An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers.

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

Using "best-fit" interventions to improve the nursing intershift handoff process at a medical center in Lebanon.

BACKGROUND: Nursing intershift handoff involves communicating essential patient information between the outgoing and the oncoming nurses during shift changes. A subsequent review of reported patient safety incidents at Labib Medical Center (LMC), Saida, Lebanon, showed that medication errors, delay in treatment, wrong treatment, duplication of laboratory tests, and near-miss events were caused by patient information omissions during intershift handoffs. In response, LMC initiated a quality improvement project using a multifaceted intervention to improve the quality of nursing intershift handoffs. METHODS: The barriers to effective intershift handoff identified in the literature that best fit the current context of intershift handoffs at LMC showed that the following three issues needed to be addressed: (1) the absence of a standardized intershift communication tool, (2) inadequate training of RNs on intershift handoff communication, and (3) the interruptions during the shift reports. Accordingly, a three-faceted intervention was constructed, entailing (1) introduction of a standardized intershift handoff tool, (2) training RNs about effective handoff communication, and (3) decreasing interruptions. RESULTS: The mean number of omissions per handoff across the three units decreased from 4.96 to 2.29 (t = 6.29, p = .000), as did the mean number of interruptions per intershift report--from 2.17 to 1.26 (t = 2.7, p = .008). RNs' knowledge of the criteria to be communicated suggested a greater appreciation of their own role in patient safety. CONCLUSION: The intershift handoff communication process can be improved using evidence-based strategies that target internal barriers where the shift report occurs. Regular monitoring and follow-up are essential to maintain the improvement.