New and Improved VA Algorithms / New SPHM App! - PowerPoint Presentation

New and Improved VA Algorithms / New SPHM App! Marie Martin, PhDKurk A. Rogers, RN, BSN, CNOR, MBA (CDR, NC, USN [RET])With information from Mary W. Matz, MSPH, CPE, CSPHP

Objectives On completion of this training program, participants will be able to:Describe the rationale, history and evidence behind the VHA Safe Patient Handling algorithms.Recognize changes made in 2014 to the VHA Safe Patient Handling and Mobility algorithms.Describe how the VHA SPHM app can be used to help caregivers use VHA SPHM Algorithms and other SPHM resources.

Speaker Disclaimers The speakers and VA do not endorse any specific vendor or manufacturer of SPHM technology. The speakers have no financial relationships or interests with any commercial topics that are discussed in this activity. This activity includes no discussion of uses of FDA regulated drugs or medical devices which are experimental or off-label.

VHA Algorithms: History Mary Matz, MSPH, CPE, CSPHPPresident, Patient Care Ergonomics Solutions, LLCPatientCareErgo@TampaBay.rr.com(813) 245-0474Former VHA National Program Manager, Patient Care Ergonomics

VHA Algorithms: History Why were the Algorithms developed?Key SPHM Program Element included in original VA SPHM study (2001-2002)Knowledge Transfer mechanisms were critical

Creating a Culture of Safety in a Health Care Environment Management/Leadership Support Knowledge Transfer Support Structures Safe Patient Care Environment Staff Buy-In/Support

Knowledge Transfer Mechanisms Learning Before Peer Leaders Best Practices Safety Huddle/After Action Review Failure Mode & Effect Analysis (FMEA) Algorithms Learning After Accident Review Boards (ARB) Root Cause Analysis (RCA) Safety Investigations (OSHA) Educational Outreach Best Practices Systems Epidemiology After Action Review (AAR) Learning During Individual Imprinting Personal Experience Human Action

VHA Algorithms: History Role of Patient Assessment, Algorithms, & Care Plan for Safe Patient Handling & Movement Provided standardized method to determine how to handle, move, and mobilize patients Ensured patient handling techniques were based on individual patient characteristics/conditions Written care plan ensured accurate transfer of information staff to staff shift to shift

VHA Algorithms: History Patient AssessmentCompleted on all patients Included…Patient Characteristics Patient Medical Condition/s Algorithms Based on Specific Patient Characteristics (from Assessment) Assisted caregivers in selecting safest Equipment Advised # of staff needed

Ergonomic Algorithm 1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

VHA Algorithms: History The Assessment, Algorithms, & Care Plan went hand in hand... Assess the Patient Use Algorithms to determine equipment and # of staff needed for each high risk task Complete the Care Plan File/Save for future use

VHA Algorithms: History Who developed the Algorithms?Technical Advisory Group (TAG)Nursing Experts led by Dr. Audrey Nelson 5 healthcare facilities represented – VHA and non-VAVHA Office of Public Health and Environmental Hazards, VHA Patient Safety Center of Inquiry (Tampa, FL), and VHA Healthcare Analysis and Information Group

VHA Algorithms: History How were these Algorithms Developed? TAG developed an algorithm for each high risk patient handling task with technology controlsTested with different patient populations (med/ surg , ED, long term care, critical care, OR) Tested in a variety of healthcare facilities (5 VA and non-VA hospitals/LTC facilities)

VHA Algorithms: History Originally published in March 2001. Periodic minor revisions to reflect new evidence and best practices. Content to provide general direction; professional judgment is needed to assure safety of patients and caregivers.

VHA Algorithms: 2014 Changes Marie Martin, Ph.D.Veterans Health Administration, Occupational Health (10P4Z) Acting National Program Manager, Patient Care Ergonomics Industrial Hygienist (Safe Patient Handling and Mobility Facility Coordinator)VA North Texas Health Care System(I represent only my own opinions and not those of VA.)

Comprehensive Patient Assessments and Algorithms: Help you determine the mobility and independence of your patientAssess their ability to perform certain tasksChoose the safest patient handling methods and equipment that might be needed to assist the patient. You can assess your patient’s ability to perform multiple tasks or specific tasks by answering a series of questionsBased on your answers, the assessments’ algorithms will provide you with technology recommendations.

When Patient Assessment and Algorithms Should be UsedUse varies by clinical settings Evaluate on initial admission Re-evaluate in clinical areas where patients / residents maintain similar status for periods of time Re-evaluate monthly Re-evaluate when status changes /as needed Ex: long term care or SCI

When Patient Assessment and Algorithms Should be UsedUse varies by clinical settings Care Plan updates not feasible in some clinical settings where status changes quickly Attach algorithms to lifts for easy access Post algorithms in patient rooms

Why Change the Algorithms and Patient Assessment Ease of use: unifying standard and Bariatric algorithms Safety upgrades: clarification to avoid situations with fall riskResolution of conflict: number of caregivers in dispute (manufacturer instructions often allow 1 caregiver, but many organizations say 2)Increased focus on patient mobilization

Patient Assessment (changed to include all Algorithm questions) WeightWeight Bearing Capability (fully/ partial/ no)Balance (sitting/ standing/ none)Can patient raise and advance both feet ? Upper Extremity Strength (fully with both/ fully with one/ insufficient) Ability to grasp (fully with both/ fully with one/ insufficient )

Patient Assessment Patient’s level of cooperation and comprehension (Cooperative & follows simple instructions/ uncooperative, combative, or unpredictable)Can patient perform independent lateral transfers (bed/stretcher/table/trolley)? Can patient reposition independently in bed ? Can patient reposition independently in chair/wheelchair ? (yes/no/Partial)

Patient Assessment Can patient assist in lifting extremities and maintaining position?Can (bariatric) patient assist by providing access to abdominal area?Can (bariatric) patient assist by providing access to perineal area?

Patient Assessment Fall History: Any Yes answer denotes high risk for falls and need for fall protectionFall during current admission?Two or more falls within past year?Any fall in past year that resulted in an injury?Is patient worried or concerned about falling? Is patient at high risk for falls as indicated by fall screening tool? (> 45 on Morse Scale or other scale used?) None of the above are applicable to this patient.

Patient Assessment (questions only for those who have fallen)For those patients who have fallen, (specific for Fall/Recovery Algorithm): Was patient injured?Was injury minor? Can Patient get up without help ? Care Plan records SPHM technology, slings, and sizes.

List of 2014 Algorithms Algorithm 1: Transfer To/From Seated Positions: Bed to Chair, Chair to Chair, Chair to Exam TableAlgorithm 2: Lateral Transfer to/from Supine Positions: Bed, Stretcher, Trolley, Procedure TableAlgorithm 3: Repositioning in BedAlgorithm 4: Reposition in Chair: Wheelchair, Dependency Chair or Other Chair

List of 2014 Algorithms Algorithm 5: Transport in Bed/ Stretcher/ WheelchairAlgorithm 6: ToiletingAlgorithm 7: Showering and BathingAlgorithm 8: Floor/Fall RecoveryAlgorithm 9: Transfer between Vehicle and Wheelchair, Powered Wheelchair, or StretcherAlgorithm 10: Ambulation

List of 2014 Algorithms Algorithm 11: Patient Handling Task Requiring Lifting of ExtremitiesAlgorithm 12: Bariatric Patient Handling Task Requiring Access to Abdominal AreaAlgorithm 13: Bariatric Patient Handling Task Requiring Access to Perineal Area

We Seek More Input! To provide input into VHA algorithms, please contact Marie Martin:Marie.Martin2@va.gov214-857-2152

Other Methods Used in VHA NAON and AORN algorithms (linked from app)Bay Pines scoring method (0-4)6 questions, same as original criteria Add up scores and choose method accordinglyBMAT and related mobility scoresPatient demonstrates current level of mobility – no guessingReverse order from Bay PinesIncluded in new early and progressive mobility programs

New VHA SPHM App Kurk A. Rogers, RN, BSN, CNOR, MBA (CDR, NC, USN [RET])San Diego, CAFormer Safe Patient Handling and Mobility Facility Coordinator, San Diego VAMC

Safe Patient Handling Mobile Application Why should you use the SPHM App?The information in this app offers the current best practices in SPHM at the point of care, to help prevent injury and improve interactions between you and your patients.

Safe Patient Handling Mobile Application Provides evidence-based SPHM techniques to help provide the safest care possible to patients. Offers a blend of knowledge and tools to prevent injury of both health care professionals and the patients they care for, Incorporates: patient assessments scoring toolsalgorithmsequipment guides videos for training peer leader activity checklists.

Safe Patient Handling Mobile Application The advice within this app has been compiled by the VA but is intended for both Department of Veterans Affairs (VA) and non-VA care teams Intended for direct care providers including nurses, physical medicine and rehabilitation (PM&R) specialists and Imaging staff. Others are welcome to use this app based upon their specific governance approval. Use of this tool should be considered as guidance and not substituted for professional clinical judgment.

VA SPHM App Locations: Future download page: https://mobile.va.gov/app/safe-patient-handling Training: https://mobile.va.gov/training/safe-patient-handlingExpected to release for iOS first and for web and Android later

Questions?