Safe Patient Handling and Pressure Injury Prevention for Patients With Delayed Sternal Closure.

BACKGROUND: Pressure injuries are associated with increased morbidity, mortality, and cost. Patients with delayed sternal closure after cardiac surgery are at increased risk of developing pressure injury because of their reduced mobility and inability to undergo complete skin assessment. LOCAL PROBLEM: Safe patient handling of patients with delayed sternal closure is challenging because of mobility restrictions, leading to increased risk for patient and staff harm. METHODS: An interprofessional team composed of bedside nurses, ergonomic specialists, a wound ostomy continence nurse, and cardiothoracic surgeons developed a patient mobility protocol for patients with delayed sternal closure consisting of levitating the patient for thorough skin assessment and care. A multimodal educational strategy was used to disseminate the new protocol. Patient information was collected on the type of surgery, results of the levitation, completion of the skin assessment, and subsequent interventions. Staff injury related to this work was monitored. RESULTS: After implementation of the protocol, 84 levitations were performed including 50 patients. No staff injuries were reported. Comprehensive skin assessments and care were completed for 98% of patients. Five patients were identified with pressure injury development, and appropriate interventions were applied. DISCUSSION: A standardized patient mobility protocol for patients with delayed sternal closure that leveraged available equipment was successful in reducing the risk for injury among staff and patients. The protocol allowed assessment and care and thus also reduced the risk for pressure injury development in these patients. CONCLUSION: Development of an innovative protocol to safely mobilize patients with delayed sternal closure resulted in improved patient care and increased staff safety.

Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing?

BACKGROUND: People with disabilities continue to experience health disparities resulting from inaccessibility of healthcare practices and medical diagnostic equipment (MDE). OBJECTIVE: The purpose of this study was to evaluate the accessibility of and accommodations for patients with mobility disabilities in clinics of a large healthcare system in the South Atlantic division of the U.S., to determine if accessibility was different based on clinic type, and to identify areas for improvement to increase accessibility. METHODS: This was a cross-sectional study of 214 healthcare professionals conducted between March and June of 2018. Chi square tests and ANOVA were used to compare accessibility between primary care, hospital based, and private diagnostic clinics. RESULTS: A relatively high proportions of respondents reported that their clinic had implemented many accessible features. However, significant differences were found by clinic type with primary care clinics having better access to MDE including height adjustable exam tables, scales with handrails, wheelchair accessible scales, or padded leg supports. However, primary care clinics were less likely to have lifts for transferring patients. The percent of clinics with MDE was higher than that reported in previous studies which may be due to the safe patient handling and mobility program implemented at the healthcare system. Accommodations for patients when a barrier to care is encountered remain an area for improvement. CONCLUSION: While accessibility for people with disabilities was greater in this healthcare system, areas for improvement were identified to help healthcare professional care for their patients with disabilities.

Factors associated with lift equipment use during patient lifts and transfers by hospital nurses and nursing care assistants: A prospective observational cohort study.

BACKGROUND: Despite wide availability of patient lift equipment in hospitals to promote worker and patient safety, nursing staff do not consistently use equipment. OBJECTIVE: To determine the influence of factors on the use or non-use of lift equipment during patient lifts/transfers. DESIGN: Prospective observational cohort study. SETTING: One university teaching hospital and two community hospitals in a large health system in southeastern United States. PARTICIPANTS: 77 nurses and nursing care assistants with patient handling duties in critical care, step-down and intermediate care units. METHODS: Participants recorded information about all patient lifts/transfers during their shifts during a 1 week period per month for three months: type of lift/transfer, equipment use, type of equipment, and presence of 20 factors at the time of the lift/transfer. With the patient lift/transfer as the unit of analysis, the association (risk ratios (RR) and 95% confidence intervals (CI)) between factors and equipment use was examined using multivariate Poisson regression with generalized estimating equations. RESULTS: Seventy-seven participants (465 person-shifts) reported 3246 patient lifts/transfers. Frequent lifts/transfers included bed-to-toilet (21%), toilet-to-bed (18%), bed-to-chair (13%), chair-to-bed (13%), chair-to-toilet (6%), and toilet-to-chair (6%). Equipment was used for 21% of lifts/transfers including powered floor based dependent lift (41%), powered sit-to-stand lift (29%), non-powered sit-to-stand lift (17%), air-assisted lateral transfer device (6%), ceiling lift (3%), and air-assist patient lift (3%). Factors associated with equipment use included: availability of equipment supplies (RR = 9.61 [95%CI: 6.32, 14.63]), staff availability to help with equipment (6.64 [4.36, 10.12]), staff preference to use equipment (3.46 [2.48, 4.83]), equipment required for patient condition (2.38 [1.74, 3.25]), patient inability to help with lift/transfer (2.38 [1.71, 3.31]), equipment located in/by patient room (1.82 [1.08, 3.06]), sling already under patient (1.79 [1.27, 2.51]), and patient size/weight (1.38 [0.98, 1.95]). Lower patient mobility score (3.39 [2.19, 5.26]) and presence of physical or mental impairments (2.00 [1.40, 2.86]) were also associated with lift equipment use. Factors associated with non-use of equipment included: patient/family preference (0.31 [0.12, 0.80]), staff assisting with lift did not want to use equipment 0.34 ([0.17, 0.68]), patient condition (0.48 [0.20, 1.20]), and patient almost fell (0.66 [0.45, 0.97]). CONCLUSIONS: Patient, worker, equipment, and situational factors influence whether nursing staff used equipment to lift/transfer a patient. Quantifying and understanding these factors associated with lift equipment use and non-use provides specific information for hospitals and safety professionals to enhance effectiveness of future organizational and ergonomic intervention efforts to prevent work-related patient-handling injuries.

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

BACKGROUND: Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. METHODS: Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. RESULTS: Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. CONCLUSION: Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption.