1. Creating a Culture of Change: The Implementation of SPHM at a Community Hospital through
the Development and Rollout of a Unit-Specific Pilot Program
PLAN
Background:
In 2012 a multidisciplinary Task Force was created to develop and implement a Safe Patient Handling and Mobility
Program. As a part of that effort, a pilot program was devised for rollout on the Acute Care for Elders (ACE) Unit, also
known as West 4 (W4). An analysis of Workers’ Compensation data and review of incident reports revealed that this unit
had the highest injury claims, claim costs and back/shoulder injuries in FY 2013, and accounted for 20% of all reported
injuries from 2009-2011.
Moreover, a pre-implementation mobility audit concluded that 40% of patients were left in bed on this unit. Because
mobilization is critical to the prevention of deconditioning and iatrogenic illness, the Task Force also sought to understand
the impact of a Safe Patient Handling and Mobility Program on overall patient mobility.
Objective:
In 2014, a unit-specific Pilot Program was developed. Its primary focus was to:
• Empower staff to mobilize patients safely by providing them with a mobility assessment tool
• Improve patient mobility
• Protect staff from injury
• Refine our SPHM Program prior to a hospital-wide rollout
STUDY
Results:
The post-implementation survey showed some areas of improvement in baseline knowledge, especially in the area of patient
assessment.
Moreover, a post-implementation mobility audit revealed increases in patient mobilization and ambulation distance and a
decrease in the percentage of patients left in bed.
Following the completion of the Pilot Program, the data suggested that nursing staff was more apt to take initiative in
patient mobilization because their level of comfort in assessing and competency in mobilizing patients had improved.
ACT
Conclusion:
Before the implementation of the Pilot Program, W4 had the highest number of employee injuries within the hospital.
While our goal was to see a steady decline in these injuries, post-program data did not reflect this. In fact, the average
injury rate per 1000 patient days was higher on W4 from 2014-2015 as compared to all other units: 0.67 vs. 0.51.
However, the linear trend for injuries on W4 during the same time period showed no significant change, while the rest of
the hospital continued to see an increase. Additionally, W4 had seven months in which they did not experience any
employee injuries following the completion of the Pilot Program. In comparison, the hospital had only one month
without injury.
Analysis of the post-program data has provided a couple of explanations as to why we did not see the end results we had
hoped to achieve. For example, the patient population/demographic on W4 could have impacted the employee injury
rate. Patients on W4 are typically older, more prone to hospital-acquired delirium and can present with challenging
geriatric behaviors associated with dementia and sundowning or cognitive decline. These conditions can make it difficult
for patients to follow commands and actively participate in their care, therefore posing a safety risk to caregivers.
Another explanation could be that employees were more likely to report their injuries to Employee Health due to
increased awareness of the reporting process following the completion of the education and training we provided.
Significance:
A pilot program helped to reveal the costs of a hospital-wide SPHM Program, demonstrating the benefits and limitations
an organization can incur, ultimately enabling Executive Leadership to determine the impact on the entire hospital.
Our Limitations:
• TIME: It was difficult for nursing staff to leave their unit for an extended period of time to come in for
the 2.5 hour training.
• FINANCIAL RESOURCES: A SPHM Program is resource intensive. Given the multiple competing
demands for a finite amount of resources, we have had to pursue limited training program options.
Moving Forward:
In an effort to encourage culture change throughout our facility, we continue to teach and review our mechanical device
competencies during New Employee Orientation (NEO) and Tech University. We act as consultants for both inpatient
and outpatient departments affiliated with Highland Hospital. We present in a variety of forums (e.g. Clinical Grand
Rounds, Wellness Fair, Lunch and Learn Seminars), in an attempt to educate our colleagues and the community that we
serve, increasing awareness about staff and patient safety. In addition, we provide individual unit training and in-service
programs on an ad hoc basis.
Disclosure: The authors of this presentation have no disclosures that would be a potential conflict of interest.
Authors: Sasha M. Latvala, CSPHA, PT Aide; Robert Masterman, MSPT, CSPHA; Priscilla Kaufman, BSN, CMSRN, MBA
For more information contact: Sasha M. Latvala, CSPHA, PT Aide  Highland Hospital  Physical Therapy Department  1000 South Avenue, Box # 78  Rochester, New York 14620  Email: sasha_latvala@urmc.rochester.edu  Tel. (585) 341-6636
Pre-Mobility Audit Data:
We found that only 39% of
patients with an “Up with
Assist” activity order were
actually being mobilized.
Post-Mobility Audit Data:
Following the completion of
the staff training on W4, 70%
of the patients with an “Up
with Assist” activity order
were being mobilized. Thus,
we saw a significant increase
as compared to the pre-
mobility audit data.
Activity Order
# of Audits
with Order
% of Audits
with Order
% of Audits with
Actual Activity
None 2 5% N/A
Bed Rest/Turns 1 2.3% N/A
Up to Chair 6 16% 83%
Out of Bed 2 5.3% 100%
Ambulate 2 5.3% 100%
Up with Assist 23 61% 39%
Activity as Tolerated 18 47% 61%
Activity Order
# of Audits
with Order
% of Audits
with Order
% of Audits with
Actual Activity
None 2 5% N/A
Bed Rest/Turns 1 2.6% N/A
Up to Chair 3 7.5% 67%
Out of Bed 1 2.5% 100%
Ambulate 5 12.5% 60%
Up with Assist 23 58% 70%
Activity as Tolerated 19 48% 68%
DO
Method:
A pre-implementation survey was administered to staff to ascertain baseline knowledge. Sixty-nine staff members
completed a 2.5 hour “hands-on” training session. At the end of the “hands-on” portion, staff were signed-off on five (5)
mechanical device competencies, one of which was for the introduction of a new device.
Mechanical Lifting Equipment posters were hung in each patient room on W4 to help inform patients and their families of
the types of devices they could potentially encounter during their hospital stay.
Staff were also provided with a Mobility Chart, which was developed to help guide them in selecting the right assistive or
mechanical device when mobilizing and transferring patients. However, after performing some typical caregiver tasks with
a strain gauge, we determined that some of the recommendations needed to be changed based on our findings and the
revised NIOSH lifting equation. For example, we are now recommending the use of an air-assist device for any lateral
transfer using only two caregivers.
EZ Way Smart Stand™ Competency
Nursing Department Staff
Name: __________________________________________________ Date: ____________
Position: RN PCT SNPCT (Circle One) Nursing Unit: ______________
Basic Operation
 Explain how you would obtain this equipment and where it should be placed after use.
 Demonstrate how to turn the EZ Way Smart Stand on / off.
 Indicate where the battery power is displayed on the EZ Way Smart Stand.
 Locate the battery and demonstrate how you would change out a “dead” battery for a charged one.
 Locate the emergency lowering handles and explain how they would be used.
 Properly demonstrate how to transfer a patient with the EZ Way Smart Stand.
 Demonstrate how to widen and narrow the base of support. Demonstrate all of the possible
adjustments for the footplate and knee bolster.
 Explain how you weight a patient using the EZ Way Smart Stand.
Multiple Choice / True-False
1. How many different mechanical methods of raising / lowering a patient are there?
A. 2
B. 1
C. 3
D. 5
2. With which of the following types of patients would it be okay to use this device?
A. A patient that is demented and confused, unable to follow commands, but able to bear
full weight through both lower extremities.
B. A patient that is alert, oriented and non-weight bearing through one upper extremity.
C. A patient that is alert, oriented and WBAT through one lower extremity.
D. None of the above
3. What is the maximum weight capacity for the EZ Way Smart Stand?
A. 440 lbs.
B. 600 lbs.
C. 800 lbs.
D. 1000 lbs.
4. It is okay to disengage the brakes on the EZ Way Smart Stand when lowering larger (bariatric) patients
onto a surface because of how their soft tissue gathers (for comfort).
 True
 False
5. Proper fitting and positioning of the sling around a patient (especially bariatric patients) is based upon
which of the following factors:
A. Patient’s girth
B. Sling should always be placed low and snug
C. Sling buckle should clasp above the pannus
D. A and B only
6. Constant tension should be kept on the buckle of the sling while raising the patient.
 True
 False
7. What is the cleaning process for the EZ Way slings?
A. Clean with Dispatch bleach wipes and return to your unit therapist or the Physical
Therapy Department.
B. Place them into the Soiled Utility Room.
C. Put them into the Dirty Linen Cart.
D. Either B or C
8. Because it is technically considered a “bariatric sit-to-stand” device, the EZ Way Smart Stand can only
be used with bariatric patients.
 True
 False
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9. What would warrant the use of the leg strap on the EZ Way Smart Stand?
A. Patients with instability while standing.
B. The leg strap should always be used, no matter what.
C. At the nurse or PCT’s discretion.
D. Either A or C
10. Where is proper hand placement for the patient in conjunction with safety and operation standards?
A. On the inside of the sling, on the black rubberized grips.
B. Anywhere the patient can hold.
C. On the outside of the sling, on the black rubberized grips.
D. All of the above
I hereby certify that I have had the opportunity to use this equipment and been trained on
its proper use regarding application during patient transfers. I further acknowledge that I
can request additional training at any time during my employment.
Employee: ___________________________________________ Date: ____________
Preceptor: ___________________________________________ Date: ____________
This competency has been written and administered by the Physical Therapy Department in conjunction with
the EZ Way Smart Stand Competency Checklist from EZ Way, Inc. Created 07/2014, Revised 08/15.
Sample Competency: EZ Way Smart Stand – This was administered to all 69 nursing staff during the 2014 SPHM Pilot. We
continue to use this competency with all new incoming nursing staff, Unit Educators, Clinical Resource Nurses and PT staff.
W4 accounted for 1/3rd of all
Workers’ Compensation
Claims in FY 2013.
Employee Health data
from 2009-2011
revealed that W4 had
more than twice as
many reported
injuries than any
other patient care
department.
Sasha M. Latvala, CSPHA, PT Aide teaching the
SPHM portion of New Employee Orientation to
nursing staff in February 2016.
Robert Masterman, MSPT, CSPHA teaching the
SPHM portion of New Employee Orientation to
nursing staff in February 2016.
Correct Answer: C (Assess the patient’s mental status and mobility, then mobilize the patient without waiting for PT).
Question: Your geriatric patient has not been out of bed yet. Orders state “Out of bed with assistance.” You should: