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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 Generally, the Site Visit Team will evaluate injury data, equipment issues, space issues, storage availability, and maintenance/repair issues. Other factors such as patient population, and staffing information are needed to determine unit characteristics that will influence intervention needs. The following data collection tools will aid in the collection of this information. In order to give nursing management adequate time to locate and compile information, these tools should be given to the nurse manager at least a few weeks prior to the site visit. This pre-site visit data should be submitted to the Site Visit Team at least one week in advance. Figure 3-3 is the Pre-Site Visit Unit Profile. Part I of this tool describes the unit and includes information on space, storage, structure, and maintenance/repair issues. Part II collects information related to the patient population and staff. While most of the questions on this survey are self-explanatory, one area, percentage of dependent patients, may need additional explanation. One approach for determining the percentage of patients on a unit who are physically dependent is the classification in the Health Care Finance Association (HCFA) Patient Assessment System, Section G titled, “Physical Functioning and Structural Problems”. This coding is consistent with Activities of Daily Living (ADL) Self-Performance Codes for a patient’s performance over all shifts during the last seven days and can be used in other patient-care areas. It is important to note that physical dependency is not the same as patient acuity. Definitions for levels of dependency are included in the tool and are also outlined below. •= Total Dependence – cannot help at all with transfers; full staff assistance for activity during entire seven-day period. Requires total transfer at all times. •= Extensive Assistance – can perform part of activity, usually can follow simple directions may require tactile cueing, can bear some weight, sit up with assistance, has some upper body strength, may be able to pivot transfer. Over the last seven-day period, help provided three or more times for weight-bearing transfers or may have required a total transfer. •= Limited Assistance – Highly involved in activity, able to pivot transfer and has considerable upper body strength and bears some weight on legs. Can sit up well, but may need some assistance. Guided maneuvering of limbs or other non-weight bearing assistance three or more times; help provided one or two times during the last seven days. •= Supervision – Oversight, encouragement, or cueing provided three or more times during the last seven days or physical assistance provided only one or two times during the last seven days. •= Independent – can ambulate normally without assistance, in unusual situations may need some limited assistance. Help or oversight may have been provided only one or two times in the last seven days. In addition, each patient will be assessed with regard to such factors as mental acuity, ability to comprehend instructions and cooperate in lifts and transfers, combativeness, weight, upper extremity strength, ability to bear weight and specific medical conditions which may affect the selection of an appropriate means for lifting and transferring. For purposes to determine 22

Ergonomic Workplace Assessments of Nursing Environments Department of Veterans Affairs the percentage of patients on these units who are physically dependent, only Class 4 and 3 patients are considered dependent. The other factors mentioned will be considered when determining the appropriate method of transfer of a patient. 23

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