Perioperative Setting Goal and Objectives Goal The purpose of this activity is to educate perioperative registered nurses RNs about manual patient lifting and movements that negatively affect the health of ID: 1045028
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1. Safe Patient Handling and Movement in the Perioperative Setting
2. Goal and ObjectivesGoalThe purpose of this activity is to educate perioperative registered nurses (RNs) about manual patient lifting and movements that negatively affect the health of surgical team members, to promote a safe perioperative work environment, and to protect perioperative team members. After completing this activity, the perioperative RN will be able to implement appropriate safe patient handling and movement practices to protect the health of surgical team members and patients.Objectives1. Identify high-risk nursing tasks performed in the perioperative setting. 2. Name at least three body parts that can be affected by musculoskeletal disorders (MSDs).3. Discuss the AORN Ergonomic Tools related to safe patient handling and perioperative team member safety. (Part ll)
3. Safe Patient Handling and Movement in the Perioperative SettingPart 1
4. OverviewIntroduction to Patient Care ErgonomicsBiomechanics of Patient Handling TasksFactors Contributing to Nursing InjuriesHigh-risk Nursing TasksErgonomics Guidelines for Safe Patient Handling and Movement (SPHM) Algorithms for SPHM using Technology Solutions (Part II)
5. History of Safe Patient Handling and Movement Research and Programs1994 Research Utilization: Nursing Back Injuries1995 Identified High-Risk Nursing Tasks on High-Risk Units1998 Funding for Biomechanics Research Laboratory 1998 Redesigned High-Risk Tasks1999 Design Evidence-Based Program 2001 Field Testing Program Elements with 700 Nurses2002 Patient Care Ergonomic Guide Published 2003 Occupational Safety and Health Administration (OSHA) Ergonomic Guideline; American Nurses Association (ANA) Initiative2009 OSHA revised its Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders as part of its four-pronged approach to decrease ergonomics-related injuries.
6. ANA surveyed nurses in 2011 Respondents expressed concerns about health and safety in their work environmentsA total of 4,614 nurses responded 2011 American Nurses Association(ANA) Health and Safety Survey
7. Acute/chronic effects of stress and overwork (74%)Disabling musculoskeletal injuries (62%)Contracting an infectious disease (43%) Top 3 Heath and Safety Concerns Identified by Nurses (ANA Survey)
8. AORN History Safe Patient Handling and Movement2005 AORN position statement “Safe Work/On-Call Practices”2006 AORN guidance statement “Safe Patient Handling and Movement in the Perioperative Setting”Approved by the AORN Board of Directors November 2006Published 2007Ergonomic Tool #3 was updated in 2011 Reformatted in September 2012 2009 AORN position statement “Key Components of a Healthy Perioperative Work Environment”
9. AORN Guidance Statement“Safe Patient Handling and Movement in the Perioperative Setting”Perioperative Standards and Recommended PracticesPrint VersionOnline Version
10. AdvocacySince 2003, state laws/rules/regulations addressing safe patient handling are inCalifornia, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington; Hawaii (resolution)
11. 2013H.R.2480 federal bill introduced - Nurse and Health Care Worker Protection Act of 2013OSHA and The Joint Commission renew alliance to protect safety and health of health care workersAmerican Nurses Association (ANA) released Safe Patient Handling and Mobility: Interprofessional National Standards
12. H.R.2480 Nurse and Health Care Worker(HCW) Protection Act of 2013Congress Findings:In 2011, RNs ranked #5 among all occupations for the number of cases of musculoskeletal disorders resulting in days away from work, with 11,880 total cases52% of nurses complain of chronic back pain and 38% complain of pain severe enough to require leave from work Patients are not at optimum levels of safety while being lifted, transferred, or repositioned manually Injuries among nursing staff and HCWs have dramatically declined at health care facilities that have implemented safe patient handling technology, equipment, devices, and practicesThe development of assistive patient handling technology, equipment, and devices has essentially rendered the act of strict manual patient handling outdated and typically unnecessary as a function of nursing care. H.R.2480 - Nurse and Health Care Worker Protection Act of 2013, 113th Congress (2013-2014)http://beta.congress.gov/bill/113th/house-bill/2480/text.
13. H.R.2480 Nurse and Health Care Worker Protection Act of 2013Congress Findings “Establishing a safe patient handling, mobility, and injury prevention standard for direct-care registered nurses and other health care workers is a critical component reasonably necessary for protecting the health and safety of nurses and other health care workers, addressing the nursing shortage, and increasing patient safety.” H.R.2480 - Nurse and Health Care Worker Protection Act of 2013, 113th Congress (2013-2014). http://beta.congress.gov/bill/113th/house-bill/2480/text accessed September 12, 2013
14. ANA Safe Patient Handling and Mobility: Interprofessional National StandardsEvidence based standardsFocus on improving patient outcomes and reducing healthcare workers’ musculoskeletal disorders
15. ANA Safe Patient Handling and Mobility: Interprofessional National Standards8 PrinciplesEstablishing a culture of safetyCreating a sustainable programIncorporating ergonomic design principlesDeveloping a technology planEducating and training health care workersAssessing patients to plan care for their individual needsSetting reasonable accommodations for employees’ return to work post-injuryImplementing a comprehensive evaluation system
16. Introduction to Patient Care Ergonomics
17. ErgonomicsThe science of fitting the demands of work to the anatomical, physiological, and psychological capabilities of the worker to enhance efficiency and well-being
18. “The adult human form is an awkward burden to lift or carry. Weighing 100 kg or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped.” The Nurses’ load. Lancet. 1965;286(7409):422-424. The Ergonomic Challenge
19. Overexertion resulting in sprains/strains to the back are the leading and most costly occupational health problem in the United StatesProviding Patient Care is High-risk
20. Aging workforce Staffing shortages Increasing patient acuity Increasing patient size/weightThe Need for Improving Caregiver Safety
21. Description of the Problem“Musculoskeletal disorder (MSD) cases (387,820) accounted for 33 percent of all injury and illness cases in 2011. Six occupations accounted for 26 percent of the MSD cases in 2011: nursing assistants; laborers; janitors and cleaners; heavy and tractor-trailer truck drivers; registered nurses; and stock clerks.” NONFATAL OCCUPATIONAL INJURIES AND ILLNESSES REQUIRING DAYS AWAY FROM WORK, 2011, News Release Bureau of Labor Statistics November 8, 2012 http://www.bls.gov/news.release/pdf/osh2.pdf. Accessed September 11, 2013.More than one-third of lost-time injuries were a result of back injuries
22. Personnel who experience pain and fatigue areLess productiveLess attentiveMore prone to consistently make mistakesMore susceptible to injuryMay be more likely to make mistakes that affect the health and safety of patients and coworkers
23. In an 8-hour shift, the cumulative weight that nurses lift is equal to 1.8 tons!!
24. Risk Factors affecting nursing staff:Overexertion due to lifting of excessive loads Cumulative effects of repeated patient-handling tasks Patient Care is High-risk
25. There is a high prevalence of back pain among nurses81% of nurses are affectedPrevalence of upper-body symptoms (24%-60%)Prevalence of lower-body symptoms (33%-72%)Patient Care is High-risk
26. Nurses under-report injuriesOnly one in three nurses with work-related back pain files an injury report with their employerSurveys of injured nurses12% consider leaving nursing profession due to back pain12% leave nursing permanently, of which back pain is cited as a main or contributing factorOne in 12 nurses who leave the profession cite back pain as the causeScope of the Problem
27. Trends Across Sectors(Injuries per 100 full-time workers)Source: Annual Survey of Occupational Injuries and Illnesses (BLS) *Baseline
28. Nursing/Health Care Support 132.1Nursing/Health Care Practitioners 46.4 Construction Industry 74.6Manufacturing/Production Industry 50.0Maintenance/Repair Industry 78.2 Bureau of Labor Statistics (BLS). 2008. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by selected worker characteristic, major occupational group, and selected natures of injury or illness,2008. http://www.bls.gov/news.release/osh2.t16.htm. Accessed February 8, 2010.2008 Injury Incident Rates (per 10,000 full time workers)
29. Nurses aides/orderlies and attendants 24,340 Registered Nurses 8,580 Licensed Practical and Vocational Nurses 2,880 Nursing TOTAL 35,800 Laborers/Freight-Stock-Materials Movers 27,040 Truck Drivers (Heavy/Tractor-Trailer) 16,470 Truck Drivers (Light-Delivery Services) 10,460 Construction/Laborers 6,950 Bureau of Labor Statistics. Industry Injury and Illness Data (2007).Tables. http://www.bls.gov/iif/oshwc/osh/case/ostb1942.pdf. Accessed October 15, 2013. Number of nonfatal injuries and illnesses involving musculoskeletal disorders with days away from work
30. “Nursing is ranked 2nd, after industrial work, for physical workload intensity.”“Nurses have approximately 30% more days off due to back pain as a percentage of all causes compared with the general population.”Lloyd JD: Cumulative trauma disorders of the upper extremities-Experiment report. Boston,MA: Liberty Mutual Insurance Co; 1991. Significance of the Problem
31. Components of Ergonomics
32. Components of ErgonomicsTo optimize system performance while maximizing human well-being and operational effectiveness, ergonomics embraces a range of human-centered issues relevant to equipment or systems design and training, including:Body size (anthropometry), motion, and strength capabilities (biomechanics)Sensory-motor capabilities—vision, hearing, haptics (force, touch), and dexterityCognitive processes and memory (including situational awareness)Training and current knowledge relating to equipment, systems, and practicesTraining and current knowledge of medical conditions (including emergency conditions).
33. Equipment that has not yet been developedEquipment that exists, but has not been purchasedEquipment that exists and has been purchased, but is not being usedGaps IdentifiedUsing Equipment for Safe Patient Handling and Moving
34. Translate what is known from other industries to health careIdentify what unique factors need to be added to ergonomic assessmentsInclude front-line staff members in assessment of hazardsLink solutions to risk assessmentGaps in Evidence: Ergonomic Assessment Protocols
35. Biomechanics of Patient-Handling Tasks
36. dForce = mass x accelerationSimple Biomechanical ModelWork = Force x distance -» Work is mass x acceleration x distance
37. Keep arms close to bodyTo Reduce Forces Acting on the Body
38. The force required to move the torsoThe force required to move the load“Lifting” Force Involves 2 Factors
39.
40. One of the main contributors to spinal loading and stress is excessive reaching across patients
41. Manual Lifting TechniquesUNSAFEIncreased risk for injury Manually lifting and moving a dependent patient create high loads on the spine, resulting in low back and shoulder painpatient
42. Factors Contributing to Nursing Injuries
43. Factors Affecting Injury Potential in the Workplace
44. What Are Musculoskeletal Disorders (MSDs)?Cumulative trauma disorders are those physiological illnesses which may develop over a period of weeks, months, or even years due prolonged mechanical stresses imposed on the musculoskeletal system, resulting in injuries recognized as physical ailments or abnormal conditionsLloyd JD: Cumulative trauma disorders of the upper extremities - Experiment report. Boston, MA: Liberty Mutual Insurance Co; 1991.
45. Occupational Safety and Health Definition of Musculoskeletal Disorders (MSDs)“(2011 and forward) musculoskeletal disorders (MSDs) include cases where the nature of the injury or illness is pinched nerve; herniated disc; meniscus tear; sprains, strains, tears; hernia (traumatic and nontraumatic); pain, swelling, and numbness; carpal or tarsal tunnel syndrome; Raynaud's syndrome or phenomenon; musculoskeletal system and connective tissue diseases and disorders, when the event or exposure leading to the injury or illness is overexertion and bodily reaction, unspecified; overexertion involving outside sources; repetitive motion involving microtasks; other and multiple exertions or bodily reactions; and rubbed, abraded, or jarred by vibration.” Occupational Safety and Health Definitions, Injuries, Illnesses, and Fatalities. Bureau of Labor Statistics, US Department of Labor. http://www.bls.gov/iif/oshdef.htm. Accessed September 11, 2013.
46. MSDs by Body Part: Extremities Forearms: Tendinitis Pronator Teres syndromeWrists: Carpal tunnel syndrome Ganglion cyst Nerve entrapment de Quervains Disease Degenerative joint diseaseHands and Fingers: Trigger digit Vibration syndrome TenosynovitisShoulders: Rotator cuff tendinitis Thoracic outlet Bursitis Bicipital tendinitisElbows: Epicondylitis Neuritis Cubital tunnel syndrome Olecranon BursitisKnees: SynovitisFeet/Ankles Tarsal tunnel syndrome
47. MSDs by Body Part: Neck and BackBack Disorders: Anulus Tear Chronic Degenerative Disc Disease Herniated Nucleus Pulposus, with or without neurological involvement Spondylolysis Spondylolisthesis Osteoarthritis Facet Arthropathy - Arthritis Scoliosis Spinal Stenosis Iatrogenic Back Pain Back Strain Rheumatoid ArthritisNeck: Cervical root syndrome Tension neck syndrome
48. Remember to Balance…WorkDemandsWorkerCapacity
49. High-risk Nursing Tasks in the Perioperative Environment
50. Example 1: Repositioning Patient on OR BedRisk Factors Back – posture, forces Shoulder – high load Elbow – high loadInterventions Patient-lifting equipment Friction-reducing device
51. Example 2: Transfer to OR BedRisk Factors Back – posture, force Shoulder – high load Elbow – high loadInterventions Patient-lifting device Lateral-transfer device Friction-reducing device
52. Defining High-risk Tasks Heavy loadsSustained awkward positionsBending and twistingReachingFatigue or stressForceStanding for long periods
53. High-risk Tasks: Operating Room Holding retractors for long periods of timeLifting and holding patients’ extremitiesReaching, lifting and moving equipmentRepositioning patients on OR bedsStanding for long periods of timeTransferring patients on and off OR beds
54. Ergonomic Guidelines for Safe Patient Handling and Movement
55. NIOSH Recommended Weight Limit (RWL) RWL = LC x HM x VM x DM x AM x FM x CM
56. NIOSH Lifting Equation Applied to Patient Handling ActivitiesPatients:are asymmetric and bulkycan’t be held close to the bodyhave no handlesPatient assistance variesPatient handling tasks are unpredictable
57. Recommended Weight Limits for Manual Materials Handling and Patient Handling ActivitiesThe NIOSH Lifting LimitsManual materials handling for an ideal lift maximum recommended weight = 51 lbPatient/Resident handling lifting limit recommendation = 35 lb
58. .Place holder for Kurt’s drawing o slips, trips and falls
59. SummaryMusculoskeletal disorders and the risk of injury affect both the health care worker and the patientUse technology for safe patient handling and movementReliance on body mechanics is not safe and does not prevent MSDsEquipment and programs are cost effective
60. “It takes an average of 17 years for new knowledge generated by randomized controlled trails (RCT) to be incorporated into practice, and even then, the application is highly uneven.”Balas EA, Boren SA. Managing clinical knowledge for healthcare improvement. In: Yearbook of Medical Informatics. Bethesda, MD: National Library of Medicine;2000:65-70.Expected Speed of Implementation
61. Please continue to Part II slide show: AlgorithmsEnd of Part I