Rehab and Safe Patient Handling: Avoid Injury in the Workplace - PDF document

1/6/2020 Rehab and Safe Patient Handling: Avoid Injury in the Workplace Stephanie Bendinelli, PT, DPT, CSPHC Ashley Hursh, PT, MPT, CSPHC Disclosure Stephanie Bendinelli and Ashley Hursh have no financial disclosures that would be of potential conflict of interest with this presentation. 1

1/6/2020 Participants will be able to identify and/or discuss: Ergonomic risk factors and common injuries leading to work-related musculoskeletal disorders (WMSDs) Impact and prevalence of WMSDs on work life and personal life Misconceptions to using Safe Patient Handling (SPH) equipment as part of therapy How to incorporate use of SPH equipment into therapy practice We are the mobility experts and we do not get hurt... Pre-Intervention OhioHealth Rehab Injury Data Fiscal Years ‘16 to ‘18 Lost Time Restricted Duty How Many Injuries What Happened (days) (days) 2 Ambulating patients 9 46 14 Supine to sit/edge of bed 75 359 8 Sit to stand 23 149 4 Boosting 64 41 6 Bed to chair 1 65 4 Miscellaneous 54 30 38 226 690 2

1/6/2020 Cost of a Patient Handling Injury Per Fiscal Year Patient Handling Injuries FY16 FY17 FY18 Totals Number of Injuries 12 4 22 38 Direct Cost of Injuries $62,212.57 $1,397.77 $62,837.30 $126,447.64 $632.238.20 Indirect Cost of Injuries (5x the direct cost) OhioHealth Rehab Specific Patient Handling Injuries FY 17 and FY18 injuries: 15/26 injuries happened during co-care (58% of the time) Injuries include PTs, OTs, PTAs and COTAs System-wide problem https://www.webmd.com/back-pain/default.htm Prevalence of Injury Among Therapists 1 1158 therapists were surveyed: 447 OTs and 681 PTs Rate of injuries: 16.5 injuries per 100 FTEs for OT 16.9 injuries per 100 FTEs for PT 35% of therapists reported at least one WMSD within a 3 year period https://www.netdoctor.co.uk/conditions/aches-and-pains/a2853/neck-pain/ 3

1/6/2020 Prevalence of Injury Among Physical Therapists 2,3 Survey of 929 Physical Therapists Lifetime prevalence of WMSDs – 91% 1 out of 6 therapists change settings or leave the profession due to WMSDs WMSDs in 952 Physical Therapists 57.5% had work-related aches, pain or discomfort The factor most likely to contribute to work-related musculoskeletal disorders was "lifting or transferring dependent patients" https://gfycat.com/gifs/search/windham+rotunda Prevalence of Injury Among Occupational Therapists 4 Survey of 600 Occupational Therapists Over half of OTs reported injury and of these injuries: 29% were due to patient handling Injury Types Ligamentous injury or muscle strain – 37.4% “Therapists who spent more time performing…mobilization had more severe low back symptoms” http:// physiodirectnz.com/occupational-therapist-required / Impact of Injury Among 600 Surveyed OTs 4 100 90 92.5 84.9 80 70 60 50 49.5 40 30 20 15.9 15.9 10 10.4 6.9 0 Continued to Work Insufficient Injury to Sought Medical Insufficient Experienced Long- Change in Clinical Too Embarrassed to After Injury Discontinue Treatment Coverage if Term Limitations Focus or Left Leave Work Working Therapist Left Work from Injury Profession Percentage 4

1/6/2020 Why are we getting hurt? “…proper body mechanics when transferring, lifting, repositioning or otherwise moving patients do not prevent WMSDs” 5 http://www.aleviapt.com/proper-lifting-mechanics-by-jordan-spence/ http://www.dixonscranes.com.au/gallery https://ungroovygords.com/2018/01/31/a-guide-to-operate-a-forklift-in-a-warehouse/ https://indianapublicmedia.org/news/apartments-included-bloomington-trash-recycling-overhaul-128217/ Ergonomic Risk Factors in Healthcare 6 Duration of Exertion Exposure Ergonomics Posture Repetition 5

1/6/2020 APTA’s Position Paper on SPH 9 Endorses SPH…policies and programs that enable health care workers to move patients and clients in a way that does not cause strain or injury Endorses the recommendation by Occupational Safety and Health Administration (OSHA) that manual lifting of patients be minimized in all cases and eliminated when feasible PTs and PTAs shall lead by example, appropriately supporting and employing the concepts of SPH during patient care Recommends utilization of technology to facilitate optimum patient outcomes while maintaining patient and caregiver safety Also recommends appropriate use of new technologies when they may be optimally applied to prevent injuries and facilitate functional recovery https://www.apta.org/ Is use of safe patient handling equipment therapeutic? Is this even skilled ? Use of SPH Equipment and Patient Progression 10,11 One study showed no difference in Functional Independence Measurement (FIM) scores in a group using SPH equipment as compared to one that did not Another study from a rehabilitation setting showed significantly higher FIM scores at discharge in a SPH group compared to a group without SPH 6

1/6/2020 Why use SPH Equipment in Therapy Practice 5 When therapists use equipment, patients: 1. Can be more active during their rehab 2. Are mobilized earlier in their recovery 3. Have improved morale (creates increased patient participation) 4. Are up more frequently and spend more time out of bed 5. Participate in more strenuous activities 6. Experience a greater sense of security http://ezlifts.com/products/product_details.cfm?ProductID=35&print=1 Why use SPH Equipment in Therapy Practice 5 When therapists use equipment, therapists: 1. Are able to free their hands 2. Are not limited by their ability to hold someone 3. Can provide more facilitation for posture and/or weight shifting 4. Feel their patients are safer 5. Note a reduction in patient falls 6. Experience less fatigue and pain at work https://www.arjo.com/int/products/patient-transfer-solutions/floor-lifters/ Keep in Mind Important Themes… Remember to maintain “ Safety ” and “ Optimize Patient Outcomes ” Safety: How can we predict and anticipate high risk situations when therapists will have an increased likelihood of being injured? Can we use SPH equipment during these high risk situations? Optimizing Patient Outcomes: How can your patient participate more, be more active and benefit more from therapy with SPH equipment than without? 7

1/6/2020 Is a manually dependent or a near-dependent transfer the best choice to maintain safety for you and the patient while optimizing patient outcomes? Safety Concerns with Supine to Sit Transfer Patient is dependent or near-dependent transfer Retropulsive posture with increased hip and trunk extension Patients tend to slide forward off edge of bed Contraversive pushing syndrome Unexpected change in patient participation What can we do instead ? Start with in-bed mobility with friction reducing devices (FRD): Boosting patient to the head of bed (HOB) Rolling with FRD underneath patient 8

1/6/2020 What can we do instead ? Put the bed in the chair position: Work on trunk control safely Incorporate exercises safely without focus on physical support for trunk control Attempt standing from chair position with foot plate removed What can we do instead ? Floor based lift or ceiling lift to edge of bed (EOB): Provides back support for patient with impaired trunk control Use the sling under the arms for functional tasks What can we do instead ? Use floor based lift to transfer patient from bed to chair 9

1/6/2020 How do we optimize patient outcomes using SPH equipment for bed mobility? Patient can maintain sitting edge of bed for longer period of time Vitals stabilization with change in position Improved patient engagement in therapy Patient able to attempt standing sooner Safety Concerns with Standing/Gait Cognitive issues Weakness and/or buckling attempting to stand or ambulate Maintaining weight bearing status Poor balance Difficulty standing from lower surfaces What can we do instead ? Use powered stand assist device: Standing: Initiate standing with sit to stand device, then ask them to engage their quads to achieve full standing position Pre-gait activities: Remove shin guard and foot plate 10

1/6/2020 What can we do instead ? Use walking harness with the ceiling lift or with the floor based lift: Standing activities of daily living (ADL) tasks Standing instrumental ADL tasks Balance training Standing therapeutic exercises Pre-gait and gait activities Floor recovery How do we optimize patient outcomes using SPH equipment for out of bed activities? Patient can perform increased repetitions of tasks Patient can tolerate standing exercises https://www.youtube.com/watch?v=_CCSwOWilR8 Allows for gait training with decreased manual support Decreases patient fall risk by giving optimal support https://at-aust.org/items/5028 Acknowledgments Melissa Bell , PT and Associate Manager for Doctors Hospital in Columbus, OH Alice Dillion , OTR/L and Director of the Southern Region for OhioHealth in Columbus, OH Anthony Fisher , PTA from Riverside Methodist Hospital in Columbus, OH Justin Martin , PT from OhioHealth Mansfield Hospital in Mansfield, OH Susan Salsbury , OTR/L and OhioHealth System Manager of Disability Services Gigi Toivonen , PT and director of the Northern Region for OhioHealth in Columbus, OH 11