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Patient Care Ergonomics Resource Guide: Safe Patient Handling ...

Patient Care Ergonomics Resource Guide: Safe Patient Handling ...


Patient Care Ergonomics Resource Guide: Safe Patient Handling & Movement Department of Veterans Affairs Step 1: Collect Baseline Injury Data There are several methods for collecting baseline injury data, including retrospective review of incident reports and OSHA Logs. Unfortunately, it is often difficult to understand the etiology of risk using retrospective injury data collection methods. For example, incident reports may not include critical information about staffing levels, whether equipment was being used, and other contributing factors. Prospective data collection, defined as collecting data as each injury occurs, allows you to ascertain details while the person is able to easily recall details. However, prospective data collection can be a time-consuming process. Injury data should focus on injuries related to patient handling and movement. Each clinical unit should gather and record their individual information. Data should minimally capture a description of the incident including the patient care activity performed at the time of the injury (bathing, repositioning, transfer from bed to chair, etc.), cause of injury (pull, push, reach, struck, etc.), type of injury (sprain/strain, contusion, etc.), time of the incident, unit/location where incident occurred, body part/s affected, days of work lost, and modified duty days. A sample Injury Data Collection tool is found as Attachment 3-2. Typically, one year of data is collected and analyzed so that trends can be identified. Analysis should first be performed by unit to characterize each unit and then aggregated across units to assess a facility. Unit analysis will minimally address the incidence, severity (defined as lost and modified duty days), primary task/s involved in injuries, and the primary cause/s of injuries on the unit. Those units with high incidence and severity of injuries are classified as highrisk units. These units should be the initial focus of ergonomic interventions. Identifying the primary cause/s of injuries as well as the primary tasks performed when injuries are occurring will provide direction when making ergonomic recommendations. Caregiver opinion regarding factors contributing to injuries can be collected through the use of staff surveys. A simple open-ended staff survey asking staff something like: “What is contributing to the injuries occurring on your unit?” may bring up significant issues such as lack of equipment, equipment maintenance and repair, storage, staffing, or problems with modified duty assignments. Management interviews may also bring up pertinent issues that cannot be gleaned from injury data. Ideally, such a management interview takes place during a walk-through of the unit. The easiest method to judge relative cost associated with injuries is to utilize number of lost and modified duty days. It’s easy to generalize that the more lost and modified duty days, the higher the costs. Injury costs can be estimated though, by multiplying the lost and/or modified duty days by the average daily salary of the injured employee. Another source of cost data is facility OWCP costs. This data is readily available, however because of its general scope, is quite limited in usefulness here. As opposed to facility-wide cost data collection, unit cost data collection requires the development of a comprehensive cost data collection tool. Cost data analysis by unit requires prospective analysis and therefore is timeconsuming. Such analysis is complex and should be undertaken only by an expert. Figure 3- 2 is a sample form for collecting baseline data from the OSHA log, nurse manager files, facility accident stats, and/or OWCP. 20

Ergonomic Workplace Assessments of Nursing Environments Department of Veterans Affairs See Chapter 11 for more details on evaluation. It is important to integrate data collection into existing data sets available at your facility. Patient Care Activity Sample: Cause of Injury Patient Reaching transfer across bed to stretcher stretcher. for patient. Figure 3-2 Patient Care Incident/Injury Profile Type of Injury Step 2: Identify High-Risk Units Strain Upper back Body Part(s) Location Patient bedside Time of Injury Lost Days 0930 3 5 Modified Duty Days Using baseline data on the incidence and severity of injuries, identify the high-risk units at your facility. While eventually you will want to include every unit in an ergonomic assessment, prioritizing time and resources are frequently necessary. High-risk units will have the highest incidence of patient handling injuries, the most workdays lost, and the highest concentration of staff on modified duty. Step 3: Obtain Pre-Site Visit Data on High-Risk Units A Site Visit Team will perform an ergonomic analysis of each unit to determine what improvements can be instituted to decrease risk. These recommendations will be made based on a walk-through (site visit) of each area, interviews with management and other staff, and through the evaluation of unit-specific information. In order to have a smooth and productive site visit, this unit-specific information should be collected and submitted to the Site Visit Team prior to their visit. 21

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