Predicting and Preventing Manual Handling Injuries

Jillian AdamsLinda Slack-Smith

Rina Cercarelli

Background:

• Mixed methods study - association between decisions and MH injuries (Nurses)

• Health Belief Model – explain and predict health behaviour

• Epidemiological approach

The Health Belief Model …

To adopt a health message individuals must perceive it to be a health threat

i.e. a serious problem to which they are susceptible

Injury Epidemiology claims …

“as injuries are predictable they are also preventable … and …

to a large extent society (hospitals) chose the injury rate it has”

(Christoffel et al 1999)

Injury Epidemiology uses …

• Host-agent-environment triad to identify problems, interaction and where to direct interventions

Environment (physical, social)

Agent = mechanical energy

(vector, vehicle)

Host (human)

Injury Epidemiology uses …

The Haddon Matrix to analyse injury and plan interventions

Host(human)

Agent(vehicle vector)

Environment (social

physical)

Pre-event

Event

Post-event

Injury Epidemiology uses …

A structured approach to injury prevention

Haddon’s 10 countermeasures

Passive or Active

Engineering, Education, Enforcement

Aim of this presentation …

• To consider the findings of manual handling research

• From an injury prevention framework perspective

Mixed Methods Study

• Focus groups (x5)• Case-control questionnaire (n=368)

– Analysed injuries (n=82)– Analysed Comments (n=90)

MH decision and their effect on injury

RN/EN in clinical positions

Triangulation …

• Combines research methodologies• To strengthen results• Improve accuracy and interpretation• Identifies consistent, convergent results• Correlations demonstrate strong

relationship

• Host – those most at risk, i.e. who to target

• Environment – hazards to eliminate from the injury area

• Agent - what delivers the energy

Host (those most at risk)

• Did not perceived MH as a health threat

• Pre-injury less likely to aches/pain related to MH

• Post-injury

↑ awareness of susceptibility to injury

Safer MH practice

Ongoing exercise programs

Agent (transfers energy)

• Patients – primary agent (vector) 74%

(↓mobility, ↑weight, AMS, v sick, anxious)

• Equipment – 17% (n=14) incidents

faulty equip (n=5)

equip only (n=9)

Environment (hazards to eliminate)

Physical

workspace

Social

staffing numbers

time limits / workload

expectations (problem in 21% injuries)

Injury prevention interventions• By Haddon’s countermeasures (x10)

• If passive or active

• By approach: education, engineering, enforcement

• If in the pre-event or event phase

#1: prevent the initial creation of the hazard

• Cannot avoid patients – but can avoid routine manual lifting

• No-lift, minimal lift, safe lift, zero-lift etc. policies

Requires enforcement (pre/event - passive)

Requires equipment (pre/event)

Requires education (pre)

• Substantial evidence base

#2 reduce the amount of energy in the hazard

• Reduce the energy transferred by using MH equipment (event - active)

e.g. Hoists, slide sheets, etc.

• Equipment alone ↓ risk factors

• More effective in multifaceted approach

• Substantial evidence ↓injuries ↓costs

#3 prevent release of a hazard that already exists

Contain the hazard by:• Assess hazards and how to manage them

(algorithms, Red Dots)(pre/event - active)• Dedicated wards for specific pt – spinal,

bariatric etc. (pre - passive) • Close beds if staffing unsafe (pre - passive)• Some evidence (assessment), dedicated

wards – cautious recommendation

#4 modify the rate of spatial distribution of the hazard

Change how the hazard is delivered• Optimal floors - minimise resistance to

wheels (pre - passive)• Large wheels (pre - passive)• Share the load – work as a team (event -

active)

• Substantial evidence

#5 separate in time and space, the hazard from that to be protected

Separation prevents transfer of energy• Dedicated lift teams – remove 95% of

routine MH from nurses (event - passive)

- Are a team, use equipment with MH their priority

-↓ MH injuries to nurses + v few injuries to lift teams personal

• Substantial evidence (from USA)

#6 separate the hazard (by a material barrier) from that which is to be protected

Form a barrier between hazardous equipment and the nurse (pre – passive)

• Remove faulty or inappropriate MH equipment and replace with appropriate equipment

• Automatic process to maintain equipment

Provision/maintenance required by MH codes

#7 modify relevant basic qualities of the hazard

Amend unsafe aspects of hazards (equip + environ) • Equipment: “state-of-the-art” (pre-event,

passive) • Work areas: de-clutter bed space, > space

for bariatric pt and their equipment - modify existing or design new facilities, flooring. (pre-event, active and passive)

#7 modify relevant basic qualities … cont

• Social environment: work expectations, safety climate of organisation and the influence of manager/supervisor (event – active)

• Policy implemented at ward level, overseen by managers group to target with education

• Substantial evidence re influence of Mx

#8 make what is to be protected more resistant to damage from the hazard

Make nurses more resilient and better able to withstand MH (pre-event, active)

• Exercise - strengthens muscles and ↑ flexibility of trunk

• Short-term benefits (voluntary/mandatory, 40-60 mins, x2/week for 3-12 months

• Substantial evidence

#9 begin to counter the damage done by the hazard

Managing the injury in a way that prevents further damage (post-event, active)• Best Practice - early aggressive managed

care, by a team led by occupational physician Includes: assessment, assurance, education, involves manager

• Substantial evidence, international best practice, legal requirement

#10 stabilise, repair and rehabilitate the object of the damage

Aims to return injured persons to work ASAP and undertake rehabilitation in the workplace if possible • Psychosocial issues related to the injury (yellow

flags) may obstruct return. Must be identified and resolved in conjunction with the manager

• Physical demands assessed modified duties

• Successful programs for general MSD and LBP include exercise programs

Passive Countermeasures

Countermeasures Event Phase Approach

1.Optimal floor surface Pre-event

2. Optimal wheel size Pre-event

3. Re-design physical environment Pre-event

4. Update to ergonomically improved “state-of -the-art-equipment”

Pre-event

5. Removal of faulty, inappropriate equipment

Pre-event

6. Maintenance of MH equipment Pre-event

7. Close bed when staffing is unsafe Pre-event

8. Dedicated lift-teams Event

9. Dedicated ward for specific patients Pre-event

Active Countermeasures

Countermeasures Event Phase Approach

1. Exercise Pre-eventPost-event

2. Practice aligns to NLP Event

3. Equipment to move, position and transfer patients

Event

4. Assessment and decision making tools

Event

5. Teams of nurses (and aides) to MH

Event

6. Safety climate for MH practice Event

7. Assessment following injury and address relevant workplace issues

Post-event

Planning injury prevention

• Injuries are predictable

• Occur as the result of a chain of events

• Intervention are planned to interrupt the chain and address identified risk factors

• Principles are used to maximise prevention

Injury epidemiology principles1. Active or passive interventions: prefers passive

- will always be effective

2. Single or mixed interventions: prefer mixed -injuries have multiple causes with multiple prevention opportunities. Must address host-agent-environment in pre/event/post phases

3. Prioritise the most effective intervention rather than relying on education to change behaviour

Injury epidemiology principles

4. Education efficacy increased if supported by:

-legislation /policy (enforcement)

-passive interventions in environment

-modification of psychosocial environment

Results of this study• Host - did not perceive manual handling as

a heath threat. Problem - active interventions may not be employed

• 10 agent - patients with obvious constraints. Problem - cannot change pt have to change approach

• 10 environment – social expectation to take risks to complete work. Problem -training and policy ignored

Implications for Practice:• Multifaceted interventions are more effective• Training/education are part of multifaceted

interventions (need infrastructure and social support to use skills/knowledge)

• Develop + implement a safety climate• Educate managers/supervisors

• Substantial evidence