Presented by:Lori Zinnecker Hoener,

Karen Schumacher & Andrew Rich

Safe Patient Movement & Handling at NMH

Northwestern Memorial Healthcare CorporationNMH Chicago Campus:

8000+ Employees 894 Bed Acute Care, Academic

Medical Center

Lake Forest Campus: 1862 Employees 215 Bed Community Hospital

Diligent Services30+ Clinicians (OT, PT &

RN’s)Partner to drive Safe

Patient & Handling Program Success

We have collaborated in over 600+ facility success stories

ObjectivesThis workshop is designed for anyone who is faced with the responsibility of

implementing a SPH Program in their facility. The objectives are to:

Discuss factors that influence the success of safe patient handling programs Define where you are in the continuum of implementing a program:

Brainstorming to Sustaining

Look at common hurdles at each stage: Technical (processes, policies, etc.) Financial Cultural

Reinforce Use of Tools & Techniques to apply to all levels in order to anticipate challenges/obstacles and change beliefs.

Begin/Create a strategy for your facility

Where You Are Now?

Sustainability Plan

Anticipating Hurdles at Each Stage

Technical Considerations Engineering

Equipment/Sling Solutions Installation Considerations Laundry Storage

Administrative Define Problem Create Processes Develop Team Problem Solve Obstacles Training Metrics

Financial Considerations

Budgeting: Initial, On-Going Staff Time: Training Off Unit,

etc. Consultants Support Service Costs

Cultural Considerations Communication to All Levels•Compliance, Expectation & Accountability

Buy In & Culture Change•Patient & Family •Employee s

•Early Adopters•Late Adopters

Training

Marketing

Resources

Beginning: Proposal Stage

Implementation StageSpending more time on

technical and financial aspects: Defining the problem, Getting support and

funding, Determining who you

are communicating tooExploring the options.

By this point, process is defined, now focus is on communication:Training employeesGetting buy-in

Problem Solving Obstacles:Financial – still need to

replace / purchase/repair items.

Getting laundry done/turned around

Anticipating Hurdles at Each Stage

What stage are you in the process?What challenges are you facing in this stage?

Technical:

Financial:

Cultural:

STOP: Workshop 1

Tools & Techniques Have a Road Map

How did we tell our story?

What did we use?Process Improvement Tool: DMAIC/Six SigmaProject Management Tools: Timelines, Project Plan &

ResponsibilitiesInternal and External Experts

DMAIC = Interstate Highway6-Sigma, Lean, and Rapid Improvement Workshops = LanesProject Management and Change Acceleration = Support StructuresTools (Excel, toolkits, templates) = Side Rails and LinesProjects = Cars

Patient Movement & Handling Patient Movement & Handling OverviewLinkage to Best Patient Experience/Best People and Exceptional Financial Performance Best People: Assure a meaningful work experience for each employee.

Problem Statement:.1. From FY00-FY04:

• xxx NMH employees have been hurt moving/handling patients, resulting in:• xx lost & restricted days/employee incident, and • $ xx million cost to the organization • Caregivers lift/move/transfer 1500-3000# per shift

2. Bariatric Demographic• NMH admits xx patients/day that weigh > 500#,• NMH does not have equipment readily available for patients > 400-500# • There is no clear protocol for moving/handling dependent &/or bariatric patients.

3. Triggering Mechanism• There is no ‘trigger’ to cue staff to consider weight limits and patient dependency level to

ensure patient and employee safety. 4. Staff Surveys:

• xx% staff unsatisfied with their options to get physical or mechanical assist to move heavy, dependent patients.

Executive Sponsor: VP Sponsor: Nursing Director Project/Process Owner: Nurse Manager Improvement Leader: Safety Leader

Goal: By xx/xx/xx 1) Equipment to move patients that weight > 500# will be readily available (within 5-10 minutes) upon a “trigger” activating an equipment protocol. 2) Patient lift equipment will be compatible with NMH beds/carts. 3) Within 1 year of a hospital-wide implementation of a comprehensive patient ‘lift’ program, there will be a xx% reduction in both workers’ compensation costs and in lost & restricted work days that result from patient handling injuries (see projections on graph above).

Scope: Initially implement a patient movement initiative on 4 Pilot Units , then if goals are achieved, plan to roll out facility-wide in FYxx.System Capabilities (see Key Metrics)

1. Safety Loss Runs: Lost and Restricted Work Days, Workers’ Compensation Costs2. Pt escort record time Escort gets request for patient to be transported and time patient is delivered to destination

(includes delivery of equipment to transport)3. Documentation: measure percent of time patient weight, height and BMI is recorded & when trigger for

equipment is sent out.4. Employee Satisfaction Surveys/Cornell Symptom Survey

Key Metric(s)

Date #1 Define Jan.#2 Measure Feb#3 Analyze March#4 Implement April,#5 Control Aug,#7 House-wide Proposal December

Date

#1 Define Jan.#2 Measure Feb#3 Analyze March#4 Implement April,#5 Control Aug,#7 House-wide Proposal December

Milestones:

Total Patient Handling Cost Projections: Future Costs with No Intervention Versus With Program Implementation

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

FY 00 FY01 FY02 FY03 FY04 FY05* FY06* FY07* FY08* FY09* FY10* FY11*

Pat

ien

t Han

dlin

g C

ost

s

Projections with No Interventions

20% Cost Savings Projection with Comprehensive Program Intervention

Defining your Problem

Who are your stakeholders? What roadmap will you use?

STOP: Workshop 2

Measure: Key Metrics Safety Loss Runs:

Lost and Restricted Work Days, Workers’ Compensation Costs

Patient Handling Financial Assessment Tool: Calculates replacement costs.

Patient Escort Database: record time Escort gets request for patient to be transported and

time patient is delivered to destination (includes delivery of equipment to transport)

Documentation: measure percent of time patient weight, height, BMI and patient

handling equipment recommended is recorded in EMR.

Staff Surveys: Measure pre- and post-implementation: staff satisfaction

Improve: Improvement Initiatives

Strategy recommended and implemented by the team:

5 Pilot Unit Plan:• Capital Budget approved w/Consultant component

• Identified Unit Needs, Purchased equipment • Installation • Equipment Delivery to Units

• Pilot Protocol: Draft Written• Logistics

• Laundry &Inventory Mgmt• Documentation & Metrics established

• Training - Prevent provided training March to staff and super-users.

• Marketing & Communication: • Communications on Intranet and in electronic

documentation • Future: Nursing and Physician Newsletters

• Metrics:• OSHA Logs and Loss Runs• Documentation – Documentation Query: BMI,

Dependency Level & Width Triggers vs Actions Taken

Improve: Loss Run Data

GOAL MET!!!

Goal: 20% reduction in employee movement and handling incidents, lost and restricted days

FY05:

Q1 & Q2

FY06:

Q1 & Q2# of Patient Handling Injuries 22 2

# of Restricted & Lost Days

430 0

Cost

(Incurred + Replacement)

$124,305

($217,185)

$500

($500)

How will you measure success?Who will monitor? What will be your control?

STOP: Workshop 3

Program SustainabilityHow will you know when there is a problem?Who is responsible?How will it get fixed?

Control: Based on Pilot Success - Go House Wide & Program Effectiveness To Date

Pilot: 4 Units

Rollout Hospital Wide

Note upward trend – Create Spc Teams

Policy Approved

Gap Analysis & Recs

How will you build in sustainability?

A Department Perspective

We’ve discussed technical, financial and culture challenges that come along the way from a global perspective – let’s see how it

impacted a Department

…lessons learned…from overcoming obstacles to unexpected

surprises

Department Application

Benefits of Early AdoptionFree stuff! Lots of one-on-one attention Recognition Opportunity to provide feedback

Meeting with manufacturer to discuss R&D“Expert” status

Department Application

Technical Barriers: Ceiling lift installation Sling storage locations Securing laundered slings

Make friends with materials handling folks Availability of floor based equipment Troubleshooting broken or malfunctioning

equipment

Department Application

Financial Barriers:No initial upfront cost for individual

departmentEarly Adopter “Benevelance Stash” Sling replacement cost Repair costs Residual workman’s comp costs

Department Application Cultural Barriers:

Nursing Culture Is the equipment most used by therapists conveniently located on

the nursing units Do nurses still “wait” for therapy to 1st mobilize pts?

Physician Culture Are the physicians willing to allow their patients (mostly post

operatively ) use lift equipment? Eg: ortho patients, gym patients

Patient Culture Are patients willing to use the lift equipment? What happens when they refuse?

Marketing to patients, physicians and other HCPsDecreased decubiti

Potential for decreased hospital acquired “super bugs” due to decreased length of stay from faster mobilization

Decreased falls, particularly with bedside transfers

Increased level of independence in all ADLs and mobility at time of D/C due to faster mobilization/decreased time spent in bed

Continuity with all health care workers involved in care of patient

Increased dignity for the patient with fewer caregivers required to assist, especially for personal hygiene.

Department Application Cultural Barriers for Rehab (con’t):

Therapist Culture Overcoming therapists’ need to “assess” AND “treat”

Recognizing how nursing and therapists use lift equipment differently Functional Mobility Assessment for Nursing vs

Therapist’s Reference Guide for OT/PT

ROM Sitting Standing Ambulation

Ceiling Lift with total lift sling or

repositioning sheet

Total Lift Sling Support Vest Master Vest

Support Vest Master Vest Lift Pants

Master Vest Lift Pants

Department Application Cultural Barriers

Changing the way we document

Documenting patient’s function (and progression)despite use of lift equipment

Providing documentation that patient is using a mechanical lift in addition to physical assistance for functional activities

Assuring documentation does not prohibit patient from going to next level of care

Excerpt from Therapist DocumentationPatient required minimal assistance to ambulate 30 feet with his rolling walker WBAT on the LLE . Lift equipment in place for safety, balance, and d/t history of knee buckling; however, patient was not dependent on lift equipment for ambulation.

Excerpt from Therapist DocumentationPatient required minimal assistance to ambulate 30 feet with his rolling walker WBAT on the LLE . Lift equipment in place for safety, balance, and d/t history of knee buckling; however, patient was not dependent on lift equipment for ambulation.

Department ApplicationFinal thoughts on Culture…

HR Opportunities Preventing injuries in the tenured

employees and the (yet uninjured) new hires

Using safe patient handling program as a recruitment opportunity

Supporting the next generation of health care providers

Department Application “Staying the course” and keeping momentum…

Ongoing annual competencies

Training new staff and students after go-live

Addressing department injuries Post incident follow up Having an action plan for change

If you know ahead of time where the obstacles will be…

Why not- move them

We know…Word of mouth is electric

You don’t get many chances to screw up

If you don’t risk screwing up – you will fail

That’s all great but

BUT PLEASE

Wake me when the data is over

Wake me when the data is over

Story Time Facts inform- stories resonate & make you feelStories inspireStories spread

Safe Patient Handling is an IDEA VIRUS

0

50

100

150

200

250

300

350

400

Transfers Toilet Transfers Lower ExtremityDressing

Locomotion Total

Tot

al D

iffer

ence

in F

IM s

core

FIM Function

Total Difference in FIM scores Pre-and Post-SPHM Program at Bay Regional Medical Center

Pre-Program Difference (60 patients)

Post-Program Difference(52 patients)

What is the story here

http://www.youtube.com/watch?v=JXv262YKzc8

Mission Statement: Medical Center Hospital is a community-based teaching health system, providing high quality healthcare to all residents of the Permian Basin.

JoeS7264 (8 months ago)

I'm the one kneeling in gray scrubs. Hope you know how miraculous this video is. Only sat up for 10 seconds exactly 1-wk ago for first time in almost 3 months.

yesican32 (8 months ago)

Wonderful...but no matter your outstanding & unbelievable improvement, I'll still dance better than you.

TxTechKami (8 months ago)

OMG this is ABSOLUTELY AMAZING!!! Joe, you area true inspiration. Love you!

From YouTube

91.83% 99.86%

“Taking the class as a refresher really helped. I feel I can use the equipment now in any situation”

“What an impact this have on my ability to care for my patients and myself”

Despair.com

Safe Patient Handling, the idea is spreading!

What are the stories here

Dealing with storage: Where’s Waldo?

Recognition

Minimal Lift Ribbon Cutting Ceremony November 24, 2004

Are you a purple cow

How do you make your program remarkable?

STOP: Workshop 4List 3 actionable steps to change current challenges?

Take Away Message Effective safe patient handling programs include: Financing – short & long-term Culture Change Requires

Visible administrative support Active engagement of nurses and other health care workers Culture shift to integrate equipment into best practice – Patient Care &

Support Areas

Patient Care – Ownership and Engagement Establish Policies/Procedures, including interdepartmental collaboration Equipment Selection Training that supports proper use of patient handling equipment & culture

change Clinical tools and patient assessments for safe patient handling Resources: ‘superusers’/‘champions’, Intranet, Posters

Support Department – Ownership & Engagement Laundry Preventive Maintenance & Repairs

‘Map’ & Metrics to keep you on track

Questions / Discussion