# Presentation: 637985

## VA Safety and Health ProgramOccupational Safety and Health

**VA Safety and Health Program****Occupational Safety and Health**

***Safe Patient Movement and Handling***

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Objectives of the Course

**Objectives of the Course**

**Describe Risk Factors**
**Identify Risk Modification Methods**
**Establish Proper Techniques**
**Promote Use of Mechanical Aids**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Definition of Ergonomics

**Definition of Ergonomics**

**Ergonomics is the study of designing work environments and technology to fit workers, rather than **
**requiring workers to **
**adapt to the **
**environment and **
**technology.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Etiology of Back Injuries

**Etiology of Back Injuries**

**Direct Trauma**
**Overexertion**
**Cumulative Trauma**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Common Causes of Injuries 

**Common Causes of Injuries **

**Repetitive motions**
**Forceful exertion**
**Vibration **
**Sustained awkward positioning**
**Mechanical compression**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Cumulative Injury

**Cumulative Injury**

**Most of the injuries sustained by caregiver, are cumulative.**
**Associated with repeated episodes of patient lifting and strenuous patient care activities.**
** ****Often impossible to pinpoint one occupational activity which caused the muscular skeletal stress.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## The Following Risk Factors Can Contribute to Injuries

**The Following Risk Factors Can Contribute to Injuries**

**Characteristics of  Nurse**
**Characteristics of Patient**
**Characteristics of Environment**
**Characteristics of Patient Care Tasks**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factors:  Caregivers

**Risk Factors:  Caregivers**

**Previous record of back injury     **
**Substance abuse**
**Age**
**Low level of fitness**
**Obesity    **
**Genetics**

**Health status**
**Poor muscle strength**
**Stress**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Why are Caregivers at High Risk for Injury? (1)

**Why are Caregivers at High Risk for Injury? (1)**

**Patient handling tasks are unpredictable.**
**The patient is asymmetric, bulky, and can not be held close to the body.**
**The amount of assistance a patient can offer varies at any given point in time.**
**Much of the patient care is completed on a horizontal plane, using the weaker muscles of the arms.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Why are Caregivers at High Risk for Injury? (2)

**Why are Caregivers at High Risk for Injury? (2)**

**The sheer volume of lifting, turning,  pulling and positioning of patients leads to fatigue, muscle strain, and injury.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Why are Caregivers at High Risk for Injury? (3)

**Why are Caregivers at High Risk for Injury? (3)**

**Inability to seek or receive assistance from co-workers, can contribute to injuries.**
***new employee***
***loner***
***staff floated from another unit***
***poor staffing***

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factors:  Patients

**Risk Factors:  Patients**

**Height and weight**
**Body shape**
**Physical impairments**
**Balance deficiencies**
**Functional ability**
**Level of cooperativeness**
**Medical condition**

**Level of fatigue**
**Cognitive functioning**
**Presence of spasms or contractures**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## How Do Patients Contribute to Caregiver Injuries?

**How Do Patients Contribute to Caregiver Injuries?**

**Patients can become combative, resist efforts, or go limp during a transfer causing the caregiver to lose balance and/or make sudden, unexpected movements.**
**Fluctuations in a patient’s physical condition, level of fatigue, or cognitive functioning makes it difficult to gauge the level of assistance a patient will provide.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factors:  Environment

**Risk Factors:  Environment**

**Practice setting ****(high concentration of **
**       ****dependent patients)**
**Role ****(direct care provider)**
**Patient Care Assignment **
**Lack of appropriate and well maintained equipment**
**Limited space**
**Under staffing**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## How Does the Environment Contribute to a Risk for Injury?

**How Does the Environment Contribute to a Risk for Injury?**

**Increased risk to caregivers who work with dependent patients, such as NHCU or SCI.**
**Lack of appropriate, accessible, well maintained equipment.**
**Crowded work areas present hazards and force staff to use awkward, unsafe positions for patient care.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factors:  Job Tasks (1)

**Risk Factors:  Job Tasks (1)**

**Reaching and lifting loads far from the body**
**Lifting heavy loads**
**Sustained bending or twisting**
**Bending or twisting during a lift**
**Sustained stretching and reaching**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factors:  Job Tasks (2)

**Risk Factors:  Job Tasks (2)**

**Unexpected changes in load demand during the lift, e.g., patient spasms.**
**Sudden maximal efforts from unexpected efforts, e.g., preventing a patient fall.**
**Reaching low or high to begin a lift**
**Moving a load a significant distance**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## How do Job Tasks Contribute to Injury?

**How do Job Tasks Contribute to Injury?**

**Lifting is the most common reason for work-related back pain.**
**Failure to properly use lifting aids or to obtain assistance from a co-worker can contribute to injury.**** **

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Which Job Tasks Contribute Most to a Risk for Injury? (1)

**Which Job Tasks Contribute Most to a Risk for Injury? (1)**

**Transfer of a patient from bed to a chair or chair to toilet.**
**Lifting a patient up in bed or a chair.**
**Repositioning a patient for side to side**
**Making an occupied bed**
**Undressing a patient**
**Feeding a patient**
**Transfer from bed to stretcher**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Which Job Tasks Contribute Most to a Risk for Injury? (2)

**Which Job Tasks Contribute Most to a Risk for Injury? (2)**

**Not all stressful tasks are lifts!**
**Nearly 20-30% of a caregiver’s time is spent in a position of forwardly bent or twisted trunk, in activities such as dressing, bathing, or feeding a patient.**
**Slight changes in posture and attention to muscle discomfort can reduce injuries.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Assessment & Decision MakingFor Safe Patient Movement

**Assessment & Decision Making****For Safe Patient Movement**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Assessment Criteria for Patient Movement

**Assessment Criteria for Patient Movement**

**Patient’s height and weight**
**Distance to be moved, frequency of move**
**Amount of assistance provided by patient (functional, mental, cognitive ability)**
**Patient’s balance and ability to bear weight**
**Patient’s physical condition, e.g., rigid joints or spasms, surgical wounds, pain**
**Patient’s level of fatigue and cooperation**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Use No Lifting Aids If the patient.......................

**Use No Lifting Aids ****If the patient.......................**

**Is independent:  physical, mental and cognitive functioning intact.**
**Work towards patient independence for all movement tasks.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Use a Transfer Board orTrapeze Bar 

**Use a Transfer Board or****Trapeze Bar**** **

**A transfer board may be appropriate for a patient with strong upper body and limited use of the legs.**
**A trapeze bar, attached to the bed, will enable patients with strong upper body and limited use of the legs to independently position themselves in bed.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Use a Transfer Belt or Gait Belt If the patient................................

**Use a Transfer Belt or Gait Belt ****If the patient................................**

**Can bear some weight, but needs assistance**
**Does not have back problems**
**Is not combative**
**No recent abdominal surgery**
**Does not have a colostomy**
**Weighs up to 160 pounds**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Use a Stand Up Lift If the patient.......................

**Use a Stand Up Lift**** If the patient.......................**

**Weighs less than 350 pounds**
**Can bear some weight but needs assistance**
**Does not have back problems**
**Is not combative**
***	*****Stand Up Lifts are particularly useful for toileting elderly patients.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Use a Friction Reducing DeviceIf the patient.............................

**Use a Friction Reducing Device****If the patient.............................**

**Is dependent**
**Horizontal move is needed, such as pulling a patient up in bed or transferring from bed to stretcher.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Strategies to Modify Risk Factors and Prevent Injuries

**Strategies to Modify Risk Factors and Prevent Injuries**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Risk Factor Modification

**Risk Factor Modification**

**Back Exercises**
**Stress Management**
**Weight Reduction**
**Blood Pressure Control**
**Warm Up Exercises**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Training Related to Equipment

**Training Related to Equipment**

**The most effective training focuses on proper use of equipment**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Lifting Equipment and Devices (1) 

**Lifting Equipment and Devices (1) **

**Mechanical lifting aids and patient care equipment should be available, easily accessible, and well-maintained.**
**The exact type and number of lifting aids needed will vary depending on the number and characteristics of the patients served.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Lifting Equipment and Devices (2)

**Lifting Equipment and Devices (2)**

**Mechanical lifts are now commercially available to lift a patient from the floor, lift a patient weighing up to 500 pounds, assist with toileting, or lift a patient out of a car.**
**Lifts have optional scale attachments for weighing patients.**
**Mechanical lifts have been redesigned to add stability and patient comfort.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Lifting Equipment and Devices (3)

**Lifting Equipment and Devices (3)**

**Innovations in bathing and showering equipment can reduce risk of injury from sustained awkward positions.**
**Simple transfer devices, such as transfer belts, can reduce the risk of injury.**
**Friction reducing devices are necessary for transferring a patient on a horizontal plane.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Body Mechanics Vary for Vertical Versus Horizontal Movements

**Body Mechanics Vary for Vertical Versus Horizontal Movements**

**Vertical movements**
***lifting a patient out of bed to a chair***
***lifting a patient from the floor to the bed***
**Horizontal movements**
***transferring a patient from a bed to a stretcher***
***pulling a patient up in bed***
***turning a patient side-to-side***

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Body mechanics for Vertical Patient Movement

**Body mechanics for **_**Vertical **_**Patient Movement**

**Keep the feet apart with one foot in the direction of the move so as not to rotate the spine.**
**Keep the back in good alignment.**
**Get close to the patient.**

**Use a mechanical lifting device or a gentle rocking motion to provide the kinetic energy so that a pulling rather than lifting action can be used to transfer.**
**Flex the knees**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Body Mechanics For Horizontal Patient Movement

**Body Mechanics For **_**Horizontal **_**Patient Movement**

**Use a friction reducing device**
**Keep feet apart and plant to maintain balance**
**Do NOT flex the knees**

**Avoid twisting movements**
**Keep the back in good alignment**
**Minimize reach; get close to the patient**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Institute Wellness Programs for Staff

**Institute Wellness Programs ****for Staff**

**Programs focus on:**
***physical conditioning***
***counseling on nutrition***
***stress reduction***

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Warm-Up Exercises

**Warm-Up Exercises**

**Prepare the body for strenuous patient care activities.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Philosophical Change

**Philosophical Change**

**Think in terms of anti-lifting, not correct lifting.**
**Promote patient independence**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Modify the Work Environment (1)

**Modify the Work Environment (1)**

**Minimize space limitations that contribute to awkward positioning**
**Remove obstacles from path**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Modify the Work Environment (2)

**Modify the Work Environment (2)**

**Customize your work environment for ease and convenience.  Rethink the room furniture arrangement.**
**Look for ways to improve:  adjustable beds and stretchers, chairs with removable arm rests, etc.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Reporting Injuries

**Reporting Injuries**

**Accident Report Form (VAF 2162)**
**U.S. Department of Labor Form (CA-1)**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Modify Work Organization (1)

**Modify Work Organization (1)**

**Evaluate patient assignments to equalize risk among workers**
**Minimize the number of transfers through careful planning**
**Assure adequate staffing**
**Warm-up exercises**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Modify Work Organization (2)

**Modify Work Organization (2)**

**Assure adequate staffing**
**Institute 10 minutes of warm-up exercises or stretching before strenuous activity**
**Work in pairs**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Post Injury Job Re-Entry

**Post Injury Job Re-Entry**

**Identify Potential Barriers**
**Physical Capabilities**
**Work Demands**
**Physiological Resources**
**Behavioral Resources**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

## Collaboration is the Key to Safety

**Collaboration is the Key to Safety**

**Remember!**
**Every employee ****can make a difference to create a safe workplace.**

**Notes:**
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________