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Ergonomics and Caregiver
Safety
Guy Fragala, PhD, CSP
Audrey Nelson, PhD, RN, FAAN
Rick Barker, MA, CPE
ERGONOMICS AND CAREGIVER
SAFETY
Issues Needing Attention
• High Rates of Nursing Back Injuries
• High Cost of Injuries
• Regulatory Pressures
• Need to Improve the Work Environment

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Size of Hospitals Included for Injury
Data Review

Number of Hospitals Hospital Bed Size

4 Hospitals 500 – 600 Beds

1 Hospital 450 Beds

2 Hospitals 150 – 200 Beds


2000 Strain/Sprain Injuries

Related to
Other 21.30%
Patient
Handling
68.70%
2001 Strain/Sprain Injuries

Related to Other
Patient 21.40%
Handling
68.6%
Ranking of Activities Causing
Strain/Sprain Injuries to Hospital
Workers
Activity Reported Injuries Percentage Rank
Repositioning Patient (Includes turning and lifting 153 17.9 1
patient up in bed)

Lifting Object 109 12.7 2

Lifting Patient (not further specified) 102 11.9 3

Transfer Bed/Chair 97 11.3 4

Transporting Patient (wheelchair/stretcher/bed) 94 11.0 5

Push/Pull Object 89 10.4 6

Aggressive Patient 70 8.2 7

Lateral Patient Transfer 49 5.7 8


OSHA and ERGONOMICS
The History
1986 - Pilot Program to Reduce Back
Injuries (NIOSH Lifting
Equation Program)
1992 – Advanced Notice of Proposed
Rulemaking
1995 – Draft Proposed Standard
1999 – Proposed Standard
2000 – Final Standard Issued
2001 – Repeal of Standard
2002 – Beverly Settlement
OSHA and ERGONOMICS
Current Situation
April 5, 2002 OSHA Four-Pronged Plan
July 15, 2002 National Emphasis Program
(Nursing Homes)
March 13, 2003 Final Healthcare
Nursing Home Guidelines
More in 2003 Regional Emphasis
Programs –
HOSPITALS
Emphasis Programs 9 out of 10 regions
JCAHO and WORKER SAFETY
EC1.1.1 “The Hospital Plans for Worker
Safety”
Intent:
3. General Safety Processes
4. Area Specific Safety
5. Specific Job-Related Hazards
6. Safety-Related Information through
Orientation and Continuing Education
JCAHO and PERFORMANCE
MONITORING

EC.4 “The Hospital Evaluates and


Improves Conditions in the
Environment”

EC.4.2 “The Hospital Analyzes Identified


Environment Issues and Develops
Recommendations for Resolving
Them”
ENVIRONMENT OF CARE
PERFORMANCE IMPORVEMENT
INITIATIVE

Intent of EC.4.2:
Based on the ongoing monitoring of
performance in each of the seven
management areas, recommendations for
one or more performance improvement
activities are communicated annually to
the hospital’s leaders.
The Practice of
Nursing
...Difficult and
Demanding
How can we make
improvements?
Ergonomic Assessments of Nursing
Practice Settings

• What has been done


• Focus on long-term care
• How does acute care differ
• What are the needs for acute care
Selecting Appropriate
Interventions

• A workable approach for long-term care

• Match preferred interventions with


dependency classifications
Dependency Status Key

ADL Self-Performance Codes


0 Independent
1 Supervision
2 Limited Assistance
3 Extensive Assistance
4 Total Dependence
Lift Aid Equipment Determination Grid
(recommended example)

Resident
Height Stand Assist Stand Assist Gait Belt with Friction
Dependency Full Sling Lift Lift Walker
Adjustable Bed Lift Aid Handles Reducing Aid
Classification

0 - Independent Recommended Never Rarely Rarely Rarely Rarely Rarely

Recommended Rarely Rarely


1 – Supervision Occasionally Occasionally Normally Occasionally

Strongly
2 – Limited Rarely
Recommended Normally Normally Normally Normally Normally
Assistance

3 – Extensive Rarely Rarely


Required Normally Normally Normally Always
Assistance

4 – Total Never Never Never Never


Required Always Always
Dependence

For a typical resident with the dependency status classification as shown, this grid indicates normal
equipment requirements to conduct a safe transfer. Some residents may have special characteristics
and not exactly match a typical profile. In those situations, special consideration will be required.
Directions for Acute Care

• Assessments driven by high-risk activity

• Identification of high risk activity based on


data analysis
The Task of Repositioning a Patient
in Bed
• Why is it a problem?
How Can We Approach this
Problem of Repositioning
• Trying to eliminate or minimize the need to
reposition
• Involving the patient in the repositioning
activity where possible, such as
application of retractable footboards
• Have assist devices in the mattress
surface
• The use of friction-reducing devices to
reposition the patient
Shearless Pivot
Retractable Footboard
Extended
Retractable Footboard
Used for Support
Turn Assist/Rotational Therapy
Examples of Some Other High Risk Activities
Encountered in Critical Care Units in Acute
Care Hospitals

• Lateral transfers
• Assist to standing position
• Bed egress and transfer
• Turning as opposed to repositioning
patient in bed
• Bed to chair transitioning
Lateral Transfer Aids

• Friction reducing lateral slide aids


– rigid boards
– flexible sheets
– rollers
– air assisted
• Mechanical lateral transfer aids
– hand cranks
– electric motor
Engineering Control Strategies
…the Preferred Control Method

• Eliminate the need to do the hazardous


activity
• Redesign the activity to reduce the hazard
• Utilize an aiding device to minimize the
hazard

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