Development of SPH and ISO implemented in the United States

Transcription

1 Development of SPH and ISO implemented in the United States REFERENCES: ISO/TR Ergonomics: Manual Handling of People in the Healthcare Sector [Reference #: ISO/TR 12296:2012(E)] An edited summary of ISO Technical Report [ArjoHuntleigh 1

2 International Organization for Standardization (ISO) 163 countries Members are from both public (government) and private sectors Develop Standards and Technical Reports Technical Reports (TRs) provide advice, information 2

3 ISO TR Objectives: Provide safe working conditions for caregivers Ensure the safety, dignity, privacy, and quality of care for patients 3

4 ISO TR Provides overview of evidence-based methods to assess risks of manual patient handling identify control measures to reduce risk implement control measures and SPHM (Safe Patient Handling and Mobility) Programs 4

5 ISO TR GENERAL Programs must include many strategies to decrease risk Policy/Program Ergonomic Evaluation Equipment/Aids Leadership/Oversight (facility/unit) Training/Education Building/Unit Design and Construction Effectiveness/Evaluation 5

6 ISO TR GENERAL Must be participatory Include input from ALL involved to Change work practices Define training needs Identify equipment needs Ensure appropriate space and design needs 6

7 ISO TR GENERAL Program/Equipment must be in place or accessible every where patient handling, movement, and mobility occurs Patient Rooms Physical/Occupational Therapy Operating Room Emergency Department Toilet Rooms/Showers 7

8 Ambulation/Rehabilitation Down Hallway In Physical Therapy Clinic 8

9 Radiology Dialysis 9

10 Operating Room 10

11 Morgue 11

12 ISO TR Includes recommendations for: Risk Assessment Implementing patient handling interventions Aids and Equipment Buildings and Workplace Education and Training Evaluation of Interventions 12

13 ISO TR RISK ASSESSMENT Conduct when New equipment is introduced Patient population changes Number of caregivers changes Plan of care changes (institute team bathing or care) Changes in room use, design 13

14 RISK ASSESSMENT RISK CLASSIFICATION: ZONE Exposure Consequences Classification GREEN ACCEPTABLE No consequences YELLOW NOT RECOMMENDED RED UNACCEPTABLE/ TO BE AVOIDED Further evaluation is required. Measures to reduce risk may be necessary, such as patient handling equipment/aids. May need to suggest organizational and/or educational strategies. Redesign or take actions to lower the risks (using patient handling equipment/aids) 14

15 RISK ASSESSMENT MODEL Step 1 Hazard Identification No Obvious Hazard Hazard Present Step 2 Risk Estimation & Evaluation Acceptable Risk (green) Risk Present (yellow, red) Risk Management Organizational aspects Equipment/Aids Environment Training Monitor and Review Negative Check of Effectiveness Positive 15

16 ISO TR RISK ASSESSMENT Hazard / Problem Identification Risk Estimation and Evaluation 16

17 RISK ASSESSMENT HAZARD IDENTIFICATION Type of manual patient handling Identify in each clinical unit/area What manual task/s being performed What technique used how performed How many average performed per day Impacted by patient characteristics functional mobility, cooperation, medical conditions, physical characteristics 17

18 Hazard Identification - Data Collection Tool Unit/Description: Facility: Date: Patient Care Ergonomic Issues Existing/Ordered Unit Equipment Patient Handling Equipment/Sling Recommendations Vertical Transfers/Lifts (dependent/extensive assistance pts) Vertical Transfers/Lifts (partial assistance pts) Ambulation Transportation Lateral transfers Repositioning Side to Side Pulling up to Head of Bed Repositioning in Chair Wound care TED Hose Application Toileting Showering/Bathing # beds: Average Census: % bariatric: % total dependent/extensive assistance: % total partial assistance: Room configurations: Storage: Notes: 18

19 RISK ASSESSMENT HAZARD IDENTIFICATION Work Organization Number of caregivers on unit Staffing teams/individual care Training/Education 19

20 RISK ASSESSMENT HAZARD IDENTIFICATION Posture and Force Exertion Awkward postures lead to increased risk of injury Impacted by Space Equipment used Number of caregivers handling the patient Caregiver education and training 20

21 How different postures affect forces on the spine 21

22 Spinal Loading & Stress Caregivers often lift/move patients away from their body To minimize risk of injury, keep load as close as possible 22

23 RISK ASSESSMENT HAZARD IDENTIFICATION Posture and Force Exertion Risk reduced by Stable and balanced posture Use of body weight/legs to minimize stress on back and shoulders Transfer surfaces at proper height Height-compatible staff Assistive devices/equipment 23

24 RISK ASSESSMENT HAZARD IDENTIFICATION Equipment/Aids/Assistive Devices USE!! Purchase decisions include staff, engineering, housekeeping, infection control, others Room, beds, chairs, accommodate equipment Adequate numbers Adequate slings/accessories Accessible Storage Staff Training Maintenance/Repair 24

25 RISK ASSESSMENT HAZARD IDENTIFICATION Environment Compatibility with equipment Adequate space for good posture Door / Hall widths Floor surfaces and transitions Uneven surfaces, thresholds Obstacles to use of equipment 25

26 RISK ASSESSMENT HAZARD IDENTIFICATION Individual Characteristics of the Caregiver Skill / Capabilities Level of Training Age Gender Health Status Clothing / Footwear 26

27 RISK ASSESSMENT HAZARD IDENTIFICATION Patient Characteristics Body weight and size Mobility level Non co-operating (NC) cannot help during lift / movement Partially co-operating (PC) all others needing help Fully co-operating (FC) do not need any help Cognitive status / Level of cooperation 27

28 ISO TR RISK ASSESSMENT Hazard / Problem Identification Risk Estimation and Evaluation 28

29 RISK ASSESSMENT RISK ESTIMATION AND EVALUATION Many Risk Assessment methods available Simple to Complex See Annex A of ISO/TR ISO/TR recommends Risk Classification by use of the three-zone model green/ yellow/ red 29

30 RISK ASSESSMENT RISK ESTIMATION AND EVALUATION MAPO Index Provides Risk Level of UNIT being evaluated Focuses on Organizational issues (# staff) Distribution over work shifts Number and type of dependent patients Types of handling Use of equipment Education of staff Uses observation and interviews Classifies risk using 3-zone model 30

31 RISK ASSESSMENT RISK ESTIMATION AND EVALUATION PTAI (Patient Transfer Assessing Instrument) Evaluates 15 factors Uses observation and interviews Classifies risk using 3-zone model 31

32 RISK ASSESSMENT RISK ESTIMATION AND EVALUATION CareThermometer Assesses potential exposure to physical overload Netherlands Guidelines for Practice Used in combination with Policy Mirror 6 page checklist Used in all clinical areas Used to assess all levels, from unit to facility to organization to country Classifies risk using 3-zone model 32

33 ISO TR ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS 33

34 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS Top-Down Approach Organizations drive program Bottom-Up Approach Worker/s drive program National Guidance has supported the development of organizational solutions (Australia, Netherlands, United Kingdom, Canada) Drives national acceptance in U.S. Veterans Administration, OSHA, NIOSH, ANA SPHM Standards 34

35 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS Evidence-based studies show: Multi-factorial interventions result in more positive outcomes policy risk assessment ergonomic assessment Equipment facility/unit leadership patient assessments change mgmt strategies training/education risk/occupational health management 35

36 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS Evidence-based studies show: An effective Culture of Safety facilitates successful implementation Organizational commitment funding, time, policy Managerial commitment leads by example Facility/Unit Leadership frontline leadership/support/expertise 36

37 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS Evidence-based studies show: An effective Culture of Safety facilitates successful implementation Participation by those involved Provision of education/training for a skilled workforce Occupational health service involvement in risk reduction and support of injured staff to return to work 37

38 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS ISO/TR Specific Guidance Management Systems Clear line of responsibility and accountability Reflects local legislation and type of healthcare organization Policies and Procedures Clearly relay the strategies for reducing risk, injuries, and losses Ensure Clinical Practice includes safe patient handling practices / risk reduction 38

39 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS ISO/TR Specific Guidance Provision of Appropriate Staff Staff to patient ratios - Incorporate numbers of staff required for SPH tasks into staffing ratio calculations. Lifting Teams must always use equipment Patient handling advisor Peer safety leaders Occupational health management services 39

40 ORGANIZATIONAL ASPECTS OF PATIENT HANDLING INTERVENTIONS ISO/TR Specific Guidance Financial Commitment Develop Cost Benefit Analysis to justify funding 40

41 ISO TR AIDS AND EQUIPMENT 41

42 AIDS AND EQUIPMENT Equipment use must be a part of any Policy Purchase decisions with input from staff Available Accessible Required accessories (slings) accessible Easy to use In good working order (Maintained/Repaired) 42

43 AIDS AND EQUIPMENT Equipment functions to Reduce the risk to staff injuries Reduce the risk to patient injuries Increase the quality of patient care Facilitate patient mobilization 43

44 Bariatric Equipment 44

45 Bariatric Abdominal Support Sling Tasks Ultrasound Wound care Bathing Bedside procedures PeriCare Patient Characteristics Required Must be able to lay in flat position 45

46 Specialized Beds 46

47 Beds/Mattresses Retractable Footboard Percussion/Vibration Raised Knee Platform Capillary perfusion enhancement Built-in Scale Height adjustable CPR function Bariatric 47

48 Repositioning Aids 48

49 Friction Reducing Devices 49

50 Lateral Transfer Devices Mechanical Lateral Transfer Device Air Assisted Lateral Transfer Device 50

51 Air Assisted Lifting Devices 51

52 Transfer Chairs Convert from chair to wheelchair to stretcher Facilitates lateral transfer from bed to chair Bariatric models available 52

53 Car Extraction Lift Wheelchair Mover 53

54 Ergonomic Shower Chair 54

55 Sit to Stand Lifts With ambulation capability Non-powered 55

56 Full Body Sling Lifts Floor-based 56

57 Ceiling Mounted Full Body Sling Lifts Ceiling and Wall Mounted Wall Mounted 57

58 Full Body Sling Lifts There are differences in use of floor-based full body sling lifts as opposed to ceiling/wall lifts Biomechanical stress on caregiver is greater when pushing/pulling portable lift & patient. (Nelson, et al, 2003; Santaguida et al, 2005; Marras, 2007) Other Risks of Injury are greater. Considerable arm strength & back torsion are required, especially when wheels are not working well. Workers can trip over lifts or run into them. Lifts on wheels are not always stable. (Garg, 1991; Garg, 1991; Daynard, 2001) 58

59 Sling Categories Repositioning Limb Support/Strap Slings Seated/Universal 59

60 Sling Categories Ambulation Supine Standing 60

61 AIDS AND EQUIPMENT PATIENT HANDLING ASSESSMENTS Determine What equipment to use How many caregivers are needed Many tools are available (Annex D) VA Method is most widely used in U.S. and Canada 61

62 VA Patient Assessment, Algorithms, & Care Plan for SPHM Provides standardized method to determine how to handle & move patients Ensures patient handling techniques are based on individual patient characteristics/conditions Written care plan ensures accurate transfer of information staff to staff shift to shift 62

63 VA Patient Assessment Completed on all patients Includes Patient Characteristics Patient Medical Condition/s 63

64 Asks: VA Patient Assessment Can the patient provide assistance? Can the patient bear weight? Does the patient have upper extremity strength? Is the patient cooperative? Can the patient follow instructions? Height and weight? Special Medical/Physical Considerations? Physicians /Therapists Orders? 64

65 VA Algorithms Based on Specific Patient Characteristics (from Assessment) Assists caregivers in selecting safest Equipment Advises # of staff needed 65

66 Ergonomic Algorithm 1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair 66

67 What Tasks Do the VA Algorithms Cover? 1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair 2. Lateral Transfer To and From: Bed to Stretcher, Trolley 3. Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table 4. Reposition in Bed: Side to Side, Up in Bed 5. Reposition in Chair: Wheelchair or Dependency Chair 6. Transfer a Patient Up from the Floor 67

68 What Additional Tasks Do the VA Bariatric Algorithms Cover? Tasks Requiring Sustained Holding of Limb/s or Access to Body Parts Transporting (stretcher, w/c, walker) Toileting 68

69 ISO TR BUILDINGS & ENVIRONMENT 69

70 BUILDINGS & ENVIRONMENT Risk assessments should identify Deficiencies in space to move and handle patients Equipment compatibility with room and furnishings 70

71 BUILDINGS & ENVIRONMENT Risk assessments should identify Structural capacities Barriers of floor surfaces slopes, ramps, steps, carpet, slippery 71

72 ISO TR STAFF EDUCATION AND TRAINING 72

73 STAFF EDUCATION AND TRAINING Training should be part of the risk management system of the organization Essential to promote behavioral changes in staff Training in body mechanics and proper lifting alone do not reduce risk 73

74 STAFF EDUCATION AND TRAINING Include ALL staff who move, handle, and mobilize patients Management VA educates non-clinical staff 74

75 STAFF EDUCATION AND TRAINING Provide appropriate equipment Hands-on equipment training is mandatory (staff must demonstrate that they know how to use equipment properly) Provide sufficient time Define competencies and test annually Have peer leaders train and implement best practices Others 75

76 ISO TR EVALUATION OF INTERVENTION EFFECTIVENESS 76

77 EVALUATION OF INTERVENTION EFFECTIVENESS Evaluation is a complex process Comparison between studies is difficult Outcomes are measured using different tools, qualities, and quantities Little agreement on best practices 77

78 EVALUATION OF INTERVENTION EFFECTIVENESS Measurement suggestions Organizational Physical and Engineering Personal level 78

79 EVALUATION OF INTERVENTION EFFECTIVENESS Measurement suggestions Organizational Injuries, lost-time, modified duty but be careful Discomfort/pain Job satisfaction Perception of risk Financial Patient Clinical Outcomes - important! 79

80 EVALUATION OF INTERVENTION EFFECTIVENESS Measurement suggestions Physical and Engineering Equipment availability, maintenance records, installation records Personal level Competence, Compliance in Use 80

81 EVALUATION OF INTERVENTION EFFECTIVENESS Measurement suggestions ISO/TR relays the Fray and Hignett Intervention Evaluation Tool. It is based on 12 section scores and an overall management performance score. 81

82 Providing Patient Care is High Risk. but the Risk can be greatly decreased with SPHM Programs and Equipment!! 82

83 83