safe patient handling & movement (sph&m) at the va san diego healthcare system kathleen l....
TRANSCRIPT
Safe Patient Handling & Movement (SPH&M) at the VA San
Diego Healthcare System
Kathleen L. Dunn, MS, RN, CRRN-A, CNS
Where we were in 2000 Most patient movement
was being done manually. Some areas had 1 mobile
lift, which was rarely used. Nurse injuries were
frequent & costly. SCI had highest nurse injury
rate in the entire hospital.
Transfers such as “quad” pivots, 2-person lifts, and 2 person “sheet pulls” were
common.
Sheet Pull2-person lift
Quad Pivot
Where we were in 2000
Traditional body mechanics training was included in orientation and reviewed annually.
Those injured were required to repeat this training.
February-April 2001 VASDHS staff attended VISN 8
Safe Patient Handling & Movement Conference.
We saw the light! Solicited support for
program within Nursing Service
Presented to PIC & approved for PIT chartering.
Costs of Injuries: FY02 VASDHS
30 nurse injuries associated with patient handling and movement tasks
17 occurred on the Spinal Cord Injury Center resulting in $162,815.53 in charge back (direct) costs.
With indirect costs being 4-10X that of direct, it is estimated that in FY02, the SCI unit had over $650,000.00 in costs related to nurse injuries caused by patient handling and movement.
Fall 2001-Summer 2002• Banned manual lifting (2 person
lifts & “quad pivots”) on SCI unit.• Established SPH&M committee.• Collected pre-project baseline
data.• Planned and held 2 equipment
fairs.• Trial install of 4 ceiling track lift
systems in SCI over 2 months.
SCI Patient Room
SCI Inpatient
Room
Single-track ceiling lift
for two beds in one room.
Auto return to preset height.
Battery Charge position
Sling hook on bedside cabinet
SCI Inpatient Room
Patients are issued a sling at
admission that stays on their bedside
closet hook.
Privacy Curtain ModificationsCurtains split & Velcroed
SCI Clinic
SCI clinic exam room
SCI Therapy Gym
Single-track ceiling lift over
P.T. parallel bars.
Scales allow measurement of % weight
bearing.
Use of Ceiling
Track Lift for
Suspended Gait
Training
Transverse-track ceiling lift over therapy mat
Cost Savings: Phase 1 $150,000 spent for Phase 1
(SCI) ceiling track lift installation in October 2002.
October 2002-March 2003: Zero (0) SCI nurse injuries
related to transfers or lifting. 1 SCI nurse injury related to
patient turning. Estimated costs savings:
$600,000 for Phase I pilot
Nursing Injuries r/t Patient Handling & Movement
012
32
4
6
9
11
65
8
50.0
40.0
50.0
18.2
11.1
0.00
2
4
6
8
10
12
2002Q1 2002Q2 2002Q3 2002Q4 2003Q1 2003Q2
# of
Inju
ries
0.0
10.0
20.0
30.0
40.0
50.0
60.0
%
SCI All Nursing Percentage
June-July 2003Presentation of Phase 2. proposal to Status of Funds
Approximately $600,000 for equipment approved for Phase 2.
October-December 2003
Installation of Phase IIPartial ceiling track lifts on all inpatient units.
New mobile lifts obtained for most areas.
“No-Lift” (SPH&M) Nursing & PCS Services Policy approved.
Staff Education & Training.
Develop “Champions” for culture change.
VASDHS – PINs (Preventing Injuries Now facilitators). Includes non-nursing staff as well.
Credible peer leaders.Ongoing hazard identification.Train-the-trainers.Implement algorithms in all
units/areas.
Strategies
PIN
Transfer to and from:* Bed to Chair* Chair to Toilet* Chair to Chair or* Car to Chair
Does the patient
have UE strength
?
Ability to bear weight
Is the patientcooperative?
Use ceiling lift or portable floor lift with full body sling and at least one care giver.
Use full body sling lift and 2
caregivers.
Is the patient
cooperative?
Caregiver assistance not needed;Stand by for safety as neededFull
Partial
Yes
No
No
No
No
Yes
Sample Algorithm
Other Examples of
Re-Engineering at
the VASDHS
ICU Ceiling Track Lifts
Wall Mounted System in Med-Surg areas
Dialysis Ceiling Track Lifts
Radiology Ceiling Track Lifts
Morgue Lift
Where are we now?ALL OF VASDHS – •Complete total patient room
ceiling track install: Spring 2007.
•Radiology, MRI, cardiac lab, and Morgue re-engineered.
•Rarely-used equipment bank (Escort).
• Increased compliance and skill in use of algorithms.
Where are we now? Before: averaged 40+ injuries a
year due to patient handling and movement.
Now: average 20 injuries a year with just partial implementation of the program.
Costs: approx. $950,000 spent on equipment and re-engineering.
Cost Savings: $2.8 million (direct and indirect)
Policy is now applicable to all direct patient care staff (not just nursing staff) as an MCM (3/06). List of banned manual handling
tasks Universal requirement to use
SPH&M techniques and equipment. Staff, supervisor and
administrative responsibilities detailed.
Where are we now?
Radiology, Rehab Medicine, and other services represented on Committee, which now reports to Process Improvement Council (PIC).
On-going education & monitoring.
Plans to have input on all patient care equipment purchases from ergonomic stand-point.
Where are we now?
VA National Directive mandating SPH&M is expected this summer.
Additional $336,000 received as VACO grant for projects through FY ’08
SPH&M Facility Champion position will be implemented by start of FY ’09.
Where are we now?
VASDHS Safe Patient Handling & Movement MCM
• Defines responsibilities at all levels.
• Applies to all clinical staff.• Lists banned patient/equipment
handling & movement activities.• Defines possible consequences for
staff failure to follow this policy & these rules.
• Contains decision making algorithms.
Thank You for
Your Attention
!