Lecture on Professionalism in Medicine, prepared and presented by Dr. Mohamed Alrukban and Dr. Ghaiath Hussein for 4th year medical students in the Medical Ethics Course on Monday Febraury 5, 2012.
Lecture on Professionalism in Medicine, prepared and presented by Dr. Mohamed Alrukban and Dr. Ghaiath Hussein for 4th year medical students in the Medical Ethics Course on Monday Febraury 5, 2012.
A 15-minutes oral presentation that was given in ISQua's 32nd International Conference, Doha, October 2015 by Dr. Yasser Amer under the track: "Quality and Safety in Developing Countries"
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
Risk Management Training Slides.
Slides prepared based on "The Healthcare Quality Handbook" by Janet A Brown. Very useful health care quality reference for CPHQ exam preparation. For more slides, contact ckmujeeb@hotmail.com
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
A 15-minutes oral presentation that was given in ISQua's 32nd International Conference, Doha, October 2015 by Dr. Yasser Amer under the track: "Quality and Safety in Developing Countries"
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
Risk Management Training Slides.
Slides prepared based on "The Healthcare Quality Handbook" by Janet A Brown. Very useful health care quality reference for CPHQ exam preparation. For more slides, contact ckmujeeb@hotmail.com
Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.
Ben Shippey discusses the important anaesthetic considerations in bariatric surgery. Obesity surgery can induce a strong response in healthcare professionals.
These biases must be overcome to facilitate efficient and safe services. Evidently, Bariatric surgery provides many challenges.
To begin with, healthcare professionals can associate negative thoughts with obesity.
Secondly, these patients present complex respiratory and cardiovascular physiology that must be considered.
Ben highlights three important considerations when preparing for, and delivery anaesthetics in the bariatric population. These are Attitude, Assessment and Act.
Attitude -
Encompasses the attitude of the physicians, theatre team and the patient themselves. One must recognise and change their thinking about the obese patient. Ben’s team does this by realising the complex psychological background these patients invariably have.
Assessment -
Furthermore, a multidisciplinary team must undertake a broad assessment.
Specifically for the anaesthetic team, there is a complex decision pathway, especially with managing the airway. The broad principle should be to shorten the time between the awake, vertical, spontaneously breathing obese person and the supine, anaesthetised, intubated and positively pressure ventilated patient.
Finally, Act -
As Ben states, the previous two points are null and void if it does not change practice. The key element to act is to plan! This involves having a clear action plan for the intubation of the patient and failing that, clear points at which Plan B, C and D will be initiated.
He encourages his theatre staff to alert him when a cut off Sp02 is reached so he can move to the next course of action. He comes prepared - for example, by having the cricothyroid membrane marked out.
Furthermore, it is important to consider putting the patient to sleep and waking them up. As Ben puts it – pay attention to the take off as well as the landing!
Lastly, the post-operative care is significantly important. Remember patient positioning in bed (not slumped) and encourage early mobilisation.
These patients need to be up and moving, as well as having the appropriate DVT prophylaxis in place. The obese patient presents unique challenges to the anaesthetist.
Anaesthetics in Bariatric Surgery: Ben Shippey
For more like this, head to our podcast page. #CodaPodcast
L'empresa Safe Patient Handling and Movement (SPHaM) presenta solucions integrals per a la mobilització de pacients.
9 de desembre de 2015
Sala d'actes del Centre Corporatiu
Institut Català de la Salut
When was your last paediatric/neonatal life support course update? Did it include the latest recommendations from the European Resuscitation Council (2015)? NO?! Well, let's have a look at the very latest consensus recommendations for the resuscitation of children in cardiorespiratory arrest and for neonates at birth - and explore any controversies therein.
Jim Warren
National Institute for Health Innovation, University of Auckland
(Friday, 3.00, General 3)
Provides background and overview of a Health IT Evaluation Framework that has been developed to support the National Health IT Plan and New Zealand health innovation generally. The framework recommends a pragmatic approach that includes use of both quantitative data (particularly data based on the transactional logs of operational IT systems), and qualitative data systematically gathered through stakeholder interviews. An Action Research orientation is recommended where the evaluators actively seek to understand barriers and find pointers to potential solutions. The investigation protocol is recommended to be iterative and flexible, and to involve dissemination of intermediate findings for feedback and broad dissemination of final results. Moreover, evaluation should be integrated with implementation, rather than a standalone post implementation activity. No single type of measurement should dominate the evaluation, which should employ a measurement framework including work and communication patterns, organisational culture, safety, effectiveness, system integrity and usability, as well as vendor factors, project management, participant experience and governance.
To increase the effectiveness of the incident analysis in improving care, analysis can’t be addressed in isolation from incident management (the multitude of activities that take place before and after an incident). Three main topics will be covered in this module: the main steps in the incident management continuum; differentiating between incident analysis (focused on system improvement) and accountability reviews (focused on individual performance), and selecting an incident analysis method.
HCSS Safety Week webinar from Jim Goss, who discusses basic steps to help contractors look for hazards and establish ways to control those hazards to prevent injuries and/or deaths.
INTRODUCTION
The term ‘non-technical skills’ was first applied to safety by the European civil aviation regulator in relation to airline pilots’ behaviour on the flight deck but is now used by a number of professions .
Non-technical skills can be defined as ‘ the cognitive, social, and personal resource skills that complement technical skills, and contribute to safe and efficient task performance.
NTS typically include situation awareness, decision-making, team work, leadership, and the management of stress and fatigue.
Safety & efficiency in any field of work is not just limited to possession of thorough academic knowledge & skilful application of the technical skills, but it also encompasses the basic human behaviour & attitude of individuals during the course of performance of their duties.
Deficiencies in non-technical skills can increase the chances of error, which in turn can increase the chances of an adverse event.
Detailed investigations of adverse health care events have shown that in almost 80% of the cases the underlying cause is poor application of NTS like poor communication, inadequate monitoring, failures to cross-check drugs and equipment.
Good non-technical skills (e.g. vigilance, anticipation, clear communication, team coordination) can reduce the likelihood of error and consequently of accidents
Two categories of NTS have been recognized:
1. Cognitive & Mental skills which include planning, decision making, situation awareness etc.
2. Social & Interpersonal skills like coordinated team work, leadership, communication etc.
The background, key features and main steps of the concise analysis method are described, discussed and applied in this module together with the main tools used during a concise analysis (timeline, guiding questions, constellation diagram, and statements of findings).
Developing well thought out, high leverage recommended actions, prioritizing, validating, and delegating them for implementation can result in fewer and more effective actions that can better help reduce the risk of recurrence and make care safer. During this module, the main steps in the development and management of recommended actions are discussed and applied to real life examples. Tools to support the process, like the hierarchy of effectiveness, heat map, tables, and the Larsen scale, will also be introduced.
Explaination of More Personal Safety program designed and delivered by Safety Culture Initiative for public use and filling gap of human resources risk management at nation state and company level.
First phase of MPS program is action "From Zero To Hero" delivered during Cybersecurity October to Poland and other countries in Polish and English language.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Introduction to Queensland Health’s Patient Handling Risk Assessment Tool (FURAT)
1. Introduction to Queensland
Health’s Patient Handling Risk
Assessment Tool
Facility/Unit Risk Assessment
Tool (FURAT)
Tony Johnston
Principal Health & Safety Adviser
Queensland Health
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
19. Regulations …
4.2 Hazardous Manual Tasks
PCBU 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. Risk Assessment Principles
Nature/Characteristics
of Load –pt profile
Work Area Tools & Equipment
- Design / Layout - PH aids
POSTURE
FORCE TIME
Work
Environment Work Organisation
-Eg lighting, - staffing & training
floor surfaces
Work Practices
& Systems –
- PH tasks performed
- Design of work procedures
23. Section 1
Facility/ Unit Description
• Persons completing risk assessment
• Work area Key contacts
• Communication arrangements
– District
– Division
– Ward
Facility Unit
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. Section 3
Environment
• Floor surface
• Access
• Space
• Overhead clearance
• Noise
• Lighting
• Temperature
• Other
26. Section 4
Equipment
• Includes equipment, aids and furniture
• SWL
• Quantity
– Existing
– Future needs
• Condition, maintenance arrangements
• Location/ access/ storage
• Meets needs?
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. 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. 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. 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. 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. 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
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. Elements of a Facility / Unit
PH Risk Assessment
Nature/Characteristics
of Load –pt profile
Work Area Tools & Equipment
- Design / Layout - PH aids
POSTURE
FORCE TIME
Work
Environment Work Organisation
-Eg lighting, - staffing & training
floor surfaces
Work Practices
& Systems –
- PH tasks performed
- Design of work procedures
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. 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. 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. 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. 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. 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. 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. 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. 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
Editor's Notes
A lot has happened over the last 10-15 years.
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