SAFE PATIENT HANDLING- AN ART TO LEARN & A SAFETY MEASURE TO

FOLLOW

REUBAN DANIEL.C

Sr.Faculty of Caregivers & Sr.Program

Manager-Spinal Injury Rehab

-The Association of People With Disability,

Bangalore

SAFE PATIENT HANDLING(SPH)-AN OVERVIEW

SPH is an important factor that determines the work

productivity of any health caregiver both in the hospitals and

community

SPH is inversely proportional to the cause of Musculoskeletal

Disorders(MSD) in care givers

MSD is generally a result of long term cumulative physical effort

during improper patient transfer

MSD also develops from “PEAK LOAD” of patient handling

In NUTSHELL- such adverse injuries in this most vulnerable

group can be prevented by drawing SPH plans

Ergonomics & Patient

handling

The best ergonomic postures in safe patient handling

plays a key role in engaging the workforce efficiently .

The best ergonomic practice has 2 components

1)PATIENT TRANSFER & 2) PATIENT LIFTS. The work

force should know about these two which would give

them a fair idea when to use/demand either one of it.

1)Patient Transfer: Is a dynamic effort in which the patient

aids in the transfer and is able to bear weight on at least

one leg

2)Patient Lifts: Is an effort by the workforce/workforces

where the patient cannot bear weight on at least

one leg

SPH –Decision making

Tree

Assessment of the patient

Weight bearing capacity on at least 1 leg/Upper body Strength

YES

Patient Transfer

NO

Patient Lift

SPH –Decision making

factors

Weight bearing capacity

Upper body strength

Co-operation & Cognitive level

Physical characteristics

Other special characteristics like

presence of tubes,IV,HOF,splints should

be considered.

Manual handling

In Growing Health care sectors its not possible to avoid

manual handling

At least Polices/ SOP’s should be developed so the

principle of Protection Using Safe Handling (PUSH) is

prioritised

PUSH –should be realistic & reflect Actual practice

A Robust Risk Management process including

Hazard Identification

Risk Assessment

Implementation of Controls

Performance Monitoring

Auditing & Review of the management

Can Gadgets make the

trick???

o Manual Handling too needs basic ,cost effective

equipments to deliver the task with great impact.

o Proper Ergo+coupling of handling gadget+PUSH

Coupling the manual

handling

Coupling the manual

handling

Coupling the manual

handling

Factors contributing safe handling

Safe

handling

Managem

ent's

commitm

ent

Employees

Participato

ry level

Ergonomic

approach

& Proper

work place

Design

System of

Investigat

ing

incident

Sufficient

Human

Resource

trained for

this Mx

Program

Developing SPH to sensitize the Work

Force

Manual Handling Training

Incident Reporting &

Investigation

Resources and competencies

Communication

Manual handling guides

Mechanical Handling

Mechanical handling is one of the safest Patient handling in the

developed countries as reported by CDC in the year 1999

In Developing countries like ours due to the fear of high investments

and lack of system to capture the details of ROI discourages the

organisations to use the effective Mechanical hoists & Lifts

Statutory bodies like NIOSH, VHA encourages care giving employees

to use the Mechanical lifts

o Having indicators for outcome at initial point of introduction

o Would measure the benefits-Tools like REBA,NIOSH,Physical Demand

Description (PDD) checklist tool can be used

ZERO LIFT-Is it

possible?

Hypothetical but still could be explored

Transferring & Re positioning using new technologies could be

the way out

ZERO LIFT would increase the quality care

Components include Technical caregivers, Customised lifts and

hoists with adequate hydraulic system

……All these would make at some point of time ZERO LIFT

Possible

Few Mechanical

technologies

Few Mechanical

technologies

Myth Breakers-Manual

Handling

MYTHS FACTS

Training workers to use

proper body mechanics

avoids injuries

It takes less time to

move the patient

manually

This alone is not effective .Along

with training commitment of

management ,implication,auditing

& maintaining the SOP aids better

delivery

It takes much time to gather the

team for a manual lift .Rather it

takes very less time while using

mechanical lift as the key

personnel involvement is less

Myth Breakers-

Mechanical Handling

MYTHS FACTS

Lifting Equipments are not

affordable to get/ not cost

effective

Employees will not use the

equipments if invested for

lifting

Use of mechanical lifts

eliminates all the risk of MSD

Several studies have shown that initial

capital investment in the policies and

equipments needed to SPH can be recovered

in 2 -5 years if effective implementation is in

process

According to the survey of 2011 among 3500

employees 76% fairly used the equipments

and 31% of frequent usage of the equipments

were reported in the first 1 year of

implementation

It reduces the risk, but doesn’t eliminate.

B’cos most of the MSD are

accumulative/Repetative .

SPH Team’s responsibilities

Implements Program

Writes Policy

Reviews/Trends Data

Ensures incidents/injuries are investigated

Facilitates Equipment Purchases

SPHM Team Members

Nursing Administrator

Nursing Staff

Nursing Service Safety

Rep

Risk Manager

Resident/Patient

Nurse Educator

Therapy Staff

(OT, PT, ST)

Purchasing

Engineering

Safe Patient Handling –Goals &

Algorithms

Goals Reduce the incidence & severity musculoskeletal injuries

Reduce costs from these injuries

To create Care Plan & Algorithms

Algorithms Based on Specific Patient Characteristics (from Assessment)

Assists nurses in selecting

• Safest Equipment

• Safest Patient Handling Technique

• No.of staff needed for the task

Lifting guidelines-OSHA

Lift loads close to the body

Never transfer when off the balance

Limit no.of lifts less than 20

Avoid heavy lifting while spine rotated

Never Lift alone

Try using /educate using the mechanical assistance

whenever possible

Avoid repetitive actions

Get guided by effective body mechanic

techniques

Case Discussion

80 year old patient named XYZ

Weight: 85 KGs Height: 5’ 9”

Has dementia and HOF.

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 XYZ

Level of Assistance

Dependent

Can the resident bear weight?

No, because the resident is

not cooperative

Resident’s level of cooperation

and comprehension

Unpredictable

Weight: 85Kgs

Height: 5’ 9”

Does resident have upper extremity strength needed to support weight during transfers?

No, because resident is unreliable for using his upper extremity strength

Special circumstances?

History of Falls

Care Plan-XYZ

Although the resident can sometimes bear weight, he can

be uncooperative.

The “No” answer to “Is the patient cooperative?” leads

you to: “Use full body sling lift and 2 caregivers”

Answer: Use full body sling lift and 2

caregivers

To draw a SOP for a SPH

Program

Collect the following Baseline Data 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

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

Baseline data of a Pre-Site

Visit on High-Risk Units

Acquire the following • Space issues

• Storage availability

• Maintenance/repair issues

• Patient population

• Staffing characteristics

• Equipment inventory/issues

Will use when performing site visit and for making recommendations

Formulating

Recommendations

Hazard Elimination Scale in sling lift

Transfer Bed

Recommending apt coupling equipments/gadgets

Administrative Controls Changes in Scheduling

Minimizing # times transfers are required

Job Rotation

Redistribution of Workload Based on Acuity

Lifting Teams

Procedures for repair/maintenance-Engineering control

Allot Storage Space to make equipment more accessible

Wishing you to facilitate a Happy work place!!!!!

reuband@apd-india.org

Thank you!!!!

WAKE UP!!!!