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					          Safe Patient
Handling & Movement (SPH&M)
at the VA San Diego Healthcare
            System




Kathleen L. Dunn, MS, RN, CRRN-A, CNS
  Where we were in 2000
 Most patient movement was
  being done manually.
 Some areas had 1 mobile lift,
  which was rarely used.
 Nurse injuries were frequent &
  costly.
 SCI had highest nurse injury
  rate in the entire hospital.
Transfers such as “quad” pivots, 2-person lifts,
  and 2 person “sheet pulls” were common.



 Quad Pivot




       Sheet Pull
                                 2-person lift
Where we were in 2000
     Traditional body
      mechanics training was
      included in orientation
      and reviewed annually.
     Those injured were
      required to repeat this
      training.
    February-April 2001
 VASDHS staff attended VISN 8 Safe
  Patient Handling & Movement
  Conference.
 We saw the light!
 Solicited support for
  program within Nursing
  Service
 Presented to PIC &
  approved for PIT
  chartering.
  Costs of Injuries: FY02 VASDHS
 30 nurse injuries associated with
  patient handling and movement tasks
 17 occurred on the Spinal Cord Injury
  Center resulting in $162,815.53 in
  charge back (direct) costs.
 With indirect costs being 4-10X that of
  direct, it is estimated that in FY02, the
  SCI unit had over $650,000.00 in costs
  related to nurse injuries caused by
  patient handling and movement.
   Fall 2001-Summer 2002
• Banned manual lifting (2 person
  lifts & “quad pivots”) on SCI unit.
• Established SPH&M committee.
• Collected pre-project baseline data.
• Planned and held 2 equipment fairs.
• Trial install of 4 ceiling track lift
  systems in SCI over 2 months.
SCI Patient Room
Battery Charge
position


                                  SCI Inpatient
                 Auto return to
                 preset height.       Room

                                   Single-track
                                  ceiling lift for
                                    two beds
                                  in one room.
           Sling hook on
           bedside cabinet
SCI Inpatient
    Room

 Patients are
issued a sling
 at admission
that stays on
their bedside
 closet hook.
Privacy Curtain Modifications
    Curtains split & Velcroed
SCI Clinic
SCI clinic exam room
SCI Therapy
   Gym

 Single-track
ceiling lift over
 P.T. parallel
      bars.
 Scales allow
measurement
 of % weight
    bearing.
  Use of
  Ceiling
 Track Lift
    for
Suspended
   Gait
 Training
Transverse-track ceiling lift over therapy mat
  Cost Savings: Phase 1
 $150,000 spent for Phase 1
  (SCI) ceiling track lift
  installation in October 2002.
 October 2002-March 2003:
   Zero (0) SCI nurse injuries
    related to transfers or lifting.
   1 SCI nurse injury related to
    patient turning.
   Estimated costs savings:
    $600,000 for Phase I pilot
                     Nursing Injuries r/t Patient Handling &
                                   Movement
                                         SCI        All Nursing        Percentage
          12                                                                                    60.0

          10             50.0                        50.0         11                            50.0

                8                    40.0                                       9               40.0
# of Injuries




                         8




                                                                                                       %
                6                                                                               30.0
                                                    6                                     6
                4                    5                             18.2                         20.0
                     4
                2                               3                               11.1            10.0
                                 2                            2
                                                                            1           0 0.0
                0                                                                             0.0
                    2002Q1      2002Q2         2002Q3       2002Q4        2003Q1       2003Q2
    June-July 2003
 Presentation of Phase 2.
  proposal to Status of
  Funds
 Approximately $600,000
  for equipment approved
  for Phase 2.
 October-December 2003
 Installation of Phase II
  Partial ceiling track lifts on
   all inpatient units.
  New mobile lifts obtained for
   most areas.
 “No-Lift” (SPH&M) Nursing
  & PCS Services Policy
  approved.
 Staff Education & Training.
               Strategies
Develop “Champions” for culture
  change.
 VASDHS – PINs
  (Preventing Injuries Now facilitators).
  Includes non-nursing staff as well.
 Credible peer leaders.
 Ongoing hazard identification.
 Train-the-trainers.
 Implement algorithms in all
                                  PIN
  units/areas.
                      Caregiver assistance

Ability
                      not needed;Stand by            Sample
            Full      for safety as needed
to bear
weight
                                                    Algorithm
            Partial

                              Is the                  Use ceiling lift or
 No                          patient         Yes   portable floor lift with
                           cooperativ              full body sling and at
                                e?                  least one care giver.

                                    No
 Is the
patient
cooper     No          Use full body sling
ative?                      lift and 2

                                             Transfer to and
                          caregivers.


  Yes                                        from:
                                             * Bed to Chair
                                             * Chair to Toilet
Does the
 patient
                      No                     * Chair to Chair or
have UE
strength                                     * Car to Chair
    ?
Other Examples
       of
Re-Engineering
    at the
   VASDHS
ICU Ceiling Track Lifts
Wall Mounted System in Med-Surg areas
Dialysis Ceiling Track Lifts
Radiology Ceiling Track Lifts
Morgue Lift
     Where are we now?
ALL OF VASDHS –
• Complete total patient room
  ceiling track install: Spring 2007.
• Radiology, MRI, cardiac lab, and
  Morgue re-engineered.
• Rarely-used equipment bank
  (Escort).
• Increased compliance and skill in
  use of algorithms.
   Where are we now?
 Before: averaged 40+ injuries a year
  due to patient handling and
  movement.
 Now: average 20 injuries a year with
  just partial implementation of the
  program.
 Costs: approx. $950,000 spent on
  equipment and re-engineering.
 Cost Savings: $2.8 million (direct
  and indirect)
     Where are we now?
 Policy is now applicable to all
  direct patient care staff (not just
  nursing staff) as an MCM (3/06).
   List of banned manual handling
    tasks
   Universal requirement to use
    SPH&M techniques and equipment.
   Staff, supervisor and administrative
    responsibilities detailed.
     Where are we now?
 Radiology, Rehab Medicine, and
  other services represented on
  Committee, which now reports to
  Process Improvement Council
  (PIC).
 On-going education & monitoring.
 Plans to have input on all patient
  care equipment purchases from
  ergonomic stand-point.
    Where are we now?
 VA National Directive mandating
  SPH&M is expected this summer.
 Additional $336,000 received as
  VACO grant for projects through
  FY ’08
 SPH&M Facility Champion
  position will be implemented by
  start of FY ’09.
      VASDHS Safe Patient Handling &
                Movement MCM
•   Defines responsibilities at all levels.
•   Applies to all clinical staff.
•   Lists banned patient/equipment
    handling & movement activities.
•   Defines possible consequences for
    staff failure to follow this policy &
    these rules.
•   Contains decision making algorithms.
Thank You
 for Your
Attention!

				
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