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Introduction to Queensland Health’s Patient Handling Risk Assessment Tool (FURAT)

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Tony Johnston
Principal Health and Safety Adviser,
Safety and Wellbeing, Human Resource Services, Queensland Health
(P51, Friday, NZI 5 Room, 11-1)

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Introduction to Queensland Health’s Patient Handling Risk Assessment Tool (FURAT)

  1. 1. Introduction to QueenslandHealth’s Patient Handling Risk Assessment ToolFacility/Unit Risk Assessment Tool (FURAT) Tony Johnston Principal Health & Safety Adviser Queensland Health
  2. 2. Outline• Introductions • Implementation strategies – Who, Where, objectives – Priority areas – Experience with other – Methodology tools – Issues and solutions• Background • Duration & frequency – History • Buy-in • recording – Legislation • Future enhancements – Patient Handling tools • Key summary points• FURAT & profile • QH resources – What is it; using it – Objectives
  3. 3. Why AssessPatient Handling Risks?
  4. 4. Patient Handling: Through the ages… 1998 2001 2007 2012
  5. 5. Patient Handling: Through the ages…Not so distant past
  6. 6. Patient Handling: Through the ages… 1998
  7. 7. Patient Handling: Through the ages…2001 1998 2001
  8. 8. Patient Handling: Through the ages…2007 1998 2001 2007 2012
  9. 9. Patient Handling: Through the ages… 1998 2001 2007 2012 What’s the problem? … with so much regulation and guidance material around..
  10. 10. • Behaviours – High risk tasks – Training solution• Equipment – Hoists – Slide sheets – Walk belts• Risk Assessment – Individual patient Mobility• Longevity – Individual dependent – Interpretation • Banned Walk-belts
  11. 11. Objective Develop and implementa comprehensive healthcare patient handling risk management tool.
  12. 12. ActivityHow many risk assessment tools do you know of?
  13. 13. Risk Management Facility / Unit Task Individual Patient ORGANISATIONAL RISK
  14. 14. Guidance from around the world…
  15. 15. Industry standards …Acceptable handling practices
  16. 16. Industry Standards…Tools
  17. 17. Legislative Basis
  18. 18. Managing Health and Safety Risks
  19. 19. Regulations …4.2 Hazardous Manual TasksPCBU must have regard to all relevant matters that may contribute to a musculoskeletal disorder … (a) postures, movements, forces and vibration relating to the hazardous manual task; and (b) the duration and frequency of the hazardous manual task; and (c) workplace environmental conditions that may affect the hazardous manual task or the worker performing it; and (d) the design of the work area; and (e) the layout of the workplace; and (f) the systems of work used; and (g) the nature, size, weight or number of persons, animals or things involved in carrying out the hazardous manual task.
  20. 20. Risk Assessment Principles Nature/Characteristics of Load –pt profile Work Area Tools & Equipment- Design / Layout - PH aids POSTURE FORCE TIMEWorkEnvironment Work Organisation-Eg lighting, - staffing & training floor surfaces Work Practices & Systems – - PH tasks performed - Design of work procedures
  21. 21. Facility / Unit RiskAssessment Tool (FURAT)
  22. 22. FURAT
  23. 23. Section 1 Facility/ Unit Description• Persons completing risk assessment• Work area Key contacts• Communication arrangements – District – Division – Ward Facility Unit
  24. 24. Section 2 Patient Profile• Age range• Service type• Dependency- I, SN,AN,D• Size (use BMI as guide)• Weight range• Primary diagnosis• Special requirements for patient handling
  25. 25. Section 3 Environment• Floor surface• Access• Space• Overhead clearance• Noise• Lighting• Temperature• Other
  26. 26. Section 4 Equipment• Includes equipment, aids and furniture• SWL• Quantity – Existing – Future needs• Condition, maintenance arrangements• Location/ access/ storage• Meets needs?
  27. 27. Section 5 Staffing and Training• Skill mix• Capacity- – PH experience – Functional limitations – Access to PH expertise• Work organisation• PH training- number of trainers, training arrangements• Injury, absenteeism, turnover
  28. 28. Section 6 Patient Handling Tasks• Patient Handling Transfer Table, adapted from: – WorkSafe Victoria Transferring People Safely 2nd edition 2006 – Sir Charles Gairdner Hospital S.A.F.E.R Patient Handling (2006)• Preferred, not preferred and not recommended methods• Range of patient dependency• Standard conditions apply Observe Consult Past History
  29. 29. Section 7 Risk analysis• From section 6: Pt Handling Tasks Performed, identify – not preferred methods – not recommended methods – Alternate methods – Additional tasks• Frequency• Analyse the 2. Patient Profile – Direct risk factors 3. Environment – Contributory risk factors (from sections 1-5) 4. Equipment 5. Staffing & training
  30. 30. Section 8 Risk control worksheet• Hierarchy of control  explained and examples given• Risk control table  existing controls  brainstorm others to be considered• Risk control plan and evaluation  short and long term controls to be implemented  Evaluation• Sign-off
  31. 31. Patient Handling Risk Profile Form• Displayed in the work area• Updated as often as required to keep the information current• A quick tool for – Induction – Casual – Students etc
  32. 32. Patient Handling Risk Profile Form• Patient profile; range of PH activities; precautions• Individual PH assessment procedure• Summary of risks and controls• Equipment register• Training and assessment program• Documentation• Compliance monitoring
  33. 33. Activity (1)
  34. 34. The Incident …• RN Smith was transferring Mrs Jones (bed 13) back to bed. – Pt slipped and fell to the floor. – With the assistance of Operational Officer (Bill) lifted pt back to bed.• RN Smith – noticed a slight back twinge at the time of the incident but was able to continue working. – Pain increased slightly by the end of the shift. – Woke Sunday morning in excruciating pain. – Went to LMO and was given pain relief and medical certificate for 2 weeks leave.
  35. 35. Elements of a Facility / UnitPH Risk Assessment Nature/Characteristics of Load –pt profile Work Area Tools & Equipment- Design / Layout - PH aids POSTURE FORCE TIMEWorkEnvironment Work Organisation-Eg lighting, - staffing & training floor surfaces Work Practices & Systems – - PH tasks performed - Design of work procedures
  36. 36. Systems Approach(Swiss cheese)
  37. 37. Activity (2)
  38. 38. Implementation Strategies
  39. 39. Implementation 2007 - Developed 2008 – Pilot 2009 - Approved• Work Practice Directive (mandatory) – Facility or Unit level – Implementation plan with 6 months – Annual review – Re-assessment at least every 3 years – Team approach – Documentation • Retained locally; copies centrally to OHS Unit • Profile Form
  40. 40. Service Level Agreements 2009 2010 2011 2012 Planning Priority 1 Areas Priority 2 Areas Priority 3 Areas• Timeline for Key Deliverables – 3mths gap analysis and plan – Prioritisation of work areas• Performance Measures – Quarterly reporting – % staff trained – % FURAT completed – Ratio Trainers to Staff (target 1:10 in priority 1 areas)
  41. 41. Strengths• Builds capacity• Encourages collaboration and participation• Risk management demonstrated• Consistent process• Clear accountability but shared responsibility• Covers direct and contributory risk factors• Highlights high risk practices• Prioritisation
  42. 42. Weaknesses• Significant shift in culture• Looks daunting• IT systems do not allow uploading to central monitoring point• Benefits not immediately obvious• No one person has the skills/ knowledge to complete• Aimed at clinical managers- competing demands
  43. 43. Opportunities• Due diligence• Business outcomes- use of resources; costs• Safety culture• Improved physical and psychosocial aspects of work• Justification/ escalation of high risk issues• Sustainability and quality of risk management• Capability
  44. 44. Threats• Competing priorities• Budget• Reactive safety culture• Conflict over responsibilities• Fear about liabilities• Does not result in actual reduction of risk factors• Perceived effort vs return• Lack of capability
  45. 45. Outcomes• Anecdotal reports of improved success with business cases• Gradually improving uptake, probably better in smaller areas• OHS doing a lot of the work• ‘Once I actually gave it a go, it wasn’t that bad’ ‘I can see the benefit now I’ve done it’• Quality issues- risk analysis and controls• Improved awareness of proactive approach- OHS and managers
  46. 46. Future Enhancements • Usability and integration with business systems – Central collation and reporting – Prioritisation and escalation • Education – Risk Analysis and higher order controls • Relationships • Culture
  47. 47. Future Direction• Other Tools and guidelines available. – MAPO – Dortmund – PTAI – Care Thermometer• ISO Ergonomics – Manual handling of people in the healthcare sector• Legislation for Safe Patient Handling Laws – USA – Hospital Patient and Health Care Worker Injury Protection Act

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