1 Safe Patient Handling and Movement in the Perioperative Setting Welcome. This Safe Patient Handling and Movement in the Perioperative Setting Tool Kit has comprehensive educational materials for you.
2 Goal and Objectives GoalThe purpose of this activity is to educate perioperative registered nurses (RNs) about manual patient lifting and movements that negatively affect the health of surgical team members, to promote a safe perioperative work environment, and to protect perioperative team members. After completing this activity, the perioperative RN will be able to implement appropriate safe patient handling and movement practices to protect the health of surgical team members and patients. Objectives 1. Identify high-risk nursing tasks performed in the perioperative setting. 2. Name at least three body parts that can be affected by musculoskeletal disorders (MSDs). 3. Discuss the AORN Ergonomic Tools related to safe patient handling and perioperative team member safety. (Part ll)
3 Safe Patient Handling and Movement in the Perioperative SettingPart 1 This is the first of two slide shows about safe patient handling and movement in the perioperative setting.
4 Overview Introduction to Patient Care ErgonomicsBiomechanics of Patient Handling Tasks Factors Contributing to Nursing Injuries High-risk Nursing Tasks Ergonomics Guidelines for Safe Patient Handling and Movement (SPHM) Algorithms for SPHM using Technology Solutions (Part II) In Part I of this slide show, we will discuss all of these important topics. However, a full discussion of the algorithms for SPHM occurs in Part II of this slide presentation.
5 History of Safe Patient Handling and Movement Research and Programs1994 Research Utilization: Nursing Back Injuries 1995 Identified High-Risk Nursing Tasks on High-Risk Units 1998 Funding for Biomechanics Research Laboratory 1998 Redesigned High-Risk Tasks 1999 Design Evidence-Based Program 2001 Field Testing Program Elements with 700 Nurses 2002 Patient Care Ergonomic Guide Published 2003 Occupational Safety and Health Administration (OSHA) Ergonomic Guideline; American Nurses Association (ANA) Initiative 2009 OSHA revised its Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders as part of its four-pronged approach to decrease ergonomics-related injuries. This slide lists research and programs that have been focused on Safe Patient Handling and Movement in the past 20 years. As you see on the slide, in 2009, OSHA revised guidelines for nursing home personnel, but these may be applicable to every work setting.
6 2011 American Nurses Association (ANA) Health and Safety SurveyANA surveyed nurses in 2011 Respondents expressed concerns about health and safety in their work environments A total of 4,614 nurses responded 6
7 Top 3 Heath and Safety Concerns Identified by Nurses (ANA Survey)Acute/chronic effects of stress and overwork (74%) Disabling musculoskeletal injuries (62%) Contracting an infectious disease (43%) The top two health and safety concerns reported by nurses remain the same since the 2001 survey. As you see, the risk of a musculoskeletal injury is a high health concern reported. 7
8 AORN History Safe Patient Handling and Movement2005 AORN position statement “Safe Work/On-Call Practices” 2006 AORN guidance statement “Safe Patient Handling and Movement in the Perioperative Setting” Approved by the AORN Board of Directors November 2006 Published 2007 Ergonomic Tool #3 was updated in 2011 Reformatted in September 2012 2009 AORN position statement “Key Components of a Healthy Perioperative Work Environment”
9 Perioperative Standards and Recommended PracticesAORN Guidance Statement “Safe Patient Handling and Movement in the Perioperative Setting” Perioperative Standards and Recommended Practices Print Version Online Version An important resource for you is the AORN guidance statement “Safe Patient Handling and Movement in the Perioperative Setting.”
10 Advocacy Since 2003, state laws/rules/regulations addressing safe patient handling are in California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington; Hawaii (resolution) Eleven states now have either laws, rules, regulations, or resolutions that address safe patient handling.
11 2013 H.R.2480 federal bill introduced - Nurse and Health Care Worker Protection Act of 2013 OSHA and The Joint Commission renew alliance to protect safety and health of health care workers American Nurses Association (ANA) released Safe Patient Handling and Mobility: Interprofessional National Standards In 2013, OSHA and The Joint Commission renewed an alliance to protect the safety and health of health care workers. The purpose of the alliance was to develop compliance assistance tools and resources and to educate workers and employers about their rights and responsibilities. In June 2013, the American Nurses Association (ANA) released interprofessional national standards about safe patient handling and movement. In 2013, a federal bill “Nurse and Health Care Worker Protection Act of 2013” was introduced, which is being supported by the ANA and AORN.
12 H.R.2480 Nurse and Health Care Worker(HCW) Protection Act of 2013Congress Findings: In 2011, RNs ranked #5 among all occupations for the number of cases of musculoskeletal disorders resulting in days away from work, with 11,880 total cases 52% of nurses complain of chronic back pain and 38% complain of pain severe enough to require leave from work Patients are not at optimum levels of safety while being lifted, transferred, or repositioned manually Injuries among nursing staff and HCWs have dramatically declined at health care facilities that have implemented safe patient handling technology, equipment, devices, and practices The development of assistive patient handling technology, equipment, and devices has essentially rendered the act of strict manual patient handling outdated and typically unnecessary as a function of nursing care. H.R Nurse and Health Care Worker Protection Act of 2013, 113th Congress ( ) A bill was introduced in 2013, and Congress findings are summarized on this slide.
13 H.R.2480 Nurse and Health Care Worker Protection Act of 2013Congress Findings “Establishing a safe patient handling, mobility, and injury prevention standard for direct-care registered nurses and other health care workers is a critical component reasonably necessary for protecting the health and safety of nurses and other health care workers, addressing the nursing shortage, and increasing patient safety.” H.R Nurse and Health Care Worker Protection Act of 2013, 113th Congress ( ). accessed September 12, 2013 A bill was introduced in 2013 and the Congress findings are summarized on this slide.
14 Evidence based standards Focus on improving patient outcomes ANA Safe Patient Handling and Mobility: Interprofessional National Standards Evidence based standards Focus on improving patient outcomes and reducing healthcare workers’ musculoskeletal disorders In June of 2013, the American Nurses Association released interprofessional national standards about safe patient handling and movement. Experts from more than 25 professional organizations, businesses and health care systems participated in the development of these standards.
15 ANA Safe Patient Handling and Mobility: Interprofessional National Standards8 Principles Establishing a culture of safety Creating a sustainable program Incorporating ergonomic design principles Developing a technology plan Educating and training health care workers Assessing patients to plan care for their individual needs Setting reasonable accommodations for employees’ return to work post-injury Implementing a comprehensive evaluation system In June of 2013, the American Nurses Association released interprofessional national standards about safe patient handling and movement. This slide lists the eight principles.
16 Introduction to Patient Care ErgonomicsLet’s begin with the Introduction to Patient Care Ergonomics.
17 Ergonomics The science of fitting the demands of work to the anatomical, physiological, and psychological capabilities of the worker to enhance efficiency and well-being This is a classic quote.
18 The Ergonomic Challenge“The adult human form is an awkward burden to lift or carry. Weighing 100 kg or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped.” The Nurses’ load. Lancet. 1965;286(7409): This is a classic quote.
19 Providing Patient Care is High-riskOverexertion resulting in sprains/strains to the back are the leading and most costly occupational health problem in the United States The leading and most costly occupational health problem is back injuries including sprains and strains.
20 The Need for Improving Caregiver SafetyAging workforce Staffing shortages Increasing patient acuity Increasing patient size/weight There are several reasons to improve the safety of the health care worker, including that we have an aging workforce, there are staffing shortages, there is an increase in patient acuity, and patients are heavier.
21 Description of the Problem“Musculoskeletal disorder (MSD) cases (387,820) accounted for 33 percent of all injury and illness cases in Six occupations accounted for 26 percent of the MSD cases in 2011: nursing assistants; laborers; janitors and cleaners; heavy and tractor-trailer truck drivers; registered nurses; and stock clerks.” NONFATAL OCCUPATIONAL INJURIES AND ILLNESSES REQUIRING DAYS AWAY FROM WORK, 2011, News Release Bureau of Labor Statistics November 8, Accessed September 11, 2013. More than one-third of lost-time injuries were a result of back injuries
22 Personnel who experience pain and fatigue areLess productive Less attentive More prone to consistently make mistakes More susceptible to injury May be more likely to make mistakes that affect the health and safety of patients and coworkers
23 In an 8-hour shift, the cumulative weight that nurses lift is equal to 1.8 tons!!
24 Patient Care is High-riskRisk Factors affecting nursing staff: Overexertion due to lifting of excessive loads Cumulative effects of repeated patient-handling tasks
25 Patient Care is High-riskThere is a high prevalence of back pain among nurses 81% of nurses are affected Prevalence of upper-body symptoms (24%-60%) Prevalence of lower-body symptoms (33%-72%)
26 Scope of the Problem Nurses under-report injuriesOnly one in three nurses with work-related back pain files an injury report with their employer Surveys of injured nurses 12% consider leaving nursing profession due to back pain 12% leave nursing permanently, of which back pain is cited as a main or contributing factor One in 12 nurses who leave the profession cite back pain as the cause We know nurses under-report back pain and the injury it causes them. Nurses cite back pain as a reason they leave the profession of nursing.
27 Trends Across Sectors (Injuries per 100 full-time workers)Although rates of total and lost-time claims have been dropping in the private sector, in the field of health care these rates have been rising. This rise has occurred both in nursing homes and health care facilities. A major driver has been the increased rate of back injuries, injuries associated with high costs, high rates of residual permanent disability, and major reasons for premature retirement or leaving the field of health care. Source: Annual Survey of Occupational Injuries and Illnesses (BLS) *Baseline
28 2008 Injury Incident Rates (per 10,000 full time workers)Nursing/Health Care Support Nursing/Health Care Practitioners Construction Industry Manufacturing/Production Industry Maintenance/Repair Industry Bureau of Labor Statistics (BLS) Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by selected worker characteristic, major occupational group, and selected natures of injury or illness, Accessed February 8, 2010.
29 Number of nonfatal injuries and illnesses involving musculoskeletal disorders with days away from work Nurses aides/orderlies and attendants 24,340 Registered Nurses ,580 Licensed Practical and Vocational Nurses ,880 Nursing TOTAL ,800 Laborers/Freight-Stock-Materials Movers 27,040 Truck Drivers (Heavy/Tractor-Trailer) 16,470 Truck Drivers (Light-Delivery Services) 10,460 Construction/Laborers ,950 Bureau of Labor Statistics. Industry Injury and Illness Data (2007).Tables. Accessed October 15, 2013. The combined number of injuries in the healthcare setting are higher than laborers, movers, truck drivers.
30 Significance of the Problem“Nursing is ranked 2nd, after industrial work, for physical workload intensity.” “Nurses have approximately 30% more days off due to back pain as a percentage of all causes compared with the general population.” Lloyd JD: Cumulative trauma disorders of the upper extremities-Experiment report. Boston,MA: Liberty Mutual Insurance Co; 1991. 30
31 Components of ErgonomicsLet’ s now discuss the components of ergonomics.
32 Components of ErgonomicsTo optimize system performance while maximizing human well-being and operational effectiveness, ergonomics embraces a range of human-centered issues relevant to equipment or systems design and training, including: Body size (anthropometry), motion, and strength capabilities (biomechanics) Sensory-motor capabilities—vision, hearing, haptics (force, touch), and dexterity Cognitive processes and memory (including situational awareness) Training and current knowledge relating to equipment, systems, and practices Training and current knowledge of medical conditions (including emergency conditions) .
33 Using Equipment for Safe Patient Handling and MovingGaps Identified Using Equipment for Safe Patient Handling and Moving Equipment that has not yet been developed Equipment that exists, but has not been purchased Equipment that exists and has been purchased, but is not being used Gaps that have been identified include equipment that has not been developed, equipment that is available but not purchased, and equipment that is available and not being used. The largest gap in the perioperative environment is that the equipment has not been developed to meet the OR’s unique needs for moving and positioning patients.
34 Ergonomic Assessment ProtocolsGaps in Evidence: Ergonomic Assessment Protocols Translate what is known from other industries to health care Identify what unique factors need to be added to ergonomic assessments Include front-line staff members in assessment of hazards Link solutions to risk assessment Other gaps identified include translating what is known from other industries into the health care environment, what are some unique factors that should be included in the ergonomic assessments, are front-line personnel including during the identification and assessments of hazards, and how do you link what you have learned from the risk assessment to solutions.
35 Biomechanics of Patient-Handling TasksLet’s discuss the biomechanics involved when participating in patient-handling and movement tasks.
36 Simple Biomechanical ModelWork = Force x distance -» Work is mass x acceleration x distance d These physics equations for work and force form the basis of safe patient handling and movement. Knowing the specifics of the formula is not as important as knowing that the ergonomic tools are based on scientific formulas. Force = mass x acceleration
37 To Reduce Forces Acting on the BodyKeep arms close to body We can draw several conclusions from our experiment with the near and far lift. Obviously, you can reduce the stress associated with lifting by keeping the load closer to your body.
38 “Lifting” Force Involves 2 FactorsThe force required to move the torso The force required to move the load Lifting force involves two factors, which includes the amount of force related to the object being lifted and the amount of force transmitted by the lifter’s body. Usually this can be estimated by considering the weight of the lifter’s torso, head, and arms.
39 As you see on the triangle, the ergonomic injury triangle includes posture, frequency, and force.
40 One of the main contributors to spinal loading and stress is excessive reaching across patients
41 Manual Lifting TechniquesUNSAFE Increased risk for injury Manually lifting and moving a dependent patient create high loads on the spine, resulting in low back and shoulder pain patient Moving patients as shown in this photo (ie, manually) is unsafe and increases the risk for injury to perioperative personnel.
42 Factors Contributing to Nursing InjuriesWhat are some of the factors that contribute to nursing injuries? Let’s discuss.
43 Factors Affecting Injury Potential in the WorkplaceThere are many factors that contribute to injuries in the workplace, and like a puzzle, they are interconnected. 43
44 What Are Musculoskeletal Disorders (MSDs)?Cumulative trauma disorders are those physiological illnesses which may develop over a period of weeks, months, or even years due prolonged mechanical stresses imposed on the musculoskeletal system, resulting in injuries recognized as physical ailments or abnormal conditions Lloyd JD: Cumulative trauma disorders of the upper extremities - Experiment report. Boston, MA: Liberty Mutual Insurance Co; 1991. The cumulative component of trauma is a very important concept in this definition of MSDs. Although it may not be the first time that you move a patient without the proper equipment, when you do it time after time, you sustain injuries.
45 Occupational Safety and Health Definition of Musculoskeletal Disorders (MSDs)“(2011 and forward) musculoskeletal disorders (MSDs) include cases where the nature of the injury or illness is pinched nerve; herniated disc; meniscus tear; sprains, strains, tears; hernia (traumatic and nontraumatic); pain, swelling, and numbness; carpal or tarsal tunnel syndrome; Raynaud's syndrome or phenomenon; musculoskeletal system and connective tissue diseases and disorders, when the event or exposure leading to the injury or illness is overexertion and bodily reaction, unspecified; overexertion involving outside sources; repetitive motion involving microtasks; other and multiple exertions or bodily reactions; and rubbed, abraded, or jarred by vibration.” Occupational Safety and Health Definitions, Injuries, Illnesses, and Fatalities. Bureau of Labor Statistics, US Department of Labor. Accessed September 11, 2013.
46 MSDs by Body Part: ExtremitiesShoulders: Rotator cuff tendinitis Thoracic outlet Bursitis Bicipital tendinitis Elbows: Epicondylitis Neuritis Cubital tunnel syndrome Olecranon Bursitis Knees: Synovitis Feet/Ankles Tarsal tunnel syndrome Forearms: Tendinitis Pronator Teres syndrome Wrists: Carpal tunnel syndrome Ganglion cyst Nerve entrapment de Quervains Disease Degenerative joint disease Hands and Fingers: Trigger digit Vibration syndrome Tenosynovitis Musculoskeletal Disorders (MSDs) affect the extremities.
47 MSDs by Body Part: Neck and BackBack Disorders: Anulus Tear Chronic Degenerative Disc Disease Herniated Nucleus Pulposus, with or without neurological involvement Spondylolysis Spondylolisthesis Osteoarthritis Facet Arthropathy - Arthritis Scoliosis Spinal Stenosis Iatrogenic Back Pain Back Strain Rheumatoid Arthritis Neck: Cervical root syndrome Tension neck syndrome Musculoskeletal Disorders (MSDs) affect the neck and back.
48 Remember to Balance… Work Worker Demands CapacityGenerally, musculoskeletal disorders may develop when work demands habitually exceed a worker’s capacity to respond to those demands. The solution is to balance work demands with worker capacity.
49 High-risk Nursing Tasks in the Perioperative EnvironmentThere are several high-risk nursing tasks in the perioperative environment related to patient handling and movement.
50 Example 1: Repositioning Patient on OR BedRisk Factors Back – posture, forces Shoulder – high load Elbow – high load Interventions Patient-lifting equipment Friction-reducing device Repositioning a patient on an OR bed places the perioperative team member at risk for injury. Using patient-lifting equipment and friction-reducing devices are interventions suggested for decreasing the risk of injury. 50
51 Example 2: Transfer to OR BedRisk Factors Back – posture, force Shoulder – high load Elbow – high load Interventions Patient-lifting device Lateral-transfer device Friction-reducing device Transferring patients from the OR bed to the transport vehicle is another example of an activity that puts perioperative team members at high risk for injury. 51
52 Defining High-risk TasksHeavy loads Sustained awkward positions Bending and twisting Reaching Fatigue or stress Force Standing for long periods These are examples of job demands that push the limits of human capabilities. It’s important to define the high-risks tasks in your work environment. These tasks can include moving heavy patients or equipment, standing and holding retractors for a long time, and bending and twisting.
54 Ergonomic Guidelines for Safe Patient Handling and Movement
55 NIOSH Recommended Weight Limit (RWL)RWL = LC x HM x VM x DM x AM x FM x CM The important point of this equation is that the recommended weight limits developed by NIOSH are based on this scientific formula that takes into consideration the weight of the object, how far the object is moved, and how frequently the object is moved.
56 NIOSH Lifting Equation Applied to Patient Handling ActivitiesPatients: are asymmetric and bulky can’t be held close to the body have no handles Patient assistance varies Patient handling tasks are unpredictable We know patients come in all sizes. Patients may or may not be able to assist in moving themselves. And we know, moving patients can be unpredictable.
57 The NIOSH Lifting LimitsRecommended Weight Limits for Manual Materials Handling and Patient Handling Activities The NIOSH Lifting Limits Manual materials handling for an ideal lift maximum recommended weight = 51 lb Patient/Resident handling lifting limit recommendation = 35 lb As you see, the recommended weight limit for patient handling is 35 pounds.
58 Place holder for Kurt’s drawing o slips, trips and fallsIn addition to incorporating safe patient handling guidelines to prevent injury to you and your patients, you should also make your OR environment safe! Help prevent trips, slips, and falls. Be aware of your environment for every operative and other invasive procedure. Be aware of where you connect cables and cords. Clean up spills as they occur. Place soft goods (eg, sponges) into a sponge-counter system. . 58
59 Summary Musculoskeletal disorders and the risk of injury affect both the health care worker and the patient Use technology for safe patient handling and movement Reliance on body mechanics is not safe and does not prevent MSDs Equipment and programs are cost effective Using technology for safe patient handling and movement is effective in preventing MSDs for health care workers. Do not rely on only body mechanics, because it is not safe and does not prevent musculoskeletal disorders. Use equipment, and develop programs.
60 Expected Speed of Implementation“It takes an average of 17 years for new knowledge generated by randomized controlled trails (RCT) to be incorporated into practice, and even then, the application is highly uneven.” Balas EA, Boren SA. Managing clinical knowledge for healthcare improvement. In: Yearbook of Medical Informatics. Bethesda, MD: National Library of Medicine;2000:65-70. This quote from Balas (2000) reminds us that the application of new knowledge that has been generated can take, on average, 17 years to be incorporated into practice. As a patient advocate, perioperative RNs can share and implement this important evidence about safe patient handling and movement to other perioperative personnel.
61 Part II slide show: AlgorithmsEnd of Part I Please continue to Part II slide show: Algorithms This concludes the Part I slide show. Please continue to Part II, which describes the algorithms for safe patient handling and movement using technology solutions.