presented, as well as the value, necessity and required elements of program audits. 1. Acquire a greater understanding of how to analyze and utilize auditing results to help prioritize suggested intervention strategies. 2. Dispel false assumptions about the SPHM programs by using hard data points to manage leadership s expectations. 3. Identify why it is necessary to examine the leading indicators of Activity Measures and Compliance Measures to insure successful Outcome Measures. 4. Clarify the connection between a comprehensive policy and accountability at all levels of management using the data findings. 1a. Purpose and goals of program audit. 1b. Compare/contrast methodology for conducting an audit: electronic surveys, live interviews, in-house or outside consultant. 1c. Basic and advanced elements needed for valid audit results. 2a. Employee practices on the unit as reported by interviewed staff provides the details not readily available from other methods of observation. 2b. Environmental conditions affecting compliance. 2c. Equipment types and inventory affecting utilization. 3a. Definition and value of Activity, Compliance and Outcome measures. 3b. How-to for building an assessment protocol. 3c. Gap analysis. 3d. Conclusions and program improvement plan. 3e. Recommendations for targeted, specific solutions to improve program results (compliance, policy, environment, injury reporting). 4a. Crucial discussions and presentations for effective comprehension and follow-up actions by SPHM coordinator and senior leaders. 5. Overview of audit findings from over 1,200 Nurse interviews and program audits conducted in U.S. 5a. Employee interview results on use of equipment, knowledge of policy & protocols, history of on-the-job injury or pain. 5b. Injury causes(tasks), costs and most frequent locations/departments where injuries are occurring. 5c. Environmental circumstances affecting compliance. 6. Value of program audits. 6a. Increase compliance 6b. Goals and purpose of an audit. 6c. Regulatory agencies and other professional associations that recommend periodic assessments. 6d. Improvements/successes following effective follow-up from audits. 7. Identify the key components and methods of effective audits. 7a. Compare/contrast methodology for conducting an audit: electronic surveys, live interviews, in-house or outside consultant. 7b. Basic elements needed for valid audit results. 7c. Additional, indepth elements for a more detailed assessment. 8. Analysis and prioritization of audit findings. 8a. Methods to sort and present data for effective comprehension and action by SPHM coordinator, committees and leaders. 8b. Recommendations for targeted, specific solutions to improve program results (compliance, policy, environment, injury reporting) Advanced (3) PowerPoint 1. American Nurses Association. (2013). Safe patient handling and mobility interprofessional national standards across the care continuum. Silver Spring MD: Author. 2. OSHA. OSHA Safety and Health Program Management Guidelines. Available at: Washington, DC: Author. 3. The Joint Commission. (2013). Highreliability health care: getting there from here. Mark Chassin & Jerod Loeb.The Milbank Quarterly, 91(3), ). Available at:

2 Call Don t Fall: Implement a Culture of Safety and Cost Benefit Savings in Your Fall Reduction Initiatives Haupt, Salazar Falls and related injury continue to be a challenge for healthcare teams. Annually in the United States there are over 800,000 hospital falls. The monetary cost of falls estimated for Medicare alone totaled over 31 billion dollars. A single fall with a related injury is estimated to cost a facility over $30,000 dollars. It is important to identify gaps and conduct root cause analysis and system re-improvements related to trends occurring in the units or with individual patients. Interprofessional teams are focusing not only on the cost savings but the many physiological and psychological effects on patients and families associated with the fall. 1. Identify the impacts of falls and why they occur within our organizations. 2. Describe challenges and barriers in promoting falls initiatives for patients and staff. 3. Discuss best practices and successes in creating a fall program focused on a culture of patient safety. 1. Cost, lost days of work, psychological. 2. Hard to convert the costs in to real-time understanding of why the fall occurs, making people understand the importance of the initiative within and without the organization, the psychological issues when practitioners start worrying about falls and cause other issues. 3. Examples of programs and people that have been successful on a personal and/or organizational level in decreasing or ending falls through collaboration and program promotion. (4) PowerPoint and Lecture 1. Burns, E. B., Stevens, J. A., & Lee, R. L. (2016). The direct costs of fatal and non-fatal falls among older adults--united States. J Safety Res, Centers for Diseaase Control and Prevention, National Center for Injury Prevention and Control. (2016). Web-- based Injury Statistics Query and Reporting System (WISQUARS). Accessed August 5, Willy, B., Osterberg, C., (2014). Strategies for reducing falls in long-term care. Annals of Long-Term Care: Clinical Care and Aging, 22(1), Innovative Strategies in Developing a Cutting Edge SPHM Program Part 1 Young, Capan, Szymczak, House This presentation will explore unique and innovative strategies that will propel SPHM initiatives to the forefront and create a cutting edge SPHM program. Useful, realistic, efficient and cost effective approaches which include: system wide inclusion and interdisciplinary collaboration from clinical and non-clinical staff, incentive programs, staff empowerment, conceptual framework used as roadmaps (which include the American Nurses Association s (ANA) magnet program and SPHM standards, New Jersey Department of Health regulations, Maslow s Theory on Human Hierarchy of Needs, Professional Advancement System, Empowerment Theory, etc.), alternative funding for SPHM equipment via grant application and donations, and practical tools used to achieve the program s objectives will be discussed at length. This session will also present years of statistical data that will demonstrate a reduction in employee injury and cost for the organization through the implementation of various innovative strategies. 1. Describe unique and innovative strategies using the resources available within the organization to propel the SPHM program above and beyond the norm. 2. Stimulate the learner s thought process appraising, exploring and identifying resources within their organization and incorporate knowledge gained from the presentation to enhance their SPHM program. 1. Explain how certain resources from within the organization are employed to propel the SPHM program above and beyond the norm. 1a. Educate/train non-clinical staff such as Security, patient care equipment/biomed engineering, patient transport personnel, respiratory therapist on SPHM devices, benefits, importance and implications of non-compliance with SPH NJ DOH regulations. 1b. Include non-clinical staff to participate in SPHM initiatives by giving them opportunities to assume different roles in the SPHM program such as taking leadership roles in leading the SPHM unit rounding, extend the SPHM specialist role to both

3 clinical and non-clinical staff, etc. 1c. Author and publish staff stories regarding personal experiences with the use of SPHM devices when providing care to the patient to influence culture change. 1d. Use electronic tracking devices to ensure availability of equipment when needed. 2a. Utilize a set of questions to evaluate the resources available within their institution. 2b. Explore opportunities to collaborate with other disciplines both clinical and non-clinical for SPHM initiatives. 2c. Provide suggestions on how to implement realistic strategies according to their existing resources. PowerPoint Presentation, Discussion, Q&A 1. Garcia,A.,(September, 2014) Standards to Protect Nurses from Handling and Mobility Injuries 2. Vollman,K., Bassett,R.,( September, 2014) Transforming the Culture: The Key to Hardwiring Early Mobility and Safe Patient Handling Nelson, A., Baptiste, A.,( May, 2016) Evidence- Based Practices for Safe Patient Handling and Movement. menucatgories/anamarketplace/anaperiodicals/oj. 4. L. Burket, T., Felmlee, M., Greider, P., Hippensteel, D., & Rohrer, E., Shay, Lynne. (2010). Clinical Ladder Program Evolution: Journey. The Journal of Continuing Education in Nursing. Vol. 41, No American Nurses Credentialing Center (2008): A New Model for ANCC s Magnet Recognition Program. July 20, Safe Patient Handling Act- NJ Legislature. Thorough Integration of the Bedside Mobility Assessment Tool (BMAT) Through Case Studies Perez, McGann This session will begin with a live demonstration of the bedside mobility assessment tool and then present and demonstrate several case studies to allow the audience to better understand the critical thinking skills needed when performing this clinical assessment. Examples of this will include that BMAT with patients who have limb amputations, stroke, cognitive or behavioral concerns, weight baring limitations and other considerations that require adaptation of the tool while maintaining its reliability and validity. Education on the complex integration of several risk tools including skin, fall and mobility will be performed due to the common confusion often seen after roll out of the BMAT. After the presentation the learner will: 1. Describe the steps and purpose of the BMAT in depth to form the foundation for proper implementation of the tool in various complex circumstances. 2. Understand the adaptations to the assessment tool that maintain the integrity, reliability and validity of the assessment. 3. Participants will be able to adapt the BMAT and train others to adapt this tool to fit the vast majority of their patient population. 4. Participants will gain a deeper understanding of the complex integration of the BMAT into a successful patient fall and caregiver injury prevention program that integrates fall scales, skin scales and the BMAT. BMAT Steps and Purpose-A demonstration and explanation of the rehab science behind each portion of the BMAT. Level 1 Trunk Stability, Balance and Equilibrium Level 2 - Leg strength, ankle flexibility and reaction Level 3 Standing balance, pain, fear, physiologic response to standing and balance Level 4 Pre-gait readiness, egress, stepping reactions. Adaptions through Case Studies Several Patient Case Studies will be presented and the BMAT will be demonstrated for each case. Discussion of each demonstration including the science behind each alteration will be discussed in detail including why these adaptions maintain validity. Adaptions that do not maintain validity will also be discussed. Education and Problem Solving Q& A of various complex mobility assessment issues will be discussed with audience participation about how to alter the tool while maintaining its validity and reliability. Results from a multi-hospital survey will be shared to demonstrate common BMAT acceptance and barriers from implementations at various stages. These will highlight best practices and lessons learned. Falls Skin and Mobility Complex

4 Integration Confusion is common for bedside caregivers when making clinical decisions based on many different risk scales. Tip sheets will be shared and best practice for tool integration will be discussed related to the Morse, Braden and BMAT. Power Hands On, PowerPoint and Discussion 1. Boynton, Kelly, Perez, Miller, An, Trudgen (2014) Banner Mobility Assessment Tool for Nurses: Instrument Validation. Journal of Safe Patient Handling and Movement Sept2014_V4N3_ Boynton, Teresa; Kelly Leslie; Perez, Amber; (2014) Implementing a mobility assessment tool for nurses American Nurse Today September 2014 Vol. 9 No. 9 Author: Teresa Boynton, MS, OTR, CSPHP; Lesly Kelly, PhD, RN; and Amber Perez, LPN, BBA, CSPHP. 3. Ann D. Gaffey, Fall prevention in our healthiest patients: Assessing risk and preventing injury for moms and babies, Journal of Healthcare Risk Management, 2015, 34, 3, Kathleen Thompson, Lisa Haddad, Sarah Smith, Reliability and Validity of the Postepidural Fall Risk Assessment Score, Journal of Nursing Care Quality, 2014, 29, 3, 263 International SPHM Symposium: Selected Topics Matz, Fray This symposium will relay new and innovative research results and best practices from research and SPHM program implementations carried out in countries other than the U.S. The presentations will provide insight into SPHM foci and research outcomes in countries that may include The Netherlands, Sweden, Finland, the UK, and others. A call for international papers will be used to select presenters and topics. (1) relay at least one research outcome from an international research study. (2) describe at least one best practice used in organization/s within another country than the U.S. Depends upon submissions received Submissions will be judged by an international team of SPHM specialists from various disciplines. PowerPoint slides and Lecture 1. International Organization for Standardization (ISO). (2012). Ergonomics: Manual Handling of People in the Healthcare Sector. [Reference #: ISO/TR 12296:2012(E)]. 2. Hignett, S., Otter, M., Keen, C. (2016). Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings: A systematic review. International Journal of Nursing Studies, 59 (2016) Boerma, W. & Kroneman, M. (2015). Home care in Europe: Structure and challenges. NIVEL, Netherlands Institute for Health Services Research. 4. Hignett, S. Crumpton, E. Ruszala, S. Alexander, P. Fray, M. & Fletcher, B. (2003). Evidence-Based Patient Handling: Task, equipment and interventions. London: Routledge. 5. Iakovou, G.T. (2008). Implementation of an evidence-based safe patients handling and movement mobility curriculum in an associate degree nursing program. Teaching and Learning in Nursing 3,

5 Repositioning: The Last Frontier in Safe Resident Handling in Long Term Care Katz, Fragala Research has shown the patient/resident repositioning task as one of the highest risk activities related to musculoskeletal injuries in all occupations. Yet many of our patients/residents require frequent repositioning due in part to the increased severity and complex medical conditions and care that is required. This is the story of how an organization over a span of 10 years has matured from the use of draw sheets to the creation of a six product plus guideline for moving their patients/residents. 1. Identify risk factors in their health care setting to justify a repositioning program. 2. Discuss some of the current research and supporting data that supports a repositioning program. 3. Have a basic understanding of some of the products used to reposition patients/residents and why we chose them. 1a. Ergonomics and dangers of "boosting in bed"; 1b. Patient/resident need for repositioning from a pysical and emotional standpoint. 2a. The hands on approach of how to develop a repositionng program will be shared. 3a. Categories of repositioning devices2a. Worker Comp Data PowerPoint and Lecture 1. Amr, S., Baumgarten, M., Hawkes, W. G., Margolis, D., Miller, R. R., Shardell, M., Shayna, R. E. (2010). Frequent manual repositioining ad incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair and Regulations. 2. Brown, D. S. (2003). Nurses and preventable back injuries. American Journal of Critical Care Nurses. Sept Nelson, Motacki, Menzel. Safe Patient Handling and Movement. Innovative Strategies in Developing a Cutting Edge SPHM Program Part 2 Young, Kuchinski, Chandler, Rodrigue This presentation will explore unique and innovative strategies that will propel SPHM initiatives to the forefront and create a cutting edge SPHM program. Useful, realistic, efficient and cost effective approaches which include: system wide inclusion and interdisciplinary collaboration from clinical and non-clinical staff, incentive programs, staff empowerment, conceptual framework used as roadmaps (which include the American Nurses Association s (ANA) magnet program and SPHM standards, New Jersey Department of Health regulations, Maslow s Theory on Human Hierarchy of Needs, Professional Advancement System, Empowerment Theory, etc.), alternative funding for SPHM equipment via grant application and donations, and practical tools used to achieve the program s objectives will be discussed at length. This session will also present years of statistical data that will demonstrate a reduction in employee injury and cost for the organization through the implementation of various innovative strategies. 1. Describe unique and innovative strategies using the resources available within the organization to propel the SPHM program above and beyond the norm. 2. Stimulate the learner s thought process appraising, exploring and identifying resources within their organization and incorporate knowledge gained from the presentation to enhance their SPHM program.

6 1. Describe unique and innovative strategies using the resources available within the organization to propel the SPHM program above and beyond the norm. 2. Stimulate the learner s thought process appraising, exploring and identifying resources within their organization and incorporate knowledge gained from the presentation to enhance their SPHM program. PowerPoint 1. Garcia,A.,(September, 2014) Standards to Protect Nurses from Handling and Mobility Injuries 2. Vollman,K., Bassett,R.,( September, 2014) Transforming the Culture: The Key to Hardwiring Early Mobility and Safe Patient Handling Nelson, A., Baptiste, A. ( May, 2016) Evidence-Based Practices for Safe Patient Handling and Movement. menucatgories/anamarketplace/anaperiodicals/oj. 4. L. Burket, T., Felmlee, M., Greider, P., Hippensteel, D., & Rohrer, E., Shay, Lynne. (2010). Clinical Ladder Program Evolution: Journey. The Journal of Continuing Education in Nursing. Vol. 41, No American Nurses Credentialing Center (2008): A New Model for ANCC s Magnet Recognition Program. July 20, Safe Patient Handling Act- NJ Legislature. Bariatric Modeling: Implications for Planning and Executing Care and Mobility Gallagher, Wiggermann This course explores the meaning of bariatric modeling in relation to space and design needs for the patient of size. This form of predictive modeling serves to guide healthcare professionals in methods to better plan and execute safe, quality bariatric care and mobility. Upon 1.Explain the engineering process of bariatric modeling. 2.Describe the ergonomic implications of bariatric modeling. 3.Integrate bariatric modeling strategies into bedside patient care and mobility 1.Introduction. 2.Bariatric Modeling engineering and ergonomic approach. 3. Practical space and design challenges of bariatric care and mobility. 4.Occupational hazards associated with bariatric care and mobility. 5.Case studies intersecting research and practice. 6.Conclusion Intermediate Lecture, Discussion 1. Davis KG, & Kotowski SE. Prevalence of musculoskeletal disorders for nurses in hospitals, long-term care facilities, and home health care a comprehensive review J Hum Factors Ergo Soc 2015;57(5): Gallagher SM. A Practical Guide to Bariatric Safe Patient Handling and Mobility: Improving Safety and Quality for the Patient of Size. Visioning Publications Wiggerman N. Effect of a powered drive on pushing and pulling forces when transporting bariatric hospital beds. Appl Ergon 2017 Jan 3;58: Wiggermann N. Smith K. Kumpar D. What bed size does a patient need? The relationship between BMI and space required to turn in bed. Nursing Research (In Press)

7 Presenters name and credentials Objectives (Learner Outcomes in completion learner will be able to: Subject Matter (Topic Outline & Content As It Corresponds to the Objectives 2-3 examples for each References (3-5 evidencebased Presenters name and credentials Objectives (Learner Outcomes in completion learner will be able to: Subject Matter (Topic Outline & Content As It Corresponds to the Objectives 2-3 examples for each ANA s 360 Degree View of Safe Patient Handling (Panel Discussion) Francis, Kumpar, Neidhardt, Berry, Turner, Ross The ANA has developed and maintained the Safe Paitent Handling and Mobility National Interprofessional Standards that are designed to infuse a stronger culture of safety in healthcare work environments and provide a universal foundation for policies, practices, regulation and legislation to protect patients and healthcare workers from injury. Due to the current healthcare climate, there is an opportunity to integrate patient safety initiatives. Healthcare workers often face multiple, concurrent initiatives aimed at improving care and safety of patients. Combining SPHM, Early Mobility and Fall Prevention initiatives into one comprehensive program can help remove the apathy, indifference and poo compliance for the benefit of the patient, healthcare workers and the hospital/organization. 1. Elucidate the use of the ANA National Standards to establish a culture of safety and create a sustainable program; Describe the role of SPHM in both early mobility and fall prevention programs for the patient and healthcare worker injury prevention for the clinician; Demonstrate the tools utilized to develop and sustain a successful SPHM/Falls Program 1. safe patient handling, patiient falls, early mobility. 2. Working with multidisciplnary teems, compling with recommendations and guidelines, better understanding and appreciation of the initiatives. 3. Tools including both equpment as well as roadmaps and guidelines. PowerPoint and Lecture 1. American Nurses Association. (2013). Safe patient handling and mobility interprofessional national standards across the care continuum. Silver Spring MD: Author. 2. OSHA. OSHA Safety and Health Program Management Guidelines. Available at: Washington, DC: Author. 3. The Joint Commission. (2013). Highreliability health care: getting there from here. Mark Chassin & Jerod Loeb.The Milbank Quarterly, 91(3), ). Available at: Safe Patient Handling and Mobility Technologies in Rehabilitation to Improve Patient Mobility and Function Rugs, Powell-Cope, Bulat, Campo, Darragh, Harwood, Kuhn, Rockefeller, Chavez This presentation reports on a Quality Improvement project conducted in the VA healthcare system determining the common and innovative practices for the use of Safe Patient Handling and Mobility (SPHM) technologies in rehabilitation. The overarching goal is to identify the scope of practice using technology in therapeutic rehabilitation. The project uses a photo-narrative methodology and an advisory board. Upon completion, the learner will be able to: 1. Understand the process of conducting a photo-narrative QI project. 2. Recognize common and innovative SPHM practices in the rehabilitation setting. 3. Apply SPHM technology to improve rehabilitation goals 1. Discuss process and planning for a QI project. 2. Identify current practices that can be utilized in rehabilitation settings to improve patient and caregiver safety. 3. Improved rehabilitation outcomes through application of technology deemed too assistive in the past.

8 References (3-5 evidencebased PowerPoint 1. Arnold, M., Radawiec, S., Campo, M., & Wright, L. R. (2011). Changes in functional independence measure ratings associated with a safe patient handling and movement program. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses,36(4), Balomenou, N., & Garrod, B. (2015). A Review of Participant-Generated Image Methods in the Social Sciences. Journal of Mixed Methods Research. 3. Campo, M., Shiyko, M. P., Margulis, H., & Darragh, A. R. (2013). Effect of a safe patient handling program on rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 94(1), Darragh, A. R., Campo, M. A., Frost, L., Miller, M., Pentico, M., & Margulis, H. (2013). Safe-patient handling equipment in therapy practice: implications for rehabilitation. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 67(1), Rockefeller, K. (2008). Using technology to promote safe patient handling and rehabilitation. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 33(1), 3 9.