1. 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

2. 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

3. 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

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

5. 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

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

7. 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?

8. 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.

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

10. 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.

11. Right Computer Resolution
The higher the resolution the smaller the text

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

13. 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

14. 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

15. Medication Dispensing System Challenges

16. 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

17. COW – WOW – COS Ergonomics
Should fit at least 5th – 95th percentile
Keyboard
Standing height: ”
Sitting height: ”
Screen height (from top):
Standing height: ”
Sitting height: ”

18. Cornell University Cart Evaluation Form

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

20. Wall Mounted Challenges

21. Wall Mounted Challenges

22. Wall Mounted Challenges

23. 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.

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

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