# Presentation: 804981

## Unit-based Hazard Assessment for Safe Patient Handling

**Notes:**
Unit-based Hazard Assessment for Safe Patient Handling

## Unit-based Hazard Assessment for Safe Patient Handling

**Mary Willa Matz, MSPH**
**VHA Patient Care Ergonomics Program Manager/Consultant **
**Occupational Health Science Researcher **
**Industrial Hygienist **
***VISN 8 Patient Safety Center of Inquiry***
**James A. Haley VA Hospital**
**Tampa, Florida**
**(813) 558-3928   (813) 558-3990 fax**
**mary.matz@va.gov**

**Notes:**
Unit-Based Hazard Assessment for Safe Patient Handling
Mary Willa Matz, MSPH
VHA Patient Care Ergonomics Program Manager/Consultant 
Occupational Health Science Researcher 
Industrial Hygienist 

VISN 8 Patient Safety Center of Inquiry
James A. Haley VA Hospital
Tampa, Florida
(813) 558-3928   (813) 558-3990 fax
mary.matz@va.gov

## Faculty Disclosure 

**Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or devices. **
**Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this activity. **
**This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label. **
**The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.**

**Notes:**
Faculty Disclosure
Ms. Matz does not endorse any specific vendor or manufacturer of patient handling equipment or devices. 

Ms. Matz has no financial relationships or interests with any commercial topics that are discussed in this activity. 

This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label. 

The opinions expressed in this presentation are the opinions of Ms. Matz, and do not represent the views/opinions of the Veterans Health Administration.

** **

**Ergonomics **
**and**
**Patient Handling**

**Notes:**
Ergonomics and Patient Handling

## Ergonomics...

***"Ergonomics is the scientific study of the relation between ***_***people***_*** and their...***
**Occupation**
**Equipment**
**Environment“**
**	**
**	****(Shackel)**

**Notes:**
Ergonomics
"Ergonomics is the scientific study of the relation between people and their...
Occupation
Equipment
Environment“

	(Shackel)

## Ergonomics Principles

**Design for human use **
***Fits***** the task to the worker**
**People are different**
**People have limitations**
**People age**

**Notes:**
Ergonomics Principles
Design for human use 
Fits the task to the worker  
People are different
People have limitations
People age

## An Ergonomic Approach...

***Provides a step-by-step process to ensure the appropriate technology is in place to reduce musculoskeletal stress & strain.... reducing the risk of injury.***

**Notes:**
An Ergonomic Approach...
Provides a step-by-step process to ensure the appropriate technology is in place to reduce musculoskeletal stress & strain.... reducing the risk of injury.

## A Simple Look at an  Ergonomic Approach

**Tasks: **
**Identify jobs and job tasks which stress body parts beyond limits **
**Develop solutions to change these task demands.**
**Workplace Environment:**
**Review the design of the physical work environment to reduce risk, remove barriers, minimize travel, etc. **
**Other Factors:**
**Consider other factors that affect work performance, such as lighting, noise, equipment storage & maintenance issues.**
**Implement these changes in the work place.**

**Notes:**
A Simple Look at an Ergonomic Approach
Tasks: 
Identify jobs and job tasks which stress body parts beyond limits 
Develop solutions to change these task demands.

Workplace Environment:
Review the design of the physical work environment to reduce risk, remove barriers, minimize travel, etc. 

Other Factors:
Consider other factors that affect work performance, such as lighting, noise, equipment storage & maintenance issues.

Implement these changes in the work place.

**Notes:**
Ergo Injury Triangle
Image of Injury as related to posture/force and frequency/duration

## Ergonomic Hazards

***What are Ergonomic Hazards?***
**Musculoskeletal System**
**Energy/Forces/Stressors**
**Exceed the biomechanical limits of the human body **

**Notes:**
Ergonomic Hazards
What are Ergonomic Hazards?
Musculoskeletal System
Energy/Forces/Stressors
Exceed the biomechanical limits of the human body 

## What Do “Patient Care” Ergonomic Hazards result from?

***Patient lifting and moving exceed caregivers’ biomechanical limits...***

**Notes:**
What Do Patient Care Ergonomic Hazards Result From?
Patient lifting and moving exceed caregivers’ biomechanical limits...

## What Do “Patient Care” Ergonomic Hazards result from?

**Ergonomic hazards for caregivers include... **
**pushing, pulling**
**lifting heavy loads**
**horizontal & vertical lifting**
**lifting light loads for long periods of time**
**twisting, bending, reaching**
**standing for long periods of time**
**awkward postures**
**repetitive motions**
**others....**

**Notes:**
What Do “Patient Care” Ergonomic Hazards Result From?
Ergonomic hazards for caregivers include... 
pushing, pulling
lifting heavy loads
horizontal & vertical lifting
lifting light loads for long periods of time
twisting, bending, reaching
standing for long periods of time
awkward postures
repetitive motions
others....

## What Do “Patient Care” Ergonomic Hazards result from?

**“****Safe” lifting rules don’t apply                 ****(Horizontal **_**and**_** vertical lifting)**
**Patients:**
**are *****asymmetric & bulky***
***can’t be held close***** to the body**
**have no *****handles***
**Patient *****assistance varies***

**Notes:**
What Do “Patient Care” Ergonomic Hazards Result From?
“Safe” lifting rules don’t apply                 (Horizontal and vertical lifting)
Patients:
are asymmetric & bulky
can’t be held close to the body
have no handles
Patient assistance varies

## 
Patient care is unpredictable due to unanticipated patient responses... 
muscle spasms, combativeness, or resistance
Results in... 
Unexpectedly heavy loads
Patient Movement 
When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object. 

**Patient care is unpredictable due to unanticipated patient responses... **
**muscle spasms, combativeness, or resistance**
**Results in... **
_**Unexpectedly**_** heavy loads**
**Patient **_**Movement**_** **
**When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object. **

**Notes:**
What Do “Patient Care” Ergonomic Hazards Result From?
Patient care is unpredictable due to unanticipated patient responses... 
muscle spasms, combativeness, or resistance
Results in... 
Unexpectedly heavy loads
Patient Movement 
When lifting/handling a moving object, loading/stress on the spine increases beyond what it would be for a slow, smooth lift of a stable object. 

## d

**d**

**F=ma**

**Simple Biomechanical Model**

**Work = ****Force ****x Distance**
**W = F x d**

**Notes:**
Simple biomechanical model showing how work equals force times distance

## Exceeding Biomechanical Capabilities results in...

***Musculoskeletal impact/stress on...****** ***
**Back**
**Shoulders**
**Neck**
**Wrist**
**Hand**
**Knees**
**Other body parts...**

**Notes:**
Exceeding Biomechanical Capabilities results in...
Musculoskeletal impact/stress on... 
Back
Shoulders
Neck
Wrist
Hand
Knees
Other body parts...

## Example 1: Pull up in Geri-Chair

**Example 1: Pull up in Geri-Chair**

_**Risk Factor**_**: **
**Manual Lifting**
_**Body Parts Affected:**_
** ****Back – posture, load/force**
** ****Shoulder – load/force**
** ****Elbow – load/force**
** ****Wrist/hand – load/force**
** ****Neck – load/force**
_**Interventions:**_
** ****Sit to Stand Lifts **
** ****Ceiling/Floor Full Body Sling Lifts**
** ****Friction Reducing Devices**

**Notes:**
Example 1: Pull up in Geri-Chair
Risk Factor: 
Manual Lifting

Body Parts Affected:
 Back – posture, load/force
 Shoulder – load/force
 Elbow – load/force
 Wrist/hand – load/force
 Neck – load/force

Interventions:
 Sit to Stand Lifts 
 Ceiling/Floor Full Body Sling Lifts
 Friction Reducing Devices

## Example 2: Transfer to Stretcher

**Example 2: Transfer to Stretcher**

_**Risk Factor**_**: **
**Manual Lifting**
_**Body Parts Affected:**_
** ****Back – posture, load/force**
** ****Shoulder – load/force**
** ****Elbow/Wrist/Hand – load/force**
** ****Neck – load/force**
_**Interventions:**_** **
**Ceiling/Floor Full Body Sling Lifts**
**Lateral Transfer Devices (LTD)**
**Friction reducing devices**
**Air Assisted LTD**
**Mechanical LTD**

**Notes:**
Example 2: Transfer to Stretcher

Risk Factor: 
Manual Lifting

Body Parts Affected:
 Back – posture, load/force
 Shoulder – load/force
 Elbow/Wrist/Hand – load/force
 Neck – load/force

Interventions: 
Ceiling/Floor Full Body Sling Lifts
Lateral Transfer Devices (LTD)
Friction reducing devices
Air Assisted LTD
Mechanical LTD

## Example 3: Transfer from Chair of partial weight-bearing patient 

**Example 3: Transfer from Chair of partial weight-bearing patient **

_**Risk Factor**_**: **
**Manual Lifting**
_**Body Parts Affected:**_
** ****Back – posture, load/force**
** ****Neck – load/force**
** ****Shoulder – load/force**
** ****Elbow – load/force**
** ****Wrist/hand – load/force**
_**Intervention:**_** **
**Sit to Stand Lift **

**Notes:**
Example 3: Transfer from Chair of Patient Weight-Bearing Patient

Risk Factor: 
Manual Lifting

Body Parts Affected:
 Back – posture, load/force
 Neck – load/force
 Shoulder – load/force
 Elbow – load/force
 Wrist/hand – load/force

Intervention: 
Sit to Stand Lift 

## Example 4: Lateral Transfer 

**Example 4: Lateral Transfer **

_**Risk Factor**_**: **
**Space Constraints**
_**Body Parts Affected:**_
** ****Shoulder – posture/load**
** ****Elbow – position/load**
** ****Wrist/hand – position/load**
** ****Neck – posture/load**
** ****Back – posture/load**
_**Intervention:**_** **
**Ceiling Lift**
**Renovate room**

**Notes:**
Example 4: Lateral Transfer
Risk Factor: 
Space Constraints

Body Parts Affected:
 Shoulder – posture/load
 Elbow – position/load
 Wrist/hand – position/load
 Neck – posture/load
 Back – posture/load

Intervention: 
Ceiling Lift
Renovate room

## Unit-Based Hazard Assessment for Safe Patient Handling

**Notes:**
Unit-Based Hazard Assessment for Safe Patient Handling

## Unit-based Hazard Assessment for Safe Patient Handling

***‘******Patient Care’ Practice Settings include...***
**ALL practice settings that move and lift patients**

_**NON-NURSING**_
**PT**
**Diagnostics**
**Treatment Areas**
**Procedure Areas**
**Morgue**
**Dialysis**
**Others..**

_**NURSING**_
**Acute Care**
**Long Term Care**
**Critical Care**
**OR**
**ER**
**SCI**
**Others...**

**Notes:**
Unit-Based Hazard Assessment for Safe Patient Handling
‘Patient Care’ Practice Settings includg...
ALL practice settings that move and lift patients
NURSING
Acute Care
Long Term Care
Critical Care
OR
ER
SCI
Others...

NON-NURSING
PT
Diagnostics
Treatment Areas
Procedure Areas
Morgue
Dialysis
Others..

## Unit-Based Hazard Assessment 

***Role***
**Drives UNIT recommendations for equipment, policy, and procedures **
**Identifies areas in need of improvement that impact safety of work environment & use of equipment**
**Storage, maintenance, clutter, etc.**

**Notes:**
Unit-Based Hazard Assessment
Role
Drives UNIT recommendations for equipment, policy, and procedures 

Identifies areas in need of improvement that impact safety of work environment & use of equipment
Storage, maintenance, clutter, etc.

## Unit-Based Hazard Assessment

**I.***** Prior to Ergo Evaluation – Data Collection***
**Identify UNIT High Risk Tasks**
**Staff Perception of High Risk Tasks**
**Unit Injury data**
**Identify High Risk Units**
**Collect Information on Unit Characteristics/Issues**

**II.***** During Ergo Evaluation***
**Meet with Mgmt/Staff**
**Conduct Site Visit**
**Meet with Mgmt/Staff**
**III.***** After Ergo Evaluation***
**Perform Risk Analysis**
**Formulate Recommendations**

**Notes:**
Unit-Based Hazard Assessment
I. Prior to Ergo Evaluation – Data Collection
Identify UNIT High Risk Tasks
Staff Perception of High Risk Tasks
Unit Injury data
Identify High Risk Units
Collect Information on Unit Characteristics/Issues
II. During Ergo Evaluation
Meet with Mgmt/Staff
Conduct Site Visit
Meet with Mgmt/Staff

III. After Ergo Evaluation
Perform Risk Analysis
Formulate Recommendations

## Unit-Based Hazard Assessment 

**I.***** Prior to Ergo Evaluation – Data Collection***
**Identify UNIT High Risk Tasks**
**Staff Perception of High Risk Tasks**
**Unit Injury data**
**Identify High Risk Units**
**Collect Information on Unit Characteristics/Issues**

**Notes:**
Unit-Based Hazard Assessment
I. Prior to Ergo Evaluation – Data Collection
Identify UNIT High Risk Tasks
Staff Perception of High Risk Tasks
Unit Injury data
Identify High Risk Units
Collect Information on Unit Characteristics/Issues

## I. Prior to Ergo Evaluation 1. Identify High Risk Tasks 

_**Collect Staff Perceptions of Unit High-Risk Tasks**_
***‘******Tool for Prioritizing High Risk Tasks’ ***
**Rank Tasks from 1 to 10**
**10 = most difficult/highest risk     **
**1 = least difficult/ lowest risk**
**When ranking, consider:**** **
**Musculoskeletal Stress  =  Load, Posture, Frequency/Duration **
**Completed by**
**Each Staff member**
**Collectively by Shift**
**Compile by Unit and Shift**** **

**Notes:**
Prior to Ergo Evaluation
Identify High Risk Tasks
Collect Staff Perceptions of Unit High-Risk Tasks
‘Tool for Prioritizing High Risk Tasks’ 

Rank Tasks from 1 to 10
10 = most difficult/highest risk     
1 = least difficult/ lowest risk

When ranking, consider: 
Musculoskeletal Stress  =  Load, Posture, Frequency/Duration 
Completed by
Each Staff member
Collectively by Shift

Compile by Unit and Shift 

## I. Prior to Ergo Evaluation 1. Identify Unit High Risk Tasks 

****Be sure to note which source is used on your Injury Log***

_**Collect Unit Injury Data**_

**Notes:**
Prior to Ergo Evaluation
Identify Unit High Risk Tasks
Collect Unit Injury Data
* Be sure to note which source is used on your injury log.

## I. Prior to Ergo Evaluation  2. Identify High Risk Units

**Beware of using Injury data....**

**Notes:**
Prior to Ergo Evaluation  2. Identify High Risk Units
Beware of using Injury data....

## I. Prior to Ergo Evaluation 2. Identify High Risk Units

***Directs focus for equipment and policy interventions ***
***Identification of High Risk Units***
**Analyze all facility UNIT injury data...**
**Highest number of patient handling injuries**
**Most severe patient handling injuries**
**Lost Time**
**Modified Duty**
***High Risk Unit Characteristics***** **
**Many dependent patients/residents**
**Patients are moved in and out of bed often **
**Many patient transfers**

**Notes:**
Prior to Ergo Evaluation 2. Identify High Risk Units
Directs focus for equipment and policy interventions 
Identification of High Risk Units
Analyze all facility UNIT injury data...
Highest number of patient handling injuries
Most severe patient handling injuries
Lost Time
Modified Duty
High Risk Unit Characteristics 
Many dependent patients/residents
Patients are moved in and out of bed often 
Many patient transfers

## I. Prior to Ergo Evaluation 3. Collect Pre-Site Visit Unit Data

***Use ‘Unit Characteristics/Issues******’ Tool  *****(Handout A-1)**
**Space issues**
**Storage availability**
**Maintenance/repair issues**
**Patient population (% dependency*) **
**Staffing characteristics **
**Equipment inventory/issues**
**Confirms site visit data**
**Used for making recommendations**

**Notes:**
Prior to Ergo Evaluation 3. Collect Pre-Site Visit Unit Data
Use ‘Unit Characteristics/Issues’ Tool  (Handout A-1)
Space issues
Storage availability
Maintenance/repair issues
Patient population (% dependency*) 
Staffing characteristics 
Equipment inventory/issues

Confirms site visit data
Used for making recommendations

## Unit-Based Hazard Assessment

**II.***** During Ergo Evaluation/Site Visit***
**Opening Meeting **
**Site Visit/Walk-through**
**Closing Meeting (optional for unit, required for administration)**

**Notes:**
Unit-Based Hazard Assessment
II. During Ergo Evaluation/Site Visit
Opening Meeting 
Site Visit/Walk-through
Closing Meeting (optional for unit, required for administration)

## II. During Ergo Evaluation/Site Visit 1. Conduct Opening Meeting 

**Discuss **
**Pre-Site Visit Data**
**Issues of Concern**
**Include**
_**Staff**_
**Unit/Area Manager**
**Safety/Risk Management**
**Facilities Management**
**Union**
**Others**

**Notes:**
II. During Ergo Evaluation/Site Visit 1. Conduct Opening Meeting
Discuss 
Pre-Site Visit Data
Issues of Concern
Include
Staff
Unit/Area Manager
Safety/Risk Management
Facilities Management
Union
Others

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***During Site Visit Walk-through, ***_***interview staff***_***...***
**Confirms Pre-Site Visit Unit Data Collected**
**Discovers staff attitudes, concerns, ideas, information**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
During Site Visit Walk-through, interview staff...
Confirms Pre-Site Visit Unit Data Collected
Discovers staff attitudes, concerns, ideas, information

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***During Site Visit Walk-through, ***_***observe***_***...***
**Equipment **
**Availability****	**** **
**Accessibility**
**Use****	****	****         **
**Condition**
**Storage**
**Structural issues that impact use**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
During Site Visit Walk-through, observe...
Equipment 
Availability	 
Accessibility
Use		         
Condition
Storage
Structural issues that impact use

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***During Site Visit Walk-through, ***_***note***_***...***
**Patient room sizes/configurations**
**Ceiling Characteristics/AC vents/TVs/Sprinklers**
**Showering/bathing facilities & process**
**Toileting process**
**Safety Design Issues: Thresholds, Doorways**
**Storage **

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
During Site Visit Walk-through, note...
Patient room sizes/configurations
Ceiling Characteristics/AC vents/TVs/Sprinklers
Showering/bathing facilities & process
Toileting process
Safety Design Issues: Thresholds, Doorways
Storage 

## II. During Ergo Evaluation/Site Visit  2. Conduct Site Visit

***During Site Visit Walk-through, ***_***document***_***... ***
**Existing/ordered patient handling equipment**
**Occurrence of high risk tasks**
**% total dependent & extensive assistance pts**
**% partial assistance patients**
**Occurrence of bariatric/obese patients**
**Room configurations**
**# beds on unit/average daily census**
**Storage issues**
**Equipment/Sling recommendations**
**Notes****   ****	****	****	****	****	****          **
**(Sample PCE Templates - Handouts A-2a & A-2b)**

**Notes:**
II. During Ergo Evaluation/Site Visit  2. Conduct Site Visit
During Site Visit Walk-through, document... 
Existing/ordered patient handling equipment
Occurrence of high risk tasks
% total dependent & extensive assistance pts
% partial assistance patients
Occurrence of bariatric/obese patients
Room configurations
# beds on unit/average daily census
Storage issues
Equipment/Sling recommendations
Notes   					          
(Sample PCE Templates - Handouts A-2a & A-2b)

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit ***_***Ceiling Lift System***_*** Coverage ***
**Based on... **
**Dependency Level of patient/resident population **
**Room configurations on unit: # of private, semi-private, 3-bed, 4-bed rooms, etc. on unit. **
**	**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Coverage 
Based on... 
Dependency Level of patient/resident population 
Room configurations on unit: # of private, semi-private, 3-bed, 4-bed rooms, etc. on unit. 

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit ***_***Ceiling Lift System***_*** Coverage ***
**Limitations... **
**Structural integrity of mounting surface (I-beam/ concrete pan)**
**Ceiling fixtures - lights, sprinkler heads, AC vents, etc.**
**Ceiling Height **
**Ceiling configuration/drop ceiling/AC housing**
**ICU Power Columns**
**Others**
**	**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

Unit Ceiling Lift System Coverage 
Limitations... 
Structural integrity of mounting surface (I-beam/ concrete pan)
Ceiling fixtures - lights, sprinkler heads, AC vents, etc.
Ceiling Height 
Ceiling configuration/drop ceiling/AC housing
ICU Power Columns
Others

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

**      **

***Unit ***_***Ceiling Lift System***_*** Track Options***
**Traverse (x-y or H)**
**Straight**

***Curved***** **
**U-shaped**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Track Options:
Traverse (x/y or H)
Straight
Curves
U-shaped

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage continued...***
**Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage:**
**Sum average % of **
**total dependent patients **
**extensive assistance patients/residents **
**	**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued...
Determine Average % of Patients Requiring Ceiling Lift (CL) System Coverage:

Sum average % of 
total dependent patients 
extensive assistance patients/residents 

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage continued...***
**2.  Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit: **
**To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage  (Previous slide)****	**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

Unit Ceiling Lift System Coverage continued...

2.  Determine # & Configuration of Rooms requiring Ceiling Lift Systems per unit: 
To calculate number of rooms needing ceiling lifts, use Average % of Patients requiring CL Coverage  (Previous slide)

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage continued...***
**	**
_**For units w/ only private patient rooms**_**:**
**Average % of Patients Requiring CLs    x    # patients   =   # **_**private**_** patient rooms w/ CLs**
_**For units w/ only semi-private rooms**_**: **
**Average % of Patients Requiring CLs    x   # patients / 2   =  #  **_**semi-private**_** patient rooms w/ CLs**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

Unit Ceiling Lift System Coverage continued...

For units w/ only private patient rooms:
Average % of Patients Requiring CLs    x    # patients   =   # private patient rooms w/ CLs

For units w/ only semi-private rooms: 
Average % of Patients Requiring CLs    x   # patients / 2   =  #  semi-private patient rooms w/ CLs

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage continued...***_** **_
_**For units with a mixture of room configurations**_**: **
**For cost effectiveness in existing construction, and if appropriate for the unit...**
**First begin calculations with ceiling lifts placed in most or all larger wards (3-bed & 4-bed wards) **
**Then, as appropriate, place in smaller rooms (private and semi-private)****  **

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued... 

For units with a mixture of room configurations: 
For cost effectiveness in existing construction, and if appropriate for the unit...
First begin calculations with ceiling lifts placed in most or all larger wards (3-bed & 4-bed wards) 
Then, as appropriate, place in smaller rooms (private and semi-private)  

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage continued...***
**Example: **
**MedSurg Unit **
**30 patients **
**4 private rooms, 10 semi-private rooms, and two 3-bed rooms.  **
**Approximately 70% of the patients will require use of Ceiling Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients).  **
**For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in... **
**two (2) 3-bed rooms (covering 6 patients)**
**seven (7) semi-private rooms (covering 14 patients)**
**one (1) private room (covering one patient) **

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued...

Example: 
MedSurg Unit 
30 patients 
4 private rooms, 10 semi-private rooms, and two 3-bed rooms.  
Approximately 70% of the patients will require use of Ceiling Lifts; therefore this unit should have coverage for 21 patients (70% x 30 patients).  

For cost effectiveness, and if appropriate for unit needs, to provide 70% ceiling lift coverage, include in... 
two (2) 3-bed rooms (covering 6 patients)
seven (7) semi-private rooms (covering 14 patients)
one (1) private room (covering one patient) 

## II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit

***Unit Ceiling Lift System Coverage Practice***
**(Handout A- 3)**
**NHCU Unit **
**Med/Surg (Tele) Unit **
**Med/Surg (Rehab) Unit **
**How many (#) patients/beds should be covered?**
**In what rooms would you place ceiling lifts on this unit?**
**How many ceiling lifts would you purchase/install for this unit?**

**Notes:**
II. During Ergo Evaluation/Site Visit 2. Conduct Site Visit
Unit Ceiling Lift System Coverage Practice
(Handout A- 3)

NHCU Unit 
Med/Surg (Tele) Unit 
Med/Surg (Rehab) Unit 

How many (#) patients/beds should be covered?
In what rooms would you place ceiling lifts on this unit?
How many ceiling lifts would you purchase/install for this unit? 

## II. During Ergo Evaluation/Site Visit 3. Conduct UNIT Closing Meeting  (optional) 

**Discuss **
**Preliminary Findings from Site Visit **
**Pre-Site Visit Data as related to findings**
**Priorities in need of immediate remediation**
**Issues of Concern**

**Include**
_**Staff**_
**Unit/Area Manager**
**Safety/Risk Management**
**Facilities Management**
**Union**
**Others**

**Notes:**
II. During Ergo Evaluation/Site Visit 3. Conduct UNIT Closing Meeting  (optional)
Discuss 
Preliminary Findings from Site Visit 
Pre-Site Visit Data as related to findings
Priorities in need of immediate remediation
Issues of Concern

Include
Staff
Unit/Area Manager
Safety/Risk Management
Facilities Management
Union
Others

## II. During Ergo Evaluation/Site Visit 3. Conduct ADMINISTRATOR Closing Mtg

**Discuss **
**Rationale for Site Visit**
**Preliminary Findings from Site Visit **
**Priorities in need of immediate remediation**
**Issues of Concern**
**Show photos of equipment recommendations**

**Include**
_**Staff**_
**Union **
**Unit/Area Managers**
**Safety/Risk Management/Employee Health**
**Facilities Management**
**CFO/Purchasing**
**Others**

**Notes:**
II. During Ergo Evaluation/Site Visit 3. Conduct ADMINISTRATOR Closing Mtg
Discuss 
Rationale for Site Visit
Preliminary Findings from Site Visit 
Priorities in need of immediate remediation
Issues of Concern
Show photos of equipment recommendations

Include
Staff
Union 
Unit/Area Managers
Safety/Risk Management/Employee Health
Facilities Management
CFO/Purchasing
Others

## Unit-Based Hazard Assessment

**III.***** After Ergo Evaluation***
**Perform Risk Analysis**
**Generate Recommendations**

**Notes:**

Unit-Based Hazard Assessment

III. After Ergo Evaluation
Perform Risk Analysis
Generate Recommendations

## III. After Ergo Evaluation1. Perform Risk Analysis

***Sources of Risk:***
***You must know the SOURCES of risk in your patient care environment to perform Risk Analyses...***

**Notes:**
III. After Ergo Evaluation1. Perform Risk Analysis
Sources of Risk:
You must know the SOURCES of risk in your patient care environment to perform Risk Analyses...

## Sources of Risk

***Risk Sources:***
**Health Care **_**Environment**_
_**Patient**_** **
**Patient Handling **_**Tasks**_
***Once risks are identified, steps can be taken to protect    Staff and Patients!***

**Notes:**
Sources of Risk
Risk Sources:
Health Care Environment
Patient 
Patient Handling Tasks

Once risks are identified, steps can be taken to protect    Staff and Patients!

## What’s Wrong with this Picture??

**What’s Wrong with this Picture??**

**Notes:**
What’s Wrong with this Picture??

## Sources of Risk

***Health Care ***_***Environment***_*** Risk Factors***
**Space limitations **
**Small rooms**
**Lots of equipment**
**Clutter**
**Cramped working space**
**Poor placement of room furnishings**

**Notes:**
Sources of Risk
Health Care Environment Risk Factors
Space limitations 
Small rooms
Lots of equipment
Clutter
Cramped working space
Poor placement of room furnishings

## Sources of Risk

***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**

**Notes:**
Sources of Risk
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

## Sources of Risk

***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**

**Notes:**
Sources of Risk
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

## What’s Wrong with this Picture??

**What’s Wrong with this Picture??**

**Notes:**
What’s Wrong with this Picture??

## Sources of Risk

_***Patient***_*** Risk Factors***** **
**Weak/unable to help with transfers**
**Unpredictable**
**Hit or bite**
**Resistive Behavior**
**Unable to follow simple    directions**

**Notes:**
Sources of Risk
Patient Risk Factors 
Weak/unable to help with transfers
Unpredictable
Hit or bite
Resistive Behavior
Unable to follow simple    directions

## Sources of Risk

_***Patient***_*** Risk Factors***
**Overweight**
**Experiencing Pain**
**Hearing or vision loss**
**No/little communication between staff about Patient or with Patient**

**Notes:**
Sources of Risk
Patient Risk Factors
Overweight
Experiencing Pain
Hearing or vision loss
No/little communication between staff about Patient or with Patient

## What’s Wrong with this Picture??

**What’s Wrong with this Picture??**

**Notes:**
What’s Wrong with this Picture??

## Sources of Risk

***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**

**Notes:**
Sources of Risk
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

## Sources of Risk

***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**

**Notes:**
Sources of Risk
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

## III. After Ergo Evaluation1. Perform Risk Analysis

***High Risk Task Identification:***
**To determine the risk of injury for each unit/patient population, high risk tasks specific to the unit must be identified...**

**Notes:**
III. After Ergo Evaluation1. Perform Risk Analysis
High Risk Task Identification:
To determine the risk of injury for each unit/patient population, high risk tasks specific to the unit must be identified...

## III. After Ergo Evaluation 1. Perform Risk Analysis

***Identify UNIT high risk tasks by...***
**Analyzing *****Unit Injury Data***** **
**Collecting *****Staff Perception of High Risk Tasks***
**Interviewing *****Employees***

**Notes:**
III. After Ergo Evaluation 1. Perform Risk Analysis
Identify UNIT high risk tasks by...
Analyzing Unit Injury Data 
Collecting Staff Perception of High Risk Tasks
Interviewing Employees

## III. After Ergo Evaluation 1. Perform Risk Analysis

***1. Analyze Unit Injury Data****** ***
***Determine:***
**#1 & 2 **_**Causes**_** of Injuries **
**#1 & 2 **_**Activities**_** being performed when staff are injured**
**What’s going on? What trends are seen?**
**	**
***	******’******Injury Incidence Profile’  ******(Handout A-4)***

**Notes:**
III. After Ergo Evaluation 1. Perform Risk Analysis
1. Analyze Unit Injury Data 

Determine:
#1 & 2 Causes of Injuries 
#1 & 2 Activities being performed when staff are injured
What’s going on? What trends are seen?

	’Injury Incidence Profile’  (Handout A-4)

## III. After Ergo Evaluation 1. Perform Risk Analysis

***2. ******Complete & Collate Staff Responses for ‘Tool for Prioritizing High Risk Tasks’******  *****(Handout A-5)**
**Rank Tasks from 1 to 10**
**10= most difficult/highest risk     **
**1 = least difficult/ lowest risk**
**When ranking, consider:**** **
**Frequency, Duration, & Musculoskeletal Stress**
**Completed by**
**Each Staff member**
**Collectively by Shift**
**Compile by Unit and Shift**** **

**Notes:**
III. After Ergo Evaluation 1. Perform Risk Analysis
2. Complete & Collate Staff Responses for ‘Tool for Prioritizing High Risk Tasks’  (Handout A-5)

Rank Tasks from 1 to 10
10= most difficult/highest risk     
1 = least difficult/ lowest risk

When ranking, consider: 
Frequency, Duration, & Musculoskeletal Stress

Completed by
Each Staff member
Collectively by Shift

Compile by Unit and Shift 

## III. After Ergo Evaluation 1. Perform Risk Analysis

***High Risk Tasks will vary by Clinical Setting....***

**Notes:**
III. After Ergo Evaluation 1. Perform Risk Analysis
High Risk Tasks will vary by Clinical Setting....

## High Risk Tasks: Long Term Care 

**Repositioning in Bed* **
**Making occupied bed***
**Transferring patient from bathtub to chair***
**Transferring patient from wheelchair to bed***
**Transferring patient from wheelchair to toilet***
**Lifting a patient up from the floor***
**Weighing a patient***
**Applying antiembolism stockings**

**Bathing a patient in bed* **
**Bathing a patient in a shower chair /trolley***
**Undressing/dressing a patient***
**Repositioning patient in dependency chair*  ****
**Making an occupied bed***
**Feeding bed-ridden patient**
**Changing absorbent pad***

- * Lifts    ** Bed mover or powered bed    *** Lateral transfer aid (FRD)

**Notes:**
High Risk Tasks: Long Term Care
Repositioning in Bed* 
Making occupied bed*
Transferring patient from bathtub to chair*
Transferring patient from wheelchair to bed*
Transferring patient from wheelchair to toilet*
Lifting a patient up from the floor*
Weighing a patient*
Applying antiembolism stockings
Bathing a patient in bed* 
Bathing a patient in a shower chair /trolley*
Undressing/dressing a patient*
Repositioning patient in dependency chair*  **
Making an occupied bed*
Feeding bed-ridden patient
Changing absorbent pad*
* Lifts    ** Bed mover or powered bed    *** Lateral transfer aid (FRD)

## High Risk Tasks: Critical Care Units 

**Transporting patients (Road Trips)** **
**Lateral Transfers (bed to stretcher)* *** **
**Repositioning patient in bed from side        to side*  *** **
**Vertical Transfers (bed/chair/commode)***
**Lifting patient to the head of the bed* *****
**Making occupied bed* *****
**Applying antiembolism stockings**
**Bending/Reaching behind & around       for equipment, etc.**

- * Lifts         ** Bed mover or powered bed       *** Lateral transfer aid (FRD)

**Notes:**
High Risk Tasks: Critical Care Units
Transporting patients (Road Trips)** 
Lateral Transfers (bed to stretcher)* *** 
Repositioning patient in bed from side        to side*  *** 
Vertical Transfers (bed/chair/commode)*
Lifting patient to the head of the bed* ***
Making occupied bed* ***
Applying antiembolism stockings
Bending/Reaching behind & around       for equipment, etc.

## High Risk Tasks:Medical/Surgical Units 

**Transfer from bed to chair***
**Transfer from bed to stretcher* *****
**Moving Occupied bed or stretcher****
**Making occupied bed*  *****
**Bathing a confused or totally dependent patient**

**Lifting a patient up from the floor***
**Weighing a patient***
**Applying antiembolism stockings **
**Repositioning in bed* *** **
**Making occupied bed* *** **
**Extensive dressing changes***

- * Lifts          ** Bed mover or powered bed         *** Lateral transfer aid (FRD)

**Notes:**
High Risk Tasks:Medical/Surgical Units
Transfer from bed to chair*
Transfer from bed to stretcher* ***
Moving Occupied bed or stretcher**
Making occupied bed*  ***
Bathing a confused or totally dependent patient 
Lifting a patient up from the floor*
Weighing a patient*
Applying antiembolism stockings 
Repositioning in bed* *** 
Making occupied bed* *** 
Extensive dressing changes*

## High Risk Tasks: Operating Room 

**Standing long periods of time**
**Lifting and holding patient’s extremities***
**Holding retractors/organs for long periods of time**
**Transferring patients on and off operating room tables/beds*  *****

**Reaching, lifting and moving equipment**
**Repositioning patients on operating room beds* *****
**Reaching for equipment**

- Lifts    ** Bed mover or powered bed
- *** Lateral transfer aid (FRD)

**Notes:**
High Risk Tasks: Operating Room
Standing long periods of time
Lifting and holding patient’s extremities*
Holding retractors/organs for long periods of time
Transferring patients on and off operating room tables/beds*  ***
Reaching, lifting and moving equipment
Repositioning patients on operating room beds* ***
Reaching for equipment
Lifts    ** Bed mover or powered bed    
*** Lateral transfer aid (FRD) 

## High Risk Tasks:Orthopedic Units

**Post-operative Total Hip Replacement Patient **
**Patient with a cast/splint on extremity **
**Use of Continuous Passive Motion Device (CPM) **
**Halo Vest, logrolling for dressing changes**
**Holding Extremity for procedure**
**Altered Gait Pattern  - Platform Walker **
**Assembling Traction**
**Transfers In/Out a Car**
**Transfers of Patients with Pelvic & External Fixators**

**Notes:**
High Risk Tasks:Orthopedic Units
Post-operative Total Hip Replacement Patient 
Patient with a cast/splint on extremity 
Use of Continuous Passive Motion Device (CPM) 
Halo Vest, logrolling for dressing changes
Holding Extremity for procedure
Altered Gait Pattern  - Platform Walker 
Assembling Traction
Transfers In/Out a Car
Transfers of Patients with Pelvic & External Fixators

## High Risk Tasks: Home Settings 

**Providing patient care in a bed that is not height adjustable**
**Providing care in crowded area, forcing awkward positions**
**Toileting and transfer tasks without proper lifting aids**
**No assistance for tasks **

**Notes:**
High Risk Tasks: Home Settings
Providing patient care in a bed that is not height adjustable
Providing care in crowded area, forcing awkward positions
Toileting and transfer tasks without proper lifting aids
No assistance for tasks 

## High Risk Tasks: Psychiatry 

**Restraining a patient **
**Escorting a ****confused or combative patient **
**Toileting a ****confused or combative patient **
**Dressing a ****confused or combative patient **
**Picking a patient up from floor**
**Bathing/ Showering confused or combative patient **
**Bed-related care**

**Notes:**
High Risk Tasks: Psychiatry
Restraining a patient 
Escorting a confused or combative patient 
Toileting a confused or combative patient 
Dressing a confused or combative patient 
Picking a patient up from floor
Bathing/ Showering confused or combative patient 
Bed-related care

## Other High Risk Tasks 

**  ****Lifting heavy    ****	****linen bags**
**  ****Standing for long  ****	****periods of time ****	****behind med carts**
**  ****Data entry**
**  ****Others...**

**Notes:**
Other High Risk Tasks
 Lifting heavy    	linen bags
  Standing for long  	periods of time 	behind med carts
  Data entry
  Others...

## Information from Risk Analysis 
drives formation of 
Equipment Recommendations...

***drives formation of ***
***Equipment Recommendations...***

**III. After Ergo Evaluation** **2. ****Generate Recommendations**

**Notes:**
III. After Ergo Evaluation 2. Generate Recommendations

Information from Risk Analysis 
drives formation of 
Equipment Recommendations...

## III. After Ergo Evaluation 2. Generate Recommendations

**Patient Handling Equipment   for each unit/area**
**Storage **
**Design Features**
**Repair/Maintenance**
**Injury Reporting**
**Bariatric Programs**
**	****Sample Report - Handout A-7**

**Equipment Support Structures**
**Unit Peer Leaders**
**Facility Champions**
**Facility Safe Patient Handling Team**
**Training**
**Knowledge Transfer Mechanisms **
**Change Strategies**

**Notes:**
III. After Ergo Evaluation 2. Generate Recommendations
Patient Handling Equipment   for each unit/area
Storage 
Design Features
Repair/Maintenance
Injury Reporting
Bariatric Programs

	Sample Report - Handout A-7
Equipment Support Structures
Unit Peer Leaders
Facility Champions
Facility Safe Patient Handling Team
Training
Knowledge Transfer Mechanisms 
Change Strategies

## Unit-based Hazard Assessments for Safe Patient Handling

***‘******Patient Care’ Practice Settings include...***
**ALL practice settings that move and lift patients**

_**NON-NURSING**_
**PT**
**Diagnostics**
**Treatment Areas**
**Procedure Areas**
**Morgue**
**Dialysis**
**Others..**

_**NURSING**_
**Acute Care**
**Long Term Care**
**Critical Care**
**OR**
**ER**
**SCI**
**Others...**

**Notes:**
Unit-based Hazard Assessments for Safe Patient Handling
‘Patient Care’ Practice Settings include...
ALL practice settings that move and lift patients

NURSING
Acute Care
Long Term Care
Critical Care
OR
ER
SCI
Others...

NON-NURSING
PT
Diagnostics
Treatment Areas
Procedure Areas
Morgue
Dialysis
Others..

## Slide 77

**Notes:**
Thanks