Frontline Training Safe Patient Handling and Mobility Program INTRODUCTION & PROGRAM DESCRIPTION Version 1.0 Feb 23, 2016 1

Introductions partners take notes (use index and pens/pencils) introduce partner to group Questions for partner: Name, job/professional title Brief description of work Where from? Something unique, interesting or recent about partner What color index card did you choose and why?

Before we get started... Readiness for change survey

Training Schedule Day 1 Time Day 2 Introductions AM Patient Risk Profile Program Description PACE Using Equipment Safety Huddles/After Action Review PM After Action Review 4

Program Description Why is a safe patient handling and mobility program needed? What does an effective safe patient handling and mobility program look like? How is a safe patient handling and mobility program implemented? What is the role of a Peer Champion? 5

Why have a program? Patient care is improved with safe patient handling programs. Falls Pressure Ulcers Thromboembolism Complications from ⬇ mobility Injuries to staff can be reduced with multi-element safe patient handling programs

Why not just teach staff how to lift properly? An average nurse will lift the equivalent of 1.8 tons in 8 hours

Every 8 hours...

Program Description

2. ID Hazards & Assess Risk Implementation Plan Build Training Capacity Peer Champions 1. ID High Risk Areas 4. Evaluate Leadership and Training 2. ID Hazards & Assess Risk 3. Implement Controls Equipment Build Database of needs 10

Principles Building capacity Changing culture Changing Behaviour and Practice Engagement

Peer Champion Role Trainer Coach Role Model Agent of Change

Frontline Training Safe Patient Handling and Mobility Program PACE Pre-mobility Check Version 1.0 Feb 23, 2016 13

Before We Get Started… Pre-test

PACE - Why? Discussion Question: What are some Issues faced by Staff when handling and mobilizing patients? What are potential solutions to these issues?

PACE – Who? All health care workers involved in moving patients should know and use PACE: Managers/supervisors Nursing Staff (RN, LPN) Support Staff (CCA, Ward Clerk, Porter, Personal Care Worker) Rehab Staff (PT, OT, RA, OTA/PTA, Recreation Therapist) Physicians Others (DI, Environmental Services)

PACE – What?

Discussion Small Groups Flip Chart P - Physical A – Agitation/Aggression C - Communication E - Environment

P - Physical Turn to their side in bed Sit up Balance Weight bearing ability while seated Stand up Stability and weight bearing ability while standing

A - Aggression Five Questions: Does the patient have clipped or angry speech? Does the patient have a history of agitated/ aggressive behaviour? Is the patient using angry facial expressions (e.g. furrowed brow)? Is the patient refusing to communicate? Is the patient using threats or threatening gestures?

C- Communication Can be assessed during regular interaction Pay attention to your patient’s ability to: Answer simple questions (e.g. How are you doing today?) Follow instructions (e.g. Can you bend your knees for me?)

E - Environment Can play a significant role in the safety of any patient handling and movement task Upon entering the room determine the following: Is there enough space to access the patient including use of necessary equipment? (3 sides of the bed) Is the floor safe to transfer on? (not slippery, dry) Is the mattress surface safe for the patient to perform assessment activities? Is the environment clear of obstacles? Is any necessary equipment present?

Demonstration Danny 35 year old who just went through an above knee amputation. Prior to his injury he worked as a personal trainer and was very physically fit. He is upset about his amputation but he communicates ok and has been cooperative with his care. He wants to transfer into a wheelchair so his friend can take him out into the hallway. He has not been seen or assessed by rehab staff and he is not aware of his abilities.

PACE Practice 3 Case Studies 1 patient 1 healthcare worker 1 evaluator

Frontline Training Safe Patient Handling and Mobility Program SAFETY HUDDLES AND AFTER ACTION REVIEWS Version 1.0 Feb 23, 2016 25

Summary Safety Huddle Overview After Action Review Overview Purpose Structure After Action Review Overview Compare/Contrast Group Discussion Structure and Principles - Safety Huddles Structure and Principles - After Action Review

Safety Huddles Address concerns with the goal of preventing incidents and near misses Before an adverse event occurs Interprofessional Same time every day 15 minutes Identify action plan to resolve issue/concern

Safety Huddle Topics Patients at high-risk for falling Patients who are confused or aggressive Patients who are bariatric Equipment/device issues Environmental concerns Staffing complement 28

After Action Reviews Immediate assessment of an adverse event What was expected to happen? What actually occurred? What went well and why? What can be improved and how? Does not replace a formal investigation or root-cause analysis 29

After Action Review - Features Informal, open and honest professional discussion Participation by everyone involved in the activity Focus on the results of an event or action Identification of ways to sustain what was done well Development of recommendations 30

Compare/Contrast Safety Huddles After Action Review Time to complete 15 minutes under 15 minutes Participants Interprofessional team Participants in an “action” When completed Beginning of shift after an “action” Purpose Communicate known hazards and risk learn from an action Blame? No

Safety Huddle Discussion List the challenges and drivers to successfully facilitating a safety huddle. What about the structure, format and principles of safety huddles lends them to overcoming the barriers?

After Action Review Discussion List the challenges and drivers to successfully facilitating an after action review. What about the structure, format and principles of after action reviews lends them to overcoming the barriers?

After Action Review – Today so far… Immediate assessment of an adverse event What was expected to happen? What actually occurred? What went well and why? What can be improved and how? 34

Frontline Training Safe Patient Handling and Mobility Program PATIENT RISK PROFILE Version 1.0 Feb 23, 2016 35

Before We Get Started… Pre-test

Learning Objectives Understand how to do a Patient Risk Profile: chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 37

Learning Objectives Understand how to do a Patient Risk Profile: chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 38

Discussion How do you currently decide how much assistance patients require to move/get in/out of bed??

Patient Risk Profile Determines the minimum amount of assistance required Provides information to help create a Mobility Plan The patient risk profile is used to determine the minimum amount of assistance necessary to transfer a patient safely. It should be integrated into all patient-related processes (e.g. care plans, admitting) in order to determine the risk associated with patient handling and movement tasks. Typically completed by admitting nurse or a consulting physiotherapist or occupational therapist or with input from a variety of health care providers. Specific patient handling and movement tasks are identified, and a plan is documented and implemented to ensure all lifts, transfers, and repositioning activities are performed as safely as possible. It is not necessary to complete the assessment in the order presented, it should be carried out in a logical manner based on assessments and care activities. Always remember to document and communicate results this will help to ensure all lifts, transfers and repositioning activities are performed as safely as possible. 40

Discussion When should a Patient Risk Profile be completed?

When should one be completed? Upon admission Transfer from unit to unit Changes in condition and/or mobility status PACE results are different than Patient Risk Profile 42

Discussion Who should do the patient risk profile?

Who? RN LPN Sometimes PT/OT Not in scope of practice for assistant roles

Discussion What type of information would you look for in the patient’s chart?

Review Patient’s Chart Gain knowledge of current and past medical history Look for: Weight bearing status History of violence Height and weight 46

Discussion Are there any patient populations that require special consideration or equipment during patient handling and movement?

Special Considerations Bariatric needs Orthopedic challenges Cognitive impairments Labour and delivery Once identified, arrange for appropriate equipment or solutions. Section 4 in the Program Guide provides additional information on ensuring safe patient handling and movement is completed with patients in the above populations. Once the patient is identified of requiring special consideration, arrange for the appropriate controls (i.e. equipment) to be put into place. 48

Special Considerations Is equipment available? Do you know how to access it?

Discussion What are some key communication factors that are necessary for safe patient handling and movement? How do communication issues increase the risk of injury during patient handling activities?

Patient’s Ability to Communicate Are they able to: Understand and follow directions Articulate intention and needs May occur through verbal and non-verbal channels, or written communication 51

Patient’s Ability to Communicate Injury increases during patient handling and movement if patient Does not understand speech Language barrier between HCW and patient Cannot follow simple commands Does not understand non-verbal communication 52

Discussion What are some quick questions you can ask to give you some understanding of your patient’s cognitive status?

Patient’s Cognitive Status Are changes normal for the patient based on their condition or medication May be obtained during chart review. 54

Discussion How could an increased risk of violence in a patient contribute to an increased risk of injury during patient handling and movement?

Patient’s History/Risk of Violence Document and communicate violent behaviour Certain clinical, psychological, and historical variables increase patient’s potential for violence Hallucinations, alcohol or drug use, history of violence etc. May be obtained from chart review

Discussion What type of information is included in other assessments such as Falls Prevention Assessment or skin integrity assessment at this facility?

Review Other Assessments Review existing falls prevention & skin integrity assessments May be obtained from chart review 58

Discussion What physical movements would be beneficial to observe to help determine the safest way or method for a patient to move?

Patient’s Physical Abilities Patient must demonstrate abilities Progresses from supine to sitting to standing to ambulation

Discussion How would you describe a high risk task?

Identify High Risk Tasks Tasks that the patient cannot do independently or with minimal assistance Keep list of high risk tasks up to date 35 lbs safe limit

Document and Communicate SPHM Document high risk tasks as well as the appropriate controls 63

Review of Learning Objectives Now you understand how to do a Patient Risk Profile: chart review Determine patient’s ability to communicate Determine patient’s cognitive status Determine if patient has any special considerations Assess patient’s physical abilities using the Mobility Decision Support Tool Document and communicate safe patient handling and mobility plan 64

Frontline Training Safe Patient Handling and Mobility Program USING EQUIPMENT Version 1.0 Feb 23, 2016 65

Before We Get Started… Pre-test

Learning Objectives Review various bed features that can assist with patient handling and mobility Know what emergency features are on ceiling and floor lifts Determine appropriate sling selection for tasks/activities Use slings for repositioning, transfer, and holding a limb Use friction reducing devices for repositioning and lateral transfers (maxi slide, breeze sheets, air-assisted lateral transfer device) Demonstrate proper body mechanics and use of gait belt during transfers 67

Discussion - Patient Bed Features

Patient Bed Features Operation Scale Chair Function Knee Gatch Edge of Bed Bed rails Reverse Trendelenburg Bed Height Safe Working Load (SWL) (also equipment)

Mattresses

Demonstration - Emergency Procedures Ceiling Lift When to use Emergency Release Location Procedure After use Portable lift 71

Emergency Procedures - Ceiling Lift

Emergency Procedures - Ceiling Lift

Emergency Procedure - Floor Lift 74

Emergency Procedure - Sit-Stand Lift 75

Good Body Mechanics Group Discussion: Describe points related to Good Body Mechanics

Good Body Mechanics Distribute Station 3 Reference: Body Mechanics Checklist

Practical Sessions 4 Stations Station 1 - Selecting Slings Station 2 - Using Sling lifts Station 3 - Using Friction Reducing Devices Station 4 - Minimal Assist transfers

Station 1 - Sling Selection Match the case scenario with the the appropriate sling Universal Repositioning limb Hygenic Long seat/hammock 6 Case Scenarios 79

Station 2 - Using Sling Lifts Practice using different slings with a lift Universal Repositioning limb Hygenic Long seat/hammock Turning sling

Station 3 - Using Friction Reducing Devices Use different equipment to perform a boost and a lateral transfer BAD Flannel Soaker BETTER Maxi slide Breeze Transfer board Air assisted lateral transfer Compare/Contrast the experience with each device

Station 4 - Minimal Assist Transfers Practice bed to chair transfer Use gait belt walker or Sit Stand lift (if available) 82

Discussion Key Messages Station 1 - Selecting Slings Station 2 - Using Sling lifts Station 3 - Using Friction Reducing Devices Station 4 - Minimal Assist transfers 83

Learning Objectives Review various bed features that can assist with patient handling and mobility Know what emergency features are on ceiling and floor lifts Determine appropriate sling selection for tasks/activities Use slings for repositioning, transfer, and holding a limb Use friction reducing devices for repositioning and lateral transfers (maxi slide, breeze sheets, air-assisted lateral transfer device) Demonstrate proper body mechanics and use of gait belt during transfers 84