# Presentation: 181164

## Ergonomics and Caregiver Safety

- Guy Fragala, PhD, CSP
- Audrey Nelson, PhD, RN, FAAN
- Rick Barker, MA, CPE

**Notes:**
Ergonomics and Caregiver Safety
Guy Fragala, PhD, CSP
Audrey Nelson, PhD, RN, FAAN
Rick Barker, MA, CPE

## ERGONOMICS AND CAREGIVER SAFETYIssues Needing Attention

- High Rates of Nursing Back Injuries
- High Cost of Injuries
- Regulatory Pressures
- Need to Improve the Work Environment

**Notes:**
Ergonomics and Caregiver SafetyIssues Needing Attention

High Rates of Nursing Back Injuries
High Cost of Injuries
Regulatory Pressures
Need to Improve the Work Environment

## Size of Hospitals Included for Injury Data Review

| Number of Hospitals | Hospital Bed Size |
| --- | --- |
| 4 Hospitals | 500 – 600 Beds |
| 1 Hospital | 450 Beds |
| 2 Hospitals | 150 – 200 Beds |

**Notes:**
Size of Hospitals Included for Injury Data Review
Number of Hospitals (Bed Size):
4 (500-600 beds)
1 (450 beds)
2 (150-200 beds)

## 2000 Strain/Sprain Injuries

- In 2000, 68.7 percent of strain or sprain injuries were related to patient handling

**Notes:**
In 2000, 68.7 percent of strain or sprain injuries were related to patient handling.

## 2001 Strain/Sprain Injuries

- In 2001, 68.6 percent of strain or sprain injuries were related to patient handling tasks.

**Notes:**
In 2001, 68.6 percent of strain or sprain injuries were related to safe patient handling tasks.

## Ranking of Activities Causing Strain/Sprain Injuries to Hospital Workers

| Activity | Reported Injuries | Percentage | Rank |
| --- | --- | --- | --- |
| Repositioning Patient (Includes turning and lifting patient up in bed) | 153 | 17.9 | 1 |
| Lifting Object  | 109 | 12.7 | 2 |
| Lifting Patient (not further specified) | 102 | 11.9 | 3 |
| Transfer Bed/Chair | 97 | 11.3 | 4 |
| Transporting Patient (wheelchair/stretcher/bed) | 94 | 11.0 | 5 |
| Push/Pull Object | 89 | 10.4 | 6 |
| Aggressive Patient | 70 | 8.2 | 7 |
| Lateral Patient Transfer | 49 | 5.7 | 8 |

**Notes:**
Ranking of Activities Causing Strain/Sprain Injuries to Hospital Workers:
Repositioning patient (includes turning and lifting patient up in bed). 153 reported injuries (17.9%).
Lifting object. 109 reported injuries (12.7%).
Lifting patient (not further specified). 102 reported injuries (11.9%).
Transfer Bed/Chair. 97 reported injuries (11.3%).
Transporting Patient (wheelchair/stretcher/bed). 94 reported injuries (11%).
Push/Pull Object. 89 reported injuries (10.4%).
Aggressive Patient. 70 reported injuries (8.2%).
Lateral Patient Transfer. 49 reported injuries (5.7%).

## Slide 7

**Notes:**
The Hidden Costs of Injuries
Direct Costs:
Compensation Payments
Medical Cost
Indirect and Hidden Costs of Injuries
Replacing Employees
Investigation Time
Supervision Time
Training
Staff Morale
Possible Patient Injury
Break-up Work Team
Administrative Time
Overtime Paid
All Other Costs

## OSHA and ERGONOMICSThe History

- 1986 - Pilot Program to Reduce Back Injuries 	  		  (NIOSH Lifting Equation Program)
- 1992 – Advanced Notice of Proposed Rulemaking
- 1995 – Draft Proposed Standard
- 1999 – Proposed Standard
- 2000 – Final Standard Issued
- 2001 – Repeal of Standard
- 2002 – Beverly Settlement

**Notes:**
OSHA and ERGONOMICS: The History
1986: Pilot program to reduce back injuries (NIOSH lifting equation program)
1992: Advanced notice of proposed rulemaking
1995: Draft proposed standard
1999: Proposed standard
2000: Final standard issued
2001: Repeal of standard
2002: Beverly settlement

## OSHA and ERGONOMICSCurrent Situation

- April 5, 2002	 OSHA Four-Pronged Plan
- July 15, 2002	 National Emphasis Program 			 (Nursing Homes)
- March 13, 2003 	 Final Healthcare Nursing Home 			 Guidelines
- More in 2003	 Regional Emphasis Programs –
-  		  HOSPITALS
- 		  Emphasis Programs 9 out of 10 regions

**Notes:**
OSHA and ERGONOMICS Current Situation
April 5, 2002: OSHA four-pronged plan
July 15, 2002: National emphasis program (nursing homes)
March 13, 2003: Final healthcare nursing home guidelines
More in 2003: Regional emphasis program: HOSPITALS (emphasis programs 9 out of 10 regions)

## JCAHO and WORKER SAFETY

- EC1.1.1  “The Hospital Plans for Worker Safety”
- Intent:
- General Safety Processes
- Area Specific Safety
- Specific Job-Related Hazards
- Safety-Related Information through Orientation and Continuing Education

**Notes:**
JCAHO and Worker Safety
EC1.1.1 “The Hospital Plans for Worker Safety”
Intent:
General Safety Processes
Area Specific Safety
Specific Job-Related Hazards
Safety-Related Information through Orientation and Continuing Education

## JCAHO and PERFORMANCE MONITORING

- EC.4		“The Hospital Evaluates and Improves 		Conditions in the Environment”
- EC.4.2	“The Hospital Analyzes Identified 		Environment Issues and Develops 		Recommendations for Resolving 			Them”

**Notes:**
JCAHO and Performance Monitoring

EC.4: The hospital evaluates and improves conditions in the environment.
EC.4.2: The hospital analyzes identified environment issues and develops recommendations for resolving them.

## ENVIRONMENT OF CAREPERFORMANCE IMPORVEMENT INITIATIVE

- 	Intent of EC.4.2:
-    Based on the ongoing monitoring of performance in each of the seven management areas, recommendations for one or more performance improvement activities are communicated annually to the hospital’s leaders.

**Notes:**
Environment of Care Performance Improvement Initiative

Intent of EC.4.2. Based on the ongoing monitoring of performance in each of the seven management areas, recommendations for one or more performance improvement activities are communicated annually to the hospital’s leaders.

## The Practice of Nursing...Difficult and Demanding

**How can we make improvements?**

**Notes:**
The Practice of Nursing...Difficult and Demanding
How can we make improvements?

## Ergonomic Assessments of Nursing Practice Settings

- What has been done
- Focus on long-term care
- How does acute care differ
- What are the needs for acute care

**Notes:**
Ergonomic Assessments of Nursing Practice Settings
What has been done
Focus on long-term care
How does acute care differ
What are the needs for acute care

## Selecting Appropriate Interventions

- A workable approach for long-term care
- Match preferred interventions with dependency classifications

**Notes:**
Selecting Appropriate Interventions
A workable approach for long-term care
Match preferred interventions with dependency classifications

## Dependency Status Key

- 	_ADL Self-Performance Codes_
- 			0	Independent
- 			1	Supervision
- 			2	Limited Assistance
- 			3	Extensive Assistance
- 			4	Total Dependence

**Notes:**
Dependency Status Key

ADL Self-Performance Codes:
0 – Independent
1 – Supervision
2 – Limited Assistance
3 – Extensive Assistance
4 – Total Dependence

## Lift Aid Equipment Determination Grid

| Resident Dependency Classification | Height Adjustable Bed | Full Sling Lift | Stand Assist Lift | Lift Walker | Stand Assist Aid | Gait Belt with Handles | Friction Reducing Aid |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 0 - Independent | Recommended | Never | Rarely | Rarely | Rarely | Rarely | Rarely |
| 1 – Supervision | Recommended
 | Rarely
 | Occasionally | Occasionally | Normally | Occasionally | Rarely
 |
| 2 – Limited Assistance | Strongly
Recommended
 | Rarely
 | Normally | Normally | Normally | Normally | Normally |
| 3 – Extensive Assistance | Required | Normally | Normally | Normally | Rarely
 | Rarely
 | Always |
| 4 – Total Dependence | Required | Always | Never
 | Never
 | Never
 | Never
 | Always |

**Lift Aid Equipment Determination Grid**
- (recommended example)

- For a typical resident with the dependency status classification as shown, this grid indicates normal equipment requirements to conduct a safe transfer.  Some residents may have special characteristics and not exactly match a typical profile.  In those situations, special consideration will be required.

**Notes:**
Above is a grid for determining lift aid equipment according to classification.

## Directions for Acute Care

- Assessments driven by high-risk activity
- Identification of high risk activity based on data analysis

**Notes:**
Directions for Acute Care
Assessments driven by high-risk activity
Identification of high-risk activity based on data analysis

## The Task of Repositioning a Patient in Bed

- Why is it a problem?

**Notes:**
The Task of Repositioning a Patient in Bed
Why is it a problem?

(shows a picture of a caregiver trying to reposition a patient in a bed without an assistive device)

## How Can We Approach this Problem of Repositioning

- Trying to eliminate or minimize the need to reposition
- Involving the patient in the repositioning activity where possible, such as application of retractable footboards
- Have assist devices in the mattress surface
- The use of friction-reducing devices to reposition the patient

**Notes:**
How Can We Approach this Problem of Repositioning?
Trying to eliminate or minimize the need to reposition
Involving the patient in the repositioning activity where possible, such as application of retractable footboards
Have assist devices in the mattress surface
The use of friction-reducing devices to reposition the patient

## Shearless Pivot

**Notes:**
Shearless Pivot

(shows a picture of a patient in a bed that turns into a chair without caregiver intervention.

##  Retractable Footboard Extended

**Notes:**
Retractable Footboard Extended

(shows a picture of the retractable footboard on a hospital bed).

##  Retractable Footboard Used for Support

**Notes:**
Retractable Footboard Used for Support

(shows a picture of the retractable footboard placed in a position so that the patient’s feet are flat against it so they can assist in repositioning and keep from sliding down on the bed).

##  Turn Assist/Rotational Therapy

**Notes:**
Turn Assist/Rotational Therapy

(shows a picture of a patient on a bed with rotational therapy and caregiver at their side)

## Slide 25

**Notes:**
Shows a picture of a caregiver standing at the base of the bed bracing the patient’s feet with their hands so he/she can assist in the move.

## Slide 26

**Notes:**
Shows a picture of a caregiver using a friction reducing device to reposition a light and partly active patient on a bed.

## Examples of Some Other High Risk Activities Encountered in Critical Care Units in Acute Care Hospitals

- Lateral transfers
- Assist to standing position
- Bed egress and transfer
- Turning as opposed to repositioning patient in bed
- Bed to chair transitioning

**Notes:**
Examples of Some Other High Risk Activities Encountered in Critical Care Units in Acute Care Hospitals
Lateral transfers
Assist to standing position
Bed egress and transfer
Turning as opposed to repositioning patient in bed
Bed to chair transitioning

## Lateral Transfer Aids

- Friction reducing lateral slide aids
- rigid boards
- flexible sheets
- rollers
- air assisted
- Mechanical lateral transfer aids
- hand cranks
- electric motor

**Notes:**
Lateral Transfer Aids
Friction reducing lateral slide aids
rigid boards
flexible sheets
rollers
air assisted
Mechanical lateral transfer aids
hand cranks
electric motor

## Slide 29

**Notes:**
Picture shows 2 caregivers transferring a patient from a stretcher to a bed using a friction reducing device.

## Slide 30

**Notes:**
Picture of one caregiver transferring a patient from a stretcher to a bed using a mechanical device.

## Slide 31

**Notes:**
Picture of a caregiver transferring a patient from stretcher to bed using an electronic transfer device.

## Engineering Control Strategies...the Preferred Control Method

- Eliminate the need to do the hazardous activity
- Redesign the activity to reduce the hazard
- Utilize an aiding device to minimize the hazard

**Notes:**
Engineering Control Strategies...the Preferred Control Method
Eliminate the need to do the hazardous activity
Redesign the activity to reduce the hazard
Utilizing an aiding device to minimize the hazard

## Slide 33

**Notes:**
Caregiver and patient shown. Patient is on a bed that converts to a sitting position.