SAFE PATIENT HANDLING

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					SAFE PATIENT HANDLING IN
 WASHINGTON HOSPITALS

Your guide to a safer healthcare environment
 On the phone…




Chris    Dan          Lynn        Barbara       Brenda
Barton   Donahue      LaSalle     Silverstein   Suiter
SEIU     Providence   MultiCare   Department    Washington
1199NW   St. Peter    Health      of Labor &    State
         Hospital     System      Industries    Hospital
                                                Association
          Credo

 “Patients should not be
harmed by the care that is
intended to help them, nor
should harm come to those
 who work in health care”

         Crossing the Quality Chasm, 2001
                    Agenda

   Safe Patient Handling Law Background
   Safe Patient Handling Website
   Law Timelines
   Equipment requirements and funding
   Questions
     Safe Patient Handling Legislation

   Governor Gregoire signed Engrossed
    Substitute House bill 1672 on March 22,
    2006
   Bill became law on June 21, 2006
   Legislation makes safe patient handling
    part of how hospitals provide care by
    adding this requirement to DOH hospital
    licensing requirements
                Background

The law was supported by:
   Service Employees International Union
    Local 1199NW
   United Food & Commercial Workers’
    Union
   Washington State Hospital Association
   Washington State Nurses Association
         Why was the law enacted?

   To improve the safety of healthcare
    employees and patients
   Provide funding to hospitals implementing
    safe patient handling programs
   To improve nurse retention
   To reduce costs to hospitals
                  We Know…

 Nurses lift an estimated 2
      tons per shift

       Do the math:
Number of patients/day
Number of lifts/patient
Average weight/patient

4 X 6 X 170 = 4,080lbs/day
                 We know…

   38% of nurses suffer work-related back
    injuries requiring time away from work
   12% of nurses consider leaving nursing due
    to low back pain at average age 39
   Nurse aides have also experienced
    significant injury
                “Zero-Lift” Program

   Lifting programs have been proven to be
    effective. WHS’s Workers’ Compensation
    “Zero Lift Program” has experienced
    remarkable success:
       Patient Handling injuries had decreased by 43%
       Time loss frequency rates had decreased by 50%
              Safe Patient Handling
               Steering Committee
   Collaboration developed to provide tools and
    models that will help hospitals implement safe
    patient handling programs.
       Healthcare Unions
       Department of Labor & Industries
       Physical and Occupational Therapists
       Employee Health Managers
       Urban and Rural Hospital Administrators
       Washington State Hospital Association
       Washington Hospital Services’ Workers’
        Compensation Program
                Law Timelines

   February 1, 2007 – establish safe patient
    handling committee
   December 1, 2007 – implement safe patient
    handling program
   January 30, 2010 – acquire lifting
    equipment



                        Enforced by the Department of Health
Poll Question
Flow Chart
       February 1, 2007


 Establish a safe patient handling
committee with at least half of the
 committee being direct care staff
          Establishing a Committee

   Recruit Participants (50% direct care
    staff)
   Elect committee chair and co-chair
   Develop meeting schedule and
    protocols

    The primary responsibility of the committee is to
    establish, implement and monitor the Safe Patient
    Handling Program.
       Labor Management


The Steering Committee recommends
 union involvement in committee
 development and decision making
Poll Question
   December 1, 2007



     Establish a safe
patient handling program
             Safe Patient Handling
                   Program

     Safe patient handling program shall include and
     hospitals must:
1.   Implement a safe patient handling policy
2.   Conduct a safe patient handling hazard
     assessment
3.   Develop a process to identify the appropriate use
     of the safe patient handling policy based on
     patient needs and availability of equipment
4.   Conduct an annual performance evaluation
5.   Consider the feasibility of incorporating
     equipment when constructing or remodeling a
     hospital
        Establishing a Safe
     Patient Handling Program
1. Implement a safe patient handling policy for
   all shifts and units of the hospital

It is recommended your safe patient handling
     committee draft a policy together

2. Conduct patient handling hazard assessment.
   Include variables such as patient handling
   tasks, types of nursing units, patient
   populations, and the physical environment
          Establishing a Safe
       Patient Handling Program
3. Facilitate the development of standards
   for assessing each patient and their
   activities
  A. Get input for department staff
  B. Include how to document and share
     information across shifts and departments
  C. Consider using algorithms
           Establishing a Safe
        Patient Handling Program
4. Conduct an annual performance
   evaluation of the program to determine its
   effectiveness-report results to your safe
   patient handling committee
5. When developing architectural plans,
   consider the feasibility of incorporating
   patient handling equipment into the
   design
    What Makes a Successful Program?

Analyze what works already in your hospital:
   Existing practices
   Attitudes about change
   Administration’s support
   Organizational culture
   Barriers to change
   Current patient flow
          Know Current Practices

   Department practices and techniques
    already used for handling their patient
    population
   Who is influential in each department
    the leaders of co-workers
           Educate Your Hospital

   Committee members to their role on the
    team, empower them to do their work
   Management - for staffing, so team
    members can attend meetings and do their
    work
   Keep the committee informed of their
    accomplishments so they feel successful
         Campaign – Build Momentum

   Use every modality possible to share what
    is being planned and implemented:
       Recruit an Administration sponsor who will
        speak directly to the care givers
       Design in accountability of managers,
        supervisors, charge nurses, house supervisors
        and direct care givers; to know when the team
        meetings occur, who the members are,
        department’s need for equipment, what
        systems and techniques will change, processes
        for acquiring what they need, etc.
Inform Your Patients, Families, and Visitors

    Advertise in brochures, newsletters,
     hospital bulletin boards
    Create expectations
    Make the work of the committee public,
     positive and rewarding



  Please visit website to view a sample marketing materials
Individual Patient Assessment
         Risk & Needs Assessment

   Measures to eliminate or reduce
    patient handling risks must be
    identified
     Conduct an analysis of injuries
     Identify and prioritize patient handling
      risks
     Assess patient mobility needs

     Conduct an inventory of patient handling
      equipment
     Identify environmental and system barriers
         Learn From Your Mistakes

    Conduct annual performance evaluations
    of the:
   System’s policy
   Committee’s work
   Program effect on injuries & falls
   Equipment Use
Annual Performance Evaluation
             Change Can Be Hard

    Have activities with rewards for individual
    care givers and departments:
   Informal brown-bag lunches
   Departments can compete against each
    other
       Rodeos
            A Successful Program

   Adheres to the requirements of the law
   Meets all deadlines
   Uses the available tools
   Involves your safe patient handling team in
    decision making
   Shares experiences, ask questions
Washington Regulatory Requirements1

   When developing architectural plans for
    constructing or remodeling a hospital or
    unit, the hospital must consider the
    feasibility of incorporating patient handling
    equipment or design needed to incorporate
    equipment later.


1RCW 70.41.390
             Before The Blue Prints

   Get all levels of staff
    involved
   Think about all possible
    scenarios
   Place real users in a mock
    up of the design concept
    and simulate simulation
   Full scale simulation with
    props or3-D computer
    simulations
              Working Space Transfer to Bed
                    (Add 12” all around the bed for bariatric patient)



    Transfer bed /wheel
     chair or bed to
     stretcher: 1500 mm 5’
    Transfer with floor lift
     or bed/geriatric chair
     1800 mm 6’ (ceiling
     lift saves 12”)
    Space for care giver
     and rest chair 100 mm
     39”
    Door room width
     1220 mm (48”) for
     bariatric patient
    *Adapted from Jocelyn Villeneuve,
    Design for Safe Patient Handling
           Single Bed/Bath Room Layout

   Total Space ~180 sq ft
   Side nearest the door 6’
    for a transfer involving
    floor device add 12” for
    bariatric
   Window side 47”
   Foot of Bed 47”
   Bed faces the door
    privacy maintained
    with curtain, better
    observation and transfer
    (working) space
   Door width 1220 mm
    (48”) for bariatric patient
Bathroom Space

           Make sure equipment,
           staff and patient can fit in
           space.
         • 36” door
         • 24” minimum clearance on
           each side of toilet
         • Retractable bars attached
           to wall for client transfers
           assisted by 1-2 care givers
         • Wheel Chair rotation 5’
           diameter
         • Toilet weight tolerance
           needs to be 600+ lbs
                 January 1, 2008

   A hospital shall develop procedures for hospital
    employees to refuse to perform or be involved in
    patient handling or movement that the hospital
    employee believes in good faith will expose a
    patient or a hospital employee to an unacceptable
    risk of injury.
   A hospital employee who in good faith follows
    the procedure developed by the hospital in
    accordance with this subsection shall not be the
    subject of disciplinary action by the hospital for
    the refusal to perform or be involved in the
    patient handling or movement.
               Employee Rights

   Hospitals MUST develop procedures for
    employees to refuse to perform or be involved
    in patient handling or movement task that the
    employee believes “in good faith” will expose
    a patient or employee to an unacceptable risk
    of injury

Please visit website to view a model policy
http://www.washingtonsafepatienthandling.org/image
  s/Refusal_final.pdf
                  January 30, 2010

   Each hospital must complete, at a
    minimum, acquisition of their choice of:
       One readily available lift per acute care unit on
        the same floor unless the safe patient handling
        committee determines a lift is unnecessary in
        the unit;
       One lift for every ten acute care available
        inpatient beds; or
       Equipment for use by lift teams
   Hospitals must train staff on policies,
    equipment, and devices at least annually
              January 30, 2010

   Acquire equipment using your hazard
    assessment, injury data and with the input
    of the hospital’s safe patient handling
    committee
             Acquire Equipment

   Step 1: Establish a safe patient handling
    committee (50% direct care staff)
   Step 2: Train the safe patient handling
    committee
   Step 3: Write your Safe Patient Handling
    Policy
   Step 4: Assess the risks and needs for each
    unit in your hospital
   Step 5: Plan for the purchase of equipment
             Our “Challenge” Is:
Getting the Equipment & Changing Practice…

  Getting from manual      To safe patient
       handling…             handling…
        Where is High Injury Risk Exposure?

Inpatient Rooms*
(+ OR, PACU, Rehab)

   Repositioning
       Move up, roll, clean
   Transferring
       Bathroom/Commode
       Walking
       Bed to Gurney
     Bed to Chair
                                           Example of continuous track
                                           from patient room to bathroom
*Biomechanical Evidence… William Marras,
PhD, CPE
                   Where to put track…

   Committee Decision – Need/Data Driven
       CCU-Tele-Neuro-Med/Renal-Rehab
   Remodel Driven
       Or combo data/remodel, needs to be cleared
        w/committee
   “Track” As Many Rooms As Possible*
       Fixed Lifts – view rooms, plus as follows…
          Isolation Rooms

          CCU

          Known heavy low mobile patient care areas

       Portables (475 lb capacity) 1 per 5 rooms
          Use until you have budget for fixed lifts

    *Tampa General Model
    Patient Transfer Devices
    Floor lifts/Bariatric Room Set-up
       From floor, chair, bed, also sit to stand
        & walking
    Slider Transfer Sheets
       Lateral and horizontal transfer
    Ceiling Lifts
       Repositioning, floor to bed, bed to chair
    Beds
       Chair posit., flexi-foot, Trendelenburg
    Transport devices
       Zoom stretcher, bariatric stretcher,
        “Ergo-tug”
This is a cut out of our transfer device locator
                 Ceiling Lifts




                 Portable lift on gantry
                  (xy) configuration       Repositioning is easy




Pam working
with training
dummy and          Seated universal
 ceiling lift.                                 Full body
                        sling              repositioning sling
         December 30, 2010

A hospital may take a credit for the cost
   of purchasing mechanical lifting
 devices and other equipment that are
  primarily used to minimize patient
  handling by health care providers,
consistent with a safe patient handling
program developed and implemented
            by the hospital
                   B&O Tax Credit

   All hospitals qualify for the B&O Tax
    Credit
   Hospitals can receive up to $1000 per acute
    care available inpatient bed
   The number of acute care available
    inpatient beds in each hospital is based on
    the year-end financial reports submitted to
    the Department of Health
    Form can be downloaded at:
    http://www.washingtonsafepatienthandling.org/images/B_O_tax_
    form.pdf
Poll Question
The Patient Handling Bible
                In Summary

   Use hazard assessment, injury data and
    committee to make equipment
    acquisitions
   Equipment: key points
   Engage your facilities staff & give
    ergonomic input for construction remodel
    design
   Think BIG and spend lots!
                             Thank you
Service Employees           Washington State Nurses    Regional Hospital
International Union Local   Association
1199NW

Regional Hospital for       Valley Medical Center      Multicare
Respiratory and Complex
Care

St. Mary Medical Center     Valley General Hospital    United Food & Commercial
                                                       Workers Union Local 21


Harrison Medical Center     Kittitas Valley Hospital   United Food & Commercial
                                                       Workers Union Local 141


Providence St. Peter        Empire Health Services     Department of Labor &
Hospital                                               Industries

Washington State Hospital   Swedish Medical Center     WHS Workers’
Association                                            Compensation Program
                      Thank you




Chris    Dan           Lynn        Barbara       Brenda
Barton   Donahue       LaSalle     Silverstein   Suiter
SEIU     Providence    MultiCare   Department    Washington
1199NW   St. Peter     Health      of Labor &    State
         Hospital      System      Industries    Hospital
                                                 Association
Questions
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