Marie Martin PhD Kurk 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 ID: 723837
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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, CSPHPSlide2
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. Slide3
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. Slide4
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 Slide5
VHA Algorithms: History
Why were the Algorithms developed?Key SPHM Program Element included in original VA SPHM study (2001-2002)Knowledge Transfer mechanisms were criticalSlide6
Creating
a Culture of Safety in a Health Care Environment
Management/Leadership Support
Knowledge Transfer Support Structures
Safe Patient Care Environment
Staff Buy-In/SupportSlide7
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 ActionSlide8
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 shiftSlide9
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 Slide10
Ergonomic Algorithm
1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair
Slide11
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 useSlide12
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
GroupSlide13
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)Slide14
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. Slide15
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.)Slide16
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. Slide17
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 Slide18
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 roomsSlide19
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 mobilizationSlide20
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
)Slide21
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)Slide22
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?Slide23
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.Slide24
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.Slide25
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 ChairSlide26
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: AmbulationSlide27
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 AreaSlide28Slide29Slide30Slide31Slide32Slide33Slide34Slide35Slide36Slide37Slide38Slide39Slide40Slide41Slide42Slide43Slide44Slide45Slide46Slide47Slide48Slide49Slide50Slide51Slide52Slide53Slide54
We Seek More Input!
To provide input into VHA algorithms, please contact Marie Martin:Marie.Martin2@va.gov214-857-2152Slide55
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 programsSlide56
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 VAMCSlide57
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.Slide58
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.Slide59
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.Slide60
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 laterSlide61Slide62Slide63Slide64Slide65Slide66Slide67Slide68Slide69Slide70Slide71Slide72Slide73Slide74Slide75Slide76Slide77Slide78Slide79Slide80Slide81Slide82Slide83Slide84Slide85Slide86Slide87Slide88Slide89Slide90Slide91Slide92Slide93Slide94Slide95Slide96Slide97Slide98Slide99Slide100Slide101Slide102Slide103Slide104
Questions?