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Patient Care Ergonomics
Remember… Through Ergonomics
• Job can be redesigned• Jobs can be improved to be within
reasonable limits of human capabilities However, ergonomics is not a magical
solution…• To be effective, a well thought out system
of implementation must be developed
Here’s A Successful Solution using Patient
Care Ergonomics…
Successful Solution using Patient Care Ergonomics…
VISN 8 Patient Safety Center Research Project:
VISN-Wide Deployment of a Back Injury Prevention Program for
Nurses: Safe Patient Handling and
Movement(2001-2002)
Results: Incidence (#) of Injuries
0
50
100
150
PRE POST
Decreased 31% (144 to 99 injuries)
Results: Injury Rates*
Decreased from 24 to 16.9
Difference was significant at 0.036 level
0
5
10
15
20
25
Pre-
Intervention
Post
Intervention
*Defined as # reported injuries per 100 workers per year
Results: Light Duty Days
Decreased 70% (1777 to 539 days) Significant at 0.05 level
0
500
1000
1500
2000
2500
PRE POST
Results: Lost Work Days
0
50
100
150
200
250
300
PRE POST
Decreased 18%, from 256 to 209 days
Results: Job Satisfaction
3.55
3.6
3.65
3.7
3.75
3.8
PRE POST
•Pay•Professional Status*•Task Requirements*•Autonomy•Organization Policy•Interaction•Overall
*Denotes Significance
Successful Solutions
Overview of a Safe Patient Handling & Movement Program
Safe Patient Handling & Movement Program
•Management Support
•Champion•SPHM Team •Program
Elements
•Equipment•Knowledge
Transfer Mechanisms
•Technical Support
For success, required infrastructure MUST be in place prior to implementing SPHM Program
SPHM Champion
CloutMover/Shaker InterestNursing, Therapy, Safety…
SPHM Team Responsibilities
Implements Program Writes Policy Reviews/Trends Data Ensures incidents/injuries are
investigated Facilitates Equipment Purchases
SPHM Team Members
Nursing Administrator
Nursing Staff (CNA, LPN, RN)
Nursing Service Safety Rep
Peer Leader (BIRN) Risk Manager Resident/Patient Union
Nurse Educator Therapy Staff
(OT, PT, ST) Purchasing Engineering Employee
Health/Safety Others…
Safe Patient Handling & Movement Program
Goals Reduce the incidence of
musculoskeletal injuries Reduce the severity of
musculoskeletal injuries Reduce costs from these injuries
Safe Patient Handling & Movement Program
Goals Create a safer environment &
improve the quality of life for patients/residents
Encourage reporting of incidents/injuries
Create a Culture of Safety and empower nurses to create safe working environments
SPHM Key Objectives
Reduce manual transfers by ___%
Reduce direct costs by ___% Decrease nursing turnover by
__% Decrease musculoskeletal
discomfort in nursing staff by ___%
SPHM Key Objectives
Reduce # of lost workdays due to patient handling tasks by ___%
Reduce # of light duty days due to patient handling tasks by ___%
Note: Best to NOT measure success by # of reported injuries…
Safe Patient Handling & Movement Program
What goals do you want to achieve for yourself, your co-workers,
and your unit?
What specific Program Objectives do you want to attain?
(Complete “A” & “B” of Handout A-1, Developing a Safe Patient Handling & Movement Action
Plan)
Safe Patient Handling & Movement Program
SPHM Program Elements Peer Leaders – BIRNS/Ergo Rangers After Action Review Process Patient Assessment, Care Plan,
Algorithms for Safe Patient Handling & Movement
SPHM Policy Ergonomic & Hazard Assessment of
Patient Care Environment Equipment
Safe Patient Handling & Movement
Program Elements
Back Injury Resource Nurses
Chapter 7
Safe Patient Handling & Movement Program
BIRNS are the Key to Program Success…
•Implement Program•Continue Program
Back Injury Resource Nurses
RN, LPN, CNA
Informal Leader/ Respected
Safety Interest
Ergo Experience Not Required
Enthusiastic/ Out-going
Good Time/ Mgmt Skills
Back Injury Resource Nurses
Roles/Responsibilities
1. Implement/Continue SPHM Program2. Act as Resource, Coach, and Team
Leader for Peers, NM, Facility3. Share/Transfer Knowledge4. Perform Continual Hazard/Risk
Monitoring5. Monitor and Evaluate Program
BIRNS Roles & Responsibilities
1. Implement/Continue SPHM Program
BIRNS activities and involvement depend on what program elements
are included in your Program.
BIRNS Roles & Responsibilities
2. Act as Resource, Coach, and Team Leader
Share expertise in use of Program elements
Motivate use of Program elements Listen to Ideas & Concerns Demonstrate Care & Concern for
Staff Well-Being Support and promote a “Culture of
Safety” Cheer on Safety Successes!!
BIRNS Roles & Responsibilities
3. Share/Transfer Knowledge
BIRNS-BIRNS Within Units, Facilities,
Organization… With Others Organizations Monthly Conference Calls Outlook Email Groups National Conferences
BIRNS Roles & Responsibilities
3. Share/Transfer Knowledge
BIRNS-STAFF AAR Meetings On-the-Job
• Co-workers• New Employees
Staff Meetings Skills Check-off Training/In-services
BIRNS Roles & Responsibilities
4. Perform Continual Hazard/Risk Monitoring
Two Levels of Hazard/Risk Evaluations
•Formal Ergonomic Hazard Evaluation – Ch. 3
•Ongoing Workplace Hazard Evaluations• Of the Environment• Of Patients/Residents• Of Patient Handling Tasks
BIRNS Roles & Responsibilities
5. Monitor and Evaluate Program
Assist in Collecting/Analyzing Injury Data
Complete Checklists for Safe Use of Lifting Equipment
Evaluate Ability to use Algorithms & Complete Care Plan
BIRNS Roles & Responsibilities
5. Monitor and Evaluate Program
Weekly BIRN Process Log (p.89)•BIRNS Activity Level•BIRNS and Program Status
•Effectiveness•Adherence•Support
What Helps Make a BIRNS Successful?
Personality• Natural Leader • Positive Outlook• Team Player• Proactive
Cooperation & Support
What Helps Make a BIRNS Successful?
Cooperation & Support Nurse Manager Nursing Administration Facility Management Facility Safety Champion Engineering & Housekeeping
What Helps Make a BIRNS Successful?
Management Support TIME to fulfill BIRNS role
(especially during implementation phase)• Coverage during meeting times,
staff in-services & BIRNS training• Lighter case-load
TIME for Staff to attend In-Services
Back Injury Resource Nurses
Outcomes for Staff Staff are empowered
•Channel to voice ideas/suggestions•Opportunity to have input in making work environment safer
Increased competence in performing job
Increased sharing of knowledge/best practices
Fosters Culture of Safety
Back Injury Resource Nurses
Examples of Problems Identified Lifts not being used on night
shifts. • Why? Batteries were being charged
on night shifts because no back-up batteries.
• Solution: Buy extra battery packs so lifts can be used 24 hours per day.
Safe Patient Handling & Movement Program
BIRNS are the Key to…
•Implement SPHM Program
•Continue SPHM Program
Safe Patient Handling & Movement
Program Elements
After Action Review ProcessChapter 9
After Action Review
An After Action Review is for transferring knowledge a team
has learned from doing a task in one setting, to the next time that team does the task in different setting. (Dixon, 2000)
AAR and Risk Reduction
Provides mechanism for whole team to learn from the experiences of one individual
Involves front line staff in identifying problems and SOLUTIONS
Guidelines for AAR Use
Used for injuries AND “near-misses” After an incident has occurred bring
staff together to discuss the incident No notes are taken Involve as many staff as possible Hold AAR in location of incident, if
possible Non-punitive approach with no fault-
finding/blaming
Guidelines for AAR Use
Keep meetings brief - less than 15 minutes
Staff-driven Assign one or two persons
to ensure corrective actions are taken
At next AAR, follow-up if needed
Guidelines for AAR Use
The AAR group asks (1) What happened?(2) What was supposed to
happen?(3) What accounts for the
difference?(4) How could the same outcome
be avoided the next time?(5) What is the follow-up plan?
Training Staff on AAR
Minimal Training requiredMinimal Training required Staff In-service – review Staff In-service – review
purpose, need for trust, purpose, need for trust, benefits, etc.benefits, etc.
Training ToolsTraining Tools• Handout A-2, AAR BrochureHandout A-2, AAR Brochure• My AAR slidesMy AAR slides
AAR Case Study
A nurse manager of a long term A nurse manager of a long term care unit decides to implement care unit decides to implement after action reviews after she after action reviews after she
notices an increase in notices an increase in musculoskeletal injuries musculoskeletal injuries
among the staff.among the staff.
AAR Case Study
After hearing an explanation of the After hearing an explanation of the process, staff decide to schedule process, staff decide to schedule
AAR meetings on Monday, AAR meetings on Monday, Wednesday, and Friday at 11 AM. Wednesday, and Friday at 11 AM.
This time was selected because most This time was selected because most of the morning care is completed by of the morning care is completed by 11:00 and it is before lunch time. 11:00 and it is before lunch time.
AAR Case Study
During the first meeting, group During the first meeting, group members ask staff to think about members ask staff to think about
what happened during the morning.what happened during the morning.
Did anything happen (near-miss or Did anything happen (near-miss or injury) that could have put them or injury) that could have put them or
their co-workers at risk of injury their co-workers at risk of injury that everyone could learn from? that everyone could learn from?
What Happened?
Sue, an LPN, begins. Sue, an LPN, begins.
I had to get Mr. Walker up because he was I had to get Mr. Walker up because he was lying in a wet bed.... I was late with my lying in a wet bed.... I was late with my meds and I knew I needed to get to the in-meds and I knew I needed to get to the in-service. Then, I couldn’t find a sling, so I service. Then, I couldn’t find a sling, so I just got him up myself. While I was lifting just got him up myself. While I was lifting him I kept thinking… ‘Don’t’ hurt him I kept thinking… ‘Don’t’ hurt yourself…’ I guess I was lucky I didn’t!yourself…’ I guess I was lucky I didn’t!
So.. So.. What happenedWhat happened was that I lifted Mr. was that I lifted Mr. Walker without help, without using a lift.Walker without help, without using a lift.
What Was Supposed to Happen?
Nancy: Nancy: OK.. So, OK.. So, what should have happenedwhat should have happened??
Sue: Sue: I should have found the sling and used I should have found the sling and used the lift, but I was in such a hurry. the lift, but I was in such a hurry.
NancyNancy: I know… It’s so frustrating to have all : I know… It’s so frustrating to have all of these new lifts but not have the slings of these new lifts but not have the slings where you need them. I know I’ve had where you need them. I know I’ve had trouble finding slings, too.trouble finding slings, too.
Others discuss their experiences related to Others discuss their experiences related to the lifts and slings. the lifts and slings.
What Accounts for the Difference?
Nancy: Nancy: Let’s see… Let’s see… What accounts for What accounts for the differencethe difference? Well... The sling ? Well... The sling wasn’t available.wasn’t available. For starters, the For starters, the sling should have been in the room sling should have been in the room and on the bed side stand, where and on the bed side stand, where we agreed to keep them.we agreed to keep them.
What Accounts for the Difference?
Ron: Ron: You’re right, but there's not You’re right, but there's not always room to put them there… always room to put them there… That’s where patients place their That’s where patients place their things too… Because of that a lot of things too… Because of that a lot of times I put slings places where ‘I’ times I put slings places where ‘I’ can find them when ‘I’ come back in can find them when ‘I’ come back in the room, but I guess that makes it the room, but I guess that makes it hard for you guys to find them when hard for you guys to find them when I’m not around…. I’m not around….
What Accounts for the Difference?
After more discussion, the group decides After more discussion, the group decides that the problems of ‘inaccessible slings’ that the problems of ‘inaccessible slings’ is caused by no good location for the is caused by no good location for the slings in patient rooms.slings in patient rooms.
How can the same outcome be avoided the next time??
NancyNancy: : OK… We’re always running OK… We’re always running around looking for slings. What do you around looking for slings. What do you think about placing a sling ‘hook’ in think about placing a sling ‘hook’ in every patient room, right at the door, so every patient room, right at the door, so you can easily pick the sling up on you can easily pick the sling up on entering and put it back on leaving? entering and put it back on leaving?
Fred: Fred: That’s a good idea! I also think it That’s a good idea! I also think it would help if we had more slings… How would help if we had more slings… How many more do you think we need? many more do you think we need?
How can the same outcome be avoided the next time??
Brad: I’ll request a work order to Brad: I’ll request a work order to install the hooks and after they’re install the hooks and after they’re installed I’ll make sure everyone installed I’ll make sure everyone gets the message on the new gets the message on the new procedure. procedure.
Ron:Ron: I’ll add the process to the new I’ll add the process to the new employee orientation packet.employee orientation packet.
Fred:Fred: I’ll put in a request to order 6 I’ll put in a request to order 6 slings.slings.
What’s the Follow-up Plan?
Sue: Sue: Let’s see if I have all of our Let’s see if I have all of our recommendations… Put in a work order for recommendations… Put in a work order for installation of the hooks, buy more slings, installation of the hooks, buy more slings, spread the word, and the add process to the spread the word, and the add process to the unit orientation packet for new employees. unit orientation packet for new employees.
Brad:Brad: Since this has been a continual Since this has been a continual problem, let’s see how we’re doing on the problem, let’s see how we’re doing on the sling issue at an AAR in one month.sling issue at an AAR in one month.
After Action Review Case Study
AAR Case Study BIRN noticed friction reducing devices
(FRDs) weren’t being used on her Unit Held staff AAR Determined FRD’s too narrow Solution: BIRN contacted manufacturer
who made new, wider FRD’s. Outcome: New, wider FRD’s used on
Unit
AAR Practice
Break into groupsBreak into groups Think of a problem common Think of a problem common
to your groupto your group Perform an AAR using the Perform an AAR using the
AAR questions.AAR questions.
Safe Patient Handling & Movement
Program Elements
Patient Assessment, Care Plan, & Algorithms for Safe
Patient Handling & Movement Chapter 5
Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling
& Movement
The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling
activities you must perform3. Follow the algorithms to
determine what equipment and # of staff are needed
4. Complete the Care Plan5. File for future use
What Tasks Do the Care Plan & 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 Bed5. Reposition in Chair: Wheelchair or
Dependency Chair6. Transfer a Patient Up from the Floor
What Tasks Do the Bariatric Care Plan & 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. Reposition in Bed: Side to Side, Up in Bed 4. Reposition in Chair: Wheelchair or
Dependency Chair5. Tasks Requiring Sustained Holding of Limb/s
or Access to Body Parts6. Transporting (stretcher, w/c, walker)7. Toileting8. Transfer Patient Up from Floor
Patient Assessment & Care Plan – Page 71
Completed on all patients Takes into consideration:
•Patient Characteristics •Patient Handling Task•Equipment
Uses Algorithms
Algorithms - Page 73
Based on Specific Patient Characteristics (from Assessment)
Assists nurses in selecting• Safest Equipment • Safest Patient Handling
Technique Advises # of staff needed
How were these Algorithms Developed?
Developed by a group of nursing experts
Tested with different patient populations in a variety of settings
When Should The Algorithms be Used?
Use the Algorithms for every patient/resident who needs help moving
Remember….• The Algorithms provide general
direction• Caregiver must use their
professional judgment in applying Algorithms
How Do We Lift This Resident?
Let’s assess NH resident: Fred Veteran
80 year old resident of a VA Nursing Home. Weight: 156 lbs. Height: 5’ 9” Has dementia and a history of falls. Some days he is cooperative. Other days
he is combative and fearful. When he is cooperative, he can bear
weight. Otherwise, he resists standing. He is to be out of bed every day in a chair.
Assessing Fred V.
Take a few minutes and complete a Patient
Handling Care Plan for Fred Veteran.
(Use Handout A-3, Patient Assessment & Care Plan)
Assessing Fred V.
Level of AssistanceDependent
Can the resident bear weight?
No, because the resident is not cooperative
Does resident have upper extremity strength needed to support weight during transfers?
No, because resident is unreliable for using his upper extremity strength
Assessing Fred V.
Resident’s level of cooperation and comprehension
Unpredictable
Weight: 156 lbs. Height: 5’ 9”
Special circumstances?
History of Falls
Finishing Fred V.’s Care Plan
Although the resident can sometimes bear weight, he can be uncooperative.
The “No” answer to “Is the Resident cooperative?” leads you to: “Use full body sling lift and 2 caregivers”
Answer: Use full body sling lift and 2 caregivers
Patient Assessment, Care Plan, & Algorithms for Safe Patient Handling
& Movement
The Assessment, Algorithms , & Care Plan go hand in hand...1. Assess the Patient2. Determine what handling
activities you must perform3. Follow the algorithms to
determine what equipment and # of staff are needed
4. Complete the Care Plan5. File for future use
Algorithms Practice
Break into groupsBreak into groups Have one person give a clinical Have one person give a clinical
description of a recent patient description of a recent patient requiring moving/handlingrequiring moving/handling
Develop a patient handling Care Develop a patient handling Care Plan using the assessment tool Plan using the assessment tool and algorithms.and algorithms.
Safe Patient Handling & Movement
Program Elements
Safe Patient Handling & Movement Policy
Chapter 6
Safe Patient Handling & Movement Policy
SPHM Policy Ties all Program Elements Together…
Based on UK Policy Implemented in high-risk units Focus on creating a safe
workplace for caregivers rather than on punitive action for mistakes
Safe Patient Handling & Movement Policy
SPHM Policy Ties all Program Elements Together…
Says to avoid hazardous Patient handling tasks.
If can’t avoid, carefully assess hazard, & if possible, always use Patient handling equipment
Safe Patient Handling & Movement Program
BUT…. Patient Handling Equipment/Aids MUST
be in place first, before implementing a SPHM Program.
So, a systematic process is needed to ensure the right equipment is in place…
Safe Patient Handling & Movement
Program Elements
9 Step Ergonomic Workplace Assessment of Nursing
EnvironmentsChapter 3
Patient Care Ergonomic Hazard/Risk Evaluation
Two Levels of Hazard/Risk Evaluations
•Formal Ergonomic Hazard Evaluation – Ch. 3
•Ongoing Workplace Hazard Evaluations• Of the Environment• Of Patients/Residents• Of Patient Handling Tasks
Patient Care Ergonomic Evaluation Process
Studies show ergonomic approaches• Reduced staff injuries from 20 - 80%• Significantly reduced workers
compensation costs• Reduced lost time due to injuries
Bruening, 1996; Empowering Workers, 1993; Fragala, 1993; Fragala, 1995; Fragala, 1996; Fragala & Santamaria, 1997; Logan, 1996; Perrault, 1995; Sacrifical Lamb Stance, 1999; Stensaas, 1992; Villaneuve, 1998; Werner, 1992)
Patient Care Ergonomic Evaluation Process
Patient Care Ergonomic Evaluation Process 1. Collect Baseline Injury Data 2. Identify High Risk Units3. Obtain Pre-Site Visit Data4. Identify High-Risk Tasks 5. Conduct Team Site Visit at each High-Risk Unit6. Risk Analysis7. Formulate Recommendations8. Implement Recommendations (Involve End Users)9. Monitor Results/Evaluate Program/Continuously
Improve Safety
Step 1. Collect Baseline Injury Data
PATIENT CARE INCIDENT/INJURY PROFILE
Patient CareActivity
Cause ofInjury
Type ofInjury
BodyPart(s)
Location Time ofInjury
LostDays
ModifiedDutyDays
Sample:Patient transferbed tostretcher
Reachingacrossstretcherfor patient
Strain Upper back Patientbedside
09:30 3 5
*Be sure to note which source is used on your Injury Log
Step 1. Collect Baseline Injury Data
Cause: Patient Handling Tasks Target Population/s: Nursing Staff
(Radiology, Therapy Staff – PT,OT,ST, Others?)
Type: Strains/Sprains (Struck, Fall..?) (Best to include all types of injuries, then analyze those of interest.)
Duration: Minimum of 1 year of data
Step 1. Collect Baseline Injury Data
Collect by Unit (will also use later during risk analysis)
Sources:• Risk Manager/Safety/Human Resources • Facility Injury Logs/Statistics, Unit
Records, OSHA 200/300 Logs • Patient Care Incident/Injury Profile
Note which source is used on your Injury Log
Step 2. Identify High-Risk Units
What units have the •Most Patient handling injuries/
incidents? •Most severe injuries/incidents?
(by lost time or modified duty days)
•Highest concentration of staff on modified duty?
Step 2. Identify High-Risk Units
Common Characteristics:•High proportion of dependent
patients/residents•High frequency of
patients/residents getting in & out of bed
•High frequency of transfers from one surface to another, e.g. w/c to toilet or bed
Step 4. Identify High-Risk Tasks
‘Tool for Prioritizing High Risk Tasks’ – p. 30 Rank Tasks from 1 to 10
1 = highest risk 10 = lowest risk When ranking, consider:
• Frequency & Musculoskeletal Stress Delete Tasks not usually performed on
Unit Completed by
• Each Staff member• Collectively by Shift
Step 4. Identify High-Risk Tasks
High Risk Task Ranking Exercise
1. Think of a high-risk unit. Complete Tools for Prioritizing High-Risk Patient Handling Tasks
(Complete Handout A-4, Prioritizing High Risk Tasks)
Step 4. Identify High-Risk Tasks
Let’s compare high risk tasks identified by you and others…
If there were differences… Why??
What factors play a role in ranking tasks?
Step 4. Identify High-Risk Tasks
High Risk Task Ranking UNIT Exercise
1. Have staff complete 2. Compare their perceptions
to yours3. Compare their and your
perceptions to Baseline Injury data
3. Obtain Pre-Site Visit Data on High-Risk Units
Use ‘Pre site Visit Unit Profile’ – p. 24• Space issues• Storage availability• Maintenance/repair issues• Patient population • Staffing characteristics • Equipment inventory/issues
Will use when performing site visit and for making recommendations
Step 3. Obtain Pre-Site Visit Data
Remember…Involve as many staff as possible and as much as
possible…
Step 3. Obtain Pre-Site Visit Data
Now… think of one of your high-risk units from your facility and complete a cursory “Unit Data Collection Tool” for that unit.
* Complete Unit Data Collection Tool Profile (Handout A-5)
Step 5. Conduct Site Visit
Site Visit Walk-through• Patient room sizes/configurations• Ceiling Characteristics/AC vents/TVs• Showering/bathing facilities• Toileting process
Step 5. Conduct Site Visit
Site Visit Walk-through• Equipment
•Availability Accessibility•Use Condition•Storage
• Staff attitudes
Step 5. Conduct Site Visit
After Site Visit… Organize data by entering into
Site Visit Summary Data Sheet (p. 34 and Handout A-6)
Use during Risk Analysis in order to make Recommendations
9 Step Ergonomic Workplace Assessment of Nursing
Environments
Step 6. Perform Risk Analysis
Step 6. Perform Risk Analysis
Risk Identification/Breakdown High Risk DEPARTMENT/AREA High Risk JOBS (RN, CNA, LPN, etc.)
• Specific TASKS of High Risk Jobs (p. 30)
• Specific ‘ELEMENTS’ of High Risk Job TASKS
Step 6. Perform Risk Analysis
What do we need to look at to identify Specific
RISKS of ‘ELEMENTS’ of High Risk Job TASKS?
Step 6. Perform Risk Analysis
Element/Task Risk Identification
Task Intensity Task Duration Work Posture General Design of Equipment Space Characteristics Where do you think problem
exists?
Step 6. Perform Risk Analysis
Methods to Gather Risk Data General Observation Staff Discussions Staff Questionnaires Review of Medical Data Symptoms Surveys Quantitative Evaluations
Previous Studies Job Consistency
& Fatigue Brainstorming &
Group Activities Job Safety
Analyses
Step 6. Perform Risk Analysis
Job Safety Analysis (JSA) Break down job into steps Identify hazards associated
with each step Determine actions necessary to
eliminate or minimize hazards
Step 6. Perform Risk Analysis
Job Safety Analysis (JSA)
Let’s try it!!!
See Job Safety Analysis Worksheet (Handout A-7)
Step 6. Perform Risk Analysis
Risk Analysis is used to find Risk Factors that may cause injury.
There are three categories of Risk Factors in a Patient Care
Environment...
What do you think they are??
Step 6. Perform Risk Analysis
Risk can come from: Patient Handling Tasks Health Care Environment Patient
Once risks are identified, steps can be taken to protect Staff
and Patients!
Step 6. Perform Risk Analysis
What Risk Factors are related to the Health Care Environment?
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors
Slip, trip, and fall hazards Uneven work surfaces (stretchers, beds,
chairs, toilets at different heights) Uneven Floor Surfaces (thresholds) Narrow Doorways Poor bathing area design
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors
Space limitations • Small rooms• Lots of equipment• Clutter• Cramped working space
Poor placement of room furnishings
Step 6. Perform Risk Analysis
Health Care Environment Risk Factors Broken Equipment Inefficient Equipment (non-electric, slow-
moving, bed rails) Not enough or Inconvenient Storage
Space Staff who don’t help each other or don’t
communicate
‘The Far Side’ Safety Humor…
Step 6. Perform Risk Analysis
What Risk Factors are related to Patients?
Step 6. Perform Risk Analysis
Patient Risk Factors Weak/unable to help with
transfers Unpredictable Vision or hearing loss Hit or bite Resistive Behavior Unable to follow simple
directions
Step 6. Perform Risk Analysis
Patient Risk Factors Overweight Experiencing Pain Hearing or vision loss No/little communication
between staff about Patient or with Patient
Step 6. Perform Risk Analysis
What Risk Factors are found in Patient Handling Tasks?
Step 6. Perform Risk Analysis
Patient Handling Tasks Risk Factors Reaching and lifting with loads far
from the body Lifting heavy loads Twisting while lifting Unexpected changes in load
demand during lift Reaching Long Duration
Step 6. Perform Risk Analysis
Patient Handling Tasks Risk Factors Moving or carrying a load
a significant distance Awkward Posture Pushing/Pulling Completing activity with
bed at wrong height Frequent/repeated
lifting & moving
Step 6. Perform Risk Analysis
Now, it’s time to tie…
Patient Handling Task Risks Health Care Environment Risks
Patient Risks to
Site Visit Data
This will show us what to consider in making recommendations.
Step 6. Perform Risk Analysis
Risk Analysis includes review of… Unit Baseline Injury Data
• Patient Care Incident/Injury Profile (p. 21)
Pre-Site Visit Data• Pre-Site Visit Unit Profile (p. 24)
High-Risk Tasks• Tool for Prioritizing High-Risk Patient
Handling Tasks (p. 30)
Step 6. Perform Risk Analysis
Risk Analysis includes review of… Site Visit Information
• Site Visit Summary Data Sheet (p. 34) Observations & Additional Information
from Site Visit
Step 6. Perform Risk Analysis
Analyzing Unit Baseline Injury Data • Will provide direction when making
ergonomic recommendations• Determine:
•#1 & 2 Causes of Injuries •#1 & 2 Activities being performed when staff are injured
•What’s going on? What trends are seen?
Step 6. Perform Risk Analysis
Analyzing Unit Baseline Injury Data Activity
Let’s try it… Use Injury Incidence Profile (Handout A-8)
1. For the NHCU, what are the:• #1 & 2 Causes of injuries?• #1 & 2 Activities involved in the injuries?
2. What trends do you see?
Step 6. Perform Risk Analysis
Analyzing Unit Baseline Injury Data
What does the unit injury data tell you?
Step 6. Perform Risk Analysis
Data to Direct Recommendations Incidence (# injuries per unit) Severity (defined by # of lost and
modified duty days) 1 - 2 Primary task/s involved in injuries 1 - 2 Primary cause/s of injuries on unit Patient Dependency Levels Number/configuration of rooms Whatever is significant to your needs
Step 6. Perform Risk Analysis
Information from the Risk Analysis drives
formation of Recommendations…
9 Step Ergonomic Workplace Assessment of Nursing Environments
Step 7. Formulate Recommendations
Step 7. Formulate Recommendations
Solutions involve:#1 Hazard Elimination#2 Engineering Controls#3 Administrative Controls
Step 7. Formulate Recommendations
Hazard Elimination Examples?
Step 7. Formulate Recommendations
Hazard Elimination Scale in sling lift Transfer Bed
Step 7. Formulate Recommendations
Administrative Controls Examples?
Step 7. Formulate Recommendations
Administrative Controls Changes in Scheduling Minimizing # times transfers are required Job Rotation Redistribution of Workload Based on
Acuity Lifting Teams Procedures for repair/maintenance Allot Storage Space to make equipment
more accessible
Step 7. Formulate Recommendations
Engineering Control Examples?
Step 7. Formulate Recommendations
Engineering Controls Result: Caregivers conduct their
job in a new way• Physical Change to the way a
job/task is conducted• Utilization of an aid/equipment
to reduce the hazard• Modifications to the
Workplace
Step 7. Formulate Recommendations
Engineering Controls are the keys to improving safety in
a health care environment….
Let’s see some examples.