Ergonomics in the Healthcare Setting Washington State Governor’s Industrial Safety & Health Conference Health Care Panel October 8, 2009 Ergonomics in the Healthcare Setting Leslie Pickett, PT Ergonomics and Injury Prevention Specialist Swedish Medical Center Seattle, Washington

Electronic Medical Records (EMR): Cons: Pros: Paperless system: save time hunting for charts Quick access to medical records, lab results, imaging Productivity / efficiency for staff Decreased medical errors Improved Outcomes Increased Patient Satisfaction Time consuming / learning curb Equipment installation challenges Adequate number of available computers Hygiene Training ERGONOMICS! US Policy has adopted recommendations of EMR utilization

EMR: Reasons for dissatisfaction 80% of nurses surveyed were ambivalent or dissatisfied with EMR. (Nursing Informatics Task Force 2005) REASONS: No prior skills with computer Poor ergonomics Hardware / battery issues

Poor Ergonomics Ergonomics in hospital setting is mostly based on single user “office set up” ergonomics. 24 / 7 user sites with need for adaptability

Poor Ergonomics Healthcare is the second riskiest occupational sector for a work related Musculoskeletal Disorder (MSD). Research supports ergonomics in healthcare: Healthcare facility in Ohio evaluated installing ergonomic equipment with ergonomic training given at the same time. Results: Close to 50% decrease in MSD rate with training and installation. (Fujishiro et al 2005, AM J. IND MED., 48:338) MSD’s take years to manifest

Five Rights of Computer Ergonomics Right number of computers Right location of computer Right height adjustments Right size monitor Right resolution

Right Number of Computers No research to provide guidelines 1 fixed in every room vs. mobile? MSD’s take years to manifest. One recommendation is to provide 1 for every 4-6 beds vs. every room having one fixed; Fixed device in room tends to leave unused computers and over stocking?

Right Location of Computer Nursing stations only vs. in room only??? RN’s carrying around scrapes of paper with notes Time lag in entering information Physicians hunting down RN’s (instead of charts) to find info.

Newer nursing station; no ergonomics – multi user site Newer nursing station; no ergonomics – multi user site. No adjustability.

Right Monitor Size Eye changes starting in the 40’s. Larger monitors help decrease eye strain and fatigue. Decrease need to scroll down Research shows increase in productivity with larger monitor. Average nurse and therapist age in the mid – late 40’s.

Right Computer Resolution The higher the resolution the smaller the text

WOW – COW - COS Mobile computing : > 20 manufacturers now vs. 3 15 years ago. COS = computer on a stick

WOW – COW - COS Problems: Heavy to push Small screen size Cumbersome design (can’t get into a room) Epidemiology problems Can’t sit ergonomically Cost

WOW – COW - COS Solutions Smaller footprint Height adjustable surface = 99% of employees for both sit and stand Battery Meter 20” monitors Dispensing Systems (i.e. Pixis) integrated Reliable hardware and power charge

Medication Dispensing System Challenges

WOW – COW - COS All stake holders should have a voice Explore types of carts that meet your needs Laptop vs. regular cart Hand held tablets that also mount on carts

COW – WOW – COS Ergonomics Should fit at least 5th – 95th percentile Keyboard Standing height: 36-46” Sitting height: 21-28” Screen height (from top): Standing height: 48-60” Sitting height: 40-53”

Cornell University Cart Evaluation Form http://ergo.human.cornell.edu/cutools.html

Patient Room or Wall Mounted Computers Challenges Space Positioning / Adjustability Power and cables Hygiene Hardware Costs

Wall Mounted Challenges

Wall Mounted Challenges

Wall Mounted Challenges

Wall Mounted Guidelines 50” track (best for sit / stand option) Keyboard: 28” mount from floor (28-39” range) 34” track (primarily for standing) Keyboard: 36” from floor (36-47” range) Medium height task stool must be used with 34” track.

Other areas of concern in the Healthcare System Imaging: PACS – Picture Archiving and Communications Systems EICU Surgery monitors for closed surgeries

Employees are a hospital’s most valuable asset! Investment in good ergonomics keeps staff healthy and productive and facilitates good patient care!