Facility design and upgrading · renovation of an existing facility. There are two points to take...

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section 9

Contents

• Overviewofhealthandresidentialcarefacilitydesign

• HealthfacilitydesignstandardsrelevanttoNew Zealand

• Facilitydesignprocess

• Ceilingtrackingandhoists

• Accessdesignfeatures

– Corridors

– Floorspacesforpassingandturning

– Doorways

– Flooring

– Ramps

– Handrails

• Clienthandlingareas

– Bedrooms

– Bathrooms,toiletsandshowers

– Dayanddiningrooms

– Clinicalsuites

– Otherclienthandlingareas

– Staffandclientcallsystems

• Equipmentstorage

• Maintainingworkingspacesforclienthandling

• Facilitydesignforbariatricclients

• Overviewofupgradingfacilities

• Assessingexistingspacesforupgrading

• Strategiesforupgradingfacilities

• Referencesandresources.

Facility design and upgrading

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9.1 Overview of health and residential care facility design

Thissectionprovidespracticalrecommendationstohelpmanagers,architects,plannersanddesignersinvolvedindesigningandredevelopinghealthcarefacilities.Itcanalsobeusedbymanagersandmovingandhandlingadvisersasaguidewhenreviewingtheirfacilities;forexample,whencompletingaworkplaceprofileoranannualmovingandhandlingprogrammeaudit.Theinitialpartsofthesectioncoverinformationaboutthebuildingdesignspacesandfeaturesneededforeffectivemovingandhandling.Laterpartsinthissectionprovidemoredetailaboutupgradingexistingfacilities.

Theaimoffacilitydesignistoprovidespacesthatallowcarerstoworkinsafeenvironments.Facilitiesforhealthcare,agedcareanddisabilitycareshouldbeplanned,designedandbuiltwithmovingandhandlingspacerequirementsasstandard,notasanafterthoughtorasaspecialconsideration.Facilitydesignshouldbebasedoninformationfromworkplaceprofiles,discussionswithendusersandtheinformationinthissection.Itismostcosteffectivetoincludemovingandhandlingfeaturesduringtheplanningstage;itismuchmoreexpensivetoaddsuchfeatures later.

Asnotedinearliersections,buildingorfacilitydesignisacrucialcomponentinanoverallprogrammetoreducetherisksassociatedwithmovingandhandlingpeople.Theinformationinthissectionincorporatescurrentbestpracticeinbuildingdesignformovingandhandlingpeople.Designersandpeopleinvolvedwithmovingandhandlingneedtoadoptoradapttheinformationfornewbuildingdesigns.Itisimportanttoconductapreliminaryassessmentoftheproposeddesignforanewfacilitytoensurerenovationsmeetthemovingandhandlingneedsofboththepeoplebeingcaredforandtheircarers.

Acommonbeliefisthataddingtherecommendeddesignspacesandfeaturesformovingandhandlingpeoplewilladdconsiderablytothecostofanewfacilityortherenovationofanexistingfacility.Therearetwopointstotakeintoaccountaboutadditionalcosts:

• First,severalresearchreportshavenotedthatthereturnoninvestmentfromaddingmovingandhandlingfeaturesisaroundthreeyears(estimatesarebetween2.5andfouryears).1Theadditionalcostsofincludingtherecommendedfeaturesformovingandhandlingpeoplewillgenerallybecoveredinaboutthreeyearsbycostsavingsresultingfromreducedinjuriesandlowerstaffabsenteeismandturnover.Afterthreeyearstherearelikelytobecontinuingcostsavingsinfacilityoperatingcosts

• Second,thecostofchangingfacilitydesignfeaturesafterafacilityhasbeenbuiltorrenovatedisconsiderablyhigherthanwhenthesedesignfeatures

1. See,forexample,Chhokaretal,2005.

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areincludedatthedesignstageforanewfacilityorduringrenovations.Forexample,itcosts10timesasmuchtowidenadoorwayinanexistingfacilityasitdoestoincludeawiderdoorwayinthedesignphase.2

In2011,thestateofhealthfacilitydesigninNew Zealandinrelationtomovingandhandlingpeoplewasgenerallypoor,inspiteofTheNew ZealandPatientHandlingGuidelinesbeingavailablesince2003.Numerousexamplesofpoorbuildingdesignfeatureswereobservedorbroughttotheattentionoftherevisionpanelatthetimeofwritingin2010‑2011(seeBox9.1).

Box 9.1

Examples of poor facility design in New Zealand

• Newlyinstalledceilingtrackinginhospitalpatientroomsnotextendedintoadjacent bathrooms

• Poorlydesignedstoragespaceswheremobilehoistsarestoredinfrontofshelves,blockingaccessto slings

• Toiletsinnewlybuiltfacilitiesplacedinthecornersofbathrooms,notallowingcareraccesstobothsidesoftoilets

• Anewsurgicaltheatreforgastricbandingoperationswithoperatingtablesanddoorwaystoosmallforobesepatients

• Wall‑hungtoiletsthatarenotdesignedtotakeheavypatients,butareeasytoclean.

Source:Observationsmadebyrevisionpanelmembers,2010

Opportunitiestoincorporatebestpracticeformovingandhandlingpeopleinfacilitydesignincludeplanninganewfacilityandundertakingminorrenovationsoramajorupgradeofanexistingfacility.SomeexamplesofdesignfeaturesthatmightbeincludedduringtheseopportunitiesareshowninTable9.1.Moredetailedinformationaboutplanningforfacilityupgradingisprovidedlaterinthissection.

2. New ZealandAssociationofOccupationalTherapists.(2006).Submission on Review of the Building Code.p.5.

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Table 9.1 Opportunities for improving facility design and function

Example of facility development

Examples of design features to consider for moving and handling people

Newbuildingdesign Ceilingtrackspecified

Minimumwidthspecifiedfordoorsandcorridors

Clientrooms

Bathroomdesign

Equipmentstorage

Areasforbariatricclients

Renovatingorupgradinganexistingfacility–mayrangefromspecificandrelativelyminormodificationstomajorchanges,possiblyincludingstructuralchanges

Doorwayswidened

Bathroomredesigned

Ceilingtrackinginstalledorretrofitted

Equipmentstorageadded

Accessformobilehoists

Rampstodoorways

Grabrails

Theguidelinesinthissectionarebasedonergonomicprinciplesthatfocusonmatchingthedesignandlayoutfeatureswiththeneedsofboththepeoplebeingmovedandtheircarers.Movingaclientinaconfinedspacemakesitdifficulttomanoeuvreequipmentandputsstaffandtheclientatrisk.Theaimistoprovideanenvironmentwherepeoplecanbemovedinanefficientmannerthatreducesrisksforboththecarersandthepeoplebeingmoved.Inpracticalterms,thismeansensuringthatfacilitiesaresuitableforthetechniquesandequipmentrequiredforeffectivemovingandhandling(seeBox9.2).Itisalsoimportanttodesignfacilitiesinawaythatencouragesclientindependenceandreducestheneedforhandling.

TherecommendationsincludedinthissectionarebasedonconsultationwithmovingandhandlingcoordinatorsandassessmentsoftheliteratureonhealthcarefacilitydesigninAustralia,CanadaandtheUnitedKingdom.Allnewdesignsshouldbeassessedusingindustrystandards3andthedevelopmentprocessshouldinvolvemanualhandlingadvisersandrelevantcliniciansearlyinthedesignstages.

3. TheWorkSafeVictoria(Australia)2007publication,A Guide to Designing Workplaces for Safer Handling of Peopleisparticularlyrecommendedfordesignersandfacilityprojectmanagersinvolvedinfacilityplanningandrenovation.

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Box 9.2

The main facility design considerations for moving and handling people

Therearefivekeyareasoffacilitydesignforensuringreducedrisksinmovingandhandlingpeople.These are:

1. Access:Corridorsanddoorsshouldbesufficientlywidetoallowtheclient,thecarerandequipmenttopassthroughandfortwobedsorwheelchairstopasseachother

2. Space requirements:Thereshouldbeenoughspacearoundfurniture,beds,toilets,showersandbathstoallowtheuseofappropriatemovingandhandlingtechniquesand equipment

3. Handrails and grab rails:Thesehelppeoplewhoarepartiallymobiletomove.Theyrequirecarefulplacementsothattheydonotobstructhandlingoperationsorthemovementofequipment

4. Floor surfaces and friction:Floorsshouldbedesignedtoenhancethesafetyofclients(fromfalls)andstaffwhopushorpullwheeledequipment

5. Equipment storage:Thereneedstobesuitablestorageforequipmentclosetohandlingareas,sothatequipmentisreadilyaccessibleforuseandeasytoputawayafteruse.

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9.2 Health facility design standards relevant to New Zealand

TheprimaryNew Zealandstandardsforbuildingdesignandconstruction(collectivelyknownas‘buildingcontrols’)aretheBuilding Regulations (1992)(withintheBuilding Act (2004))andtheBuildingCode,whichistheFirstScheduletotheBuildingRegulations.4Thepurposesoftheselawsaretoprovidecontrolsandtoensurebuildingsaresafeandsanitaryandhaveadequatefireescapes.Thesectionscoveringfiresafety,accessandtheinteriorenvironmentsofbuildingsareparticularlyrelevanttomovingandhandlingpeople.

TheNew ZealandStandard4121:2001Design for access and mobility: Buildings and associated facilities(NZS4121DesignforAccess)providesguidelinesfordesignandsetsoutaccessandfacilityrequirementsforpeoplewithdisabilitieslivingindependently.SomeaspectsoftheNZS4121Design for Accessrecommendationsarenotsuitablefordependentdisabledpeoplewhorequireassistancefromoneortwocarers.Forexample,thebathroomrecommendationsaretoosmalltoallowsufficientspaceforcarersandmovingandhandlingequipment.

Thereareseveralitemsoflegislationthatemployersanddesignersmusttakeintoaccount.The Health and Safety in Employment Act (1992)(includingthe2002amendments)requiresallpracticablestepstobetakentoensurethereisasafeandhealthyworkplace.5DesignersandmanagershavespecificdutiessetoutundertheHealth and Safety in Employment Regulations (1995).

TheNew ZealandMinistryofHealthgenerallyrequiresuseoftheAustralasian Health Facility Guidelines(AustralianHealthInfrastructureAlliance,2009)forbuildingsandfacilitiesforDistrictHealthBoards(DHBs).TheAustralasian Health Facility GuidelinesaregenerallyappropriateforNew Zealand.However,wheretherearedifferencesbetweentheAustralasianguidelinesandthissectiononfacilitydesign,werecommendthatthespecificationsdescribedintheseGuidelinesbeused.NotethatsomeofthebathroomrecommendationsintheAustralasian Health Facility Guidelinesaretoosmallandmaynotallowsufficientspaceformovingandhandlingandusingequipment.Alltoiletsandbathroomsinhealthcarefacilitiesshouldallowsufficientspacefortwocarerstoassist.

4. Source:www.dbh.govt.nz/building‑law‑and‑compliance,retrieved19December2010.5. Seepamphleton‘Takingallpracticablesteps’atwww.osh.dol.govt.nz/order/catalogue/hse‑factsheets.shtml.

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9.3 Facility design processWithanyfacilitydevelopment,itisimportanttouseasystematicapproachsothatphysicalspacesneededformovingandhandlingpeoplearegivenadequateconsideration.Twospecificstagesshouldtakeplace:

• Amovingandhandlingassessmentdocumentisdevelopedbyamovingandhandlingcoordinatororhealthandsafetystaff.Thisdocumentidentifiesdesignspecificationsforspaces,outliningthemanualhandlingtasks,includingmovingandhandlingpeople,thatwilltakeplaceinthosespaces

• Setupaspecificprojectforfacilitydevelopment.

Forthefirststage,adocumentisprepared(withatitlesuchasMoving and Handling Assessment for Facility Design).Thisdocumentwillprovideanevolvingplanforthedevelopmentoffacilitiesthateliminatestheneedformanualliftingofdependentclients(seeBox9.3).Oncedeveloped,thisdocumentcanbeusedtoassesscurrentfacilitiesandplanchangestobuildingswheneveropportunitiesforfacilityupgradingoccur.Thisdocumentshouldbeusedintheinitialbudgetcalculationsforthestrategicplanninginthenextstage.

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Box 9.3

Example: Moving and Handling Assessment for Facility Design

ThepurposeofaMoving and Handling Assessment for Facility Design(MAHA)istodevelopfacilitiesprogressivelytoeliminatetheneedformanuallyliftingorhandlingdependentclients,patientsorresidents.Theplanwillusuallybedevelopedbyfacilitystaffasabriefingforanexternaldesignteam.Thepurposeoftheplanistoensurethatphysicalchangesmadetobuildingsandfixturesincorporatebestpracticeformovingandhandlingpeoplewheneveropportunitiesfornewfacilitiesorupgradingoccur.PreparinganMAHAtakesseveralsteps.

1. Assessthephysicaldependencyneedsoftheclientsorresidentpopulationbydeterminingthedegreeofassistancetheycharacteristicallyrequireineachcarearea.Dothisfirstforspecificwardsorunitsbeingupgraded.Foreacharea,identifyandlisttheequipmentneeded,aswellasanystorageandservicerequirementsfortheequipment.Itisimportanttoconsultstaffworkingintheseareasandseektheinputofthemanualhandlingcoordinatororequivalentperson.

2. TheMAHAdetailsshouldbecollatedandprovidedtotheteampreparingthedesignplan.TheMAHAcanbeusedtoinformprojectspaceanddesignrequirements,addressingallarchitectural,structuralandutilityplanningandcoordinationissues.

3. Amock‑upoftheproposedchangesshouldbeconstructed.Thiscanbeassimpleasusingtapeonafloortomock‑uptheareaandwherefurnitureandequipmentwillbeplaced.Thiswillprovideusefulinformationabouthowpracticaltheplanis.Askstafffortheirinputatthemock‑upstage.

4. Modifytheplanwiththeinformationgatheredfromthemock‑up.Themodifiedplanshouldthenbesenttotheexternaldesignteamsothatthefacilitydesigncanbedevelopedfurtherpriortoconstruction.

5. Followingcompletionofthefacilityconstructionorrenovation,managersshouldensurethatcarersandotherfacilitystaffarefamiliarisedwiththenewfacility,andknowhowtouse,serviceandmaintainallequipmentinthefacility.

6. ThepreparationofaMAHAisonlyrequiredforeachareainwhichclientorresidenthandlingwilltakeplace.Itcanbeanindispensabletoolforincreasingstaffandclientsafety,andassistingclientmobilisationand rehabilitation.

Adaptedfrom:Leib&Cohen,2010.

Asecondstageistosetupaspecificprojectforafacilitydevelopment.ThestepsinvolvedforaspecificfacilitydesignprojectaresummarisedinTable9.2andaredescribedinmoredetailbelow.Wherethereisanexternaldesignteam,thesestepsareintendedforaninternalfacilityprojectteamthatisliaisingwiththeexternaldesignteam.Thestepsaremostrelevantfordesigningnewbuildingsandformajorrenovationstoexistingfacilities.Abrieferversioncanbeusedforsmaller‑scalefacilitiesupgrades.

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Table 9.2 Steps in the facility design or renovation process

Step Main activity

Step 1Strategicplanning Identifyneedsandsetgoals,developaplan

Step 2Initialconsultationandactionplan

Gaincommitmentfromdecision‑makers,setupprojectworkinggroup.Developactionplanandtimetable.Assign responsibilities

Step 3Facilityreviewanddevelopmentofdesignbrief

Reviewexistingfacilityandfutureneeds.Collectspecificinformationfordecision‑making.Collateandprepareafacilityreport.Prepareadesignbrief

Step 4Facilitydesign Consultstaffandkeypeople.Finalisedesign

Step 5Implementationoffacilitybuildingorupgrade

Approvalsandbudgetconfirmed,workcommenced

Step 6Commissionreportandongoingreview

Closingreportthatrecordstheprogressoftheproject.Regularlyinspectandreviewfacilities

Step 1 Strategic planning

Thefirststepistodevelopastrategicplanthatsetsouttheprojectgoalsandstrategies.Theplanshould:

• Identifythehealthcareservicesneedednowandforthenextfiveyears

• Describethemodelofcarethatwillunderpinservicedelivery.Forexample,ifitistoassistelderlypeopletoliveasindependentlyaspossibleandmaintainmaximumcontrolovertheirlives,thismodelofcarewillhavedesign implications

• Definethescopeoftheproject.Forinstance,isthisbuildinganewcentreorredesigninganexistingone?

• Setouttheprojectgoalsandyourstrategiesforreachingthem

• Setouthowyouwillcommunicatewithandconsultstafftogaintheir commitment

• Definehowtheclienthandlingfacilitydesignprocessfitsintotheoverallredesignorbuildproject

• Ensurethatthefacilityis‘futureproofed’byallowingforserviceorclientdemographicchanges.

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Step 2 Initial consultation and action plan

Theprojectshouldgainthecommitmentofpeoplethroughouttheorganisation,especiallythosewhocaninfluencetheoutcomeoftheproject,suchasthosewhomakethedecisions,controltheresourcesandunderstandtheworkprocessesandissues.Setupaworkinggroupofkeypeople,including:

• Management,financerepresentatives

• Keyclinicalstaff

• Thedesignerorarchitect

• Healthandsafetyunitrepresentatives

• Themovingandhandlingcoordinator

• Anemployeeorunionrepresentative.

Involvingclinicalstaffandemployeerepresentativesisimportantbecausetheyarelikelytobefamiliarwiththepracticalissuesinvolvedinmovingandhandlingpeopleandcanprovidevaluableideasrelatedtotheirworkactivitiesandclientneeds.

Theactionplanincludessettingtimelinesandspecificprojecttaskssothatkeypeopleareclearabouttheirrolesandresponsibilities,andthereisaclearpathtofollowtoachievetheprojectobjectives.Thiswillincludethefollowingtasks:

• Identifyandprioritisetheprojectobjectives

• Assignresponsibilitieswithintheprojectgroup

• Decidewhatinformationisneededandhowtogatherit(seeStep5)

• Developaninitialplanandtimelinefortheproject

• Identifywhatthecommunicationstrategywillbebetweenthedesignteam andtheorganisation’sbuildingcommitteeormanagementteam(e.g. meetingschedules,keystakeholdersandcontacts,agendasanddistributionof minutes)

• Ensuretheprojectplanisincorporatedintotheoveralldevelopmentplanforthefacility.

Step 3 Facility review and development of design brief

Beforemakinganychanges,areviewoftheexistingfacilitiesshouldbecarriedoutsothatissuesrelatedtothefacilitydesignandlayoutcanbeidentified.Thereareseveralpotentialsourcesofspecificinformationthatcanbeusedtohelpthedevelopmentofthedesignbrief.Theseincludetheuseofexistingrecords,thefacilityprofileand simulations.

• Existing records:Mosthealthcareorganisationshaveoperationalrecordsofclientpopulations,handlingtasksperformedandequipmentused.Accident

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andinjurydatashouldalsobeavailable.Theremaybeinformationfromsourcessuchasclientandworkplaceprofiles,staffquestionnairesandworkplaceaudits.Archiveddocumentsfrompreviousprojectsshouldbereadfor‘lessonslearned’.

• Current facility profile:Compileaprofileofthecurrentstateofthefacilityusingmethodssuchaswalkthroughaudits(seeSection13onconductingaudits),groupdiscussionsandstaffself‑reportquestionnaires.Topicstobereviewedincludemovingandhandlingpolicies,staffandclientneeds,equipmentuse,workflowanalysis(includinganytime‑and‑motionstudiesandstaffingandresidentprofiles)andthestateofcurrentfacilitiessuchasworkspaces,roomlayout,accesswaysandstorage.

• Simulations:Itisstrongly recommendedthatmock‑upsofphysicallayoutsbeusedtoassesswhetherplannedspacesareadequate.Onewayofdoingthisistouseatapedlayoutonanemptyfloorspacesothatallstaffworkinginthatareacantrialtheworktasksthatwillbehappening.

Oncetheinformationhasbeengatheredandcollated,prepareafacilityreportsothattheprojectgroupcanreviewthefindingsanddecideifmoreinformationisneeded.Oncethereviewiscomplete,seniormanagementshouldappointkeypeoplefromtheworkinggrouptodevelopthedesignbrief,preferablyincludingorconsultingamovingandhandlingcoordinator.Thebriefsetsspecificationsforworkspaces,layouts,accessways,fixtures,fittingsandotherfeatures.Theprojectplanmayneedupdatingatthis point.

Step 4 Facility design

Therewillusuallybeseveraldesignstages,frominitialconceptstofinishedplans.Itisimportantthatkeypeopleareconsultedateachstage.Themovingandhandlingcoordinatorwillensurethatthedesignis‘userfriendly’andpromoteslow‑riskclienthandlingpractices.Staffshouldbeaskedforfeedback,astheywillprovidepracticalviewsbasedontheirexperienceofmovingandhandlingoperations.

Step 5 Implementation of facility building or upgrade

Thisstepinvolvesgainingapprovalsandbudgets,obtainingpricesortenders,commissioningthework,andmonitoringprogresstoensuretheworkiscarriedoutto specifications.

Step 6 Commission report and ongoing review

Oncetheprojecthasbeencompletedandpriortofacilityuse,thereshouldbeaclosingreportthatrecordstheprogressoftheproject,listinganyproblems,deviationsfromplanandresolutions.Oncethishasbeenarchiveditcanbeused

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asaguideforfutureprojectsasa‘lessonslearned’document.Ongoingandregularreviewsoffacilitiesareneeded.Informationtoassistthisprocesscanbeobtainedfromresourcessuchastheaudittool,staffquestionnaireandworkplaceprofile–seeSections12and13intheseGuidelinesformoredetails.Regularreviewsoffacilitiesandidentifyingsafetyissuesarecriticalpartsoftheriskassessmentprocessandshouldbedoneatleastonceayear.Addressingissuesandupgradingfacilitiesshouldbepartoftheprocessofcontinuingqualityimprovement.

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9.4 Ceiling tracking and hoistsOneofthemostimportantdesignfeaturestoincludeinallnewbuildingprojectsandrenovationsistheinstallationofceilingtracking,whichallowstheuseofceiling‑mountedhoists.Ceilinghoistsfacilitatemovingandhandlingandsavespace.Ceilingtrackingcanalsoberetrofittedtoexistingfacilities.Asaminimumfornewbuildings,ensurethattheceilingstructureissufficientlystrongtoallowlaterfittingofceilingtrackingandhoistswhenfundsareavailable.

Ceilinghoistssupportverticalandlateraltransferswithminimalmanualeffortbycarers.Thehoistsoperatefromceiling‑mountedtrackingandmostarebatteryoperated.Theyallowtheliftingandtransferofpeopleinslingswithinareascoveredbythetrack.

Researchhasshownthattheinstallationofceilinghoistsleadstosignificantreductionsinmusculoskeletalinjuriesandphysicalstresstocarers.6Italsoincreasessafetyforclients.Paybackperiods(basedonreturnsoninvestmentthroughreducedinjuriesandabsenteeism)forceilinghoistsvaryfromlessthanayeartothreeyears,dependingontheequipmentpurchasedandtheextentoftrainingprovided.Injuryreductionratesof58%to72%havebeenachievedwithinonetothreeyears.7

• Specificadvantagesandfeaturesofceilinghoistsare:

• Ceilinghoistsrequirefewercarerstocarryouttransfertasksandtakelesstimetousethanmobilehoists

• Ceilinghoistscanbeeffectiveforenvironmentsthatareproblematicformobilehoists,suchasrestrictedspacesandspaceswithcarpetedfloors

• Theycanreducetheneedforotherstructuralchangesrequiredinaclient’shome,suchasdoorwaysandbathrooms

• Theinitialcostsofceilinghoistsaretypicallymorethanthoseofothertransfermethods–theyaremostcosteffectivewheninstalledinnewbuildings

• Transfersbyceilinghoistcanonlybeprovidedintheareaswithtracks installed.

Layout options for ceiling tracking

Therearemultipledesignsforceilingtracksystems–singleandmultipletracksystems,andstraight,angled,curvedandmultidirectionaltracksystems.Thetypeofceilingtracksystemselectedwilldependonthetypesofuseintended.Forsingle

6. Jung&Bridge,2009.7. CeilingHoists,WorkplaceHealthandSafety,Queensland(Australia).Retrieved7January2011fromwww.deir.qld.gov.au/workplace/subjects/

ceilinghoists/index.htm.

Ceiling tracking with hoist

figure 9.1

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rooms,straighttrackingmaybetheeasiesttoinstall.However,itsmajorlimitationisthatitonlyallowstheliftingandmovementofclientsinastraightline.Addingcurvedsectionsoftrackingallowsincreasedcoverageandrepositioningflexibility,especiallyinbathrooms(seeFigure9.2).Innewdesignswherethebedandtoiletlocationsareknown,itmaybepossibletoorganiseastraighttrackfromneartheheadendofthebedtothetoiletbyappropriatepositioningofthedoorway.Thiscanresultinsignificantcostsavings.

Themostversatiletrackingsystemisaparalleltrackingpatterncalledthe‘XY’system,whichprovidesfullroomcoverage.Withthissystemaclientcanbemovedanywhereintheroom.TheXYsystemhastwostraightsectionsoftrackoneachsideoftheroom,paralleltoeachother,withanothertrackjoiningthetwo.Thejoiningtrackcanslidealongthetwoparalleltracks.

Morecomplextracksystemsareavailableforhealthcarefacilitieswheretransfersbetweenrooms,suchasbedroomtotoilet,arerequired.Forexample,‘gates’(fortransitbetweentwoadjacenttracksystems)and‘turntables’(whichallowmovingfromonetracktoanotherattrackjunctions)canalsobefittedtoincreasetheversatilityofceilingtrackingsystems.MoreinformationaboutthetypesofceilinghoistusedwithceilingtrackingisprovidedinSection7Equipmentformovingandhandlingpeople.

Designing for ceiling tracking and hoists

Ceiling support structures:Aprimarydesignfeatureistoensurethattheceilingsupportstructureisadequatefortheadditionalloadsimposedbyaceilingtrackingsystemandhoist(seeBox9.4).Manyceilingtrackingsystemswithhoistshaveasafeworkingload(SWL–weightofpersonlifted)of200kilogramsand270kg.AdditionalsystemsareavailablethathaveSWLcapacitiesof363kgand454kg.Thefollowingdesignspecificationsarerecommended:

1. Fornewinstallations,therecommendedminimumSWLforthehoistshouldbe 270kg

2. Boththetrackingandtheceilingsupportstructuresshouldbeabletosupport1.5timestheSWLforaperiodof20minutes

3. Whereceilinghoisttrackscouldbesubjecttomorethanonehoistloadingatatime,engineeringapprovalmustbeobtained

4. Duringinstallation,allceilingtrackingmustbeclearlylabelledwiththeSWLatregularintervalsalongthetracking

5. Iftheinitialdesigndoesnotprovideforhoists,everyattemptshouldbemadetoprovideadesignthatmaximisestheopportunityforfuturehoistandtrack

Example of curved ceiling tracking in bathroom

figure 9.2

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installation(e.g.avoidtheinstallationoffalseceilingsorservicesabovewheretracksmaygointhefuture).

Box 9.4

Australasian Health Facility Guidelines: Ceiling tracking

TheAustralasian Health Facility Guidelines(AUSHFG2009)notethefollowingdesignspecificationsforceilingtracking:

501441Roomswithceilingmountedequipment,suchasX‑RayRoomsandOperatingRoomsorotherroomswhereceiling‑mountedpatientliftingdevicesarefittedmayrequireincreasedceilingheights.Heightsshouldcomplywithequipmentmanufacturers’recommendations.Themostcommonceilingheightinsuchareasis3000mm.(AUSHFG2009pp.851‑852)

501444Reinforcementoftheceilingsupportstructureshouldbeprovidedforoverheadpatienthoistswhereinstalled.Thisshouldbenotedintheprojectbrief.Inaddition,informationprovidedbyequipmentmanufacturersshouldbereviewedintermsoftheneedsofparticularitemsofequipmentforpassagethroughfullheightdooropeningse.g.toensuitebathrooms;orthatmayaffectthepositioningofbedscreentracksorothersuchfixturesinmultiple‑bedrooms.

Ceiling heights:Forceilingheights,allowing3,000mminnewbuildingsprovides dequatespaceforceilingtrackingandscreeningcurtaintracking.Specifyingadoorwayheightthatextendstotheceilingwillassistintheplacementofceilingtrackingtoconnectrooms.

Doorways:Typicaltransfertasksoccurbetweenrooms,soceilingtrackingneedstogoacrossrooms,throughdoorwaysandintoadjacentareassuchasbathrooms.Usuallyfull‑heightdoorwaysshouldbespecifiedwhenceilingtrackingistobeinstalled.

Screening curtains:Whenscreeningcurtainsareusedinconjunctionwithceilingtracking,specificplanningisneededduringcurtaintrackinginstallation.Curtaintrackingistypicallyinstalledbelowceilingtrackingandlocatedsothatscreeningcurtainscanbepulledclearoftheceilingtrackingandceilinghoists.However,someceilingtrackingsystemsallowcurtaintrackingtobeplacedaboveceilingtracking.Thereareseveraloptionsforcurtaintrackingthataredesignedtobecompatiblewithceilingtracking.

Figure9.4showsasuggestedconfigurationforceilingtrackingandcurtaintracksforaroomwithmultiplebedsandadjacentensuitebathroom.Ceilingtrackingandhoistsshouldreachwithin1000mmoftheheadsofbeds.

Example of curved ceiling tracking in bathroom

figure 9.3

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Figure 9.4

Example of ceiling and curtain tracking in rooms with multiple beds

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9.5 Access design featuresCorridorwidths,doorwidths,flooringandhandrailfeaturesaffectaccessforstaffandclientsbetweenthevariousfunctionalareasofahealthcarefacility.Thissectionrecommendssuitabledimensionsforaccesswaysandturningandpassingspaces,withdrawingsshowingsuggesteddesigndetails.Themovementofclientsrequiresassistancefromcarers,whomayneedtouselargeequipmentsuchasbeds,trolleys,hoistsandwheelchairstotransferclients.Theuseofhandrails,grabrailsandlightingisalsocovered.

Corridors

Corridorsareexpensivetobuildandmaintain,sotheminimumwidthsrecommendedreflectabalancebetweenuserequirementsandcost.Themainconsiderationsincludewherethecorridorislocated,frequencyofusebystaffandclientsandequipmentthatisused(suchasbeds,trolleys,wheelchairsandhoists).

• Major corridorsarehigh‑usecorridorswheretheunrestrictedmovementofclientsisimportant.Theyareusuallyemergencyevacuationroutesandhigh‑frequency‑usecorridors.

Minimum clearance widths for corridors

Major corridors need adequate clearance widths

figure 9.5 figure 9.6

• Regular corridorsneedclearpassagesforassistedclientmovementsandmaybelower‑frequency‑usecorridors.

Therecommendedminimumwidthsdescribedbelowallowstafftomoveclientsduringtheirnormaldailytasks,aswellasduringemergencyevacuations.Thesewidthsmustbeclearandunobstructed.Fixedandportableitemssuchashandrails,basins,trolleysandfurnitureshouldnotbeplacedwheretheyreducetheclearwidth–oradditionalspaceshouldbeprovidedfortheseitems.

• 2,200mmclearwidthformajorcorridorssuchasinterdepartmentalandpublic routes.

• 1,800mmclearwidthforregularcorridorswhereclientsmaybemovedinlargeequipment(suchasbeds)andwherepassingisrequired,andcorridorswithin

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wardswhereclientsaremovedwithlargeequipmentitemsandareoftenassistedbycarers.

Corridorsneedtocomplywiththerelevantbuildingcodes.8

Floor spaces for passing and turning

Thewidthsforcorridorsalsoapplytospaceswherepassingorturningclientsinwheelchairsislikely,orwhenusingotherlargeequipment.Thewidthsspecifiedrefertoclearspacesbetweenhandrailsandanyotherfixtures.Widthsforthesespacesarelistedbelow.

Forclientbeds,theminimumpassingspacesare:

• 2,200mmminimumclearwidthforbedpassing

• 1,800mmminimumclearwidthforotherpassing–thisincludespassingspaces forclientsassistedbycarersandforlargeclienthandlingequipment,includingmobilehoists,mobilesittostandhoists,wheelchairs,commodechairsand trolleys.

Minimum turning spaces

Forturningwheelchairs,commodechairsandwalkingframes:

• 1,800mmminimumturningcirclediameterspaceforcarerstorotatechairswithclients

• 1,500mmminimumturningcirclediameterspaceforpeopleusingself‑propelledchairsandwalking frames.

Foracarertoturnabed,wheelchairorhoistthrough90°whenenteringorleavinga room:

• 1,800mmminimumwidthforturning beds

• 1,500mmminimumwidthforturningwheelchairsorhoists.

8. TheseincludetheBuilding Act (2004),theFireSafetyandAccessRouteprovisionsoftheBuilding Regulations (1992)andNZS4121Design for Access).

Bed passing space

figure 9.7

Turning circle for assisted and unassisted wheelchairs

figure 9.8

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Doorways

Therecommendationsprovidedrefertothedimensionsoftheclearspaceinthedoorwaywhenthedoorisfullyopen,andapplytobothswingingandslidingdoors.

Doorway height:Theminimumheightis2,030mmtoenableequipmenttopassthroughthedoorway.

Doorway width:Forcorridors,theminimumdooropeningwidthis1,800mm(doubleopeningswingingdoorswitha900‑900mmsplit).

Forbedroomsandotherroomsusedbyclients,theminimumdooropeningwidthis1500mm(doubleopeningswingingdoors,forexamplewitha1,050–1,450mmsplit;seeFigure9.10)wherelargeequipmentmaypassthrough.

Fortoilets, showers and bathrooms,theminimumdooropeningwidthis1,200mm.Slidingandswingingdoorsareacceptable.Doorsshouldnotswingintotoilets.

Inotheraspects,dooropeningsneedtocomplywithNZS4121Design for Access.

Flooring

Choosingfloorcoveringsthatmeettheneedsofstaff,clientsandmanagerscanbechallengingfornewandrenovatedfacilities.Floorcoveringsneedtobe:

• Safeforstaffandclients

• Comfortableforclientsandstaff

• Functionalfromacleaningandmaintenanceperspective.

Somecommonrisksrelatingtofloorcoveringsinhealthworkplacesincludestrainsandinjuriescausedbymanoeuvringwheeledequipmentandinjuriesfromslips,tripsandfalls.Somesoftfloorcoverings(e.g.carpet)candoubletheforcesrequiredformanoeuvringmobilehoistscomparedwithhardsurfacessuchasvinyl.Smalllipsorjoinsbetweendifferentfloorcoveringscanincreasetheforcesrequiredtomanoeuvrewheeledequipmentsuchasmobilehoistsbetweenrooms.

Ensure adequate doorway widths

figure 9.9

Door opening 1500mm width with 1,050–1,450mm split

figure 9.10

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Wherecarersaremovingandhandlingclients,somerecommendationsforflooringare:

• Floorcoveringsshouldbetightlyfittedtoavoidtriphazards

• Jointsinfloormaterialsmustbepermanentlysealedtoavoidgapsandlooseedgesthatcouldcausetrippingorrestrictthemovementofclienthandlingequipment.Jointsshouldbelevelwiththemainfloortoavoidbeingobstaclesforwheeledequipment

• Wherewheeledclienthandlingequipmentisused,selecthardfloorcoveringssuchasvinylinsteadofcarpettomakemovingequipmenteasier

• Ensureedgingstripsinflooringarebevelledandnotmorethan10mmabovethefloor.9

Forwetareas,makesuretheflooringisnon‑slipwhenwet.Slopethefloorfourwayswithaminimumfallofatleast1:50tostopwaterpooling.Laptheflooringupshowerwallsatleast150mm,andupthewallsofdressingareasatleast75‑100mmtoavoid leaks.

FloorsshouldcomplywithfiresafetyrequirementsandtherelevantAustralianandNew Zealandstandardsforslipresistance.10

Ramps

Rampsareusedinmanyhealthcareandresidentialcarefacilitiesaswellasinprivatehomes.Asageneralrule,rampspresentsignificanthazardstocarersandpeopleinmanualwheelchairsbecauseoftheforcesrequiredtopushwheeledequipmentupthem.Rampsalsopresenthazardstobothcarersandclientswhenmanoeuvringwheeledequipmentdownthem.Acurrentdesignviewistoavoidrampsifpossiblebecauseofthepotentialhazardstheycreate.However,avoidingrampsmaynotbefeasibleinsomeprivatehomes.

Iframpsareinuseandcannotberemoved,severalcriteriaarerelevanttodecreasingthehazardsrampscreate.Asageneralrule,thesteeperrampsare,themorehazardoustheybecome.Manydesignstandardsspecifyapreferredgradientof1:14forpeoplewithdisabilitiesandamaximumgradientof1:10(5.7°).Rampswithgradientsgreaterthan1:8(7.12°)aredifficulttousebyelderlyanddisabledpeople.Evenwithgradientsthatarenottoophysicallydemanding,landingsarenecessaryasrestingplaces.Moststandardslimitthedistanceoframpsbetweenlandingstoaround 9,000mm.11

Rampflooringshouldbeofnon‑slipmaterial.Outsiderampsthatcangetwetrequirespecialconsiderationforflooring.

9. SeeWorkSafeVictoria(2007,pp.35‑44)formoreinformationonflooring.10. ThesestandardsincludeAS/NZS4586‑2004andAS/NZS4663‑2004–seeAustralian/New ZealandStandards,2004aand2004binthe

referencelist.11. SeeTempler(1992,p.44)foradetaileddiscussionoframpdesign.

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Handrails

Handrailsorgrabrailsshouldbeprovidedinmultiplelocations,suchasbathroomsandotherspaces,forsemi‑mobileclients.Ahandrailisusedforgeneralsupportandmayoccasionallytakeaclient’sfullweightiftheytriporfall.Anexampleishandrailsalongthesidesofcorridors.AllhandrailsandgrabrailsshouldhaveknownSWLsandtheseshouldbevisiblewhereappropriate,suchasongrabrailsbesidetoilets.

Agrabrailprovidesstrongersupportthanahandrail.Itcantakeaclient’sfullweightduringhandlingoperations;forinstance,acombinedhorizontal/verticalgrabrailfittedadjacenttoatoiletcanhelpaclienttostand.12Grabrailsinareasusedbybariatricclientsmayneedwallswithadditionalload‑bearingcapacity.

12. StandardsforhandrailandgrabraildesignsareinNZS4121Design for Access–seeNew ZealandStandards,2001.

Fit handrails and grab rails where needed

figure 9.11

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9.6 Client handling areasThedesignofallhealthcarefacilitiesshouldenableindependentmobilitybyclientsandallowcarerstoworkwithclientsinwaysthatreduceriskstoclientsandcarers.Effectivemovingandhandlingplacesadditionaldesignrequirementsonfacilities.Extraspaceisneededforcarerstoworkalongsideclientsandtoallowsuitableequipmenttobeused.Howmuchextraspaceisneededdependsonthenumberofcarersrequired,thelevelofmobilityofclients,theequipmentbeingusedandthespecifictechniquesusedtomoveclients,andpossiblechangesintheprofilesofclientsinthefacilityorunit.

Themainareaswheremovingandhandlingtaskstakeplacearebedrooms,bathrooms(includingtoilets,showersandbaths),corridors,dayrooms,diningroomsandclinicalsuites.Eachonehasspecialrequirements.Inthissection,suggestedlayoutsandfittingsforeachtypeofroomareprovided.Akeydesignfeaturethatshouldbeconsideredearlyinthedesignprocessistheinstallationofceilingtrackingtoallowtheuseofceilinghoists.

Bedrooms

Theareasadjacenttobedsneedtoallowcarerstouseeffectiveworkingposturestocarryouthandlingtechniques.Thereshouldalsobesufficientclearspacetoallowmovingandhandlingequipment,suchasmobilehoistsandwheelchairs,tobeused.

Accessspaceshouldbeprovidedsothatequipmentsuchasmobilehoistscanbemovedfreelybetweenbedsanddoorways.Keepfurnitureoutoftheseareas,orensurethatitiseasytomove.Ifhandbasinsorotherfixturesaretobeinstalled,spaceshouldbeaddedtoallowsufficientclearspaceformovingandhandling.

Dimensions for bedrooms

Thefollowingclearspacesarerequiredformovingandhandlingandapplytoatypicalbedthatis2,200mmlongby1,000mmwide.Theseclearspacesareconsistentwiththerecommendationsmadeinareviewofbedspacesforclientsreceivinghealthcare.13

• 1,200mmclearspaceoneachsideofthebedsothatcarerscanworkwithequipmentitemssuchasmobilehoists.Ceilingtrackhoistsandwheelchairsneedlessspacethanthis,butallowing1200mmenablesmosttransfertaskstobeperformedeffectively

• 1,500mmclearspacebesidethebedwherestandinghoistsandbedtotrolleytransfersmayberequired14

• 1,200mmclearspaceatthefootofthebedsothatequipmentcanbemovedfromthebedtothedoor.Thisallowsahoisttobepositionedandaclienttobetransferredtoachairatthefootofthebed.

13. SeeHignett&Lu,2010.14. SeeWorkSafeVictoria,2007,pp.46and47.

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Furniture in bedrooms

• Bedsshouldbeheightadjustablesothatmovingandhandlingtaskscanbecarriedoutatthecorrectworkingheight

• Bedsshouldhaveanunder‑bedclearanceofatleast150mmtoaccommodatemobilehoists

• Bedsshouldbeoncastorssothatcarerscanmovethebedstocreateextraspaceifneeded

• Providechairswitharmreststohelpclientsstandup

• Providefurnitureoncastorssothatitiseasyforcarerstomoveittoallowspaceforlargemovingandhandlingequipment

• Ifreclinerchairsareused,theyshouldbeelectricandhaveeasy‑to‑cleansurfacessuchasvinyl.

General features for bedrooms and other client areas

• Provideastaffcallingsysteminasmanylocationsaspossibleandwithineasyreachofclients,sothatclientsandcarerscancallforhelpifnecessary.Thesystemactivationlightshouldoperatesothatitcanonlybecancelledattheactivationpoint

• Havesufficientelectricaloutletsinclientareassothatpowercordsdonotneedtocrossaccessways.Itisrecommendedthattherebeadoublegeneralpoweroutletundereachbedandanotheronasidewall(e.g.underawindow)forelectricarmchairs

• Wherefeasibletoinstall,slidingdoorsallowmoreeffectiveuseofspace.

Single bedrooms

Figure9.12showsanexampleofasingle‑roomlayout.Inthisexample,toprovidefor1,200mmclearspaceoneachsideofthebed,theminimumbedroomdimensionsshouldbe4000mmwidetoallowforfixedwallfittingsandfurnitureononeside,and3,400mmdeep.

Fortransfersfromabedtoatrolleyusingatransferboard,thereneedstobeatleasta1,200mmclearareabesidethetrolley,sothatthecarercanadoptasafeworkingposture.Providingfor1,200mmoneachsideofthebedallowslargerspacesforbedtotrolleytransfersifthebedispushedtooneside.

266

Figure 9.12

Example of a single‑room layout

Rooms with two or more beds

Theminimumspacerecommendationsforsingleroomscanbeusedasaguideforroomswithmultiplebeds(seeFigure9.13).Inbedroomswithmultiplebeds,thereshouldbeminimumclearspacesof2,400mmbetweenbedsthataresidetosideand2,400mmbetweenbedsthatareendtoend.Itisassumedthatthetypicalbedsizeis2,200mmlongby1000mmwide.Thesedimensionsmayneedtobelargerforbedswithadditionalequipmentandaccessoriesattached.

For beds that are side by side

• 3,400mmbetweenbedcentrelines

• Allowatleast1,200mmbetweenthebedandthescreeningcurtainforuseofequipmentwithintheprivacycurtain.Ifceilingtrackhoistsareinstalled,allowing1,000mmbetweenthebedandcurtainenablesclientmovementstobeperformedeffectively

• 1,200mmclearancebetweenthefootendofthebedandtheprivacycurtain.

• 900mm‑widecorridorspaceoutsidetheprivacycurtainattheendofthebedforaccessbetweenthebedandthedoor.

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For beds that are end to end

• 2,400mmclearancebetweenbedfootends

• 1,200mmclearancebetweenthefootofthebedandtheprivacycurtain

• 900mm‑widecorridorbetweenprivacycurtainsforaccesstodoorwhenprivacycurtainsareused.

Figure 9.13

Example of a room layout with four beds

Bathrooms, toilets and showers

Thelayoutsforbathroomswilldependonthespecificneedsofthefacility.Thetextbelowdescribeslayoutsforbothseparatefacilities,inwhichtoilets,showersandbathsareinseparaterooms,andcombinedfacilitiessuchasensuitebathrooms,wheretoiletsandshowersareprovidedinthesameroom.Thegenerallayoutprinciplesforseparatetoiletsandshowerscanbeadaptedwherethesefacilitiesarelocatedinasingleroom.

Toilet spaces

Toiletsneedadequatespacearoundtoiletbowlsandsinks,plusclearpassagestoallowcarerstoassistclientsanduselargeequipmentifneeded.Formultiple‑bedfacilities,atleastoneall‑genderaccessibletoiletshouldbeprovidedineachward

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orunit.AcommondesignerrorinNew Zealandhealthfacilitiesistoplacetoiletsincornersofbathrooms,withthebacksofthetoiletstooclosetothewalls.

Theamountofspacerequireddependsonhowmanycarersareinvolvedandtheequipmentused.Movingandhandlingactivitiesandequipmentintoiletsincludetransfersfromawheelchairorcommodechair(eithersideonorfronton),clientswalkingwithframes,andstandinghoists.

Figure9.14givesthetypicalspacesthatwouldbeadequateforatoiletinahealthcarefacility.Forroomswithasingletoiletandforensuitebathrooms,theminimumrecommendeddimensionsrequiredforcarersandequipmentare:

• Dooropening:minimum1,200mmclearwidth

• Depthofroom:minimum2,200mmfromdooropening

• 1,500mmclearspaceinfrontoftoilettoallowforequipmentfortoilet transfers.

Figure 9.14

Toilet plan allowing space for carers and equipment

Fordoorsintoensuiteandotherbathrooms,considerationcouldbegiventohavingcornerswithtwoslidingdoorssothattheentirecornerscanbeopenedforaccess.

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Forspacebetweenthetoiletbowlandwall:

• Thefrontofthetoiletseatneedstobe700‑750mmfromthebackwall

• Fortwocarers,thereneedstobeatleast950mmoneachsidefromthetoiletbowlcentre,plus200mmononesideforindependentdisabledsidetransfers

• Infacilitieswithmostlymobileresidents,itmaybeadequatetoprovideforonecarerwithatleast950mmononesideand450mmontheothersidefromthetoiletbowlcentre,plus200mmforindependentdisabledsidetransfers.

Anotherdesignalternativefortoiletspaceistoanglethewallandthetoiletpedestaltoprovidespaceoneachsideofthetoilet(seeFigure9.16).Thiscanbeacost‑effectiveoptionforsmalltoiletareas.

Toilet fittings:Astableandsecuretoiletseatisimportantasitmakesiteasytotransferpeople.Thetoiletbowlheightneedstoallowforequipmentthatmaybeused.Forexample,allowforacommodechairbeingusedoverthebowl.Inaunitthatprovidescareforbariatricclients,largetoiletseatsmaybeneeded.Infacilitiescaringforpeoplewithdementia,toiletseatsshouldbedifferentcoloursfromthepedestals.

Handrails:Handrailsorgrabrailsextendingfromthewalloneachsideofthetoiletcanhelppeopletomoveonandofftoilets.Horizontaldrop‑downgrabrails700mmfromthefloor,thatcanbefoldedaway,aremostsuitable(seeFigures9.15and9.17).

Basins:Whenpositioningbasins,thecentreofeachbasinshouldbeatleast400mmfromanyadjacentwall,sothatthebasincanbeusedbyaclientinachair.Allowaclearspaceofatleast800mmwideby1,200mmdeepinfrontofthebasinforwheelchairandequipmentaccess.Thereshouldbeaclearanceof50‑60mmbetweenthetapsandanyobstructionorwall.

Allowatleast675mmclearspaceunderthebasinforusebyaseatedclient(Figure9.17).Ensurepipesandwasteoutletsdonotobstructthespaceunderthebasin.

Toilet with space for carers and equipment

figure 9.15

Angled toilet pedestal

Figure 9.16 Angled toilet pedestal

figure 9.16

Floor heights for toilets and basins

figure 9.17

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Shower rooms

Adequatespaceshouldbedesignedforshowerroomssothatcarerscanassistclientstoshower,dry,moveandtransfer,andtoallowaccessforlargeclienthandlingequipmentsuchaswheelchairsandcommodechairs.Thereshouldbenoplinth,raisededgesorotherobstaclesinashowerunitthatmaylimitwheelchairaccess.Allfloorsneedtobedesignedwithfallstostopwaterfrompooling,withincreasedfallsincurtained‑offshowercubicles.Thefloorsshouldhavenon‑slipfloormaterial.

Figure 9.18

Shower room with space for a shower trolley

Showerroomsneedenoughspaceforcarersandequipmentinbothwetanddryingareas(seeFigure9.18).

• Wetshowerareas:1,800mmby 1,000mm

• Dryingspace:1,800mmby1,800mmor2,200mmby2,200mmiflargemobileshowertrolleysareusedandforbariatricclients.

Mobileshowertrolleysvaryinsize,butareusually600‑750mmwideand1,500‑2,200mmlong.Thedryingspaceneedstobeatleast2,200mmby2,200mm

Shower room fittings

figure 9.19

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tomovemostshowertrolleysintoposition.Lessspacemaybeneededwhenusingsmallershowertrolleys.

Forshowerroomfittingsthefollowingfeaturesaredesirable(seeFigures9.18and 9.19):

• Ahingeddrop‑downseatintheshowercubiclethatisatleast600mmwidecanhelpclientswhoarepartiallymobile.Theseatcanbehingedoutofthewayforclientswhoarewalkingorusingcommodechairs.Adisadvantageisthathingedseatsrequireregularcleaningandmayimpedemobileshower trolleys

• Afixedgrabrailwithhorizontalandverticalarmsneartheshowerseatcanhelpclientstostand

• Theshowershouldhaveadetachable,height‑adjustableshowerheadandahoseatleast1,500mmlongclosetotheshowerseat.Ifashowertrolleyisused,thehoseneedstobeatleast2,000mmlong.

Combined shower and toilet rooms

Combinedshowerandtoiletroomscanbeusefultocarers,becausetheyprovideimmediateaccesstoatoiletifaclientneedsonewhileshowering.Aceilingtrackhoistwithacurvedsectionaroundthebathroomwillhelpcarerstomoveclientsbetweentheshowerandtoiletmoreeasily(seeFigure9.20).Therearemultipleoptionsforlayingoutacombinedshowerandtoiletroom.Itismostimportanttoallowadequatespaceinshoweringanddryingareassothatcarerscanuselargeequipmentif required.

Figure 9.20

Example of ceiling tracking through into bathroom

Figure9.21showstheminimumspacerequiredforthesingle‑doorwayoption.Ifacombinedshowerandtoiletroomissharedbetweenrooms,extraspacewillbeneededforanotherdoor.Thiscanbedonebyextendingtheroomlengthfrom2,700mmto3,350 mm.

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Figure 9.21

Combined shower and toilet room

TherecommendedrequirementsforcombinedshowerandtoiletroomfittingsareshowninFigure9.22.NZS4121Design for Accesshasfurtherinformationondesigningshowersandcombinedshowerandtoiletareasfordisabledpeople.

Figure 9.22

Fittings for combined shower and toilet room

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Rooms with baths

Asbathshavebeenlargelyreplacedbyshowers,fewbathsareinstalledinnewandrenovatedhealthcarefacilities.Ifabathisinstalled,therecommendeddimensionsforspaceareshowninFigure9.23.Wherefeasible,installceilingtracking.Ifceilingtrackingisnotavailable,allow1,200mmonbothsidesofthebathtomoveapersonfromawheelchairtothebathusingamobilehoist.Considermountingthebathonaplinth(300mmhigh),otherwisecarerscanfindbendingoverthebathstressfulontheirlumbarspines.Haveatleast150mmclearspaceunderneathsothatamobilehoistcanbepositionedoverthebath.Birthingpoolsneedceilingtrackingaboveforhandlingandemergencyevacuations.

Figure 9.23

Layout for a room with a bath

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Day and dining rooms

Fordayroomsanddiningrooms,Figure9.24showsthetypicalspacesneeded.Somekeypointsare:

• Allowadequatespacearoundchairsanddiningtablessothatclientsusingmobilityaidsandwheelchairscanaccessthefurnitureeasily

• Makesuretheaccessareabetweentheentrancedoorwayandseatingareasisatleast1,500mmwidesothatclientsandtheircarershavespacetomoveand pass

• Provideextraspaceforthetemporarystorageofequipment,suchaswalkingaidsandwheelchairs,whileitisnotbeingused.

Figure 9.24

Spaces needed around furniture in day rooms

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Clinical suites

Clinicalsuitesaretakentoincludemedicalimagingsuites,obstetricdeliverysuites,operatingsuitesandmortuaryandautopsysuites.Thelayoutofclinicalsuitesneedsspecialconsideration,asbedsmaybesurroundedbyequipmentandcannoteasilybemovedifmorespaceisneededforhandlingtasks.

Thefollowingarerecommendationsforclearareasandspacesrequiredforclinical suites:

• Allowa1,200mmspaceonbothsidesofthebedtoaccommodateclienthandlingequipmentandtransfertrolleys.Ifthisisnotpractical,700mmononesideofthebedand1,200mmontheothermaybesufficient–facilitiesforbariatricclientsshouldallow1,500mmonbothsidesofthebed

• Clinicalsuitesshouldhavedouble‑openingdoors.Doorwaysneedtobeatleast1,500mmwidetoallowforequipmentitems

• Thepathwayfromthedoortothemaincareareashouldbeatleast1,500mm wide

• Allowatleast1,200mmclearspaceatthefootofthebed

• Keepallequipmentawayfromclearspaces,orputequipmentoncastorstoallowittobemovedeasily.

Thespacesneededaroundbedsinpre‑andpost‑medicalroomsaresimilartothoserequiredaroundbedsintypicalunitsandbedroomsforclients.

Other client handling areas

Thereareseveralotherareasthatmayneedtobeincludedinthedesignofclienthandlingspaces.Theseincludeliftsinmulti‑storeybuildings,externalaccesstobuildingsandoutdoorareassuchasgardens.

Lifts:Keyelementstobeconsideredforliftdesigninclude:

• Dooropenings–ensurethewidthandheightaccommodatelargeequipmentandpeople

• Internaldimensions–allowforstafftostandoneithersideofabedortrolley

• Positionofliftcontrols–ensuretheyareeasytoreach

• Doorhold‑opentimes–allowtimeforthepositioningofequipmentand people

• Accuracyoflevellingbetweenliftfloorandexternalfloor–itshouldnotcreateatriphazard

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• Thehorizontalwidthofthegapbetweentheliftfloorandtheexternalfloors,relativetothediameterofthewheelsofmobileclienthandlingequipment,includingliftingmachinesandbeds–allowforsmoothmovement.15

External access to buildings:Considerbuildingaccessandexitpointsforpeopleandvehiclestoreduceclienthandlingandotherrisks.Forpedestrianaccess,staff,clientsandvisitorsneedeasyaccessfromcarparksandfrompublictransport.Mainentrancedoorsshouldbeuseablebyalltypesofmobilityequipment,includingwheelchairs,walkingframesandelectricscooters.Twospecificfeaturestoassistaccessareautomaticopeningdoorsandcoveredentrancesatgroundlevel.Enquiryorreceptionareasshouldbelocatedatmainentrancestoassistpeopleinwheelchairsandusingothermobilityequipment.

Whenplanningforvehicularaccess,identifythetypesofvehiclethatneedaccess.Thesemightincludeambulancesandotheremergencyvehicles,clientandstaffvehicles,funeralcarsandvehiclesusedbysuppliersofgoodsandservices.Planningforappropriatevehicleaccessneedstotakeintoaccountvehicleturningcircles.Vehicleaccesspointstobuildingsshouldbeseparatefromthemainpedestrianaccesspointstobuildings.Vehicleaccessareasshouldprovidesufficientspacefortheuseoflargeequipmentsuchaswheelchairs,stretchersandtrolleys.

Outdoor areas:Somefacilitiesprovideclientsandstaffwithaccesstooutdoorareassuchasgardensandcourtyards.Theseshouldfunctioneffectivelyfromstaffsafetyandqualityofcareperspectives.Inaged‑careandcommunitysettings,outdoorareasareimportantforthewellbeingandmobilityofclients.Asafeenvironmentforclientsincreasestheirmobilityandreducesthepotentialriskstoemployees.Ifadequatelydesigned,suchareashavehightherapeuticvalue,providingopportunitiesforwalking,recreationandsittingspace,particularlyforpeoplewithdementiaandthoseindisabilityhousing.

Carersmaybeinvolvedinthefollowingtasksinanoutdoorsetting:

• Pushingwheelchairsandotherequipment

• Assistingwithtransferstoandfromseating

• Assistingwalking

• Assistingclientsinvolvedinactivitiessuchasgardening.

Checkoutdoorenvironmentsforthefollowinghazardsthatmaycreaterisks:

• Accessdoorsthatpresentbarrierssuchasraisedsteps

• Pathsordoorsthataretoonarrow,notprovidingspaceforclientsandtheirmobilityequipmentandcarers

• Steepslopes,rampsandstairs,particularlyformobilityaidsandwheeled equipment

15. AdaptedfromWorkSafeVictoria,2007,p.32.

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• Unevenorroughgroundsurfacescausingtriphazardsandobstaclesforwheeledequipment

• Courtyardsthataretoosmallforthenumberofpeoplelikelytousethem

• Outdoorfurniturethatistoolowanddifficultforclientstogetintoandoutof

• Sharpfoliage,poisonousplantsandwaterdisplays,whichmaypresentriskstopeoplewithdementia.

Staff and client call systems

Providingstaffandclientcallsystemscanplayanimportantroleinthehandlingofclients,particularlyinemergencies.Duringtheplanningofnewbuildings,ensurethatadequatecallsystemsareinstalled.Duringrenovations,considerupgradingcallsystems.Planthelocationsofcallbuttonstofacilitateeaseofuseandreduceawkwardpostures.

Intoilets,wheredrop‑downgrabrailsareinstalledonbothsidesofatoilet,thecallbuttonshouldbeaccessiblewhetherthegrabrailisdownorfoldedaway.Twocallbuttonsmaybeneeded.

Inbedrooms,callbuttonsshouldbeaccessibleforuseoneithersideofthebedsandturn‑offswitchesshouldbelocatedwitheasyaccessforstaff.

Inshowers,callbuttonsmustbelocatedataheightthatisaccessiblebyapersonwhohasfallen.

Inclinicalandtreatmentrooms,callbuttonsshouldbelocatedsothattheyareeasilyidentifiableandaccessiblebystaffandclients.

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9.7 Equipment storageThenumberofstorageareas,andwheretheyarelocated,dependonthelayoutofthemainfacilityroomsandonthetypesofmovingandhandlingequipmentused.Somethingstoconsiderwhenplanningstorageareasare:

• Allowspaceforbothlargeandsmallitemsofequipment

• Storageareasneedtobelocatedinthewardorunit,within2,000mmofhandlingareasandwithin1,000mmofasupervisorstation

• Storageareasshouldnotblockorreduceaccessways

• Doorwaysshouldbeatleast1,200mmwideforstorageareasforlargeequipmentitemssuchasmobilehoists.

Formobileandstandinghoistsandotherbattery‑operatedequipment,itisimportanttoensurethatsuchequipmentisstoredclosetowhereitwillbeused.Ifitisstoredtoofaraway,carersmaybereluctanttousetheequipmentbecauseoftheincreasedtimetoaccessit.Suchequipmentshouldbeavailablewithin2,000mmofitsprimaryareaofuse.Apreferredoptionisdirectlyoffamaincorridorinarecessedalcovewithapowersupply.Anyequipmentaccessories,suchasslingsforhoists,mustbeinthesameplacetoreducethetimeneededtoaccesstheequipment.

Theamountofspaceneededforstoringequipmentdependsonwhatequipmentisneededandhowmanyitemsthereare.Workplaceprofilescanhelptoidentifystorage needs.16Althougheachwardorunitinalargefacilitymayhavesomewhatdifferentequipmentitems,standardisestorageareasasmuchaspossibleacrossunitsorwardssothatwhenstaffrotatetodifferentunitstheycanfindequipmenteasily.Designersandplannersshouldrefertoequipmentmanualsforspecificsize details.

Avoidusingstorageroomsforstoringdamagedequipment.Movingandhandlingequipmentshouldbewellmaintained,andrepairedorreplacedwhendamaged.

Storage layout

Thereareseveraloptionsforconfiguringstorageareassuchasastorageroomorrecessedbayinacorridor.Storagelayoutshouldprovideeasyaccesstotheequipmentbeingstored.Ensurethatequipmentstoragedoesnotobstructclearspacesincorridors.Storagedesignoptionsinclude:

Long,narrowstoreroomswithaislesdownthemiddleandspaceonthewallsforstoragearegenerallybetterthansquarestorerooms,whereitisoftenhardtoretrieveitemsnearthewallsasthemiddleoftheroomscanbecomeclutteredwithequipment

Storagebaysaccessiblefromthecorridorcanbeaneffectiveoptionforstorage,insteadofbuildingaroom

Shelvingthatisheightadjustableallowsforflexibilityintheitemstobestored.

16. Forresidentialcare,areasonablebenchmarkforequipmentstorageistoallowonesquaremetreperresident.

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9.8 Maintaining working spaces for client handlingAkeymaintenancetaskforstaffistoensurethatareasusedformovingandhandlingremainfreeofstoredfurnitureandotheritemsthatreducetheworkingspace.Ongoingroutinesshouldinvolvetheremovalofitemsthatimpedeclearspace.Suggestedproceduresarenotedbelow.

Bedrooms

• Keepclientbedroomstidyandfreeofclutter

• Createapermanentclearpassagefromthefootofthebedtothedoor,sothereisalwaysclearaccesstomoveequipmentfromthedoortothebed

• Insmallroomswherespaceisatapremium,attachcastorstothefurnituresothatitcanbeeasilymovedoutofthewayduringmovingandhandlingtasks.Forchairsorbedswithwheels,brakesshouldalsobefitted

• Makesurethatbedsareheightadjustable

• Makesurethatchairshavearmreststohelpclienttransfers

• Trytolocateclientswhoneedtousewheelchairsclosetodayanddiningroomstominimisethedistancetheyhavetotravel

• Provideplentyofelectricalsockets,topreventtrailingleads.

Toilets, showers and bathrooms

• Iftoiletsaresmall,inaccessibleanddifficultplacesinwhichtoperformclienthandlingtaskssafely,considerusingothertoiletingmethodssuchascommodes,pansandbottles.

• Iftheshowerorbathroomistoosmallandinaccessibleforlargemovingandhandlingequipment,considerbedbathinguntilanalternativeisfound,orusingashowerchairthatcanbepushedintotheshowerorbathroom

• Installgrabrailsintoilets,showersandbathroomstoencourageclientstostandandsitindependently.

Corridors and doors

• Checkthatcorridorsandaccessroutesarefreeofitemsthatrestrictminimumrecommendedwidths

• Ensurethatitemsarenotstoredbehinddoorsthatcanpreventthemfully opening

• Installcontinuoushandrailsalongcorridorsandstairs

• Ifthresholdsorstairsimpedewheeledequipment,fittemporaryrampstoeliminatetherisksassociatedwithliftingequipmentoverthresholds.

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9.9 Facility design for bariatric clientsHealthcareandotherfacilitiesprovidingcareforbariatricclientsneedtoprovideadequatespacesfortheseclients.Anyfacilitydesignshouldtakeintoaccountboththecurrentdemographicprofileofclientsandchangesthatmayoccurinthefuture.SuchplanningshouldtakeintoaccountSWLsandrequirementsforlargepeople.Planningforabariatricclient’sentrytoafacilitystartswithrampsandhandrailsatentrancestofacilitateaccesstothebuilding.Ensurethatbariatricwheelchairsareavailableandthatthefacility’smainentrancehassufficientclearance.Liftsshouldhaveadequatedoorclearanceandweightcapacity.17

Increaseddoorclearancesandstoragespacesarealsonecessarytoaccommodateoversizedwheelchairs,stretchers,trolleysandbeds,aswellasmobilehoists.Although1,500mmhasbeenrecommendedasthedesignstandardfordoorwaywidths,largerdoorwaywidthsmaybeneededfordiagnosticandtreatmentrooms,inpatientroomsandsurgicalsuitesinareaswherebariatricclientsaretreated.

Forclientrooms,increasethespaceforeachroombyapproximately10squaremetresabovethesizeofastandardroom,andprovidefora1,750mmclearancearoundbeds.Thisadditionalroomspaceisnecessaryforspecialisedequipmentsuchaswheelchairsandmobilehoists,aswellasforadditionalnursingstaffrequiredtocareforbariatricclients.Ifceilingtrackingisfittedintoareasforbariatriccare,ceilingsrequireadditionalsteelreinforcementtobedesignedintothestructure.

Inbathrooms,biggershowerstallsshouldfeatureheavy‑dutyhandbars.Otheroptionsforshowersaremultiplehandrails,largeseatsandhand‑heldshowerheads.Largetoiletseatsarealsoneeded.Toiletfixturesandsinksshouldbefloormounted,althoughcareshouldbetakenthatfloor‑mountedsinksdonotinterferewithwheelchairs.Bathroomsshouldbesizedtoallowforstaffassistanceontwosidesofclientsatthetoiletsandshowers,forcaseswherebothlargepeoplewillbetransferredandlargeequipmentisneeded.

17. PartsofthissectionwereadaptedfromWignall,2008.SeealsoCollignon,2008.

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9.10 Overview of upgrading facilitiesForfacilitieswithlimitedresources,andforhome‑basedcare,upgradingexistingfacilitiesisoftenthemostfeasibleoptiontomakeexistingworkspacessaferforbothclientsandcarers.Thispartprovidesanoverviewoffacilityupgrading,describestheassessmentsofexistingspacesaspartofplanningupgrades,andoutlinessomestrategiesforupgradingfacilities.

Inmanycasesitmaybefeasibletomodifyexistingbuildingsandspacestoallowmoreeffectivemovingandhandlingofclients.Forlargeorganisations,suchasfacilitiesoperatedbyDHBsandprivatehospitalswhereextensiverenovationsornewbuildingsarebeingplanned,thedesignfeaturescoveredearlierinthissectionmayprovetobemostrelevant.

Whereexistingfacilitiesposedifficultiesformovingandhandlingpeople,theupgradingoffacilitiesandspacesleadstoimprovementsinclientcareandcarerefficiency.Designimprovementsarelikelytodecreaseclientcarecostssubstantially,despitetheinitialset‑upcostsformodificationsandequipment.Forhomecareclients,itmaymeanthattheclientscanremainathomeratherthanmoveintomanagedcarefacilities.Itmayalsoreducethenumberofhomevisits,orthetimerequirementsofcarersmakinghomevisits.Estimatesofthepaybacktimefromthecostsoffacilityupgradingandmovingandhandlingequipmentrangefromtwotofour years.

Therearealsolikelytobeotherbenefits,suchasimprovementsinthequalityofcare,increasedcarermoraleanddecreasedassociatedcosts.Therearealsopotentialbenefitsforclients.Costsavingshavebeenestimatedtobeashighasfivetimestheupgradingandequipmentcosts,butmorecommonlyarearoundtwotimes.18

18. Cohenetal,2010,p.43.

Box 9.5

Example of building modifications reducing injury risks

Thecasedescribedbelowillustrateshowasimpleredesignofflooringreducedriskstostaffatafacilityin Australia.

‘WorkCoverNSWundertookastudytoinvestigateseriousshoulderinjuriesassociatedwithmovingaloadedmobileliftinghoistbetweenabedroomandanensuite.Thestudyfoundthatinjurieswerecausedbythehighforcesinvolvedinpushingthehoistoveraridgeinthefloor(anedgingstripbetweenthecarpetofthebedroomandthevinyloftheensuite).Duetothenarrowdoorwayintotheensuite(740mm)thestaffmemberneededtostopthehoistattheentranceandcarefullypullitthroughthedoortoavoidastrikingrisk.Theresultantpullforcemeasured44kg,whichexceededmaximumlimitsforinitialforcerecommendedbySnook.Redesignofthefloorcoveringstoensureflatjoinsbetweendifferentfloortypes,combinedwithawiderdoorway,wouldreducerisksforstaffmovingaloadedhoistfrombedroomtoensuite.’

Source:WorkSafeVictoria,2007,p.38

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ExamplesofdesignfeaturesthatmaybeincludedwhenupgradingfacilitiesareshowninTable9.3.

Table 9.3 Improving facility design and function in existing facilities

Type of facility development

Examples of design features for moving and handling people

Upgradinganexistingfacility Ceilingtrackinginstalled

Providingaccessformobilehoists

Installinghandrails

Doorwayswidened

Bathroomsre‑designed

Equipmentstorageareasadded

Specificmodificationstosmallunitsandhomes

Ceilingtrackinginstalled

Increasingspacetoaccommodateequipmentintoiletandshowerareas

Providingaccessformobilehoists

Providingrampstobypassstairs

Installinghandrails

Opportunitiesformodificationstobuildingsandfacilitiesmayalsoarisewhereahazardorotherproblemformovingandhandlingisidentified.Whenbuildingrenovationsareplannedforotherpurposes,therecanalsobeopportunitiestoincludechangestoimprovemovingandhandlingandreducehazardsandinjuryrisks.

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9.11 Assessing existing spaces for upgradingAkeyphaseinbuildingandfacilityrenovationsistocarryoutareviewandassessmentoftheexistingspacesintermsoftheirsuitabilityformovingandhandling.Themainfeaturesrelevanttoassessingexistingspacesforbuildingrenovationsarelikelytoinclude:

• Thecurrentmobilityprofileofclients

• Aninventoryofexistingmovingandhandlingequipment

• Whatadditionalequipmentisrequiredforimprovingclientmobilityandcarer safety

• Spacesrequiredformovingandhandling

• Modificationsneededtoexistingspaces

• Future‑proofingthefacilityforchangesintypesofclientorfacilityuse.

Client profile and renovations

InformationaboutassessingclientmobilityisincludedinSection3Riskassessment.Iftherenovationisforasingleclientlivingathome,theassessmentwillinclude:

• Thecurrentmobilityoftheclient

• Anychangesinclientmobilityorprofile

• Theextenttowhichcarerswillberequiredtoassisttheclient,andwhatequipmentwillbeneededforthat.

Itisalsousefultolookatthenumberandcostsofcarersneededcomparedwiththepotentialcostsofequipmentorrenovations.Sometimesitwillcostlesstoupgradefacilitiesandprocuresuitablemovingandhandlingequipment.

Forsmallandmediumfacilities,suchasthosecateringfor10‑20clients,aclientprofilewillbeneeded.Theclientprofileshouldinclude:

• Anassessmentofthemobilitystatusandcognitivestatusofclients

• Aninventoryofexistingmovingandhandlingequipment

• Possiblefuturepurchasesoracquisitionsofnewequipmentbasedonthemobilityprofileofclients.

DescriptionsofmovingandhandlingequipmentareincludedinSection7ofthese Guidelines.

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Client destination assessment

Oneapproachrecommendedforplanningspacesformovingandhandlingisdescribedasa‘clientdestinationassessment’.19Thisinvolvesidentifyingthedestinationpointsforclientstowhichtheyneedtobemoved.Therearetwotypesofclientdestinationpoints:

1. Thoseusedbycarerstoprovideclientcare

2. Thoseusedbyclientsforinvolvementinactivitiesandrelationshipsthatareimportanttothem.

Informationonthereasonsforclientmovementsandthedestinationstowhichclientsaremovedcanthenbeusedto:

• Identifyanychangesneededtospacestoensuretheyaresuitableforthetypesofequipmentneededformovingandhandling

• Developafacilityupgradedesignthatsupportstheequipmentneededandencouragesself‑mobilisationofclientstomaintainandimproveclient functioning

• Planthetypesofspacethatassistcarerefficiencybyreducingturnsandtraveldistancesalongtheroutestothemostfrequentdestinations

• Identifyfloorcoverings,handraillocationsandrestareasthatencourageboththeassistedmovementofclientsandclientself‑mobilisation.

Forspecificmedicalandresidentialcarefacilitiesitmaybeusefultodistinguishshort‑stay,acute‑careroomsandspacesfromlong‑stayresidents’roomsandspaces,bearinginmindthatthesemaychange.Onepracticalwaytocarryouttheassessmentistowalktheroutewiththeequipmentandclient,notingalltherisksanddifficultiesencounteredalongtheway.Identifyredesignsolutionsforeachofthehazardsandrisksencountered.Inlargefacilities,thefunctionsofroomsandspacesmaychangeconsiderably,sofutureproofingshouldbeconsidered.

Short‑stay, acute‑care rooms and spaces

Inshort‑staycarefacilities,suchasacute‑carehospitalsandrehabilitationfacilities,movementstospecificdestinationsusuallystartfromclients’rooms.Clientmovementsbetweenlocationsmaybebywheelchair,stretcherorhoist.Thefollowingdestinationsmayberelevantfortheassessmentprocess:

• Toilets

• Bathingandshoweringareas

• Changesinclients’roomsowingtochangesinacuityorpreparingforclient discharge

• Diagnosticandtestingareasforexamination

19. ThissectionhasbeenadaptedfromCohenetal,2010,p.35.

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• Surgicalsuites

• Therapyareasforgroupsupportandtherapy

• Lobby,cafeteria,vendingmachinesandoutdoorsforvisiting,exercise,foodandachangeofscenery.

Long‑term‑care resident rooms and spaces

Inlong‑stayclientfacilities,suchaschroniccarehospitalsandresidentialcarefacilities,thefollowingactivitiesmayrequiretransportbywheelchairorhoisttoparticulardestinations:

• Toiletinaprivateorsharedbathroom

• Bathingandshoweringinanadjacentroomorasharedfacility

• Dininginashareddiningarea

• Meetingplacesforresidentsandgroupssuchasfamily,friendsand organisations

• Exercisespacesthatmaybeoutdoors,exerciseroomsorgroupexercise spaces

• Examinationandtreatmentroomsandspaces

• Specialinterestactivities,suchascraftrooms,kitchenandchapel

• Socialising,suchastearoom,lounge,outdoorsandcorridors(bywalkingorassistedmovement)

• Therapy,suchasphysical,occupationalandspeechtherapyareas.

Modifications needed to existing spaces

Aspartoftheassessmentprocess,itisusefultoconsiderthespecifictypesofmodificationandfeaturethatmaybeneededtoreducehazardsformovingandhandling.Table9.4listssomeofthecommontypesofmodificationthatarelikelytoimprovemovingandhandlingoperations.

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Table 9.4 Examples of specific modifications to facilitate moving

and handling

Type of modification Purpose of modification

Doorwayswidened Improveaccessforwheelchairs,mobilehoistsandelectric beds

Doorsillsandstepsremovedor bypassed

Improveaccessforwheelchairs,mobilehoistsandwalking frames

Handrailsfitted Improvesafetyinbathrooms,showersandtoilets

Floorcoveringsorseparators changed

Improvemobilityforwheelchairsandmobilehoistsorimproveinfectioncontrol

Electricalwallplugsinstalled Accessforchargingbatteriesonmobilehoistsandwheelchairsorinstallingelectricbeds

Roomlayoutchanged Improveaccessforwheelchairs,mobilehoistsandelectric beds

Spacerequirementsformanoeuvringequipment

Providestoragespaceforequipment

Followingamovingandhandlingneedsassessment,specificmodificationsareplanned,whichincludedetailsofthechangesneededinthebuildingandclientspacestousetheequipmentrequiredformovingandhandling.

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Section 9: facility design and upgrading

9.12 Strategies for upgrading facilitiesThereisaseriesofstepsneededintheprocessforplanningandimplementingrenovationsinhealthcarefacilities(seeBox9.6).Thesestepscanbeadaptedtosuitthescopeandbudgetavailableforaspecificrenovationproject.

Forhousingmodifications,theMinistryofHealthprovidesdetailsaboutapplicationproceduresthroughthewebsite‘accessable’(www.accessable.co.nz).Italsoprovidesaprocessdocumentforcomplexhousingmodifications.20

Box 9.6

Example of steps for renovation of health facilities

1. Perceivingtheproblemsanddeterminingthattheyaresolvable

2. Appointingamedicalfacilitiesconsultantandabuildingdesigner(suchasanarchitect)

3. Assessingthefacilitiestoidentifypreciselytherenovationneeds

4. Prioritisingthefacilitiesandtheworktobedoneinthem

5. Establishingabudgetnotonlytocoverthecostsfortheproposedrenovationsbutalsoforunanticipatedworkthatarisesduringthe renovations

6. Agreeingwiththestakeholdersineachfacilityontherenovationsneeded

7. Developingdesignsandtechnicalspecificationswithcostestimates

8. Contractingtheconstructionworktoprivateagenciesoragovernment department

9. Supervisingtheconstructionandrespondingtounforeseenchanges

10.Confirmingthattheconstructionhasbeencarriedoutaswasdesignedand specified

11. Installingequipmentandcommissioning(startingtouse)therenovated space

12. Formalinaugurationofthefacility.

Source:Mavalankar&Abreu,2002,p.26

Aswellasthetechnicalfeaturesfornewbuildingdesignandbuildingrenovations,somekeystepstoincludewhenplanningbuildingrenovationsare:

• Theformationofaprojectplanninggrouptosteertheprojectandsolicitinputfromkeystaffandusergroups.Thisgroupshouldincludeamovingandhandlingspecialistandthehealthandsafetymanager.Foraclientlivingintheirownhome,theclient,familymembers,primarycarersandthebuildermayneedtomeettoputaplantogether

• Discussionswithmanagersandstaffregardingfeaturesneededforeffectivemovingandhandling,giventheclientprofileofthefacilityorunit

20. SeeMinistryofHealth,2008.

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• Theidentificationofspacesanddesignfeaturesintheexistingfacilitythatneedimprovement

• Thedevelopmentofthedraftplanforthenewfacility,oralistofchanges needed

• Communicationoftheconstructionscheduleortimetabletokeyusergroupspriortoandduringtheconstructionphase

• Thedevelopmentofaplanformaintainingservicesduringrenovations

• Planningapost‑occupancyreviewreportaftertherenovationshavebeencompletedandtheareaisfullyoperational.Thisreportshouldbearchivedandusedforfutureprojectsasaguideorreference.

Maintaining services during renovations

Undertakingamajorbuildingconstructionorrenovationprojectatahealthfacilityisachallengethatcanbefraughtwithunanticipatedeventsthatcandisruptservicesandhavemajorimpactsonstaffandclients.Forafacilityanditsassociatedservicestocontinuefunctioningadequatelyduringabuildingorrenovationproject,adetailedtransitionplanisneededtoallowstafftocontinuetodeliverqualitycareinanefficientmanner.

Manyprojectmanagersspendagreatdealoftimeonarchitecturalandconstructionplanning.Thetransitionalplanningforservicedeliverythatisessentialtoaproject’ssuccesscaneasilybeoverlooked,especiallyintermsofimpactsonclients,staffandothers.Failuretoplanfortransitionaloperationsduringarenovationprojectcanresultinsubstantialincreasesinstaffworkloads,delaysinscheduledservicedeliveryanddelaysintherenovationtimetable,allofwhichcancompromiseclientqualityof care.

Beforecompletingarenovationplanthatinvolvesbuildingmodifications,considertheinterimmovesandadjustmentsthatmayberequiredforthecontinuedoperationofunitsandservices.Oncetheconstructiontimetablehasbeenprepared,developadetailedplanofhowthefacility’sserviceswillfunctionduringeachstepoftheconstructionprocess.Whichroomswillbefunctionalduringeachphase?Whatequipmentwillbeoutofserviceduringeachphase?Whatcontingencyplans(suchasequipmentloansandrentals)areneededtomaintainfunctionality?Whatistheproject’simpactonclientadmissions,careanddischarges?Iftheclientislivingintheirownhome,dotheyneedtobemovedintosuitableaccommodationwhilerenovationsareinprogresstoenablethemtousethetoiletandshower?

Communicationisakeyaspectoftransitionarrangements.Renovationprojectsinvolvingmultipleunitsrequiredetailedplanningtoensureeffectivecommunicationwithallaffectedgroups.Disseminateadetailedmovesequenceforallunitsthatrequirerelocationpriortoconstructionstarting.Updatethesequenceduring

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constructionasneeded.Thiswillenablesupportservicesthatworkwiththeaffectedunitstoplanforthemoveaswell.

Somekeyissuestoconsiderforaservices’transitionplanare:

• Whataspectsoftheshiftfromtheexistingsystemtothecompletedrenovationswillbeconductedbyoutsidemovers,equipmentsuppliersandinternalstafforunits?

• How,whenandwherewillnewequipment,furniture,fittingsandsignagebeinstalled,inspectedandinventoried?

• Howwillcarersbetrainedintheuseandmaintenanceofthenewequipment?

• Howwillyoubriefstaffaboutthenewspace,equipmentandoperational systems?

• Howwillyounotifyclients,staffandfamiliesofthechanges?

Post‑occupancy review

Oncethebuildingmodificationshavebeencompletedandthenewpremisesoccupied,itisusefultocarryoutapost‑occupancyreview.Mostnewfacilitieshaveteethingproblems,suchaslackofsigns,fittingslocatedinthewrongpositions,andfeaturesthathavenotbeenfinishedproperly.

Whencarryingoutapost‑occupancyreview,developarunninglistofissues,encouragingallstafftocontribute.Conductaformalpost‑occupancyassessmentinvolvingbothusergroupsandthedesigners.Notepositiveandnegativeaspectsofthenewfacility,andnotewhichfeaturesneedpost‑occupancymodifications.Transferknowledgegainedtootherusergroupsanddesignprojects.Keystakeholdersshouldformallycontributetothereviewandarchivethereportforfuturereference.

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References and resourcesAustralasianHealthInfrastructureAlliance.(2009).Australasian Health Facility

Guidelines.Sydney:CentreforHealthAssetsAustralasia,UniversityofNewSouthWales.Retrieved5November2010fromwww.healthfacilityguidelines.com.au.

Australian/New ZealandStandards.(2004a).AS/NZS4586:2004Slip Resistance Classification of New Pedestrian Surface Materials.www.standards.co.nz.

Australian/New ZealandStandards.(2004b).AS/NZS4663:2004Slip Resistance Measurement of Existing Pedestrian Surfaces.www.standards.co.nz.

Chhokar,R.,Engst,C.,Miller,A.,Robinson,D.,Tate,R.B.,&Yassi,A.(2005).Thethree‑yeareconomicbenefitsofaceilingliftinterventionaimedtoreducehealthcareworkerinjuries.Applied Ergonomics,36(2),223‑239.

Cohen,M.H.,Nelson,G.G.,Green,D.A.,Leib,R.,Matz,M.W.,&Thomas,P.A.(2010).Patient Handling and Movement Assessments: A White Paper.Dallas,Texas:TheFacilityGuidelinesInstitute.Retrieved16June2010fromwww.fgiguidelines.org.

Collignon,A.(2008).Strategies for Accommodating Obese Patients in an Acute Care Setting.TheAmericanInstituteofArchitects.Retrieved12September2011fromwww.aia.org.

Hignett,S.,&Lu,J.(2010).Spacetocareandtreatsafelyinacutehospitals:Recommendationsfrom1866to2008.Applied Ergonomics,41(5),666‑673.doi:10.1016/j.apergo.2009.12.010.

Jung,Y.M.,&Bridge,C.(2009).The Effectiveness of Ceiling Hoists in Transferring People with Disabilities.Retrieved26October2010fromwww.deir.qld.gov.au/workplace/subjects/ceilinghoists/index.htm.

Leib,R.,&Cohen,M.(2010).Easydoesit:TheFGIGuidelines’patient‑handlingrequirements.Health Facilities Management,23(9),53‑54,56,58.

Mavalankar,D.,&Abreu,E.(2002).Conceptsandtechniquesforplanningandimplementingaprogramforrenovationofanemergencyobstetricfacility.International Journal of Gynecology and Obstetrics,78,263‑273.

MinistryofHealth.(2008).accessable Process for Complex Housing Modification Application and Housing Clinics.Retrieved20October2010fromwww.accessable.co.nz/manualsforms.php.

New ZealandAssociationofOccupationalTherapists.(2006).Submission on Review of the Building Code.p.5.

StandardsNew Zealand(2001).NZS4121:2001Design for access and mobility: Buildings and associated facilities.http://standards.co.nz

Templer,J.(1992).The Staircase: Studies of Hazards, Falls, and Safer Design.Boston:MIT Press.

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Wignall,D.(2008).Designasacriticaltoolinbariatricpatientcare.Journal of Diabetes Science and Technology,2(2),263‑267.

WorksafeVictoria.(2007).A Guide to Designing Workplaces for Safer Handling of People: For health, aged care, rehabilitation and disability facilities.Melbourne:VictorianWorkCoverAuthority.

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