The Aid of Ergonomics in Reducing Back Injuries in the Healthcare Industry

A Paper in Fulfillment of the Requirements for the Completion of Basic Occupational Safety and Health Course,

A Seminar conducted by the World Safety Organization (WSO) held in Hotel Rembrandt, Tomas Morato, Quezon City last February 20-24, 2012.

Submitted by: Henessey Auda O. Castillo, RN Date: February 24, 2012

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Purpose and Scope: The aid of Ergonomics in safe patient handling is one part of a comprehensive program to prevent musculoskeletal injuries to frontline caregivers. The policy recommends guidelines to ensure that the transferring needs of all patients are assessed. All healthcare personnel responsible for transferring patients shall be aware and trained on the correct procedures for lifting and moving patients.

Background Every day, nurses suffer debilitating and often career-ending and life-altering injuries from repeatedly lifting and moving patients. Back injuries affect up to 38% of all nurses. More than any other work-related injury or illness, musculoskeletal disorders (MSDs) are responsible for lost work time, the need for protracted medical care, and permanent disability among health care workers. A substantial body of scientific evidence clearly supports efforts to provide workers with ergonomic protections. The risk factors have been clearly identified: Repeated lifting and forceful movements associated with patient care activities lead to serious health problems for health care workers. Lifting, transferring, and repositioning patients are the most common tasks that lead to injury.

CONTROL MEASURES Engineering and Work Practice Equipment (i.e. mechanical assistive devices) Physical Facilities Administrative Controls Proper Training Comprehensive Policies and Procedures Adequate and Appropriate Staffing Personal Controls Personal Fitness/Health

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Personal Safety Healthcare Provider Involvement in Ergo Process

ASSIGNMENT OF RESPONSIBILITIES The administrator is responsible for: - Supporting the implementation of this policy. - Providing training opportunities for all staff affected by the safe-lifting policy. - Furnishing sufficient lifting equipment and repositioning aids. - Identifying acceptable storage locations for lifting equipment and repositioning aids. - Providing resources for the medical management program and the evaluation of the safe-lifting program. The unit/nurse manager, the physical and occupational therapy departments, and frontline caregivers are responsible for: - Assessing the transferring needs of each patient and prescribing lifting and transferring method(s) that are consistent with the patient's care plan and rehabilitation goals and their ability to ambulate, bear weight, and follow verbal instructions. Patients should be reassessed if their condition changes. The Unit/nurse manager and supervisors are responsible for:: - Ensuring that all staff affected by the policy completes initial and annual training. - Ensuring that the transferring needs of patients are assessed and all high-risk patienthandling tasks are completed safely using mechanical lifting devices or other appropriate equipment or techniques. - Ensuring that mechanical lifting devices, slings, and other equipment are available, maintained in proper working order, and stored conveniently and safely. - Ensuring that patient transfers are being performed as prescribed. - Maintaining training records. Nursing staff and frontline caregivers are responsible for:

Page |4 - Being knowledgeable of the procedures to follow when transferring patients. Using proper techniques, mechanical lifting devices, and other approved

equipment/aids when performing high-risk patient handling tasks. - Notifying supervisor if a change has occurred in a patient's condition. - Notifying supervisor if you have a need for retraining in the use of mechanical lifting devices, other equipment/aids, and lifting/moving techniques. - Notifying supervisor if mechanical devices, slings, or equipment/aids are damaged or need repair. - Notifying supervisor of any injury sustained to staff or patients. Maintenance personnel are responsible for: - Inspecting the patient lifting equipment, slings, and batteries each month. - Maintaining lifting devices and other equipment in good working order. - Establishing procedures for removing damaged equipment from service.

IMPLEMENTATION METHOD PLAN The following steps can help institute a safe patient handling and movement program in the facility. 1. Create an ergonomics committee. Include representatives from management, direct caregivers, purchasing, and risk management. Establish, implement, and monitor a comprehensive program. 2. Analyze the injury data and conduct a walkthrough of departments. Review OSHA 300 Logs, incident report data, and other reporting systems. Walk through all units during all shifts to look for risk factors. Look for trends and patterns in who is being injured, how and why. 3. Survey Employees. Survey employees about their concerns, experiences, and suggestions. 4. Assess patient dependency levels. Select equipment after assessing the patients ability to provide assistance in the transfer, ability to bear weight, their upper extremity strength, their height and weight, as well as special circumstances, and specific orders.

Page |5 5. Assess high-risk patient handling tasks. Based on collected information and analysis determine which tasks are backbreaking on each unit. The assessment must be unit specific. (Is it frequent lifts of dependent patients in rehab? Multiple transfers of geriatrics on all units? Obese patients in the ICU? Repositioning in medical surgical units? Lateral transfers of anesthetized patient are in the perioperative area?) 6. Determine safest possible approaches to high risk tasks. These approaches should use technology and input from frontline health care workers who perform high-risk tasks. Use available science based information such as algorithms to assist in solutions. 7. Research, pilot, select, evaluate and implement lifting devices. Involve frontline healthcare workers at every step to ensure use of new equipment. When testing devices, including mechanical lifts, lateral transfer devices, gait belts, and transfer chairs, seek input from nurses, other healthcare workers and patients. 8. Provide comprehensive and interactive training for staff. Train staff on policies and devices before implementing new devices. Remember to train new staff and any health care workers whose staff assignments are changed. Identify and train peer safety leaders. 9. Track patient and worker injuries and evaluate program. Continue to routinely collect analyze the data.

Ways to Reduce Injury Risks There are several ways that hospitals, care facilities and nursing professionals can reduce injury risks. These include:

Using lifting assistance devices - a variety of devices is available to help lift and move patients from bed to seat, such as:
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Gait belt - this is a specialized belt that fits snugly around the patient's waist and has hand straps for the nurse or caregiver to grasp while assisting during transfers or walking.

Walkers - lightweight metal frame devices with rails that can be gripped by the patient to help to support their body weight during transfer and rising from sitting.

Rails - wooden or metal rails that are fixed to walls or equipment, such as beds, to allow the patient to help to support their body weight during transfer.

Page |6 'Hoyer' lifts - a hydraulic lift that consists of a metal frame and a heavy canvas swing. It is capable of lifting and suspending a patient for transfer.
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Sliding boards - a smooth board with tapered ends made of either wood or plastic that is used to help someone get from one sitting surface to another.

Draw/lift sheets - a regular flat sheet placed under a person in bed can be used to move them. If the sheet is strong enough it can also be used to lift and transfer the patient.

Using appropriate equipment - there is a choice of powered equipment available to reduce patient handling activities, such as powered beds to change a patient's posture, height adjustable chairs, and powered wheelchairs.

Use appropriate beds - the height of the bed determines how much bending and reaching a nurse has to do. Nurses are different heights, so a simple-to-operate, heightadjustable bed is important to allow bed height to be appropriately adjusted to the nurse.

Implement regular equipment maintenance procedures - equipment must be kept in good working order.

Ergonomic design of workplaces - use architectural and design features, such as rails or ramps, to minimize awkward movements.

Providing better ergonomics training - train nurses and health aides in good work postures and ways of minimizing twisting, bending and/or lifting items from the floor. Also train them in safe lifting practices, and in the correct use of appropriate equipment. Provide ways of refreshing and reinforcing the training.

Provide adequate staffing - injury risks can be reduced by increasing the number of people available to assist with lifting patients.

Systematic record-keeping - implement processes that facilitate more detailed statistics on manual handling activities and outcomes so that this can help to identify injury trends before more serious incidents occur.

Medical management program

Page |7 If an employee is injured on the job, employees should report the injury to their supervisor immediately. Every injury should be treated promptly and each incident should be investigated so that preventive measures can be implemented.

DOCUMENTATION / MONITORING Documentation is particularly important as it details a record of activities and evidence of compliance with legislation. Documentation also provides a means of consistent communication on risk management and assists with monitoring and performance evaluation. The types of documentation that should be kept include: Hazard and incident reports Risk assessments Control strategies Training provided Consultation with employees Injury data Incident investigations Results of evaluations and reviews

CONSULTATION Consultation is a key element in risk identification and assessment and finding solutions to manual handling problems. Consultation should involve all people directly or indirectly connected with the equipment, the environment and the activities performed. In keeping with the managers duty of care, the nurse manager should promote awareness of ergonomics, and create a team approach to manual handling risk management. It may also help to identify a ward advocate who can take some responsibility for the practical aspects of handling projects and help to motivate other nurses. Nurses and other staff are an invaluable source of information. Their knowledge can be tapped at all stages of the risk management process. Consultation means all staff are part of the process, the workload is shared, and changes are more likely to be accepted.

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Ways of consulting include: Talking with staff who perform the program activities, either individually or in groups, to learn from their experiences, thoughts, ideas and suggestions Forming a group or using an existing one that represents the different classifications of workers in your area Inviting discussion of manual handling issues at staff meetings and shift handover Providing staff with information for discussion, such as journal articles or manual handling statistics Conducting brainstorming sessions for risk identification and solutions Providing staff with short awareness-raising sessions on handling issues Involving the workplace occupational health and safety committee in dealing with complex issues, or issues with broader relevance to the workplace.

*** Proposed Date of IMPLEMENTATION: First Week of MARCH, 2012