Safe Patient Handling And Mobility Research Articles

A Novel Approach to Safe Patient Handling and Mobility Training in Physical Therapist Education

Background: Safe patient handling and mobility (SPHM) training is prevalent in health care education and practice. However, there is limited evidence of this training in physical therapist education programs. Purpose: To determine if a single training session with a mobile laboratory equipped with SPHM equipment increases the knowledge of SPHM principles and techniques and is valuable to students prior to their first clinical experience. Methods: Training included a 1-hour lecture on SPHM principles, research, and techniques, followed by two 50-minute SPHM practice stations. One session was conducted using a mobile laboratory. Students completed a pretest/posttest measuring knowledge of SPHM principles. Students completed a survey regarding the perception and placement of SPHM training within the curriculum. Results: A total of 129 students in a physical therapist education program were invited to participate; 59 from first-year cohorts and 70 from second- and third-year cohorts. Eighty-seven students volunteered to participate, including all 59 students from the first-year cohorts receiving training as the experimental group, and 28 from the other cohorts receiving no training as the control group. Seventy students met the criteria for survey data analysis; 42 experimental and 28 control. Of those who received training, 90.5% reported that SPHM training improved their confidence prior to their inpatient clinical experience; 85.5% in the control group would have felt more confident being placed in an inpatient facility if they received SPHM training, and 85.7% of the experimental group and 89.3% of controls agreed that SPHM training should be performed prior to the first clinical experience. A paired t test showed that first-year students reported a statistically significant increase in knowledge of SPHM principles (P < .001). Conclusions: Physical therapist education programs should consider SPHM training prior to students’ first clinical experience to increase student confidence in inpatient settings.

Individual and organizational factors associated with injury history and patient handling behaviors: Results from a nationwide survey of healthcare workers

With proper compliance, safe patient handling and mobility (SPHM) programs reduce musculoskeletal disorders (MSDs). To better understand individual, environmental, and organizational factors associated with both the adoption of SPHM and prevalence of MSDs, a nationwide online survey was administered. 973 healthcare workers (HCWs) completed the survey, for which 59.6% reported past work-related MSDs or pain. Among those with pain or injury, 33.3% changed roles, 79.7% worked while injured, and only 30.9% reported workers’ compensation claims. Less than half of HCWs agreed that SPHM equipment is readily available, and most considered manually handling patients weighing over 91 kg acceptable. Equipment availability, ceiling lift availability, supervisor encouragement, and annual training were associated with increased use of SPHM equipment. Availability of SPHM equipment reduced the likelihood of injured nurses changing roles. Despite overall agreement that SPHM programs are beneficial, common clinical practice remains insufficient to adequately protect HCWs from risk of injury.

Coding and applying injury claims data to implement and sustain effective safe patient handling and mobility solutions

Investigating and accurately categorizing employee injury claims are essential for identifying trends and implementing effective solutions. This process is especially important for injuries associated with patient handling injuries (PHIs) for which data is often lacking. This study summarizes how improved coding of injuries for 15 years of workers’ compensation (WC) data was used to improve system-wide injury prevention efforts, in particular those related to safe patient handling and mobility (SPHM) practices across an 11-hospital region within the system. Accurate coding of caregiver injuries and implementing SPHM solutions based on this data had a significant impact on accurately identifying risk, implementing injury prevention strategies, and decreasing frequency and severity of employee injuries related to outdated manual patient handling practices.

Reliability and validity of the Veterans Administration Mobility Screening and Solutions Tool

ObjectivesThe Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was developed to screen a patient’s safe mobility level ‘in the moment’ and provide clinical decision support related to the use of safe patient handling and mobility (SPHM) equipment. This evidence-based flowchart tool is a common language tool that enables any healthcare worker at any time to accurately measure and communicate patient mobility and transfer equipment needs across disciplines and settings.MethodsThe VA MSST has four levels and differentiates between the need for powered and non-powered equipment depending on the patient’s independence. Subject matter experts wrote scenarios for interrater reliability and validity testing. The initial VA MSST draft iteration was reviewed by 163 VA staff (mostly physical therapists and occupational therapists) amongst simulation scenarios and provided content validity, and additional insight and suggestions. Revisions were made to create the final VA MSST which was evaluated by over 200 healthcare workers from varied disciplines (including medical doctors, advanced practice registered nurses, registered nurses, licensed practical nurses, certified nursing assistants, occupational therapists, physical therapists, speech therapists, radiology and ultrasound technicians, etc.). An instruction video and eighteen scenario videos were embedded in an online survey. The survey intended to demonstrate the interrater reliability and validity (concurrent and construct) of the VA MSST. Over 500 VA staff (raters) received a survey invitation via email.ResultsRaters (N = 230) from multiple disciplines and healthcare settings independently screened patient mobility status for each of 18 scenarios using the VA MSST. The raters were diverse in their age and years of experience. The estimated interrater reliability (IRR) for VA MSST was excellent and statistically significant with an estimated Krippendorff’s alpha (ICC (C, k)) of 0.998 [95% CI: 0.996–0.999]. Eighty-two percent of raters reported that overall VA MSST instructions were clear or very clear and understandable. VA MSST ratings made by technicians and nursing assistants group correlated strongly (r = 0.99, p < 0.001) with the ‘gold standard’ (experienced physical therapists), suggesting a high concurrent validity of the tool. The VA MSST significantly discriminated between the different levels of patient mobility required for safe mobilization as intended (each difference, p < 0.0001); this suggests a good construct validity.ConclusionsThe VA MSST is an evidence-based flowchart screening and decision support tool that demonstrates excellent interrater reliability across disciplines and settings. VA MSST has strong face and content validity, as well as good concurrent and construct validity.

A return-on-investment model using clinical and economic data related to safe patient handling and mobility programs in the ICU

Safe Patient Handling and Mobility (SPHM) programs are well-established to reduce patient-handling related injuries among healthcare workers (HCWs). Evidence also suggests SPHM practices promote early mobilization (EM) and help reduce preventable hospital-acquired complications among intensive care unit (ICU) patients. However, research on the economic benefits of SPHM is limited, particularly related to patient outcomes. These evidence gaps make it difficult for hospitals to accurately estimate return on investment (ROI) for a SPHM program implementation or expansion. The purpose of this paper is to summarize the evidence of SPHM programs on HCWs and patient outcomes necessary to develop a ROI model for the ICU setting. A structured search of SPHM literature on the following three key variables (1) HCW patient-handling related injuries, (2) hospital-acquired conditions, including pressure injuries (PI), ventilator-associated pneumonia (VAP), and venous thromboembolisms (VTE), and (3) ICU Length of Stay (LOS) and mechanical ventilator (MV) days, was conducted. Findings suggest significant heterogeneity in terms of sample sizes, patient populations, interventions, and outcome measures among studies conducted on these key variables. An example ROI model is presented to demonstrate how the published evidence and its variability can be used when estimating the potential economic benefit of SPHM in an ICU.Relevance to industry. This work provides a summary of literature findings and a demonstration of how facilities can use the published evidence to customize a ROI estimate for any proposed SPHM program implementation or expansion in the ICU.

Critical review on applications and roles of exoskeletons in patient handling

Musculoskeletal Disorders (MSDs) remain a major concern for workers in the healthcare industry. Healthcare workers are at high risk of work-related MSDs mainly caused by overexertion from manually handling patients. Exoskeletons may be a useful tool to help reduce the risk of MSDs during patient handling. As a review study, we surveyed articles focusing on applying exoskeletons to patient handling tasks specifically. We also reviewed relevant government databases and other studies related to Safe Patient Handling and Mobility (SPHM) programs and exoskeleton applications in general. The exoskeletons specifically designed for patient handling were found to be sparse. To have a better understanding of the needs and challenges of developing and using exoskeletons for reducing risks of work-related MSDs in healthcare workers during patient handling, this critical review (1) provided an overview of the existing issues and projected future burdens related to work-related MSDs during patient handling tasks, (2) recognized current and potential roles and applications of existing exoskeletons, and (3) identified challenges and needs for future exoskeleton products. In conclusion, we do not expect exoskeletons to replace the existing SPHM programs, but rather play a complementary role to these multi-pronged programs. We expect that emerging exoskeleton products can be introduced to uncontrolled or specialized healthcare environments. There are various expectations and requirements for an exoskeleton used in different healthcare settings. Additionally, introducing certain types of exoskeletons for patients to assist them during treatment and rehabilitation may help reduce the MSD risks to the healthcare workers.

Safe patient handling and mobility (SPHM) for increasingly bariatric patient populations: Factors related to caregivers' self-reported pain and injury

This study was conducted at 5 Veterans Administration Medical Centers (VAMCs). A cross sectional survey was administered to 134 workers who routinely lift and mobilize patients within their workplaces’ safe patient handling and mobility (SPHM) programs, which are mandated in all VAMCs. The survey was used to examine a comprehensive list of SPHM and non-SPHM variables, and their associations with self-reported musculoskeletal injury and pain. Previously unstudied variables distinguished between “bariatric” (≥300 lb or 136 kg) and “non-bariatric” (<300 lb or 136 kg) patient handling. Significant findings from stepwise and logistic regression provide targets for workplace improvements, predicting: lower injury odds with more frequently having sufficient time to use equipment, higher back pain odds with more frequent bariatric handling, lower back pain odds with greater ease in following SPHM policies, and lower odds of upper extremity pain with more bariatric equipment, and with higher safety climate ratings.

Use of Champions Identified by Social Network Analysis to Reduce Health Care Worker Patient-Assist Injuries

Safe patient handling and mobility (SPHM) programs recommend having champions, but have not indicated how to identify them and have confined their role to peer-based activities, limiting their ability to influence control measures. In a pilot program conducted at a community access hospital in Oregon, researchers applied social network analysis (SNA) of safety advice to identify champion candidates. Candidates were invited to complete mobility, communication, and quality improvement (QI) training modules to become champions. Champions' roles included peer-based instruction and participation in QI quarterly meetings with hospital leaders. The program process was evaluated through weekly e-mail check-ins and documentation of quarterly meetings. Outcomes were evaluated with a pre-post design, observing 12-month changes in self-reported leading indicators and Good Catch reports, as well as trends in patient-assist injuries (2011-2019). SNA identified six candidates, four of whom became champions. Champions completed 48 weekly logs. The quarterly meetings concerned unitwide SPHM training, equipment storage, and onboarding. Results showed significant improvements in equipment use, safety participation, and safety compliance, particularly among workers who would seek SPHM advice from champions or recently hired workers. Compared with the prior year, the Good Catch monthly entries increased from 11.69 to 28.81. The average annual incidence rate of patient-assist injuries dropped from 13.01 for the six years before the program to 3.7 per 100 full-time equivalents (FTE) for the two years after. A program with SNA-identified and QI-trained champions improved safety outcomes after one year. Better-designed evaluations are needed to establish the replicability and long-term impact of this program.

Simulation to Teach Safe Patient Handling and Mobility for Home Caregivers

Safe patient handling and mobility (SPHM) programs are needed in the home care environment. As patient-lifting technology and devices become more widely available for use in the home setting, caregivers need opportunities to learn how to properly use these devices. Nonmedical caregivers employed by personal support services agencies (PSSAs) and home caregivers have very limited access to opportunities for SPHM training in rural areas of Tennessee. Safe patient handling and mobility training utilizing simulation with an interprofessional approach was developed and provided to 17 nonmedical and family home caregivers. The training was evaluated utilizing Kirkpatrick’s Four-Level Training Evaluation Model. Participants completed anonymous surveys immediately following the training and 4 to 6 weeks after the training. Survey I (n = 17): Respondents indicated increased knowledge of safe patient handling (94%) and applied knowledge of safe patient handling in training (90%). Survey II (n = 6): Most respondents (67%) indicated that they had applied the knowledge and skills that they had learned in the training. Two respondents (33%) indicated that they had not yet had the opportunity to apply the knowledge and skills they learned. The survey also showed that all respondents believed that the knowledge and skills they had learned helped to decrease the risk of personal injury and injury to patients. Safe patient handling and mobility training utilizing simulation with an interprofessional approach was effective in promoting safety of nonmedical and family caregivers in the home setting. Based on the success of this program, more training opportunities should be implemented to improve patient and caregiver safety.

The use of safe patient handling and mobility equipment in rehabilitation.

Increasingly, occupational and physical therapists are using safe patient handling and mobility (SPHM) equipment, such as mechanical lifts, in rehabilitation. However, there is little guidance in the literature on how SPHM equipment can be used to assist patients to reach rehabilitation goals. The purpose of this projectwas to document and categorize common and innovative ways rehabilitation therapists use SPHM equipment in their clinical practice. This article investigates common and innovative uses of SPHM equipment in rehabilitation practice. Occupational, physical and kinesio therapist employed at the Veterans Health Administration wrote narratives and took photos describing rehabilitation therapy activities where they used SPHM equipment in their clinical practice. The authors used a systematic process to review and categorize the narratives and subsequent photos by using the World Health Organization's International Classification of Functioning, Disability and Health (ICF). Thirty narratives (13 innovative and 17 common) were coded into four categories on the ICF section of mobility. The most common category was "changing and maintaining basic body position"(21) followed by "walking and moving" (5). The category "carrying, moving and handling objects" garnered two narratives and there were no narratives for "using transportation." Project findings may serve as a guide for therapists who would like to enhance their use of SPHM equipment in rehabilitation. Additional research is needed to expand the use of SPHM in rehabilitation practice and evaluate the impact on patient rehabilitation outcomes and therapist safety outcomes.

Integrating Safe Patient Handling and Early Mobility: Combining Quality Initiatives.

Safe Patient Handling and Mobility (SPHM) programs reduce staff injuries from lifting and repositioning patients. Early Mobility programs improve many patient-centered outcomes. Reframing SPHM equipment as mobilization tools can help safely mobilize hospitalized patients to their highest abilities. Combining SPHM and Early Mobility programs is logical, but to date, no one has articulated the process of integration. A quality improvement process was developed at the Phoenix Veterans Affairs Health Care System to integrate an Early Exercise and Progressive Mobility initiative in the intensive care unit into an ongoing SPHM program using the Iowa Model for Evidence-Based Implementation. Integration of these programs was possible through extensive collaboration between stakeholders throughout planning, implementation, and refinement phases. Interdisciplinary Early Exercise and Progressive Mobility simulation training, standardized assessment, communication of patient status, and appropriate equipment use facilitated staff confidence to safely mobilize patients. Successful integration of Early Exercise and Progressive Mobility and SPHM was achieved at the Phoenix Veterans Affairs Health Care System.

Integration of Safe Patient Handling and Mobility Principles in Professional Physical Therapist Education: A Case Report

Background and Purpose. Safe patient handling and mobility (SPHM) programs are being used across the country to safely transport and mobilize patients while at the same time reducing injury risk to caregivers, including physical therapists (PT) and physical therapist assistants (PTA). The American Physical Therapy Association has called PTs and PTAs to not only use the concepts of SPHM in clinical practice, but also be leaders in utilization, development, and implementation of SPHM programs, including training and education of other health care team members. Perlow, et al have recommended that SPHM content be integrated into Doctor of Physical Therapy (DPT) education. This case report outlines 1 current module used to deliver such content. Case Description. A neurologic interventions course within the DPT curriculum was selected using a framework that linked content, objectives, and learning activities with relevant Normative Model criteria and Physical Therapist Code of Ethics to improve student self-efficacy with SPHM content. Primary goals were to improve student awareness about risk and impact of work-related musculoskeletal disorders, expose students to the expected role of the PT as an advocate for and educator in SPHM programs, and provide hands-on experience with SPHM technologies. The 6-hour session was completed in 1 day with a 1-hour lecture and 5 hours with a variety of hands-on activities. Outcomes. Student learning was assessed through a pre–post class questionnaire, documentation/discussion of experiences, and presentations of student-generated neurologic interventions using SPHM equipment. Awareness of increased risk of injury, limits of 'good' body mechanics, and feasibility of using SPHM technologies to improve the quality of physical therapy practice dramatically increased. Discussion. Students should participate in a variety of learning activities threaded through the curriculum to provide sufficient hands-on opportunities to improve self-efficacy in using SPHM principles in rehabilitation. By developing a basic level of competency with SPHM principles, students may be more likely to adopt SPHM as a professional value once graduated. Improvements to this model, recommendations for SPHM integration into DPT curricula, and research opportunities are discussed. Conclusion. We have provided 1 model that embeds SPHM content into entry-level physical therapist education. In doing so, educators are advancing physical therapy skills needed to apply evidenced-based therapeutic principles in difficult to move patients while reducing risk of injury to students and new graduates of the profession.

Reducing Intensive Care Unit Staff Musculoskeletal Injuries With Implementation of a Safe Patient Handling and Mobility Program.

The purpose of this safety initiative was to reduce work-related injuries through the implementation of a safe patient handling and mobility (SPHM) program in a medical intensive care unit. An SPHM program was implemented on a critical care medicine unit in February of 2017. Nursing and assistive personnel completed education via hands-on and online educational modules regarding SPHM equipment and techniques and an SPHM policy. All staff were expected to follow SPHM practices. Critical care medicine unit nursing leadership and unit-based SPHM peer coaches rounded to ensure staff compliance with the program. A 1-year evaluation demonstrated a reduction of 86% in work-related injuries. In 2016, there were 7 injuries while in 2017, only 1 injury occurred. Lost and restricted days away from work were reduced by 54% or from a total of 112 days in 2016 to 52 days in 2017. The implementation of an SPHM program in a medical intensive care unit appears to be highly effective at reducing health care worker injuries. More research is needed to identify the best and most effective ways to provide care to our most critical patients. Positive behaviors from the staff regarding the SPHM program have helped reduce injuries and lost workdays.

"Add It to the Parking Lot": Safe Patient Handling and Mobility in the Emergency Department.

Nelson and Baptiste noted that a standard approach to safe patient handling and mobility (SPHM) cannot be generalized to all patient care areas because the unique, high-risk tasks of each area require specific intervention. Matching the SPHM program to the setting, tasks, and roles is important in developing a program that will prevent harm. However, there is little evidence related to the use of SPHM programs in nontraditional care environments, such as emergency departments (EDs). A such, there is no standardized method for training ED nurses in safe patient handling. An SPHM challenge unique to the ED is extricating patients out of vehicles. There are several ways to extricate patients from vehicles, with some requiring more resources, people, and equipment than others. These resources vary depending on the patient's level of activity and acuity. The purpose of this article is to articulate the importance of SPHM programs in EDs and the unique challenges and workflows that complicate implementation in this chaotic environment through a review of manual and equipment-assisted methods of extricating patients from the vehicle.

Nurses and nursing assistants decision-making regarding use of safe patient handling and mobility technology: A qualitative study

AimThis study explored decision-making regarding use of safe patient handling and mobility (SPHM) technology among registered nurses (RN) and nursing assistants (NA). BackgroundLifting injuries are common among healthcare workers. Despite development of standards for SPHM, the introduction of regulation for monitoring access to SPHM technology, and implementation of education programs and process improvements, threat of injury remains a concern. Although access to SPHM equipment is associated with decreased workplace injuries, access alone does not guarantee use. Questions remain concerning how healthcare workers make decisions to use SPHM equipment, and how they weigh decisions against personal safety. MethodsA qualitative descriptive study was conducted. Data collection consisted of four 60min focus groups. Two focus groups consisted of all RNs (n=14) and two consisted of all NAs (n=11). Each focus group was audiotaped and transcribed verbatim. Transcripts were coded, repeating concepts identified, and codes collapsed into themes and subthemes. ResultsQualitative analysis revealed three major themes: barriers to use, perceived risk, and coordination of care. Barriers to use include subthemes of physical barriers, knowledge and skill, and unit culture. Perceived risk includes patient risk and perceived risk to self. Coordination of care includes patient factors and characteristics, assessment of patient needs and abilities, and interprofessional collaboration. ConclusionsThese findings provide new knowledge about the complexity of decision making among care providers in the use of SPHM technology. Interprofessional team approaches to patient assessment and care are important components of confident decision making in use of SPHM technology.

Barriers to the Use of Assistive Devices in Patient Handling.

Work-related musculoskeletal disorders (WMSD) are a major safety concern in today's health care environment due to the manual lifting of patients with higher acuity levels and obesity. Nurses move patients multiple times each day, incurring cumulative stress and trauma resulting in chronic pain and potential injury. The purpose of this study was to assess barriers to the use of assistive devices in safe patient handling and mobility (SPHM) that contribute to WMSD in health care workers. Interpersonal, situational, organizational, and environmental influences have both direct and indirect effects on workers' commitment to use, or their actual likelihood of using, assistive devices. This study confirmed that time constraints contribute to fewer instances of assistive device use. Comprehensive ergonomic programs are needed to promote staff and patient safety. By providing safe environments for health care workers who engage in patient handling and mobility, the risk of injury can be significantly reduced.

Initial Results of an Evidence-Based Safe Patient Handling and Mobility Program to Decrease Hospital Worker Injuries.

The rate for musculoskeletal injuries among health care workers is one of the highest for all industrial sectors in the United States; these injuries often occur during manual handling (i.e., lifting, moving, transferring, and repositioning) of patients. The following article describes the process used to complete a comprehensive assessment, as well as the planning, implementation, and initial evaluation of a quality improvement program to reduce work-related musculoskeletal disorders (WMSD) among health care workers employed by a rural Midwest hospital. Key elements for WMSD injury reduction were identified and compared across literature sources, national standards, and current state and federal legislative requirements for hospitals. The program used a multi-factor design that included evidence-based interventions (i.e., those supported by emerging evidence) to create a comprehensive Safe Patient Handling and Mobility (SPHM) program intended to address the unique needs of the organization. Initial program results are reviewed as well as significant considerations and challenges for SPHM programs.

Reports From RNs on Safe Patient Handling and Mobility Programs in Acute Care Hospital Units.

The aim of this study was to investigate the perceptions of RNs on the implementation of safe patient handling and mobility (SPHM) programs in states with and without SPHM legislation. Despite numerous strategies developed to reduce caregiver injuries, nurses are still experiencing work-related musculoskeletal injuries. A comprehensive SPHM program has been found to be effective in reducing patient handling injuries among nurses. By using data from 143 480 RNs working in 321 acute care hospitals in 44 US states, RNs' perceptions on 6 key aspects of SPHM programs were compared between states with and without SPHM legislation and among 11 unit types. Registered nurses in states with SPHM legislation are more likely to report the implementation of SPHM programs in contrast with those in comparison states. This finding was found for each of the 11 unit types. This study provides evidence to support the positive effect of state-based efforts for legislative actions on the development and implementation of SPHM programs.

Musculoskeletal Injury Prevention for New Nurses.

Nurses continue to sustain musculoskeletal injuries even with increased emphasis on safe patient handling and mobility (SPHM) and organizational cultures of safety to protect health care workers. Analysis of data from 2011-2014 registered nurse graduates explored hospital safety culture, SPHM education/training, and incidence of new-nurse musculoskeletal injury. Results indicated hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines. Merely 13.9% of participants stated a written "no manual lifting policy" had been implemented; only 32.9% indicated staffing was adequate for SPHM tasks; and only 39.4% stated the hospital had all of the equipment needed to perform SPHM safely. Thirty-nine percent of participants had already sustained a musculoskeletal injury with an additional 35% sustaining but not reporting an injury. More actions are needed to ensure a decrease in musculoskeletal injuries for new nurses.

Effects of a safe patient handling and mobility program on patient self-care outcomes.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.