1. Safe Patient Handling:
The Hazards of Immobility
Nearly every health care organization has made
some attempt to introduce safety measures in an
effort to reduce musculoskeletal injuries related to
handling and moving patients. What makes a
multifaceted safe patient handling and movement
implementation a challenge is the complexity
involved in creating this safer work environment. A
successful implementation of SPHM will consider the
people, the technical solutions and critical elements
of program management. In this session you will
learn the lessons of why body mechanics training
and other efforts fails. More importantly, you will
hear what can be done to overcome the hazards of
lifting. By knowing the pitfalls, you will be able to lead
your team more effectively and avoid costly setbacks
and injuries.
Content includes: Pathophysiology and nature of work-related musculoskeletal
disorders, physical demands of lifting tasks, ergonomic risk factors found in the
patient care environment, fallacies of using proper body mechanics when manually
lifting, transferring, moving and repositioning patient, examining workers’
compensation loss data, examining the consequences in direct and indirect cost of
manual handling, trends in healthcare that are driving SPHM national regulation and
legislation, obesity and workforce demographic trends, recognize essential elements
to create sustainable and effective SPHM practices and, solutions and mechanical
lifting devices.
Prepared by :

2. Learning Objectives
Discuss the opportunity for quality improvement using SPHM practices
Discuss expected positive patient outcomes using SPHM practices
Discuss the role of SPHM practices in patient care initiatives
Discuss how a mobility assessment is able to meet individualized needs

3. Hospital Acquired Disability
Hazards of immobility include:
accelerated bone loss
delirium
malnutrition
sensory deprivation
isolation
musculoskeletal weakness
decreased cardiopulmonary function

4. Early Mobility Avoid the effects of immobility which include:
functional decline
increased morbidity
increased mortality
increased cost of care
increased length of stay
What is early mobility?
Early mobility is the practice of introducing physical activity early into a patient’s hospitalization to combat the degenerative effects of prolonged hospitalization. This practice was developed originally to address functional decline, increased morbidity and mortality, increasing cost of care and improve length of overall hospital stay to mechanical ventilation in the intensive care setting. This has lead many hospitals to adopt an early mobility program for their Intensive Care Units. We have recently added such a program to Banner Baywood Medical Center as a result of research and progress in medicine.

5. Expected Practice Bed mobility Out of bed mobility Ambulation
Toileting
Boosting/repositioning/turning
Transfers
Others
Since adopting a new system policy in May 2011, these safer procedures should be the expected practice for nearly every interface involving patient handling (i.e., in-bed mobility, limb holding, out-of-bed mobility, ambulation, toileting, boosting/repositioning, turning and transfers, etc.). What is lacking, is not only a general awareness of the problems but also a knowledgeable and skilled clinical specialist with time dedicated to focus on this project.

6. Benefits Comfort, safety and dignity for patient
Accelerated patient mobility, independence and rehabilitation
Fall prevention
Improved skin integrity
Positive patient outcomes
Reduced hospital associated disability
Safe patient handling and movement (SPHM) improves safety for patients, and leads to improved quality of patient care. Specific clinical benefits include: (1) increased patient comfort, satisfaction and dignity; (2) accelerated patient mobility, independence, and rehabilitation; (3) fall prevention; and (4) improved skin integrity. Additional positive patient outcomes are expected in efforts to reduce hospital associated disability.

7. Example: Clinical Application
Certification in hip facture management
High volume of hip fractures
Orthopedic focus
Target population
Key metrics
ED to OR < 24 hours
< Hospital-acquired conditions
< LOS
< Readmissions
Patient mobility focus
PT starts POD 1
Screen mobility
Efficient and safe
Disease-specific certification in hip fracture management
First for organization
First for Arizona

8. Positive Patient Outcomes
SPHM supports early patient mobility
delirium prevention
post-op knee initiatives
small bowel initiatives
HA pressure ulcer prevention
HA pneumonia prevention

9. Positive Patient Outcomes (continued)
SPHM benefits patient satisfaction
increased movement and activity
toileting and hygiene dignity and privacy
improved response time

10. Revised NIOSH Lifting Equation

11. Summary of the Evidence
Confirms risks associated with manual patient handling
Shows tasks cannot be performed safely manually
Demonstrates the result of cumulative trauma

12. 2007 NIOSH Revision Maximum weight a caregiver should
lift = 35 lbs (single leg of 200 lb patient)
Lateral transfer guidelines: >157 lbs, use mechanical device or air-assisted device

13. Excessive Biomechanical Force
3400 N DCF Limit
1000 N SF Limit
Type of patient transfer
Disc compression forces (DCF): one person, two person;
shear force (SF): one person, two person
Marras et al., 1999

14. Evaluating Risk Factors
Lifting heavy, awkward loads
Supporting the patient’s body weight
Working in small and/or tight spaces
Maintaining awkward postures
Reaching away from the body
Pushing and pulling forces
Force
Repetition
Awkward posture

15. Classifying Risk High risk activity High frequency task
High probability for injury

16. Risk Assessment and Ergonomic Analysis
How many patients are you caring for today?
What physical tasks are the most frequent and difficult?
How many people are typically needed to accomplish the following patient handling task?

17. Boosting with Draw Sheet
Moving up in bed
(Photo from Griffin AG, Potter PA: Clinical nursing skills & techniques,
ed 17, St. Louis, Mo, 2010, Elsevier Mosby)

18. Stand and Pivot Transfer
(Photo from Perry AG, Potter PA: Clinical nursing skills & techniques,
ed 7, St. Louis, 2010, Mosby)

19. Slide Board Transfer
(Photo from Perry AG, Potter PA: Clinical nursing skills & techniques, ed 7, St. Louis, 2010, Mosby)

20. Risk Assessment and Ergonomic Analysis (continued)
How do you define the dependency level of your patients?
How do you define the mobility level of your patients?
How do you make decisions about how to do tasks and how many people are needed to perform them safely?

21. JAMA, October 26,2011
Vol. 306, No. 16;

22. Clinical Application Define the root cause of exposure
Develop common language—consistency
Standardize decision making
Customize solutions for routine procedures
Select appropriate equipment

23. Banner Mobility Assessment Tool

24. Clinical Application Risk assessment tool for nurses
Solutions for “Good, Better, Best, and Avoid”
Linkage with clinical outcomes
Developed and mentored champions
Integration with shared-leadership councils

25. Modified Independence
Mobility is Linked with Solutions
Total lift, rollboards, air-assistive device, slide-sheets or slide-tubes
Mobility Level 1:
Mobility Level 2:
Total lift or powered sit-to-stand lift
Non-powered stand aid, gait belt, cane, crutches, walker or ambulation equipment
Mobility Level 3:
Modified Independence
No equipment required however, supervision is needed to promote safety
What equipment do I need?
Once you know your patient’s assessment level you should be able to decide what assisted devices, if any, should be used to ensure safety and promote early mobility.
All patient transfers to another departments for exams, procedures, and treatments…
The mobility level will be assessed and communicated to you through a variety of mediums sharing the patients abilities and limitations. This information and process will increase the safety and efficiency of our areas as we no longer need to guess our patients ability. This information will be clearly identified and communicated to you.
For example:
Assessment Level 1: This patient is the highest of acuity; the patient requires the most assistance and may require the use of such safety equipment as: Total lift, roller boards, air-assistive device, slider-Sheets or slide-tubes.
Assessment Level 2: This patient is able to sit yet is not able to bear weight. The total lift or powered sit-to-stand lifts should be used.
Assessment Level 3: This patient is able bear some weight with assistance or assistive devices. The non-powered stand aid can be used; gait belt, cane, crutches, walker or ambulation equipment should be used.
Assessment Level “Modified Independence” This patient is able to walk without assistance yet each patient
should be supervised to promote and ensure safety. This patient is the most independent.
Always default to the safest lifting method (total lift) if there is any doubt in the patient’s ability to perform the task.
Always default to the safest method (total lift) if there is any doubt in the patient’s ability to perform the task.

26. SPHM Equipment

27. Equipment Solutions Slider Sheets Roller Board Ambulation Pants
Sit-to-Stand
Ambulation Vest
How do we practice Early Mobility?
Early Mobility can be from range of motion exercises to supervised ambulation with the expectation of increased activity correlating with increased capabilities. Exercises are identified and specific goals and tools are used to promote growth specific to meet the patient’s needs and ability change while maintaining a safe environment by utilizing Safe Patient Movement and Handling Tools and equipment.
Safe Patient Handling Equipment and Movement (SPHM): is available to aid in early mobility by maintaining a safe environment for the patient to maximize work while preventing injury as well as protecting staff injury in the process.
Sitting Upright
Transfer Device
Convertible Chair
Range of Motion

28. Why Safe Patient Handling?
Essential skill set for patient outcomes
Rethink how we provide care
Innovative practices
Technology and equipment
Clinical tools, protocols and procedures
Work design changes
Results—better, safer and more reliable
Patient handling and movement activities are essential job functions in healthcare, but what makes for the safe handling and movement of our patients. In plain words, safe patient handling means rethinking how we provide care to patients in ways that are innovative, linking best practices in clinical care with clinical practices. This program rests on scientific evidence implementing: (1) technology and equipment; (2) clinical tools, protocols and procedures; and (3) work design change to provide better, safer and more reliable care to patients.

29. Bariatric Considerations
Provide rooms with overhead/ceiling-mounted lifts
Evaluate weight capacity of lift system
Propose minimum room dimensions
Measure bathroom door width
Measure shower stall width
Evaluate shower bench weight capacity

30. Bariatric Considerations (continued)
Evaluate toilet weight capacity
floor mounted toilet
wall mounted toilet
toilet jack installation
Consider proximity to nurses’ station

31. Create a Bariatric Suite
Bariatric bed with pressure reducing mattress
Extended capacity patient lift(s)
Extended capacity wheelchair
Extended capacity and extra wide walker
Extended capacity shower chair or shower stretcher
Extended capacity standing aids

32. Create a Bariatric Suite (continued)
Extended capacity floor-based toilet
Extended capacity bedside commode
Bariatric patient recliner
Bariatric size friction reducing devices (air-assisted and/or slide sheets or tube sheets)
Bariatric rollboard
Optimal space in room and bathroom
Doors that are wide enough for egress

33. Results of a Pilot Program
Program milestone metrics
Workers’ compensation data
frequency
severity
task specificity

34. Frequency of Injury

35. Pilot Project Light Duty Days (2010–2012)

36. Pilot Project Lost Duty Days (2010–2012)
Prepared by :

37. Pilot Project (2007–2009 vs. 2010–2012) 54% Decrease 65% Decrease

38. Implementation Success
Dedicate an SPHM coordinator
Encourage interdisciplinary involvement
Partner with facility leadership
Integrate with system initiatives and projects
Create opportunities to share the need and shape vision

39. Safe Patient Handling and Movement
Safe for staff and patients:
process driven (continuous improvement)
evidence-based
behavior based:
assessment and critical thinking
competent selection of proper equipment
proficient execution of task
tool for achieving objectives

40. If you have questions or would like a copy of this presentation, please contact: Merl Miller, MS, ATC, CIE Ashton Tiffany, LLC (602)