Expert Safety Tips

More safety tips from Sue Unger, OTR/L. For further information, contact Medcare or email Sue at safety@medcarelifts.com
Click on a heading or scroll down for the section you want.

STEPS TOWARDS A ZERO LIFT POLICY

Here I’d like to discuss ways that a facility can go about implementing a zero lift policy. In my opinion, the first step is to get commitment from upper management. Once management has been educated and bought in to the idea of reducing staff injuries a formal policy must be developed. In order to do this, an injury prevention committee should be formed. In most health care facilities safety or risk management individuals are already identified and should be on the committee. Other committee members should include director of nursing, facility CEO/administrator, nursing department supervisors and front line health care workers whom are interested in workplace safety. If there are union leaders they should be involved in the committee also.

A key component to include when developing the zero lift policy is that staff will be expected to use the safest work techniques. Workers who perform hazardous or unsafe patient handling should be formally disciplined and the policy should reflect the plan for how to do this. In other words, workers must know that they will be held accountable for their choices in individual work practices.

The next step is to formally educate the health care workers at the facility. Educate, re-educate and review the impact of the education. Family members need to be educated about the new policy too. Finally, it is important to inform the patients. Solicit and use input from both patients and staff. This can be very useful as they will be the beneficiaries of this policy and advocates for using the equipment. They need to see how equipment will be utilized for their protection and safety. Demonstration and practice sessions with patients, staff and family members will help to promote the new policies and procedures. Invoking patient and staff input on equipment and safe lifting/moving procedures will help to get the program off to the right start!

Training staff is the next step. Practice and demonstration (on patients and staff on each other) are crucial to this step. When training personnel, be sure to include supervisors and administration. In addition, it may be a good idea to develop “super trainers”. These are individuals who are very familiar with the equipment and can do specialized training to others in the facility. Sometimes this is called a train the trainer program and has been found to be very successful in implementing successful program changes.

Health care facilities need to develop written competencies for the equipment that will be utilized in moving patients. Staff should have to demonstrate a certain level of competency. At least annually staff need to be re-evaluated in order to show that they are correctly using the safest procedures with the equipment in patient transfer and handling situations. In other words, train, retrain and then train again.

Lastly, develop a system for training new and or temporary staff. They will need to be educated and trained as much as the regular staff.

November, 2007

FRICTION-REDUCING DEVICES

Now I would like to discuss the use of friction reducing devices with patients.

Medcare’s friction reducing device options are:

Each of these products has a variety of uses. What makes them special is that they actually make the patient move easier over the material. Because of how they are constructed they are able to reduce the friction of a patient moving over a bed, chair, gurney, etc. When they are utilized with patients/residents caregivers reduce their risk of injury. Studies have shown that they can reduce the push/pull force by about 30-60% depending on the type of device. They are especially useful in bed to cart/gurney transfers or boosting a patient up in bed or chair. Those patients who are prone to bed sores or skin break down (ulcers) benefit by being moved with less skin shear.

Caregivers reduce their risk of back injury and other injury because the patient’s/resident’s weight actually feels lighter and moves with less “friction” that in traditional transfers.

One thing that is unique about the MedCare One-Way-Glide is that they can be kept under the patient rather than removing them right after each use. This also helps to reduce caregiver injuries as the  patient isn’t handled as frequently. Also, the Medcare One-Way-Glide has 2 chair size sheets that will help to keep wheelchair or chair individuals in a more upright seated position. Certain individuals tend to slide down and then the caregiver would have to pull the patient/resident from the back of the chair or wheelchair to prevent them from sliding out of the chair seat.

Medcare’s newest device is the MedSheet/MedsSheet Tube.  It is great for boosting patients up in bed. It has handles for the health care staff to hang onto when moving the patient or resident up in bed. It does have to be removed after the boost is completed.

Here are some tips to use it safely:

October, 2007

BACK MAINTENANCE

Recently, there was a collapse of the I-35W bridge in Minneapolis. There is much speculation as to the cause, but so far, it is clear that the Minnesota Department of Transportation knew the bridge needed maintenance and that performing the maintenance would have inconvenienced a lot of drivers. We heard about the difficulties of examining the underneath supporting structure of the bridge how difficult this process is. We learned that there are more than 70,000 other bridges in the U.S. that are in the same or worse “rating” as was the I-35W bridge.

This got me to thinking about our body and the spine one of our main “supporting structures”. While, we are not a bridge, certainly most of us know our bodies need maintenance (exercise) and yet we do not perform it on a regular basis. This month, I would like to do some education about your spine and how and why each of us does not know how close we are to a disc bulge or herniation.

Our spine is made up of bone called “vertebrae”, and “discs” which allow for the flexibility we have in our backs. Discs are spaced between every vertebrae and act as shock absorbers so that we do not have bone rubbing against bone. “Ligaments” are tough, non-elastic bands that run along the outside of the vertebrae and discs and hold them together. The vertebral bones provide the structural support for our backs. Each vertebra is formed or designed differently by the “facet joint”. “Nerve roots” exit from the facet joints. Nerves are what carry the message of pain to your brain and help to provide the energy to make our muscles work. The facet joint controls the amount and direction of movement in your spine. For example, in your neck the facet joint allow for 90 degrees of rotation in each direction. This is why you can turn your head both right and left. Each segment of spine/facet joint from the neck on down gets less and less rotation. Many of you have experienced “sciatic nerve pain”. This segment of spine is called L4/L5 (lumbar vertebrae 4 and 5). The sciatic nerve exits at L4/L5. At L4-L5 we only have 1-2 degrees of rotation. This is why experts say that loaded rotation (twisting with a weight in our hands) is one of the worst things that we can do for our backs.

Health care workers do “loaded rotation” when moving a patient from bed to chair with a transfer belt. To avoid twisting, you’ve no doubt learned that you should pivot with your feet. Pivoting puts less pressure on your L4-L5. When pushing the Medcare Lift and Care Stand, learn how to do it correctly so that you are not twisting your back or doing loaded rotation. When a patient is in the Lift and Care Stand, do not push from the back rather, pivot the machine from its front casters. Align your body at the side of the machine (rather than in the back) and push from the side of the handles. This will allow you to keep correct spinal alignment.

How far are you from getting a bulged or herniated disc? The fact is, about 50% of us have stage 3 bulging in our L4-L5 disc and have no pain. How can this be? Remember, I stated that nerves carry the message of “I’m in pain” to your brain. Well, there are no nerve endings inside discs. They are all on the outsides of the disc.

As with the I-35W bridge it was difficult to see what was happening to the internal support structure of the bridge. The only way to actually see what is going on inside our discs is to have a MRI or CT scan. Doing this would allow us to look “inside the disc” and see if there is any bulging going on.

A stage 4 disc bulge is enough to touch the nerve root and you will feel pain. Stage 5 is a ruptured or herniated disc. How does bulging in a disc occur? Forward bending from the waist and twisting (loaded or unloaded rotation) motions are the #1 and #2 causes. Doing about 8 back bends a day or extending the back backwards will decrease your risk of having a bulging or herniated disc by about 50%. This will also help to correct a stage 1-5 disc bulge and help alleviate pain from a bulging or herniated disc.

LEARNING FROM AN INJURY

One of Medcare’s goals is to reduce injuries to both healthcare workers and the patients/residents they serve. This month, I would like to focus more on these two points. First, I will share some statistics related to injuries suffered by health care workers in nursing homes while lifting residents. Second, I would like to briefly discuss a process for learning from an injury when one does occur (to either staff or resident).

  1. Bureau of Labor statistics from 2003 indicate that there are 211,000 occupational injuries suffered by healthcare workers.
  2. Injuries to healthcare workers are projected to increase by 25% between 2002 and 2012.
  3. Research (by Nelson et al., 2003) has shown that nurses rank lifting equipment as the most important element of a safe lifting program.
  4. Safe resident lifting programs:
    • Reduce resident-handling work comp injury rates by 61%.
    • Decrease lost workday injury rates by 66%.
    • Decrease restricted workdays by 38%.

Once an injury occurs, it is important to develop a plan to investigate the W’s (Who, What, Where, When and Why). After Action Reviews (AAR) is a process that can be implemented to investigate and assist staff in learning when an injury or near miss occurs. There should be a team in place to review patient handling injuries. Team members may be department managers, safety committee members, human resource staff, chief executive nursing officers and facility senior administration. Post injury review by the team provides an opportunity to review the injury and learn ways to prevent further injury. AAR’s can be formal, informal or personal. The process is what should be stressed. The goal of the process is to learn from a task that caused an injury and to apply that knowledge to the same task being performed in a different setting.

Questions asked in the AAR include:

  1. What was supposed to happen?
  2. Who was supposed to do what?
  3. What actually happened?
  4. What accounts for the difference?
  5. How could the same outcome be avoided the next time?
  6. What is the follow-up plan?

Some information for this safety tip was taken from “Beyond Getting Started: A Resource Guide for Implementing a Safe patient Handling program in the Acute Care Setting” and “Safe Lifting and Movement of Nursing Home Residents”.

POSITIONING A PATIENT IN BED

Last month for the safety tip we looked at assessing the patient for lifting and moving. The focus was on asking the “right questions’ related to getting ready to transfer the patient with some type of moving device. This month, I would like to focus on asking the right questions when preparing to move the patient in bed. How do we prepare our selves for patient movements in bed?

When the patient is in bed, start with 3 basic safety questions:

  1. Does the patient need full or partial assistance to perform repositioning bed activities related to rolling over, boosting or sitting up in bed?
  2. What type of equipment or assistive device would the patient need to do bed activities of rolling, boosting or sitting up?
  3. How many caregivers are needed to complete each task safely?

Details related to #1 above:

Details related to # 2 above:

Details related to # 3 above:

Other details to consider:

ASSESSING THE PATIENT FOR LIFTING AND MOVING: ASK THE RIGHT QUESTIONS

To ensure patient and staff safety it is important to ask the right transfer related questions.

ALL OF THESE CAN INDICATE THAT A PATIENT MAY NEED TO USE SOME TYPE OF PATIENT MOVING EQUIPMENT—

A. Start with the patient and assessing their ability to assist the caregiver.

  1. Does the patient have weight bearing capability? If so, can they weight bear on one leg or both. What percent can they weight bear on each leg? If the patient has less than 50% weight bearing (on 1 or both legs) or requires the assistance of more than 1 staff person in transferring.
  2. Does the patient require more that 50% assistance from 1 or more staff persons when moving in bed or transferring or is the amount of assistance that the patient provides or offers unpredictable?
  3. What type of upper-extremity strength does the patient have in both arms? Is one side of the body weaker or limited in range of motion?
  4. What kind of trunk control does the patient have? Are they able to sit up in bed without leaning to one side? Can they maintain an upright position without having anything behind their back to support them? Can they scoot forward in a chair or bed without assistance?
  5. What is the patient’s level of cooperation? What is their level of understanding and comprehension? Do they understand what you are asking them to do? Can they follow simple commands? Are there any behavior issues?

B. Next, look at some patient’s specific history information.
     Most of this information can be found in the patient’s medical record.

  1. What is the patient’s weight and height patient? Is there a match between the size of caregiver and patient? Is the patient heavier or taller that the caregiver?
  2. What is the patient’s body type? Are they pear shaped?
  3. How is the patient’s balance?
  4. What is the patient’s level of independence in their activities of daily living? Can they eat, get dressed
    Is the patient receiving any therapy services such as Occupational, Physical or Speech Therapy?
  5. Are their cognitive issues?
  6. Is the patient combative?
  7. Does the patient have any visual, auditory or speech deficits?
  8. Has the patient had surgery? Are they in pain? Do they have normal touch sensation/feeling?
  9. Does the patient have any tubes (feeding, airway, urinary, or other)?

Look to patient’s caregivers and family for added and up to date information as to how the patient is functioning that day. Ask them questions and they will help you in your up to the minute assessment of the patient.

Some information was taken from the following article: Safe Patient Handling & Movement; By Audrey Nelson, PhD., RN, FAAN, Bernice Owen, PhD, RN, John Dl Lloyd, MErgS, CPE, Guy Fragala, PhD, PE, CSP, MaryW. Mata, MSPH, Margaret Amato, RN, Judith bowers, PhD, RN, Susan Moss-Cureton, RN, Glenn Ramsey, and Karen Lentz, RN. American Journal of Nursing, March 2003, Vol. 103. No. 3.

SAFETY AT THE COMPUTER

Since we live in a computer age and more and more health care workers are having to input patient information on computers, this month’s safety tip is on computer ergonomics. In fact, many health care centers/facilities are going to “paperless” patient documentation.

So how should you be sitting at a computer?

  1. Start with your chair. Generally, you want your thighs to be parallel to the floor. Adjust your lumbar support up or down so that you are supported in the small of the back. Next adjust the depth of the seat. To be correct, you should be able to fit 2-3 fingers behind your knee. You do not want the chair to hit you behind the knee as this may be cutting off blood flow to your lower legs.
  2. To prevent arm/wrist problems, your wrists should be fairly straight when your fingers are on the home row keys. Once your chair is adjusted, look to see where your arms are. Try this: relax your shoulders and then bring your elbows to the 90-degree position. With your palms down this is the height you should be keying at. Have someone measure from the floor to the bottom of your elbow. Also, there are some general guidelines to follow. 27” is an average height for women, but use 28” if you do both computer and writing tasks. For an average height male try 28” and 29”.
  3. If you are not able to have an ergonomic keyboard/mouse tray, and you are at a fixed height that is to high for you to key comfortably try this:
    a. Raise your chair up and use a footrest. If you do not have a footrest, a ream of paper or phonebook will often work until you can get one.
  4. To prevent neck problems think about monitor placement. Generally, your monitor should be directly in front of you and about fingertip distance away (18-28” is a good average) and you should be eye level with the “address line”. The exception to this is if you wear bifocals; then your monitor should be 2-4” lower than eye level. Almost always, with bifocals the monitors should be directly on the desk or work surface.
  5. Most of us do not key or mouse with “correct technique”. The correct way to key is to float your wrists, (like playing a piano). The wrist rest is for when you take a break from keying—you should not plant your wrists on it. Most of us do plant our wrists because of muscle weakness in our upper back. The correct way to mouse is to hold the wrist straight and pivot from the elbow. Instead, most of us move our wrist side to side. Knowing and using correct technique can help prevent the injuries such as tendonitis and carpal tunnel.
  6. Lastly, what is the first sign of carpal tunnel? Generally it occurs at night when you are sleeping. You wake up and feel numbness/tingling in your thumb, index and middle finger. Often, you do not relate this “fall asleep feeling” to all the keying you do during your waking hours.

BACK SAFETY AT HOME AND WORK

  1. Pushing is always easier on your back than pulling.
  2. When you push something heavy, try to use your leg muscles more than your back or your arm muscles. Try this technique to use your legs more: “lock” your arms in place by holding them into the starting push position. Try to keep your arms close to your trunk. Use your legs and weight shift on them. Weight shifting requires that you have a wide base of support; feet should be at least shoulder’s width apart. Generally, there are two ways to weight shift on your legs:
    a. Side to side weight shifting is done from right leg to left leg or vise versa; think of it as “lunge” type movement.
    b. Forward to back weight shifting is done with your legs in a diagonal stance and is done from front leg to back leg.
  3. Your best working height when standing is your elbow height or 2”-4” below your elbow height. The reason for this is that when tasks are done at your elbow height, you do not do forward bend. When working at counters that are too short for you, try simple modifications to the environment. For example, place an object such as a phone book or an upside down cake pan under a cutting board to raise it up to a better height. Fold clothes on top of your washer and dryer.
  4. If standing at a countertop that is too low, open the bottom cupboard and put one foot up on the ledge or a small footstool. Putting a foot up keeps the spine straighter and takes weight of your spine. Alternate feet if standing in place for a long period of time. You can do this when brushing your teeth or washing dishes. Place an object such as an upside down basin at the bottom of a sink to raise the surface up.
  5. Forward bending either with of without weight is the #1 cause of back injuries. If you have done a lot of forward bending balance this by doing 2 to 3 back bends/back extensions. To do a back bend support your low back with your hands by placing them near your hips. Stretch backwards as far as comfortable. Hold for 5-10 seconds.
  6. Try to avoid twisting of the spine. Twisting puts a torquing-type force on your low back. To avoid twisting point both your feet and arms in the same direction as the object you are trying to move. Instead of twisting your back move your feet by taking small steps in the direction you are trying to move.
  7. Be on the look out for trip or slip hazards that you may come across:
    a. Wet or slippery floor surfaces should be wiped up immediately.
    b. Cluttered areas or obstacles in hallways or by stairs should be cleared.
    c. Be aware of surfaces that are uneven such as pavement or flooring surfaces that change from one type to another (i.e.: tile to carpet).

Lastly, be aware of the early warning signs of a back injury. See a doctor or other health professional if you have pain in the back, hip or buttock muscles that lasts for more than 3 days. If you have burning pain, shooting pain or numbness or tingling (could be a fall asleep sensation) in a certain area of the back or that travels down a leg or arm you should seek immediate medical attention. Remember that in your first 24 hours of a muscle sprain you should treat the area with ice and anti-inflammatory medication such as ibuprofen. After 24 hours you can apply heat as needed.

REPORTING AN INJURY

Musculoskeletal Pain and Health Care Injuries: When should you report a "possible" work injury and to whom should you report?

MUSCULOSKELETAL SYMPTOMS MAY OR MAY NOT BE REPORTED IMMEDIATELY. OFTEN IT WILL DEPEND ON THE SEVERITY AND TYPE OF INJURY THE EMPLOYEE IS EXPERIENCING.

Musculoskeletal symptoms may vary especially given the nature of the physical work that health care workers do. Symptoms may include a sore or achy back or other body part (neck, shoulder, knee, etc.). Typical disorders are sprains and strains of the muscles. Often, a worker may not initially see a doctor or other health care professional and may just try to self treat with heat or ice and over the counter medication to reduce pain and/or swelling. Sometimes, symptoms occur gradually over time rather than quickly (i.e. you wake up with a sore back).

In reporting a possible work injury, here are some general guidelines to follow:

  1. Seek out medical attention the same day of symptoms, if the discomfort does not allow you to perform your regular job duties or interferes with your ability to perform your normal daily activities.
  2. If discomfort/pain does not resolve within 2-3 days of self- treatment you should see a health care provider.
  3. Seek out professional medical* help immediately—within 24 hours, if you experience:
    • Numbness or a pins and needles/ fall asleep sensation in an extremity (arm/leg).
    • Shooting pain/burning pain in an extremity or other body area
    • Weakness in the ability to do firm gripping or pinching
    • Inability to stand on tip toes or perform a squat
    • Bowel or bladder problems

If you do not know if the pain/discomfort is related to your job tasks, let your doctor know. You should notify your supervisor too. You may need to fill out a first report of injury form describing how you think the injury occurred. Typically, Human Resources or employee Occupational Health Department will have these forms. Your supervisor may request that you complete a form, too.

*Professional medical persons may include: doctors, nurses, nurse practitioner or emergency room treatment.

DID YOU KNOW...

Training nurses and other health care workers in body mechanics alone has been found to be not effective in reducing back injuries.

An article on “Reducing Risk For Back Pain in Nursing Personnel” featured in the Journal of American Association of Occupational Health Nurses ranked the 16 most stressful patient-handling nursing tasks. They are:

One way to eliminate high-risk manual activities is to use patient lifting equipment.

PATIENT TRANSFER GUIDELINES FOR HEALTHCARE WORKERS

Before moving a patient from bed (with or without equipment), you should consider these “TOP 10” actions and thoughts:

10)   Designate the person who will be in charge of coordinating the move. Communicate with all staff how the transfer is going to be done. Call ahead and plan for any special equipment that will be needed.

9)   Make sure all breaks are locked (beds, wheelchairs, gurneys etc).

8)   Put bed side rails down and remove arms and footrests from wheelchairs.

7)   Make sure that the bed is ready. Does the mattress need to be inflated?

6)   Is the bed at the right height for all staff working together? You should set bed and gurney heights to the shortest person in the group.

5)   If using a wheelchair or gurney, make sure that it is positioned properly. If the patient has a weaker side then the equipment should be located so that they are moving toward their strong side.

4)   If the patient wants to hold on to you, instruct them to place their hands just above your elbows (not your neck shoulders or waist). This way if the patient pulls on you then they will not injure you.

3)   Assess your patient. Are they more tired, ill, confused? Do they have more pain? Will the same transfer work this time?

2)   Explain to the patient what you are going to do and what they should do to help them out. For example: cross your arms, hold your head up, relax, etc.. Tell them what to expect …how will this movement feel to them if you are using a piece of equipment. Explain to the staff what they are going to do. Count 1, 2 , 3 to synchronize the move and move on 3.

1)   ASK YOURSELF…….is there a better way to do this transfer that will not put myself, my colleagues or my patient at risk?


          Page updated Tuesday, September 19, 2006   |   ©2006 Medcare Products, Inc.

MedCare Products