Benefits Achieved for Patients Through Application of Height-Adjustable Examination Tables.

OBJECTIVES: Ambulatory care is a rapidly growing segment of overall healthcare delivery and populations seen in ambulatory care settings are aging resulting in many patients with mobility limitations. Mounting a fixed height examination table can present a challenge to a patient with mobility limitations and may be somewhat difficult for the general patient population. This study sought to investigate potential benefits to the patient which might be achieved through introduction of height adjustable examination tables. METHODS: A data collection tool was administered to patients at the time of a regularly scheduled clinic visit intended to measure exertion required, level of difficulty and feeling of safety. RESULTS: Both patients requiring assistance and independent patients reported higher exertion, more difficulty and feeling less safe when mounting higher fixed height versus height adjustable examination tables. CONCLUSIONS: Height adjustable examination tables provide benefits to patients and should be considered when seeking furnishings for ambulatory care clinics.

Reducing Occupational Risk to Ambulatory Caregivers.

In recent years, safe patient handling in the health care industry has been addressed by various stakeholders, but much work remains to reduce health care worker injuries, and improve safety and care quality for patients. Recently, safe patient handling in ambulatory care settings has gained attention. As health care delivery evolves, demands on ambulatory care will increase and more dependent patients will visit ambulatory care clinics. Typically, ambulatory care clinics are not equipped with appropriate safe patient handling equipment. Examination tables, standard in ambulatory care clinics, currently have fixed height and are not easily accessible. This study investigated the benefits of introducing new height-adjustable examination tables to an ambulatory care setting. The results of this study indicate that by using height-adjustable examination tables, work-related musculoskeletal disorder (WMSD) risk for caregivers can be significantly reduced.

Bed care for patients in palliative settings: considering risks to caregivers and bed surfaces.

Ensuring patients are comfortable in bed is key to effective palliative care, but when moving and positioning patients in bed, health professionals face an occupational risk of injury. The turning and positioning (TAP) system is a new method of moving patients in bed, that evidence has shown to reduce the risk of injury to caregivers. Providing the correct bed surface is another aspect of bed care essential to the comfort of the palliative patient, and to aid wound prevention and treatment. It is important to take a patient-centred approach when considering the most appropriate bed surface patients. This article provides an overview and discussion of these two aspects of bed care for palliative patients.

Improving the safety of patient turning and repositioning tasks for caregivers.

Current evidence demonstrates why turning and positioning patients in bed presents a serious occupational risk of musculoskeletal disorders for caregivers. Results of the laboratory study investigating a new method of turning and positioning patients in bed are presented. The study was designed to evaluate how this new method reduced the risk of occupational musculoskeletal disorders to caregivers and may improve outcomes for patients.

Repositioning patients in chairs-an improved method.

Proper seated posture is important in health care settings because immobilized patients may be sitting for extended periods. In many situations, a caregiver is required to assist a slouching patient to a proper, more comfortable upright posture. The caregiver is at risk from exposure to the physical demands of this task. This study evaluated exertion and risk to the caregiver using three methods of repositioning patients in chairs in the health care setting. Through application of a new method employing an ergonomically designed device, exertion and risk were reduced. Results from this study indicate that the high-risk occupational activity of repositioning a slouching patient in a chair can be made safer for caregivers.

Facilitating repositioning in bed.

Repositioning patients in bed presents an occupational hazard to direct care nursing staff. Much research has been conducted in the area of safe patient handling and movement. However, little progress has been made in reducing risks associated with patient repositioning, especially pulling patients toward the head of the bed. This laboratory study investigated risk reduction achieved by introducing the gravity assist feature into bed system design for post-acute health care. Through the application of gravity assist, the amount of work required to reposition a simulated 200-pound patient was reduced by 67%. This reduction in work should reduce some of the occupational risk for nurses.

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks.

PROBLEM STATEMENT: Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. SPECIFIC AIMS: The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment. INTERVENTION: The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy. METHODS: A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs. RESULTS: The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of 'unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation. CONCLUSIONS: This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Proper positioning of clients: a risk for caregivers.

The primary objective of this study was to learn more about the occupational risk of client repositioning by caregivers. This study also included information on frequency demands and factors contributing to the need to reposition clients and future risk-reduction solutions and interventions. A questionnaire was administered to caregivers at 12 hospitals. Targeted groups were client care units with caregivers who are required to reposition clients in bed. The task of client repositioning presents a high frequency demand to caregivers. Some characteristics such as size and health condition made it more likely clients would require repositioning. Researchers need to study client repositioning further and look for methods that will reduce the caregiver occupational risk factors. Caregivers are seeking new devices and techniques that facilitate client repositioning and benefit both the caregiver and the client.

Addressing occupational strains and sprains: musculoskeletal injuries in hospitals.

Recognition related to the need for ergonomic design improvements among health care workers, management and administration, and equipment manufacturers is growing. The future should bring new concepts and innovations which can provide many benefits. Beyond the potential reduction in caregiver injuries, many possibilities exist to improve patient outcomes through better equipment design. As an additional benefit, applying the principles of ergonomics may enhance and increase caregiver productivity through a reduction of patient transfers required, and by minimizing staff required to ambulate patients. Another added value to applying ergonomics to equipment design is the development of convertible furnishing which could create a reduction in operating and capital expenses by reducing the need for some furnishings. Equipment such as cardiac chairs, sling scales, patient chairs, special rental surfaces, and other features might be incorporated into bed design. Ergonomic programs make sense and provide opportunities to create win-win situations throughout the health care industry. Current and future innovations will provide improvements resulting in outcomes from which everyone will benefit. These benefits include a higher quality of work life for health care workers and an improved quality of care for patients.