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HEALTH CARE ERGONOMICS & PATIENT HANDLING

The Oregon Coalition for Healthcare Ergonomics (OCHE)

Formed in 2003, OCHE is a volunteer partnership between business and labor groups and includes, Associated Oregon Industries, Oregon Association of Hospitals and Health Systems, Oregon Chapter of the Association of Occupational Health Professionals, Oregon Federation of Nurses and Health Professionals, Oregon Health Care Association, Oregon Nurses Association, Oregon OSHA, SAIF Corportation, Liberty Mutual, and the University of Oregon's Labor Education and Research Center.

'The mission of OCHE is to improve healthcare employee and consumer safety in Oregon by promoting ergonomics best practices across the continuum of care. This is achieved through education of healthcare providers, educators, facility administrators, and risk management and safety personnel about ergonomics issues, and through promotion of networking activities and communications to facilitate the sharing of ergonomics best practices throughout the state.'

Please visit OCHE's website at www.hcergo.org. This website provides a plethora of information pertaining to all aspects of health care ergonomics and healthcare safety, with links to many other healthcare ergonomic related websites. You will find information specifically for health care safety and ergonomics professionals, practitioners, organizations, employees, and consumers.

 

Determining Manual Patient Transfer Best Practices to Improve Training of Community-Based Health Care Providers

Funded by: Collins Medical Trust and SAIF Corporation

LERC Faculty:

    • Jennifer Hess, Principal Investigator
    • Laurel Kincl, Co-Principal Investigator
    • David Mandeville, Graduate Research Fellow

Three manual patient transfer techniques for bed to wheelchair transfers by a single provider:

There are over 1,200,000 home care workers or ‘caregivers’ in the US and this occupation is expected to grow more than 27% by 2114 (BLS 2005). This group of workers included home care workers, certified nursing assistants (CNAs), physical therapists, occupational therapists, and home health nurses, all of whom may be called upon to assist in patient transfers. Even though hospitals and long term care facilities are moving toward safe patient handling policies that include the use of powered mechanical lifting devices, in most home care settings use of such devices continues to be prohibitive and single-person manual handling of patients is common. Several factors account for this. In some states the patient is the employer. These patient-employers may not be able to afford the cost of renting or purchasing mechanized lift equipment and most private insurance carriers and Medicare do not cover the cost of patient handling aids. Transfer boards, slide sheets, transfer belts are expensive and the purchase of mechanical lift equipment can cost as much as $6000. Home environments may also be too small or crowded to allow use of mechanized equipment.

Until mechanized lift and transfer equipment becomes practical and affordable those working in the home setting will continue to manually lift and transfer patients and safer methods of manually transferring people between surfaces are needed. The purpose of this study was to compare three single person manual patient transfer methods to assess which method carries the least risk to home care caregivers.

Two ‘mock patients’ one ‘light’ patient (125 lbs) and one ‘moderate’ weight patient (160 lbs) were transferred from a bed to a wheelchair. Low back stresses and caregiver perceptions were measured. The three single-person manual transfer techniques were chosen because they are frequently used or have the potential for being less risky for both caregivers and patients; the modified standing pivot; and transfer board; and the scoot transfer. The modified standing pivot (pivot) is a variation on the traditional ‘hug’ technique. Typically, transfer boards (slides) are used when a patient is sufficiently independent so that they can slide themselves from one surface to another with minimal assistance from caregiver. In this study, we rained caregivers to transfer a moderately dependent patient using a slide board. The scoot transfer (scoot) uses a series of small scoots to move the patient and has been suggested to be less physically demanding than other patient transfer technique. For each testing scenario the patient was moved from a ‘bed’ surface to a wheelchair that was of similar height. The wheelchair was angled toward the bed to decrease the transfer distance, rather than set at 90 degrees to the bed. The arm and footrest of the wheelchair closest to the bed were removed. A 2-inch wide transfer belt was used for all transfers.

While we do not recommend any of these techniques as ‘safe’ for dependent patients, based on the combination of clinician and ‘patient’ perceptions, exposure duration, and biomechanical evaluation, the slide board technique appears to be the safest and most comfortable. The scoot and the pivot each have elements that make them more risky and they should be avoided.

Our evaluation should not be mistaken for promotion of manual patient handling. We advocate use of mechanical and other patient handling equipment, in addition to slide boards. Powered portable lifts, stand assist devices, lateral transfer devices (slide sheets)., and other equipment are necessary to significantly reduce the risk of musculoskeletal injury in clinicians working in the home environment.

 

Long Term Care Facility Safe Resident Handling Program

LERC Faculty:

  • Jennifer Hess, DC, PhD, Principal Investigator

It has been established that there is no safe way to manually lift or handle residents. Nonetheless, nurses and nursing assistants (CNAs) ar frequently called upon to lift, transfer and reposition dependent and semi-dependent residents in most health care facilities. These tasks place them at high risk for sprains, strains, and other musculoskeletal injuries. Data show that musculoskeletal injuries to nurses and CNAs are a serious problems in Oregon, which results in costly and disabling injuries to workers and to the residents being handled. Long-term care facilities (LTC) such as skilled nursing homes and assisted living facilities lag behind acute care in the need to adopt safe patient handling (SRH) practices that rely on the use of motorized mechanical equipment and that engage management and staff in an ongoing ergonomics process.

The goal of the current project, funded by an Oregon OSHA training grant, is to develop a dynamic SRH program for LTC facilities and the appropriate training materials. The program will include a step-by-step guide for acquiring funding assistance for motorized patient handling equipment and for implementing a sustainable joint labor-management program. These materials will be made available to LTC facilities in Oregon and used by Occupational Safety and Health (OSH) personnel at OR OSHA, SAIF, Liberty Mutual and others, to facilitate the transition to SRH in these facilities. This project is being carried out with the help of the Oregon Coalition on Healthcare Ergonomics (OCHE) subcommittee comprised of volunteers from the LTC industry, unions (Oregon Nurses Association (ONA), Service Employees International union (SEIU)), researchers, the Oregon Healthcare Association (industry group for long-term care), OR OSHA, and workers compensation insurers.

Publications:

Hess, JA., Kincl, L., Mandeville, DS. "Comparison of Three Single Person Manual Patient Transfer Techniques for Bed to Wheelchair Transfers," Home Health Nursing, 2007, 25(9), 572-579.

HOMECARE WORKERS

Homecare workers are a fast-growing part of the workforce in Oregon and this growth will continue as the baby-boom generation ages. The continued expansion of the homecare industry has created an urgent need to support homecare workers by providing opportunities for basic training and continued professional development. Better training and support for homecare workers will naturally lead to improved care for the elderly and disabled who are their clients.

Long Term Care Workers Website

A new website for long-term care workers, their clients, trainers, and researchers are being sponsored through the partnership of LERC/OLSHEP and SEIU 503: www.ltcworkers.com. The website lists training opportunities by region and has links to many resources.

Safety Manual for Homecare Workers

OLSHEP, SAIF and the Home Care Commission Training committee have created a Health and Safety manual for both workers and clients. The manuals will soon be available on the Long Term Care Workers Website.

Inventory of Training Resources for Homecare Worker

LERC is working to create a comprehensive inventory of relevant training courses, resources, and materials available to homecare workers in Oregon. This inventory would be accessible on the long-term care training resource website and will be promoted in newsletters and in various materials.

New Training for Homecare Workers

LERC faculty have participated in a stakeholders group that is developing a systematic training program for homecare workers. This increased training,, which prioritizes health and safety, will raise quality of care and promote homecare career advancement and core competencies. Partnering with the Better Jobs/Better Care grant, LERC faculty also worked to create a standard group of competencies for caregivers in a variety of community-based settings.

Communication Skills Workshops

LERC faculty partnered with SEIU 503 and the Better Jobs/Better Care homecare training grant steering committee to present a series of workshops on “Communication Skills and Problem-Solving for Homecare Workers.” Improved communication skills can lead to better, safer, person-centered care for the client, and a safer, more satisfying job for the HCW. Participants who completed the Communication and Problem-solving Skills workshop were admitted to a First Aid/CPR class for free. CPR is a “skill-building” class that is a high priority for all stakeholders.

If you are interested in additional information about training programs for homecare workers, please contact Helen Moss.