Many government agencies have produced manuals or guidelines for moving and handling people as part of initiatives to reduce injuries to carers. Given the increasing number of specialised guidelines appearing, it is timely to assess the evidence about the impacts that guidelines might have on moving and handling practices and injuries among healthcare staff. While there is some evidence of positive impacts from clinical practice guidelines on patient outcomes, there appears to be little information on the impacts of moving and handling guidelines. This presentation considers possible causal links between use of moving and handling guidelines and the reduction of negative impacts among carers. It covers the purposes of guidelines, primary audiences, writing and presentation styles and the uses of guidelines reported by practitioners. The session will draw on the presenters’ involvement as members of an ACC panel, which produced Moving and Handling PeopleSee refs in folderGuidelines impacts docs
Notes John W will cover in following session
Guidelines for moving and handling people: Do they improve practice?
Guidelines for moving and handling people: Do they improve practice?David R. Thomas Yoke Leng ThomasEmeritus ResearchWorks NZProfessor, University ofAucklanddr.firstname.lastname@example.org
History of NZ Guidelines 1st version published in 2003 by ACC - 5 years to complete 2nd version published March 2012 by ACC 24 month review process Expert panel to guide development Survey of 50 users of 2003 Guidelines Draft version circulated for public comment Multiple submissions or comments on draft Formation of M&H Association of NZ – 2011?
Examples of Guidelines: Other countries UK – HOP6 (Handling of People v6, 2011) Australia Qld Health: Think Smart Patient Handling Better Practice Guidelines 2010 Workcover NSW: Manual handling guide for nurses 2005 Worksafe Vic: Transferring people safely 2009 Canada OSHA, BC: Safe Patient & Resident Handling 2000 Worksafe BC: Handle With Care: Patient Handling and the Application of Ergonomics (MSI) Requirements 2006 USA - CDC Safe lifting and movement of nursing home residents 2006
Why ACC funds Guidelines ACC work-related entitlement claims for employees in health services around $8 million pa ACC injury prevention initiatives to reduce injuries and their costs Multiple workplace health and safety initiatives – ACC & Department of Labour The DPI (discomfort pain and injury) framework used by ACC to address gradual onset injuries, especially in workplaces
Questions regarding guidelineseffectiveness1. What evidence is available about the impacts of guidelines on practice?2. What attributes of guidelines make them more or less effective for specific audiences?3. What organisational processes or procedures facilitate or impede the use of guidelines in everyday practice?
Types of guides and protocols General guidelines (broad and extensive) covering a broad area or set of topics in health and safety Moving and handling guidelines to prevent injuries Targeted guidelines for specific health problems or events Preventing ladder injuries Guidelines for treating depression Guidelines for mild head injuries Detailed protocols (brief & focused) for specific clinical practice Algorithms for specific movements when moving and handling people
Review of literature: Impacts ofguidelines Three frameworks or perspectives relevant: Clinical trials framework favouring RCTs and experimental trials, excluding non-experimental studies (systematic reviews) Evaluation framework using multiple types of evidence for assessing effectiveness Descriptive accounts based on interviews with practitioners No clinical trials or similar studies found for general guidelines Some experimental trials/RCT studies for clinical protocols Several commentaries on clinical guidelines and protocols Developing literature on evidence-based clinical
Algorithms for patient handling and movement: Nelson et al 2003, 2006 Algorithms - Standardized processes for decisions about equipment & number of staff to perform high-risk activities safely (Nelson et al 2003) Intervention included 6 program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role (Back Injury Resource Nurses), (4) State- of-the-art equipment, (5) After Action Reviews, (6) No Lift Policy The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days
Example: Cochrane review of printededucation materials (PEM) on clinicalpractice We did not locate any studies comparing multifaceted interventions that included PEMs with multifaceted interventions. Yet during our literature search, we retrieved 82 studies that compared the effects of PEMs with one or more interventions that included PEMs. … [There are] difficulties in separating the effects of PEMs when combined with other interventions. …. some studies used PEMs alongside other interventions for investigating additive effects of interventions …. Future intervention studies examining the effect of PEMs should consider the impact of educational materials
Purposes of general guidelines Improve knowledge about topic Provide rationale for specific health and safety practices (e.g. reduction of injuries) Provide health and safety information for managers Describe specific techniques and procedures for practitioners
Survey of users of NZPHG 2003 Survey of 50 users in 2010 - included M & H coordinators, trainers and physiotherapists Most used sections were: techniques (72%), risk assessment (30%) and equipment (30%) 15/50 (30%) used external trainers Some of the changes recommended Remove 16kg limit Simplify forms and audit tools Clarify who are audiences for each section More information about training
Context for M & H in NZ Practitioners and trainers often hold strong views about best practice for M & H people Most views are consistent Some conflicting views Revised version of the Guidelines endeavoured to take into account both emerging consensus on best practice and conflicting views, for example… using brakes on mobile hoists exclusion of unsafe techniques
Factors affecting clinicians’ compliancewith evidence-based guidelines (Gurses2010)1. Relative advantage: Is complying with the guideline superior to not complying with it in terms of its effectiveness and cost- effectiveness?2. Compatibility: Is the guideline consistent with practitioners’ values, norms, and perceived needs?3. Complexity: How easy is it to integrate the guideline into the current work practice?4. Trialability: Can the practitioner test or try this guideline with relative ease?5. Observability: Can the practitioner observe others that have incorporated the new guideline
Framework for assessing impactsof M & H guidelines - 1 Regulatory Senior Management environment Establish policy & programme (DoL, ACC) Provide resources Moving and Health and Safety Staff Handling M & H Coordinators Guidelines Operate M & H programmes Organise training Audit M & H practices Outcomes Reduced injuries, Carers absenteeism and staff Training, risk assessment, turnover techniques. use of equipment
Framework for assessing impactsof M & H guidelines - 21. Features of Guidelines docs and resources2. Health and safety regulatory environment in NZ (e.g., legislation, compliance requirements, resource development, incentives)3. Cultures in healthcare organizations (e.g., DHBs, private providers)4. Characteristics of practitioners (e.g., health & safety awareness, professional associations, union support)
Features of guidelines:Presentation and writing styles Multiple styles evident in existing guidelines and manuals (UK, Australia, Canada, USA) Move to pictorial styles (photos) to accompany specific aspects (e.g., techniques, equipment) Writing styles include; instructional/prescriptive, technical/ academic and descriptive. NZ Guidelines (2012) reduced instructional text (compared to 2003) and used more descriptive and technical text. Includes more photos, tables, bullet points and examples (side boxes)
Enhancing guidelines use andimpacts Target audiences identified Awareness of guidelines – professional associations, government agencies, health & safety staff Access to guidelines Print, online & DVD docs (pdf), video of techniques (DVD) Print friendly format for electronic pdfs Readability – multiple styles, multimedia versions of key messages Useability – can contents (techniques and procedures) be easily used by practitioners and
Conclusions 1 – Key points Extensive publication of guidelines for moving and handling people in developed countries Few studies on effectiveness of guidelines – research on guideline effectiveness appears to be a low priority Impacts of guidelines likely to be similar to other injury prevention/clinical practice initiatives Readability and useability of guidelines likely to be important Need for research on enhancing influence of guidelines on M & H practices
Conclusions 2 - Do Guidelinesimprove practice?Absence of evidence about effectiveness does not mean absence of effectivenessGuidelines probably do improve practice: By providing information about specific techniques and other resources By providing a set of standards for moving and handling people Over time, through setting an agenda and context for health and safety in moving and handling people
References Farmer, A. P., Légaré, F., et al. (2008). Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004398 doi:10.1002/14651858.CD004398.pub2 Gurses, A. P., Marsteller, J. A., et al. (2010). Using an interdisciplinary approach to identify factors that affect clinicians’ compliance with evidence-based guidelines. Critical Care Medicine, 36(8 (suppl)), S282-S291. doi:10.1097/CCM.0b013e3181e69e02 Nelson, A. , Owen, B., et al. (2003). Safe patient handling and movement. American Journal of Nursing, 103(3), 32-43. Nelson, A., Matz, M., et al. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43(6), 717-733.