Saving Healthcare Workers From Back Injuries Healthcare Ergonomics PART II - What is your next step? Massachusetts Care Self-Insurance Group, Inc. S afety A wareness F or E veryone from Cove Risk Services

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 An Ergonomic Approach

1.Identify jobs and job tasks which stress body parts beyond limits. 2. Develop solutions to change these task demands. 3.Implement these changes in the work place. 4.Review the design of the physical work environment to remove barriers, minimize travel and consider spatial relations. A Simple Look at an ERGONOMIC APPROACH

5 Step Process STEP 1 - Risk Identification and Assessment STEP 2 - Risk Analysis STEP 3 - Recommendation Development STEP 4 - Program Implementation STEP 5 - Measurement and Results

Step 1: Risk Identification and Assessment Perceived high risk jobs Specific high risk job tasks High risk departments or areas Task intensity and duration Work postures General design of equipment and space Where do we think problems exist?

Methods to Gather Data General observation Employee discussions Employee questionnaires Review of medical data Symptom surveys Job consistency and fatigue Brainstorming and group activities

A list of some Patient Handling Tasks Transferring to and from bathtub Transferring patient to and from chair/bed Weighing patient Transferring patient to and from toilet Making bed with patient in it Walking with patient Undressing patient Repositioning patient in chair Making bed when patient is not in it Lifting patient up in bed Feeding bed-ridden patient Changing absorbent pad Repositioning patient in bed Transferring to and from vehicle Showering

Step 2: Risk Analysis Confirm perceived problems Analyze cost data Specify high risk jobs and areas List priorities Perform a formal JHA (Job Hazard Analysis) Study risk factors Quantify risk factors

Step 3: Develop Recommendations Make them achievable and simple Identify constraints Prioritize Explain Approach –Engineering –Administrative

Job Hazard Controls Engineering Controls …reduce or eliminate hazard Administrative Controls …changes in work practices and management policies

Engineering Control Strategies… the preferred control method Eliminate the need to do the hazardous activity Redesign the activity to reduce the hazard Utilize an aiding device to minimize the hazard

Engineering Controls – Basic Transfer Aids Gait belts with handles Slide Sheets Sliding boards Stand assist and repositioning aids –on furnishings –on walls –self supporting Leverage Devices & Rotators

Engineering Controls – Lateral Transfer Aids Friction reducing lateral slide aids –rigid boards –flexible sheets –Seat Glides –rollers –air assisted (i.e. Hover Mats) Mechanical lateral transfer aids –hand cranks –electric motor

Engineering Controls – Mechanical Lifts Portable base full sling Portable base stand assist Ceiling mounted track Wall mounted Bathing

Engineering Controls – Ergonomic Furnishings Transfer chair Bed improvements –aiding transfers –minimizing transfers –minimizing repositioning Stretchers Toilets Scales Tubs and showers

Step 4: Program Implementation The Implementation Team Education and training Involve everyone affected Resistance to change Policies and procedures Goals and objectives Incident Investigation

The Team SUGGESTED: CNA’s Direct Care Workers Nurses Rehab Services Human Resources Staff Education/In-service Training Consultants Identify a SPH Champion and Unit Peer Leaders, involve key operational staff, identify resource staff, and create a multi-disciplinary team. See appendix A

Education and Training Equipment Specific Patient Handling Task Specific 1) Transfers 2) Repositioning 3) Bathing Full Demonstration Full Re-demonstration Establish Competency Evaluation 1) What will you measure? 2) Be consistent with competency checks 4) Feeding 5) Bedside Care 6) Transporting

Involve Everyone Affected All Caregivers All Direct Care Workers All Direct Supervisors All Direct Managers Rehab Department

Resistance to Change Explain what the ultimate goal is Share statistics Share survey results Share articles and studies Explain the policy Explain who is supporting the program (Upper Management)

Policies and Procedures Clearly state the need Clearly state the desired outcome Clearly state the correct actions Clearly state exceptions Clearly state the accountability structure Clearly state who, what, why, how, and when

Goals and Objectives What are the goals How will they be measured How often will they be measured Who is responsible to measure

Incident Investigation Establish what types of incidents will be investigated Establish when will they be investigated Establish who will investigate each incident Develop a format for trending injuries Share data with the affected staff and committees

Step 5: Measurement and Results Select measures (not just injury data) Survey Work Improvements –Quality of work life –Quality of care Share Reporting results Announce ongoing efforts and interest Commit to a continuous improvement cycle

Appendix A: Some Team Responsibilities Meet regularly Investigate Incidents Identify Root Causes Develop policies Hold Brainstorming sessions Interact with staff Announce the team Promote open door commitment –Create buy-in –Discuss perceived high risk activity –Foster communication of “near miss” activity Create and Follow a Time-Line

Massachusetts State Law? Massachusetts Senator Richard T. Moore (D) introduced Senate Number 1294 on January 10, 2007, “An act to require the use of evidence-based practices for safe patient handling and movement.” Massachusetts has pursued legislation for safe patient handling since the first introduction in December If passed, SN 1294 would require every licensed health care facility to implement an evidence-based policy for safe handling and movement of patients; and to provide training on use of patient handling equipment and devices, patient care ergonomic assessment protocols, no lift policies, and patient lift teams. The intent of the “No Lift Policy” is the elimination of manual handling in virtually every patient care situation, apart from all but exceptional or life threatening situations. Constituting a pledge from administrators that proper equipment, adequately maintained and in sufficient numbers, will be available to care providers, the “No Lift Policy” is an integral part of a comprehensive safe patient handling and movement program in acute care hospitals and long-term care facilities. MA SN 1294 history: MA SN 1294 text:

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