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

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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.

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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

Participants will be able to identify and/or discuss:

We are the mobility experts and we do not get hurt...

How Many Injuries What Happened Lost Time (days) Restricted Duty (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

Pre-Intervention OhioHealth Rehab Injury Data Fiscal Years ‘16 to ‘18

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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

Indirect Cost of Injuries (5x the direct cost)

Cost of a Patient Handling Injury Per Fiscal Year

$632.238.20

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

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

Prevalence of Injury Among Therapists1

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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"

Prevalence of Injury Among Physical Therapists2,3

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%

Prevalence of Injury Among Occupational Therapists4

“Therapists who spent more time performing…mobilization had more severe low back symptoms”

http://physiodirectnz.com/occupational-therapist-required/ 92.5 84.9 49.5 15.9 15.9 10.4 6.9 10 20 30 40 50 60 70 80 90 100 Continued to Work After Injury Insufficient Injury to Discontinue Working Sought Medical Treatment Insufficient Coverage if Therapist Left Work Experienced Long- Term Limitations from Injury Change in Clinical Focus or Left Profession Too Embarrassed to Leave Work Percentage

Impact of Injury Among 600 Surveyed OTs4

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“…proper body mechanics when transferring, lifting, repositioning

• r otherwise moving patients do not prevent WMSDs”5

Why are we getting hurt?

Exertion Repetition Posture Duration of Exposure

Ergonomics

Ergonomic Risk Factors in Healthcare6

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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

APTA’s Position Paper on SPH9

Is use of safe patient handling equipment therapeutic? Is this even skilled?

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

Use of SPH Equipment and Patient Progression10,11

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Why use SPH Equipment in Therapy Practice5

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

Why use SPH Equipment in Therapy Practice5

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

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?

Keep in Mind Important Themes…

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Is a manually dependent or a near-dependent transfer the best choice to maintain safety for you and the patient while

• ptimizing patient outcomes?

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

Safety Concerns with Supine to Sit Transfer

Start with in-bed mobility with friction reducing devices (FRD):

Boosting patient to the head of bed (HOB) Rolling with FRD underneath patient

What can we do instead?

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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

What can we do instead?

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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

How do we optimize patient outcomes using SPH equipment for bed mobility?

Cognitive issues Weakness and/or buckling attempting to stand or ambulate Maintaining weight bearing status Poor balance Difficulty standing from lower surfaces

Safety Concerns with Standing/Gait

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

What can we do instead?

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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

What can we do instead?

Patient can perform increased repetitions of tasks Patient can tolerate standing exercises Allows for gait training with decreased manual support Decreases patient fall risk by giving optimal support

How do we optimize patient outcomes using SPH equipment for out of bed activities?

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

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2003 Sep; 60(9): e6.

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References Contact Information

Stephanie Bendinelli, Stephanie.Bendinelli@OhioHealth.com Ashley Hursh, Ashley.Hursh@OhioHealth.com

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Thank you!