Significant changes in handling and movement techniques ….Who remembers these ones?? Who still sees them in action??
The 1998ish saw the union “no lift 2000” campaign.For its time, it was a significant strategy – employee group pushing for improvements in working conditions.The title “no lift” took off Some pioneer facilities accepted the concept several private providers established programs – Kate Touy-Main; NSCA, bullbrook system, O’Shea No lift And some employee groups resisted the change or more to the point the misunderstanding of the concept “no lift”Physiotherapy – therapeutic handling was excludedOperational areas – historically seen as the muscle, and threatened by “no lift” as potential job or identify loss
By 2001, guidance material was finally being deliveredAdvisory std – There was a definition of what safe handling and no lift wasNo worker should lift a person, other than a small child unaided (that is without assistance from, for example mechanical aids, assistive devices or another worker/s)Introduced Risk framework - Direct risk factors (3 factors) - forceful exertion - working posture (awkward, static) - repetition and duration -Contributory Risk factors (6 factors) - work area design - work environment - Handling procedure - Characteristics of the person being handledModifying factors - Characteristics of the Worker - work organisationSimilarly, common language was evolvingrisk managementRisk assessmentsHierarchy of control
Manual tasks standard and code of practiceStart of the national harmonisationIntroduced characteristics of hazardous manual taskshandling of peoplemore aligned to the WorkSafe Victoria Body Stress conceptPrescribed duties to wide range of stakeholders – designers, manufacturers, suppliers, etc
A lot has happened over the last 10-15 years.
At the end of the day, uptake was considerably variableSome Hospitals took on commercial programs, some developed their ownSome carried on “business as usual” … the 30 min back care presentation was enoughSome critical features remainedRisk Management increased as a key term and practiceTraining was the predominant and preferred solutionHigh risk tasks had a greater range of solutions – top and tail, shoulder lifts, sit-standEquipment – slide sheets, hoists, walk beltsAn various debate over the purchase, maintenance, efficiencies Banning of “walk belts”, turning discsIndividual Patient risk assessment – or at least the documentationPrograms commonly survived a 2-3 year cycles dependent upon either An individuals “champion” - they would burn-out, look elsewhere for interesting, new things to do equipment needing significant replenishing – slide sheets or slingsOrganisationally - Resistance to ChangeConflict over responsibility – clinical versus OHSEquipment did not respond to changing needs and technology; eg. BariatricsCost, Cost, Additionally, within Queensland at least, a number of the commercial providers no longer existed, or the presence reduced.
NIOSH lifting equationSnook’s tables –acceptable weights and forcesREBA – Rapid body assessmentRULAPATH – Posture, Activity, tools, handlingManTRA – Manual Tasks Risk Assessment toolPErforM – OCRA index – Ax of repetitive movements and exertion of upper limbsWork organisation assessment questionnaire (WOAQ) – tool for the risk management of stress.MSD risk assessment questionnaireOWAS - Ovako Working Posture Analysis SystemQEC - Quick exposure checkUK MAC - Manual Handling ChecklistPsychosocialPhysiologicalPosturalBiomechanicalEpidemiological
From our analysis of the performance of risk assessments of patient handling Rarely doneKnowledge of risk assessment focused on the risk matrixMany considered the risk assessment the individual patient mobility assessment leaving the solutions to the individual care giverSo we concluded there are layers for risk:Operational level at the patient and taskTactical level at the facilityStrategic level or organisational levelOut focus was to build on the tactical level – ensuring business process, plan and are ready for the health service they are providing … not leaving the primary decision to risk to the care giver.
WorkSafe (Vic) (2002). Transferring People Safely.
ACC- LITE programLoad (patient)IndividualTaskEnvironmentACC WorkSafe (NZ) (2003). "The New Zealand Patient Handling Guidelines: The LITEN UP Approach." Retrieved 18 October, 2006, from http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_ip/documents/guide/pi00212.pdf.Patient safety Centre of Inquiry, Tampa - http://www.visn8.va.gov/visn8/patientsafetycenter/safePtHandling/default.aspAudrey Nelson
2001 Advisor Standard / Code of PracticeEstablished framework for risk factorsEstablished process “If there are no direct risk factors involved, the risk can be assumed as low”Essentially, this has been supported in the national standards (2007) and codes of practice (2011), give or take some titling changes to the Characteristics of hazardous manual tasks; and Sources of the risk
Many hazards are well known and have well established and accepted control measuresIn these situations, the second step to formally assess the risk is unnecessary.Should be planned, systematic and cover all reasonably foreseeable hazards and associated risks.Additionally;If legislation prescribes a specific way – must complyIf a code of practice or other guidance sets out a way of controlling a hazard, the guidance can be followedThere is well-known and effective controls – they can be implemented** Risk assessment process detail here is only about the likelihood and consequences. Within Manual handling the source of the hazard/risk is important and therefore the focus of the risk assessmentControl measuresIf is always possible to do something.The cost of controlling a risk may be taken into account in determining what is reasonably practicable, but cannot me used as a reason to do nothing.
In determining the control measures to implement under subregulation (1), the person conducting the business or undertaking must have regard to all relevant matters that maycontribute to a musculoskeletal disorder, including:(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.
The FURAT consists of 8 sections …The premise is to consider:Typical work conditions and practicesAssume last 12 months (where appropriate)More about the process
Basic demographics and risk assessment documentation
Patient characteristics will influence the healthcare service provided and the handling techniques requiredYou start to paint a picture of the type of handling and moving techniques that would be requiredSpecial precautions or stakeholders to consider for approvals/recommendations/education for equipment and techniques (eg. Orthopaedic surgeons – Interestingly, I recall theatre spinal surgery, the surgical option to fix the bad backs, presented special challenges and significant manual liftingEquipment needs Quantities and range of sizesWhat about Bariatrics …….Within this tool, or a separate strategy. Again facility or unit levelThree main pointsWeight compared to the equipment SWLEquipment characteristics – width, ht etcFunction – independent vs dependent
Consider the patient and service needs and the environmental requirementsThere may be some issues identified that are common across the facility – eg carpet in bed rooms
Existing equipment / patient aids / furnitureTypes, BrandsQuantities .. Consider laundry turn aroundConditionMaintenance / laundry / storage issuesAvailability – central storage – Many advantages in managing stock quantity and maintenanceaccess, availability, quantity, speed of deliveryOptimal types and quantities based on:Patient profile/needsPatient handling tasks
Start to considerTraining modelstrain the trainer / ergo coach / championTraining needs – skilled workforce vs novice/unskilled Will relate to the work patterns (eg. AIN/EN patient cares)Relate the staff mix to the patient needs and tasks requiredEg. Bariatric admission – 4 person roll/hygiene care, but only 2 rostered on a nightWill also be influenced by the equi
Developed 2007Trialled 2008 (at Melbourne Conference)Approved October 2009Support material and training was provided:Information sheet for users (line managers)User guideWorked exampleTraining for Ergonomics Coordinators and OHS PractitionersCriteria for Patient Handling Trainer Competency AssessmentThe development phase took about 2 years. The process was iterative and built on the experience of many people internal and external to Queensland Health. A variety of consultation methods were used along with piloting and formal feedback at the final stages. The directive was important once the tool was finalised because it outlines the mandatory process to be followed.There is a network of about 12 ergonomics coordinators around the state and these people were positioned to champion the process and build capability in their local areas.The directive mandated that a plan be developed based on priority for each district, within 6 months.Self directed training resources were the strategy of choice to build capacity in managersVarious sessions were run for OHSP to build capacity in risk management for healthcare ergonomics, FURAT was part of this.Building the requirement to do FURAT into existing structures was important to normalise the processMarketing opportunities were always sought out and taken up and still areAll feedback is being collected and will be taken into account at the 12 month review.
Also Performance and development plans for all OHS practitioners that included healthcare ergonomics.
‘Tax Pack’ style tool would help; pre filling of areas (e.g from HR data; equipment purchasing data) unload to central point for collation/ escalation/ prioritisation/ identification of state wide issues.Risk analysis and control- need ongoing education about how this is done. Relationship building is critical to success of the process. Evaluation- once a higher proportion of FURATs have been completed, a quality process will be undertaken on a random sample to review how successful the process was in identifying direct and contributory risk factors; developing appropriate control measures; facilitating implementation and evaluation of controls.
Risk Assessment toolsMAPODortmundPTAITilThermometer / CareThermometerCaliforniaMaintain a safe patient handling policy – replacing manual lifting with powered pt transfer devices, hoists, or team liftsProvide trained lift teams or staff training in safe lifting techniquesAdopt an injury prevention plan
Introduction to Queensland Health’s Patient Handling Risk Assessment Tool (FURAT)
Introduction to QueenslandHealth’s Patient Handling Risk Assessment ToolFacility/Unit Risk Assessment Tool (FURAT) Tony Johnston Principal Health & Safety Adviser Queensland Health
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
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.
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
Section 4 Equipment• Includes equipment, aids and furniture• SWL• Quantity – Existing – Future needs• Condition, maintenance arrangements• Location/ access/ storage• Meets needs?
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
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
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
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
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
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
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.
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
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
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)
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
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
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
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
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
Future Enhancements • Usability and integration with business systems – Central collation and reporting – Prioritisation and escalation • Education – Risk Analysis and higher order controls • Relationships • Culture
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