Introduction to Queensland Health’s Patient Handling Risk

Assessment ToolFacility/Unit Risk Assessment

Tool (FURAT)

Tony JohnstonPrincipal Health & Safety Adviser

Queensland Health

Outline

• Introductions– Who, Where, objectives– Experience with other

tools• Background

– History– Legislation– Patient Handling tools

• FURAT & profile– What is it; using it– Objectives

• Implementation strategies– Priority areas– Methodology– Issues and solutions

• Duration & frequency• Buy-in• recording

• Future enhancements• Key summary points• QH resources

Why Assess Patient Handling Risks?

Patient Handling: Through the ages…

1998 2001 2007 2012

Patient Handling: Through the ages…

Not so distant past

Patient Handling: Through the ages…

1998

Patient Handling: Through the ages…

1998 2001

2001

Patient Handling: Through the ages…

1998 2001 2007 2012

2007

Patient Handling: Through the ages…

1998 2001 2007 2012

What’s the problem?… with so much regulation and guidance material

around..

• Behaviours– High risk tasks– Training solution

• Equipment– Hoists– Slide sheets– Walk belts

• Risk Assessment– Individual patient Mobility

• Longevity– Individual dependent– Interpretation

• Banned Walk-belts

Objective

Develop and implement a comprehensive healthcare

patient handling risk management tool.

Activity

How many risk assessment tools do you know of?

ORGANISATIONAL RISK

Individual Patient

Task

Facility / Unit

Risk Management

Guidance from around the world…

Industry standards … Acceptable handling practices

Industry Standards…Tools

Legislative Basis

Managing Health and Safety Risks

Regulations … 4.2 Hazardous Manual TasksPCBU must have regard to all relevant matters that may

contribute to a musculoskeletal disorder … (a) postures, movements, forces and vibration relating to the

hazardous manual task; and

(b) the duration and frequency of the hazardous manual task; and

(c) workplace environmental conditions that may affect the hazardous manual task or the worker performing it; and

(d) the design of the work area; and

(e) the layout of the workplace; and

(f) the systems of work used; and

(g) the nature, size, weight or number of persons, animals or things involved in carrying out the hazardous manual task.

Risk Assessment Principles

POSTURE

TIMEFORCE

Work Area - Design / Layout

Nature/Characteristics of Load –pt profile

Work Environment- Eg lighting, floor surfaces Work Practices

& Systems –- PH tasks performed- Design of work procedures

Work Organisation - staffing & training

Tools & Equipment - PH aids

Facility / Unit Risk

Assessment Tool(FURAT)

FURAT

Section 1 Facility/ Unit Description

• Persons completing risk assessment• Work area Key contacts• Communication arrangements

– District– Division– Ward

Facility Unit

Section 2 Patient Profile

• Age range• Service type• Dependency- I, SN,AN,D• Size (use BMI as guide)• Weight range• Primary diagnosis• Special requirements for patient handling

Section 3 Environment

• Floor surface• Access• Space• Overhead clearance• Noise• Lighting• Temperature• Other

Section 4 Equipment

• Includes equipment, aids and furniture• SWL• Quantity

– Existing– Future needs

• Condition, maintenance arrangements• Location/ access/ storage• Meets needs?

Section 5 Staffing and Training

• Skill mix• Capacity-

– PH experience– Functional limitations – Access to PH expertise

• Work organisation• PH training- number of trainers, training arrangements• Injury, absenteeism, turnover

Section 6 Patient Handling Tasks

• Patient Handling Transfer Table, adapted from:– WorkSafe Victoria Transferring People Safely 2nd edition 2006– Sir Charles Gairdner Hospital S.A.F.E.R Patient Handling (2006)

• Preferred, not preferred and not recommended methods• Range of patient dependency• Standard conditions apply

Observe Consult Past History

Section 7 Risk analysis

• From section 6: Pt Handling Tasks Performed, identify – not preferred methods– not recommended methods– Alternate methods– Additional tasks

• Frequency • Analyse the

– Direct risk factors– Contributory risk factors (from sections 1-5)

2. Patient Profile3. Environment4. Equipment5. Staffing & training

Section 8 Risk control worksheet

• Hierarchy of control explained and examples given

• Risk control table existing controls brainstorm others to be considered

• Risk control plan and evaluation short and long term controls to be implemented Evaluation

• Sign-off

Patient Handling Risk Profile Form

• Displayed in the work area• Updated as often as required to keep the information

current• A quick tool for

– Induction– Casual– Students etc

Patient Handling Risk Profile Form

• Patient profile; range of PH activities; precautions• Individual PH assessment procedure• Summary of risks and controls• Equipment register• Training and assessment program• Documentation• Compliance monitoring

Activity(1)

The Incident …• RN Smith was transferring Mrs Jones (bed 13) back to bed.

– Pt slipped and fell to the floor. – With the assistance of Operational Officer (Bill) lifted pt

back to bed.

• RN Smith – noticed a slight back twinge at the time of the incident but

was able to continue working. – Pain increased slightly by the end of the shift. – Woke Sunday morning in excruciating pain. – Went to LMO and was given pain relief and medical

certificate for 2 weeks leave.

Elements of a Facility / Unit PH Risk Assessment

POSTURE

TIMEFORCE

Work Area - Design / Layout

Nature/Characteristics of Load –pt profile

Work Environment- Eg lighting, floor surfaces

Work Practices & Systems –- PH tasks performed- Design of work procedures

Work Organisation - staffing & training

Tools & Equipment - PH aids

Systems Approach (Swiss cheese)

Activity(2)

Implementation Strategies

• Work Practice Directive (mandatory)– Facility or Unit level– Implementation plan with 6 months– Annual review– Re-assessment at least every 3 years– Team approach– Documentation

• Retained locally; copies centrally to OHS Unit• Profile Form

Implementation 2007 - Developed 2008 – Pilot 2009 - Approved

Service Level Agreements

• Timeline for Key Deliverables– 3mths gap analysis and plan– Prioritisation of work areas

• Performance Measures – Quarterly reporting– % staff trained– % FURAT completed– Ratio Trainers to Staff (target 1:10 in priority 1 areas)

2009 20122010 2011

Planning Priority 1 Areas Priority 2 Areas Priority 3 Areas

Strengths• Builds capacity• Encourages collaboration and participation• Risk management demonstrated• Consistent process• Clear accountability but shared responsibility• Covers direct and contributory risk factors• Highlights high risk practices• Prioritisation

Weaknesses• Significant shift in culture • Looks daunting• IT systems do not allow uploading to central monitoring

point• Benefits not immediately obvious• No one person has the skills/ knowledge to complete • Aimed at clinical managers- competing demands

Opportunities• Due diligence• Business outcomes- use of resources; costs• Safety culture• Improved physical and psychosocial aspects of work• Justification/ escalation of high risk issues• Sustainability and quality of risk management• Capability

Threats• Competing priorities• Budget• Reactive safety culture• Conflict over responsibilities• Fear about liabilities• Does not result in actual reduction of risk factors• Perceived effort vs return• Lack of capability

Outcomes• Anecdotal reports of improved success with business

cases• Gradually improving uptake, probably better in smaller

areas• OHS doing a lot of the work• ‘Once I actually gave it a go, it wasn’t that bad’ ‘I can see

the benefit now I’ve done it’• Quality issues- risk analysis and controls• Improved awareness of proactive approach- OHS and

managers

Future Enhancements• Usability and integration with

business systems

– Central collation and reporting

– Prioritisation and escalation

• Education

– Risk Analysis and higher order controls

• Relationships

• Culture

Future Direction

• Other Tools and guidelines available.– MAPO– Dortmund– PTAI– Care Thermometer

• ISO Ergonomics – Manual handling of people in the healthcare sector

• Legislation for Safe Patient Handling Laws– USA– Hospital Patient and Health Care Worker Injury Protection Act