Clinical Services Building (CSB)Patient Care Area Beds (117)Theatres 14Recovery Unit 23Theatre Admission and Discharge Unit 20Short Stay Assessment & Planning Unit 42High Dependency Unit 18Other ServicesSterile Supply UnitSupport Services
Design Phases Concept Design Preliminary Design: Meetings – Architects – Project Managers: CMDHB and External – Clinicians and Physicians – CMDHB Service Improvement Managers – Other stakeholders eg OH&S, Infection control, Engineering Develop Design: More meetings… Detailed Design: Meetings & more meetings… Construction
Design Risk Risk: Design and build a clinical environment that doesn’t support safe moving and handling practice – Patient Moving and Handling challenges for the lifetime of the facility Copyright CMDHB 2011
Impact of poor ergonomic design Clinical time Injury 27% Patient Handling, 20% Manual Handling CMDHB Injury Claims Data 2003-2011 Cost Quality of care Model of care and practice 57% of staff sometimes, infrequently or never have sufficient space in room to safely use equipment CMDHB Staff Survey November 2011
Patient Handling Needs AnalysisPatients Medical condition Physical characteristics Mobility levelMoving and Handling Tasks High risk activities and scenariosEnvironment Space in room Other equipment and Storage
CMDHB Adapted ToolConcise Patient Ceiling Track Needs Assessment Tool forCMDHB – October 2011Adapted for CMDHB use from: Patient Care Ergonomics Resource Guide: Safe PatientHandling & Movement, Department of Veterans Affairs (October 2001)1) Patient Physical Characteristics and Dependency Levels a. Describe the patients/residents on your unit. b. Describe their level of cognitive participation. c. Average Unit population characteristics (# hospice beds, Alzheimer beds, TBI beds, etc.) and variability in this. d. Discuss proposed changes in the average daily census over the next two years. e. Identify typical distribution of patients by physical dependency level according to the definitions below. (Base on PHYSICAL LIMITATIONS not on clinical acuity) Note: This is not the same as patient acuity. The total for the 5 categories should equal your average daily census. ____ Total Dependence – Cannot help at all with transfers, full staff assistance for activity during entire seven-day period. Requires total transfer at all times. ____ Extensive Assistance – Can perform part of activity, usually can follow simple directions, may require tactile cueing, can bear some weight, sit up with assistance, has some upper body strength, or may be able to pivot transfer. Over the last seven-day period, help provided three or more times for weight-bearing transfers or may have required a total transfer. ____ Limited Assistance – Highly involved in activity, able to pivot transfer and has considerable upper body strength and bears some weight on legs. Can sit up well, but may need some assistance. Guided maneuvering of limbs or other non-weight bearing assistance three or more times, or help provided one or two times during the last seven days. ____ Supervision – Oversight, encouragement, or cueing provided three or more times during the last seven days or physical assistance provided only one or two times during the last seven days. ____ Independent – Can ambulate normally without assistance in unusual situations may need some limited assistance. Help or oversight may have been provided only one or two times in the last seven days. Total Number of Patients on Unit : ____ f. Indicate the weight range of patients on your unit. g. Indicate the number of patients over 137kg. h. Indicate the number of patients over 200kg.
2) Tool for Prioritizing High-Risk Patient Handling TasksDirections: For each task, consider the frequency of the task (high, moderate, low) andmusculoskeletal stress (high, moderate, low) of each task. Cross out tasks not typicallyperformed on your unit. Assign a rank (from 1 to 10) to the tasks you consider to be thehighest risk tasks contributing to musculoskeletal injuries for persons providing direct patientcare. A “10” should represent the highest risk, “9” for the second highest, etc. TASK STRESS OF Task RANK PATIENT HANDLING TASKS FREQUENCY H= high 10= high-riskH= high M= moderate 1= low riskM= moderateL= low L= low Transferring a patient: (includes reverse activity) From bed to wheelchair or shower/commode chair From bed to chair/arm chair From wheelchair or shower/commode to toilet From bed to stretcher/bed Moving a patient: Lifting patient to the head of the bed Repositioning patient in bed from side to side Repositioning patient in chair or wheelchair Lifting a patient up from the floor Weighing a patient Bathing a patient: In bed In a shower chair On a shower trolley or stretcher Other handling activities Undressing/dressing a patient Applying antiembolism stockings Making an occupied bed Feeding bed-ridden patient Changing absorbent pad Transporting patient off unit Other Task:Adapted from Owen, B.D. & Garg, A. (1991). AAOHN Journal, 39, (1).
What and How Much Equipment Floor hoists - 1 hoist to 10 patients Sit to Stand - 1 hoist to 10 patients Other Equipment - PAT slides, Sliding Sheets, Handling Belts Ceiling Hoist Coverage – Limited information available – Patient Handling and Movement Assessments: A White Paper (2010) Comprehensive Risk Assessment
Ceiling Hoist Estimations Determine % of patients requiring lift % Dependent + % Extensive Assistance = % Requiring lift Determine # of rooms requiring lift # Patients x % Requiring Lift = # of Rooms with liftThe Facility Guidelines Institute 2010, Patient Handling and Movement Assessments: A White Paper (2010) Example: 30% Dependent + 20% Ext Assist = 50% Require lift 50 Patients x 50% Require lift = 25 Bed spaces have a lift
Equipment Considerations Where it will be used and stored Number of staff required Size and dimensions Maintenance Features Safe Working Load (SWL) Provision for Bariatric patients 33% CMDHB adults are obese Compared with 23% for NZ NZ Health Survey 2006/2007 www.liko.com
Turning SpaceSourced: ARJO Guidebook for Architects and Planners, 2005
Dimensional Considerations Width of the room – for turning space Room layout and adaptability – bathroom and bedroom Wide doorways and corridors - to fit equipment through Position of toilet - with space each side Location of services – storage of equipment Bariatric and other specialist areas Copyright CMDHB 2011 NZ Patient Handling Guidelin es 2003
Process Considerations Stakeholder awareness of safe handling Specialist Resource Availability Meeting Format Stakeholders requirements and focus Layers of hierarchy Prioritisation of needs – Clinical – Functional – Budgetary
Overcoming Challenges Research: – Articles and resources – Industry expertise – Assessment Tools Moving and Handling network Supplier advice___________________________________________________________________________________________________________________________________________________________________________________________________________________ Work directly with clinicians Obtain senior management commitment Develop committee OH&SS team generic guidelines
Learnings Highly consultative process Project of this size needs clear: – Process for specialist input into decision making process – Prioritisation process to negotiate different stakeholder requirements More industry research required
Recommendations Early input from specialist Determine effective method for specialist input Business case as soon as possible Determine safe handling priorities Clearly establish patient handling needs and equipment requirements Educate and liaise with stakeholders Hang in there!
ReferencesA Guide to designing Workplaces for Safer Handling of People, Worksafe Victoria, 3rd edition, Sept 2007ARJO Guidebook for Architects and Planners – Elderly Care Facilities, 2nd Edition, 2005, SwedenAustralian Health Facility Guidelines Vol 1 – Vol IV 2009CMDHB Risk Pro Incident reporting system 2011CMDHB Staff Patient Handling Survey 2011Cohen M.H, et al, Patient Handling and Movement Assessments: A White Paper. April 2010. Prepared by the 2010 Health Guidelines REvison committee Specialty Subcommittee on Paient Movement. The Facility Guidelines Institute, April 2010.ECRI Institute, Ceiling Mounted Patient Lifts, Health Devices, April 2009FGI Guidelines for Design and Construction of Health Care Facilities 2010 editionJoliff, J., The miracle of lifting technology. Nursing Homes Magazine. September 2006Owen, B.D. & Garg, A. (1991), AAOHN Journal, 39 (4)Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Department of Veteran Affairs (October 2001)Ronald, L.A, Yassi, A, Spiegel, J., Tate, R.B, Tait, D. and Mozel, M.R., Effectiveness of Installing Overhead Ceiling Lifts. AAOHN Journal, Mar 2002, Vol 50, No 3.Spiegel, J., Yassi, A., Ronald, L.A., Tate, R.B, Hacking, P. and Colby, T. Implementing a Resident Lifting System in an Extended Care Hospital. AAOHN Journal, Mar 2002, Vol 50, No 3.The New Zealand Patient Handling Guidelines, The Liten up Approach, ACC Worksafe 2003Weinel, D., Successful Implementation of Ceiling-Mounted Lift Systems. Rehabilitation Nursing, Mar/Apr 2008: Vol 33, No. 2Weitekamp, K., 2011. Just five years ago Gundersen Lutheran Health System, based in La Crosse, WI, was facing a challenge that’s common among healthcare facilities. Advance for Nurses.
Thank you Kirstyn Albrecht – Kirstyn.firstname.lastname@example.org – Occupational Health & Safety – Middlemore Hospital – Otahuhu, Auckland 1640 – New Zealand – Ph: 0064 9 276 0044 extn 8570