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SAFE PATIENT HANDLING IN WASHINGTON HOSPITALS Your guide to a safer healthcare environment Slide 2 On the phone Chris Barton SEIU 1199NW Dan Donahue Providence St. Peter Hospital Brenda Suiter Washington State Hospital Association Lynn LaSalle MultiCare Health System Barbara Silverstein Department of Labor & Industries Slide 3 Credo Patients should not be harmed by the care that is intended to help them, nor should harm come to those who work in health care Crossing the Quality Chasm, 2001 Slide 4 Agenda Safe Patient Handling Law Background Safe Patient Handling Law Background Safe Patient Handling Website Safe Patient Handling Website Law Timelines Law Timelines Equipment requirements and funding Equipment requirements and funding Questions Questions Slide 5 Safe Patient Handling Legislation Governor Gregoire signed Engrossed Substitute House bill 1672 on March 22, 2006 Governor Gregoire signed Engrossed Substitute House bill 1672 on March 22, 2006 Bill became law on June 21, 2006 Bill became law on June 21, 2006 Legislation makes safe patient handling part of how hospitals provide care by adding this requirement to DOH hospital licensing requirements Legislation makes safe patient handling part of how hospitals provide care by adding this requirement to DOH hospital licensing requirements Slide 6 Background The law was supported by: Service Employees International Union Local 1199NW Service Employees International Union Local 1199NW United Food & Commercial Workers Union United Food & Commercial Workers Union Washington State Hospital Association Washington State Hospital Association Washington State Nurses Association Washington State Nurses Association Slide 7 Why was the law enacted? To improve the safety of healthcare employees and patients To improve the safety of healthcare employees and patients Provide funding to hospitals implementing safe patient handling programs Provide funding to hospitals implementing safe patient handling programs To improve nurse retention To improve nurse retention To reduce costs to hospitals To reduce costs to hospitals Slide 8 Nurses lift an estimated 2 tons per shift Do the math: Number of patients/day Number of lifts/patient Average weight/patient 4 X 6 X 170 = 4,080lbs/day Nurses lift an estimated 2 tons per shift Do the math: Number of patients/day Number of lifts/patient Average weight/patient 4 X 6 X 170 = 4,080lbs/day We Know Slide 9 We know 38% of nurses suffer work-related back injuries requiring time away from work 38% of nurses suffer work-related back injuries requiring time away from work 12% of nurses consider leaving nursing due to low back pain at average age 39 12% of nurses consider leaving nursing due to low back pain at average age 39 Nurse aides have also experienced significant injury Nurse aides have also experienced significant injury Slide 10 Zero-Lift Program Lifting programs have been proven to be effective. WHSs Workers Compensation Zero Lift Program has experienced remarkable success: Lifting programs have been proven to be effective. WHSs Workers Compensation Zero Lift Program has experienced remarkable success: Patient Handling injuries had decreased by 43% Patient Handling injuries had decreased by 43% Time loss frequency rates had decreased by 50% Time loss frequency rates had decreased by 50% Slide 11 Safe Patient Handling Steering Committee Collaboration developed to provide tools and models that will help hospitals implement safe patient handling programs. Collaboration developed to provide tools and models that will help hospitals implement safe patient handling programs. Healthcare Unions Healthcare Unions Department of Labor & Industries Department of Labor & Industries Physical and Occupational Therapists Physical and Occupational Therapists Employee Health Managers Employee Health Managers Urban and Rural Hospital Administrators Urban and Rural Hospital Administrators Washington State Hospital Association Washington State Hospital Association Washington Hospital Services Workers Compensation Program Washington Hospital Services Workers Compensation Program Slide 12 Law Timelines February 1, 2007 establish safe patient handling committee February 1, 2007 establish safe patient handling committee December 1, 2007 implement safe patient handling program December 1, 2007 implement safe patient handling program January 30, 2010 acquire lifting equipment January 30, 2010 acquire lifting equipment Enforced by the Department of Health Slide 13 Slide 14 Poll Question Slide 15 Slide 16 Slide 17 Flow Chart Slide 18 Slide 19 Slide 20 Slide 21 Slide 22 February 1, 2007 Establish a safe patient handling committee with at least half of the committee being direct care staff Slide 23 Establishing a Committee Recruit Participants (50% direct care staff) Recruit Participants (50% direct care staff) Elect committee chair and co-chair Elect committee chair and co-chair Develop meeting schedule and protocols Develop meeting schedule and protocols The primary responsibility of the committee is to establish, implement and monitor the Safe Patient Handling Program. Slide 24 Labor Management The Steering Committee recommends union involvement in committee development and decision making Slide 25 Poll Question Slide 26 December 1, 2007 Establish a safe patient handling program Slide 27 Safe Patient Handling Program Safe patient handling program shall include and hospitals must: 1.Implement a safe patient handling policy 2.Conduct a safe patient handling hazard assessment 3.Develop a process to identify the appropriate use of the safe patient handling policy based on patient needs and availability of equipment 4.Conduct an annual performance evaluation 5.Consider the feasibility of incorporating equipment when constructing or remodeling a hospital Slide 28 Establishing a Safe Patient Handling Program 1.Implement a safe patient handling policy for all shifts and units of the hospital It is recommended your safe patient handling committee draft a policy together 2.Conduct patient handling hazard assessment. Include variables such as patient handling tasks, types of nursing units, patient populations, and the physical environment Slide 29 Establishing a Safe Patient Handling Program 3.Facilitate the development of standards for assessing each patient and their activities A.Get input for department staff B.Include how to document and share information across shifts and departments C.Consider using algorithms Slide 30 Establishing a Safe Patient Handling Program 4.Conduct an annual performance evaluation of the program to determine its effectiveness-report results to your safe patient handling committee 5.When developing architectural plans, consider the feasibility of incorporating patient handling equipment into the design Slide 31 What Makes a Successful Program? Analyze what works already in your hospital: Existing practices Existing practices Attitudes about change Attitudes about change Administrations support Administrations support Organizational culture Organizational culture Barriers to change Barriers to change Current patient flow Current patient flow Slide 32 Know Current Practices Department practices and techniques already used for handling their patient population Department practices and techniques already used for handling their patient population Who is influential in each department the leaders of co-workers Who is influential in each department the leaders of co-workers Slide 33 Educate Your Hospital Committee members to their role on the team, empower them to do their work Committee members to their role on the team, empower them to do their work Management - for staffing, so team members can attend meetings and do their work Management - for staffing, so team members can attend meetings and do their work Keep the committee informed of their accomplishments so they feel successful Keep the committee informed of their accomplishments so they feel successful Slide 34 Campaign Build Momentum Use every modality possible to share what is being planned and implemented: Use every modality possible to share what is being planned and implemented: Recruit an Administration sponsor who will speak directly to the care givers Recruit an Administration sponsor who will speak directly to the care givers Design in accountability of managers, supervisors, charge nurses, house supervisors and direct care givers; to know when the team meetings occur, who the members are, departments need for equipment, what systems and techniques will change, processes for acquiring what they need, etc. Design in accountability of managers, supervisors, charge nurses, house supervisors and direct care givers; to know when the team meetings occur, who the members are, departments need for equipment, what systems and techniques will change, processes for acquiring what they need, etc. Slide 35 Inform Your Patients, Families, and Visitors Advertise in brochures, newsletters, hospital bulletin boards Advertise in brochures, newsletters, hospital bulletin boards Create expectations Create expectations Make the work of the committee public, positive and rewarding Make the work of the committee public, positive and rewarding Please visit website to view a sample marketing materials Slide 36 Individual Patient Assessment Slide 37 Risk & Needs Assessment Measures to eliminate or reduce patient handling risks must be identified Measures to eliminate or reduce patient handling risks must be identified Conduct an analysis of injuries Conduct an analysis of injuries Identify and prioritize patient handling risks Identify and prioritize patient handling risks Assess patient mobility needs Assess patient mobility needs Conduct an inventory of patient handling equipment Conduct an inventory of patient handling equipment Identify environmental and system barriers Identify environmental and system barriers Slide 38 Learn From Your Mistakes Conduct annual performance evaluations of the: Systems policy Systems policy Committees work Committees work Program effect on injuries & falls Program effect on injuries & falls Equipment Use Equipment Use Slide 39 Annual Performance Evaluation Slide 40 Change Can Be Hard Have activities with rewards for individual care givers and departments: Informal brown-bag lunches Informal brown-bag lunches Departments can compete against each other Departments can compete against each other Rodeos Rodeos Slide 41 A Successful Program Adheres to the requirements of the law Adheres to the requirements of the law Meets all deadlines Meets all deadlines Uses the available tools Uses the available tools Involves your safe patient handling team in decision making Involves your safe patient handling team in decision making Shares experiences, ask questions Shares experiences, ask questions Slide 42 Washington Regulatory Requirements 1 When developing architectural plans for constructing or remodeling a hospital or unit, the hospital must consider the feasibility of incorporating patient handling equipment or design needed to incorporate equipment later. When developing architectural plans for constructing or remodeling a hospital or unit, the hospital must consider the feasibility of incorporating patient handling equipment or design needed to incorporate equipment later. 1 RCW 70.41.390 Slide 43 Before The Blue Prints Get all levels of staff involved Get all levels of staff involved Think about all possible scenarios Think about all possible scenarios Place real users in a mock up of the design concept and simulate simulation Place real users in a mock up of the design concept and simulate simulation Full scale simulation with props or3-D computer simulations Full scale simulation with props or3-D computer simulations Slide 44 Working Space Transfer to Bed (Add 12 all around the bed for bariatric patient) Transfer bed /wheel chair or bed to stretcher: 1500 mm 5 Transfer bed /wheel chair or bed to stretcher: 1500 mm 5 Transfer with floor lift or bed/geriatric chair 1800 mm 6 (ceiling lift saves 12) Transfer with floor lift or bed/geriatric chair 1800 mm 6 (ceiling lift saves 12) Space for care giver and rest chair 100 mm 39 Space for care giver and rest chair 100 mm 39 Door room width 1220 mm (48) for bariatric patient Door room width 1220 mm (48) for bariatric patient *Adapted from Jocelyn Villeneuve, Design for Safe Patient Handling Slide 45 Single Bed/Bath Room Layout Total Space ~180 sq ft Total Space ~180 sq ft Side nearest the door 6 for a transfer involving floor device add 12 for bariatric Side nearest the door 6 for a transfer involving floor device add 12 for bariatric Window side 47 Window side 47 Foot of Bed 47 Foot of Bed 47 Bed faces the door privacy maintained with curtain, better observation and transfer (working) space Bed faces the door privacy maintained with curtain, better observation and transfer (working) space Door width 1220 mm (48) for bariatric patient Door width 1220 mm (48) for bariatric patient Slide 46 Bathroom Space Make sure equipment, staff and patient can fit in space. 36 door36 door 24 minimum clearance on each side of toilet24 minimum clearance on each side of toilet Retractable bars attached to wall for client transfers assisted by 1-2 care giversRetractable bars attached to wall for client transfers assisted by 1-2 care givers Wheel Chair rotation 5 diameterWheel Chair rotation 5 diameter Toilet weight tolerance needs to be 600+ lbsToilet weight tolerance needs to be 600+ lbs Slide 47 January 1, 2008 A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement. Slide 48 Employee Rights Hospitals MUST develop procedures for employees to refuse to perform or be involved in patient handling or movement task that the employee believes in good faith will expose a patient or employee to an unacceptable risk of injury Hospitals MUST develop procedures for employees to refuse to perform or be involved in patient handling or movement task that the employee believes in good faith will expose a patient or employee to an unacceptable risk of injury Please visit website to view a model policy http://www.washingtonsafepatienthandling.org/image s/Refusal_final.pdf Slide 49 January 30, 2010 Each hospital must complete, at a minimum, acquisition of their choice of: Each hospital must complete, at a minimum, acquisition of their choice of: One readily available lift per acute care unit on the same floor unless the safe patient handling committee determines a lift is unnecessary in the unit; One readily available lift per acute care unit on the same floor unless the safe patient handling committee determines a lift is unnecessary in the unit; One lift for every ten acute care available inpatient beds; or One lift for every ten acute care available inpatient beds; or Equipment for use by lift teams Equipment for use by lift teams Hospitals must train staff on policies, equipment, and devices at least annually Hospitals must train staff on policies, equipment, and devices at least annually Slide 50 January 30, 2010 Acquire equipment using your hazard assessment, injury data and with the input of the hospitals safe patient handling committee Acquire equipment using your hazard assessment, injury data and with the input of the hospitals safe patient handling committee Slide 51 Acquire Equipment Step 1: Establish a safe patient handling committee (50% direct care staff) Step 1: Establish a safe patient handling committee (50% direct care staff) Step 1: Step 1: Step 2: Train the safe patient handling committee Step 2: Train the safe patient handling committee Step 2: Step 2: Step 3: Write your Safe Patient Handling Policy Step 3: Write your Safe Patient Handling Policy Step 3: Step 3: Step 4: Assess the risks and needs for each unit in your hospital Step 4: Assess the risks and needs for each unit in your hospital Step 4: Step 4: Step 5: Plan for the purchase of equipment Step 5: Plan for the purchase of equipment Step 5: Step 5: Slide 52 Our Challenge Is: Getting the Equipment & Changing Practice Getting from manual handling To safe patient handling Slide 53 Where is High Injury Risk Exposure? Inpatient Rooms* (+ OR, PACU, Rehab) Repositioning Repositioning Move up, roll, clean Move up, roll, clean Transferring Transferring Bathroom/Commode Bathroom/Commode Walking Walking Bed to Gurney Bed to Gurney Bed to Chair Bed to Chair Example of continuous track from patient room to bathroom *Biomechanical Evidence William Marras, PhD, CPEWilliam Marras, PhD, CPE Slide 54 Where to put track Committee Decision Need/Data Driven Committee Decision Need/Data Driven CCU-Tele-Neuro-Med/Renal-Rehab CCU-Tele-Neuro-Med/Renal-Rehab Remodel Driven Remodel Driven Or combo data/remodel, needs to be cleared w/committee Or combo data/remodel, needs to be cleared w/committee Track As Many Rooms As Possible* Track As Many Rooms As Possible* Fixed Lifts view rooms, plus as follows Fixed Lifts view rooms, plus as follows Isolation Rooms Isolation Rooms CCU CCU Known heavy low mobile patient care areas Known heavy low mobile patient care areas Portables (475 lb capacity) 1 per 5 rooms Portables (475 lb capacity) 1 per 5 rooms Use until you have budget for fixed lifts Use until you have budget for fixed lifts *Tampa General Model Slide 55 Patient Transfer Devices Floor lifts/Bariatric Room Set-up Floor lifts/Bariatric Room Set-up From floor, chair, bed, also sit to stand & walking From floor, chair, bed, also sit to stand & walking Slider Transfer Sheets Slider Transfer Sheets Lateral and horizontal transfer Lateral and horizontal transfer Ceiling Lifts Ceiling Lifts Repositioning, floor to bed, bed to chair Repositioning, floor to bed, bed to chair Beds Beds Chair posit., flexi-foot, Trendelenburg Chair posit., flexi-foot, Trendelenburg Transport devices Transport devices Zoom stretcher, bariatric stretcher, Ergo-tug Zoom stretcher, bariatric stretcher, Ergo-tug This is a cut out of our transfer device locator Slide 56 Ceiling Lifts Portable lift on gantry (xy) configuration Repositioning is easy Full body repositioning sling Seated universal sling Pam working with training dummy and ceiling lift. Slide 57 December 30, 2010 A hospital may take a credit for the cost of purchasing mechanical lifting devices and other equipment that are primarily used to minimize patient handling by health care providers, consistent with a safe patient handling program developed and implemented by the hospital Slide 58 B&O Tax Credit All hospitals qualify for the B&O Tax Credit All hospitals qualify for the B&O Tax Credit Hospitals can receive up to $1000 per acute care available inpatient bed Hospitals can receive up to $1000 per acute care available inpatient bed The number of acute care available inpatient beds in each hospital is based on the year-end financial reports submitted to the Department of Health The number of acute care available inpatient beds in each hospital is based on the year-end financial reports submitted to the Department of Health Form can be downloaded at: http://www.washingtonsafepatienthandling.org/images/B_O_tax_ form.pdf Slide 59 Poll Question Slide 60 The Patient Handling Bible Slide 61 In Summary Use hazard assessment, injury data and committee to make equipment acquisitions Use hazard assessment, injury data and committee to make equipment acquisitions Equipment: key points Equipment: key points Engage your facilities staff & give ergonomic input for construction remodel design Engage your facilities staff & give ergonomic input for construction remodel design Think BIG and spend lots! Think BIG and spend lots! Slide 62 Thank you Service Employees International Union Local 1199NW Washington State Nurses Association Regional Hospital Regional Hospital for Respiratory and Complex Care Valley Medical Center Multicare St. Mary Medical Center Valley General Hospital United Food & Commercial Workers Union Local 21 Harrison Medical Center Kittitas Valley Hospital United Food & Commercial Workers Union Local 141 Providence St. Peter Hospital Empire Health Services Department of Labor & Industries Washington State Hospital Association Swedish Medical Center WHS Workers Compensation Program Slide 63 Thank you Chris Barton SEIU 1199NW Dan Donahue Providence St. Peter Hospital Brenda Suiter Washington State Hospital Association Lynn LaSalle MultiCare Health System Barbara Silverstein Department of Labor & Industries Slide 64 Questions Slide 65 Thank you for participating! Please fill out the evaluation.