Patient Care Ergonomics
Remember…
Through Ergonomics
• Job can be redesigned
• Jobs can be improved to be within reasonable
limits of human capabilities
However, ergonomics is not a magical
solution…
• To be effective, a well thought out system of
implementation must be developed
Here’s A Successful
Solution using Patient
Care Ergonomics…
Successful
Solutions
Overview of a Safe
Patient Handling
& Movement
Program
Safe Patient Handling &
Movement Program
For success, required infrastructure
MUST be in place prior to implementing
SPHM Program
• Management • Equipment
Support • Knowledge
• Champion Transfer
• SPHM Team Mechanisms
• Program • Technical Support
Elements
SPHM Champion
Clout
Mover/Shaker
Interest
Nursing, Therapy, Safety…
Safe Patient Handling &
Movement Program
Goals
Reduce the incidence of
musculoskeletal injuries
Reduce the severity of
musculoskeletal injuries
Reduce costs from these injuries
Safe Patient Handling &
Movement Program
Goals
Create a safer environment &
improve the quality of life for
patients/residents
Encourage reporting of
incidents/injuries
Create a Culture of Safety and
empower nurses to create safe
working environments
SPHM Key Objectives
Reduce # of lost workdays due to
patient handling tasks by ___%
Reduce # of light duty days due to
patient handling tasks by ___%
Note: Best to NOT measure
success by # of reported
injuries…
Safe Patient Handling &
Movement Program
What goals do you want to achieve
for yourself, your co-workers,
and your unit?
What specific Program Objectives
do you want to attain?
(Complete “A” & “B” of Handout A-1, Developing a
Safe Patient Handling & Movement Action Plan)
Safe Patient Handling &
Movement Program
SPHM Program Elements
Peer Leaders – BIRNS/Ergo Rangers
After Action Review Process
Patient Assessment, Care Plan, Algorithms
for Safe Patient Handling & Movement
SPHM Policy
Ergonomic & Hazard Assessment of
Patient Care Environment
Equipment
Safe Patient Handling
& Movement
Program Elements
Back Injury Resource Nurses
Chapter 7
BIRNS Roles & Responsibilities
4. Perform Continual
Hazard/Risk Monitoring
Two Levels of Hazard/Risk Evaluations
• Formal Ergonomic Hazard Evaluation
– Ch. 3
• Ongoing Workplace Hazard
Evaluations
• Of the Environment
• Of Patients/Residents
• Of Patient Handling Tasks
Back Injury Resource Nurses
Outcomes for Staff
Staff are empowered
• Channel to voice ideas/suggestions
• Opportunity to have input in making
work environment safer
Increased competence in performing job
Increased sharing of knowledge/best
practices
Fosters Culture of Safety
Back Injury Resource Nurses
Examples of Problems Identified
Lifts not being used on night shifts.
• Why? Batteries were being charged on
night shifts because no back-up
batteries.
• Solution: Buy extra battery packs so
lifts can be used 24 hours per day.
Safe Patient Handling
& Movement
Program Elements
Patient Assessment, Care Plan,
& Algorithms for Safe Patient
Handling & Movement Chapter
5
Patient Assessment, Care Plan, &
Algorithms for Safe Patient Handling &
Movement
The Assessment, Algorithms ,
& Care Plan go hand in hand...
1. Assess the Patient
2. Determine what handling
activities you must perform
3. Follow the algorithms to
determine what equipment
and # of staff are needed
4. Complete the Care Plan
5. File for future use
What Tasks Do the Care Plan &
Algorithms Cover?
1. Transfer To and From: Bed to Chair, Chair to
Toilet, Chair to Chair, or Car to Chair
2. Lateral Transfer To and From: Bed to Stretcher,
Trolley
3. Transfer To and From: Chair to Stretcher, Chair to
Chair, or Chair to Exam Table
4. Reposition in Bed: Side to Side, Up in Bed
5. Reposition in Chair: Wheelchair or Dependency
Chair
6. Transfer a Patient Up from the Floor
What Tasks Do the Bariatric
Care Plan & Algorithms Cover?
1. Transfer To and From: Bed to Chair, Chair to
Toilet, Chair to Chair, or Car to Chair
2. Lateral Transfer To and From: Bed to Stretcher,
Trolley
3. Reposition in Bed: Side to Side, Up in Bed
4. Reposition in Chair: Wheelchair or Dependency
Chair
5. Tasks Requiring Sustained Holding of Limb/s or
Access to Body Parts
6. Transporting (stretcher, w/c, walker)
7. Toileting
8. Transfer Patient Up from Floor
Patient Assessment & Care
Plan – Page 71
Completed on all patients
Takes into consideration:
• Patient Characteristics
• Patient Handling Task
• Equipment
Uses Algorithms
Algorithms - Page 73
Based on Specific Patient
Characteristics (from Assessment)
Assists nurses in selecting
• Safest Equipment
• Safest Patient Handling
Technique
Advises # of staff needed
How were these Algorithms
Developed?
Developed by a group of nursing
experts
Tested with different patient
populations in a variety of
settings
When Should The
Algorithms be Used?
Use the Algorithms for every
patient/resident who needs help moving
Remember….
• The Algorithms provide general
direction
• Caregiver must use their professional
judgment in applying Algorithms
How Do We Lift
This Resident?
Let’s assess NH resident:
Fred Veteran
80 year old resident of a VA Nursing Home.
Weight: 156 lbs. Height: 5’ 9”
Has dementia and a history of falls.
Some days he is cooperative. Other days he
is combative and fearful.
When he is cooperative, he can bear
weight. Otherwise, he resists standing.
He is to be out of bed every day in a chair.
Assessing Fred V.
Take a few minutes and
complete a Patient
Handling Care Plan for Fred
Veteran.
(Use Handout A-3, Patient Assessment & Care Plan)
Assessing Fred V.
Level of Assistance Does resident have
upper extremity
Dependent
strength needed to
support weight
Can the resident during transfers?
bear weight? No, because
No, because the resident is
unreliable for using
resident is not
his upper
cooperative extremity strength
Assessing Fred V.
Resident’s level of Special
cooperation and circumstances?
comprehension History of Falls
Unpredictable
Weight: 156 lbs.
Height: 5’ 9”
Finishing Fred V.’s
Care Plan
Although the resident can sometimes
bear weight, he can be uncooperative.
The “No” answer to “Is the Resident
cooperative?” leads you to: “Use full
body sling lift and 2 caregivers”
Answer: Use full body sling lift
and 2 caregivers
Patient Assessment, Care Plan, &
Algorithms for Safe Patient Handling &
Movement
The Assessment, Algorithms ,
& Care Plan go hand in hand...
1. Assess the Patient
2. Determine what handling
activities you must perform
3. Follow the algorithms to
determine what equipment
and # of staff are needed
4. Complete the Care Plan
5. File for future use
Step 3. Obtain Pre-Site
Visit Data
Remember…
Involve as many staff as
possible and as much as
possible…
Step 3. Obtain Pre-Site
Visit Data
Now… think of one of your high-
risk units from your facility and
complete a cursory “Unit Data
Collection Tool” for that unit.
* Complete Unit Data Collection Tool Profile (Handout A-5)
Step 5. Conduct Site Visit
Site Visit Walk-through
• Patient room sizes/configurations
• Ceiling Characteristics/AC vents/TVs
• Showering/bathing facilities
• Toileting process
Step 5. Conduct Site Visit
Site Visit Walk-through
• Equipment
• Availability Accessibility
• Use Condition
• Storage
• Staff attitudes
Step 5. Conduct Site Visit
After Site Visit…
Organize data by entering into Site
Visit Summary Data Sheet
(p. 34 and Handout A-6)
Use during Risk Analysis in order to
make Recommendations
9 Step Ergonomic Workplace
Assessment of Nursing
Environments
Step 6. Perform Risk
Analysis
Step 6. Perform Risk
Analysis
Risk Identification/Breakdown
High Risk DEPARTMENT/AREA
High Risk JOBS (RN, CNA, LPN, etc.)
• Specific TASKS of High Risk Jobs (p. 30)
• Specific ‘ELEMENTS’ of
High Risk Job TASKS
Step 6. Perform Risk
Analysis
What do we need to look at
to identify Specific RISKS
of ‘ELEMENTS’ of High Risk
Job TASKS?
Step 6. Perform Risk
Analysis
Element/Task Risk
Identification
Task Intensity
Task Duration
Work Posture
General Design of Equipment
Space Characteristics
Where do you think problem
exists?
Step 6. Perform Risk
Analysis
Methods to Gather Risk Data
General Observation Previous Studies
Staff Discussions Job Consistency
& Fatigue
Staff Questionnaires
Brainstorming &
Review of Medical Data Group Activities
Symptoms Surveys Job Safety
Quantitative Evaluations Analyses
Step 6. Perform Risk
Analysis
Job Safety Analysis (JSA)
Break down job into steps
Identify hazards associated with
each step
Determine actions necessary to
eliminate or minimize hazards
Step 6. Perform Risk
Analysis
Job Safety Analysis (JSA)
Let’s try it!!!
See Job Safety Analysis Worksheet (Handout A-7)
Step 6. Perform Risk
Analysis
Risk Analysis is used to find Risk
Factors that may cause injury.
There are three categories of Risk
Factors in a Patient Care
Environment...
What do you think they are??
Step 6. Perform Risk
Analysis
Risk can come from:
Patient Handling Tasks
Health Care Environment
Patient
Once risks are identified, steps can
be taken to protect Staff and
Patients!
Step 6. Perform Risk
Analysis
What Risk Factors are
related to the Health Care
Environment?
Step 6. Perform Risk
Analysis
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
Step 6. Perform Risk
Analysis
Health Care Environment Risk
Factors
Space limitations
• Small rooms
• Lots of equipment
• Clutter
• Cramped working space
Poor placement of room furnishings
Step 6. Perform Risk
Analysis
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
‘The Far Side’ Safety Humor…
Step 6. Perform Risk
Analysis
What Risk Factors are
related to Patients?
Step 6. Perform Risk
Analysis
Patient Risk Factors
Weak/unable to help with
transfers
Unpredictable
Vision or hearing loss
Hit or bite
Resistive Behavior
Unable to follow simple
directions
Step 6. Perform Risk
Analysis
Patient Risk Factors
Overweight
Experiencing Pain
Hearing or vision loss
No/little communication
between staff about Patient
or with Patient
Step 6. Perform Risk
Analysis
What Risk Factors are found in
Patient Handling Tasks?
Step 6. Perform Risk
Analysis
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
Step 6. Perform Risk
Analysis
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
Step 7. Formulate
Recommendations
Hazard Elimination
Scale in sling lift
Transfer Bed
