Overview• Community North Team / client base• ARV Community Initiatives• Physiotherapy Assessment• Training• Risk Assessment / controls• Challenges• Benefits• Manual Handling Case Studies
The Team: July 2011 – Feb. 2012• Manager: Co-ordinators : CACP, EACH & EACH D, CDC• Physiotherapist Workplace Trainer – Manual handling focus• Registered Nurse• Workplace Trainer,• Chaplain•Administration assistant/roster co-ordinators• Access to staff within ARV Health• Access external health professionals• Care staff- Certificate 3 in Aged Care
Staff and Client Profile• 44 Care staff• 38 Extended Aged Care at Home and Dementia Clients• 122 Community Aged Care Package• 1 Consumer Directed Care - high care client
CommunityServices, Sydney Northextends from:-Hornsby to Warriewood -approx 33 kms-Warriewood to Gordon -approx 14 kms-Gordon to Hornsby -approx 21 kms.
ARV Community Initiatives & Timeline• Post ‘April Zero Falls’ Month 2011 • Better Balance Program (BB) for at risk Community North CACP & EACH/D clients planned. • Small client group of 8 + BB physio, Community physio, guest speakers- OT, Pharmacist• Nov. 2011 • Initial 4 week BB program for medium falls risk clients • 6 clients completed course• Feb. 2012 • Retested after 10 weeks continued exercise supervised by care staff) Further 4 groups planned for 2012
ARV Community Initiatives continued … The Step Back Program Step Back Program When would the step back approach be appropriate? Aim: To improve client care & decrease staff injuries due to client aggression Initiative: Prompt staff to calmly assess & determine appropriate action. Review: Physiotherapist with MH expertise
Step Back – Keep Yourself Safe 1. •STEP BACK 2 •REVIEW 3 •APPROACH WITH CAUTION
Physiotherapy AssessmentValidated testing • Physical Mobility scale, Berg, TUAG, x 5 chair stands, Quickscreen Falls risk; Muscle tone, ROM & exercise requirementsAdditional • Client symmetry, mobility, transfers, transport needs, adaptive clothing needs, assistive devices [OT, sensory loss RN], primary carer’s role in MH • Substitution of risks • Causation • Documentation • Co-ordinator informs carers of manual handling updates
Ask yourself -‘What will my instructions convey to the newest, youngest, smallest carer with potential cultural interpretations?’
Care Staff /Agency advised re equipment position
The Risk Assessment Approach1. Historically – near-miss reporting and formal risk assessments low.2. Result = Frustration at all levels. High incidents of injuries.3. Action • ARV Community Risk register developed. • Risk assessment within the team - New equipment, new clients, changes in client’s mobility, Manual Handling work practices. • Risk Assessment Courses offered. • Equipment trials in client’s home essential. • Transporting clients – consideration of all factors. • Policy rewritten to support hierarchy of control. • Personal risk factors of carers - Each service for a client will be different.
Complacency is dangerous. It does not foster a risk assessment approach.To reduce injuries we must take anassertive and proactive approach to risk assessment.
Manual Handling Risk Factors Duration & Frequency Location of Loads & Distances Moved Workplace & Workstation Layout Weights & Forces Actions & Work Movements Organisation Manual Handling Risk Factors Other Work Factors Environment Special Needs Working Posture & Position Clothing Characteristics of the Load/Equipment Skills & Experience
Risk Assessment Workcover: Guideline to Risk Ax in Aged Care]
TrainingManual Handling Induction - CommunityInitial training • Workplace trainer demonstrations of equipment • Safe work procedures and simulated learning activities • Minimum 2 day buddy shift • Review activitiesDelayed staff competence • Buddy with WPT and/or physio and attend client’s service/ home.Continued poor practice • Coaching & re-allocation • Modification of work tasks.
Training continued …•For EACH & EACH D client’s with complex manual handling needs, co-ordinatorwill if possible engage preferred Agency staff with appropriate skills.• Mandatory yearly updates for EACH and EACHD staff for manual handling toprovide opportunity for up skilling and further mentoring. External training ifnecessary.• Ad hoc coaching and mentoring by Physiotherapist / OT, Co-ordinator & orWorkplace Trainer is provided where reassessment identifies altered manualhandling work practices or client’s care/equipment needs .
Meeting the ChallengesChallenges Meeting the ChallengesARV Community clients or their Risk assessment is still required, greateradvocates have a greater awareness of carer support for manual handling hazardsend of life directives, choices in staying athome [eg Palliative Care] etcIncreased demands on Community Engage CACP clients earlier,education,BBservice providers. classesAn ageing workforce –showing some Rotation of tasks, mentoring & support,limited physical ability for sustained teaching posture, stance, staticmanual handling of high care clients abdominalsYoung, new Community staff lacking Best practice buddying, mentoring andmanual handling knowledge and skills. supervision. Attracting Nursing & Allied Health students as carers for shared knowledge
Meeting the ChallengesChallenges Meeting the ChallengesCommunication – client, family and staff Co-ordinator directs the teamall hearing the same message.Families distress over client’s altered Family Conferences -doctor , client orcognition or mobility may overshadow advocate, Co-ordinator, OT, RN,goals for client’s safe manual handling Physiotherapist, ‘Bright Minds’ Team.and careProviding ongoing and timely staff Bright Minds team, mental healtheducation team, RN’s,Palliative Care,PhysiotherapyHow to optimise client mobility & Continue 4 week Better Balanceindependence and decrease falls risk Programs for small groupswhilst prompting less manual handling Trial equipmentof clients.Dealing with clients who have a Continue support for use of Step Backpotential for aggressive behaviour. program by all staff .
Benefits of a Team Approach• Empowerment of ARV Community care staff to understand theirresponsibilities and the importance of early disclosure of hazards & risks. [Co-ord.Survey Jan. 2012]• Early disclosure and reduction of hazards and risks has improved• Staff feel supported as part of the team by co-ordinators, WPT, physio, RN, WH&S rep. & manager. [ARV Community NorthStandards Review Report Sept.2011- NSW Dept.Health & Ageing.• Staff in Community North can see a career path for themselves.• Timely referral to relevant team members for assessment of CACP client withhigh risk manual handling needs.
ReferencesJournal Articles• Larsson,B. (2010). Evidenced-based ergonomics. Exploring new directions in people handling. AAMHP. Sydney.October 2010.• Marras, W., Davis, K., Kirking, B., and Bertsche, P. (1999) A comprehensive analysis of low back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics, 42(7), 904-926• Mitchell, T., OSullivan, P.B., Burnett, A.F. and Rudd, C, J. (2008), Low back pain characteristics from undergraduate student to working nurse in Australia: A cross-sectional survey, International Journal of Nursing Studies. Nov;45(11)• Naughton,V.and Stafford,D.(2010). Hands off training for health professions in effective mobility management for people with dementia. Exploring new directions in people handling. AAMHP. Sydney, October.• Engkvist,I. (2006). Evaluation of an intervention compromising a No Lift Policy in Australian hospitals. Applied Ergonomics, 37(2).141-148.Books• Chaffin, D. & Andersson ,G. (1984), Occupational Biomechanics, USA:Wiley.• Hignett,S., Crumpton,E., Ruszala,S., Allexander,P., Fray,N. and Fletcher,B. (2003).Evidenced-based patient handling: Tasks, equipment and interventions. London:Routledge.Teaching Materials• A.R.V, (2010), ARV Induction - Manual Handling : Safe Work Practice Summary-Version 5• A.R.V, (2011),Brightminds-The Step Back Program ,Trainers Guide.• Lusted, Marcia (2000).Manual Handling Instruction Card. Ergonomics Australia Pty.Ltd• Rothmore,,Paul and Elix,Gillian.(2004) ,Patient transfers-Forces. ,R.G.H Adelaide & Flinders Medical Centre,S.AWebsites• National Occupational Health and Safety Commission http://www.nohsc.gov.au/SmallBusiness/BusinessEntryPoint/laws/• Workcover http://www.workcover.nsw.gov.au/default.htm . Aged Care Risk Control Worksheet,,June 2010
CASE STUDY 1• Client attended in bed –contracted right side, tonic movements left side, actively assists by turning head only• Rigid right elbow and right lower limb.• Wife insists on client being dressed in singlet,button-up pyjama shirtand pyjama pants,over pull -up continence aid.• Care staff increasingly complaining of back soreness and shoulder acheswhilst rolling and dressing rigid client.• PLAN ….
CASE STUDY 2• Palliative care client is now unable to stand but her husband wants to take herout in wheelchair.• Stand up lifter was used previously by 2 staff with client when client couldpartially weight bear.• Now sling lifter is more appropriate for all clients transfers into air chair ratherthan wheelchair. Appropriate now as client has no antigravity sitting balance andis rigid in extension due to pain.• Client’s husband still wants wife to be showered on commode, ‘’wash her hairetc’.’ To minimise a falls risk staff have been restraining client in wheeledcommode whilst pushing commode to shower.• PLAN ….
CASE STUDY 3• Client is a high falls risk as has Lewy Body Dementia with poor insight andParkinsons Disease,• EACH D Client is varying in his mobility; morning for 2-3 hours much bettermobility –Physio assessed him mid morning with 4 wheeled walker and stand-byassistance, short distances-poor turning ,’freezes’ in doorways.• Client refuses to use newly prescribed four wheeled walker, & due to his cognitivedeficit, staff are providing a 2 hour socialization in late afternoon (discussion, mealpreparation program) x 5 per week. Compliance varies.• Family do not prompt use of walker. Hip protectors prescribed but not worn.• Falling frequently in a.m. now as client tries to get up from chair at will, if notsupervised.• PLAN ….