Safe Patient Handling Research Articles

Low back demands from assisting a patient with an unexpected loss of balance.

To combat the high incidence of lower back musculoskeletal injuries in healthcare workers, it is important to identify potentially injurious tasks. Although risk of injury has been estimated for many clinical tasks, assisting a patient following an unexpected loss of balance or sudden fall has not been assessed. This study aimed to quantify the lower back forces of healthcare workers when assisting a patient from a standing loss of balance. Peak L5/S1 intervertebral joint forces were estimated from thirteen healthcare workers in a laboratory setting as they assisted a patient from a standing loss of balance to a nearby wheelchair. The patient was a healthy male (64kg) who simulated a loss of balance by buckling at the knees. An additional condition with 18% of the patient's body weight unloaded was also tested. In a minority of trials, lower back demands exceeded ergonomic guidelines of 3400 and 1000N for compression and shear, respectively. Patient body weight affected both compression and resultant shear forces (p-values < .001). The lower back demands when assisting a 64-kg patient during a simulated loss of balance did not consistently exceed ergonomic safety guidelines. However, the results imply a high-risk task for heavier patients in simulated settings, or potentially all patients in realistic clinical settings. Several experimental design considerations and limitations may have created a best-case scenario that underestimated the lack of injury risk during the task studied. Use of safe patient handling and mobility equipment is advisable to minimize risk when ambulating patients.

From Theory to Practice: Integrating Safe Patient Handling and Mobility into Occupational Therapy Curriculum (Part 2/2)

From Theory to Practice: Integrating Safe Patient Handling and Mobility into Occupational Therapy Curriculum (Part 2/2)

From Theory to Practice: Integrating Safe Patient Handling and Mobility into Occupational Therapy Curriculum (Part 1/2)

From Theory to Practice: Integrating Safe Patient Handling and Mobility into Occupational Therapy Curriculum (Part 1/2)

Leaving Slings and Other Transfer Devices Under Patients: A Clinical Decision Support Quality Improvement Project.

The purpose of this quality improvement project was to develop guidance for safe patient handling and mobility efforts to prevent pressure injuries (PIs) within the Veterans Health Administration (VHA) when slings and other transfer devices are left under patients. Health care staff (n=112) in patient safety and nursing at 77 unique VHA facilities responded to surveys between November and December 2019. Interviews (n=24) were conducted using purposive sampling with VHA staff at facilities with highest and lowest PI rates (n=9) between January and March 2021. Feedback on practices and perceptions related to leaving slings and other transfer devices were evaluated using online cross-sectional surveys and interviews with VHA staff. Secondary data for VHA inpatient rates of PIs were used to examine associations with staff-reported sling and other transfer device practices. Leaving slings under patients was associated with higher proportion of patients developing PIs in intensive care units (ICUs, P =.042) and medical-surgical care units (P =.025). In addition, use of sliding boards for seated transfer among short-stay residents in Community Living Centers was associated with higher PI occurrences (P =.017). Qualitative interviews found perceptions and guidance about PI risk related to slings and other transfer devices varied among staff who consider many factors when determining risk. There are perceived benefits and risks of leaving slings and other transfer devices under patients and limited knowledge of PI occurrences associated with this preactice. Clinical decision support can help staff determine safe sling use. More work is needed to test the safety of common sling and transfer device practices and define best practices for communicating PI risk related to sling and transfer device use across the care continuum.

ASSESSMENT OF NURSES' KNOWLEDGE REGARDING SAFE PATIENT LIFTING AND HANDLING IN TERTIARY CARE HOSPITALS

Safe patient handling is a critical aspect of nursing care, aimed at preventing musculoskeletal injuries among healthcare providers and ensuring patient safety. In Pakistan, nurses face challenges such as limited access to handling equipment and inconsistent training, increasing their risk of injury and affecting patient care quality. Objective: This study assesses nurses' knowledge of safe patient lifting and handling and explores demographic and professional factors influencing this knowledge. Methods: A cross-sectional study was conducted among 200 nurses at the Department of Nursing, Superior University, Lahore, using a self-structured questionnaire. The questionnaire comprised demographic and professional information, alongside a 15-item knowledge assessment on safe patient handling. Correct responses were scored, and the mean score was calculated to categorize knowledge as "good" or "poor." Data analysis was conducted using SPSS version 22.0, employing descriptive statistics and chi-square tests for associations, with p≤0.05 considered significant. Results: Of the 200 nurses surveyed, 56.0% demonstrated good knowledge of safe patient handling, while 44.0% exhibited poor knowledge. Significant associations were found between knowledge levels and gender, qualifications, work position, and department. Females and those with advanced qualifications had higher knowledge levels, while age and work experience showed no significant influence. Nurses who had received training reported higher knowledge, though the difference was not statistically significant (p=0.16). Conclusion: The findings indicate that a significant proportion of nurses lack adequate knowledge of safe patient handling, highlighting the need for enhanced training and resources. Targeted interventions considering demographic and professional variations can bridge knowledge gaps and promote safer handling practices, reducing occupational risks and improving patient care quality. Further studies are recommended to explore institutional policies and cultural factors that may impact the adoption of safe patient-handling practices in Pakistan.

Update on Ergonomics Standards in the United States

After two decades of dormancy, activity around ergonomics rulemaking has increased recently, primarily due to legislation passed at the state level. Several states have enacted laws addressing production quotas in warehouses and the impact they have on worker safety and health. Minnesota added an ergonomics program requirement for industries with known risk for work-related musculoskeletal disorders to their safe patient handling and warehouse quota regulations in response to legislation passed in 2023. In that same year, the Washington State Legislature passed laws that resulted in a warehouse quota regulation and initiated industry-specific rulemaking efforts. This paper provides an overview of current ergonomics standards at the state level and offers a national perspective from federal OSHA.

Clinical Issues - September 2024.

Selecting nonsterile sharps disposal containers Key words: sharps safety, Occupational Safety and Health Administration (OSHA), bloodborne pathogens, occupational exposure, disposal container. Life support certification requirements for perioperative RNs Key words: basic life support, advanced cardiac life support (ACLS), cardiopulmonary resuscitation, certification, training. Using crisis checklists in the perioperative environment Key words: emergency manuals, cognitive aids, clinical emergencies, crew resource management, crisis checklist. Walking patients to the OR Key words: fall prevention, fall risk, mobility assessment, safe patient handling and mobility (SPHM), ambulate.

Development of a New Tool to Combine the Promotion of Patient Mobility With Safe Patient Handling Equipment: The Johns Hopkins Safe Patient Handling Mobility (JH-SPHM) Guide.

Promoting safe patient mobility for providers and patients is a safety priority in the hospital setting. Safe patient handling equipment aids safe mobility but can also deter active movement by the patient if used inappropriately. Nurses need guidance to choose equipment that ensures their safety and that of the patients while promoting active mobility and preventing workplace-related injury. Using a modified Delphi approach with a diverse group of experts, we created the Johns Hopkins Safe Patient Handling Mobility (JH-SPHM) Guide. This diverse group of 10 experts consisted of nurses, nurse leaders, physical and occupational therapists, safe patient handling committee representatives, and a fall prevention committee leader. The application of the tool was then tested in the hospital environment by two physical therapists. Consensus was reached for safe patient handling (SPH) equipment recommendations at each level of the Johns Hopkins Mobility Goal Calculator (JH-Mobility Goal Calculator). Expert SPH equipment recommendations were then added to JH-Mobility Goal Calculator levels to create the JH-Safe Patient Handling Mobility Guide. JH-Safe Patient Handling Mobility Guide equipment suggestions were compared with equipment recommendations from physical therapists revealing strong agreement (n = 125, 88%). The newly created JH-Safe Patient Handling Mobility Guide provides appropriate safe patient-handling equipment recommendations to help accomplish patients' daily mobility goals. The Johns Hopkins Safe Patient Handling Mobility Guide simultaneously facilitates patient mobility and optimizes safety for nursing staff through recommendations for safe patient handling equipment for use with hospitalized patients.

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 &lt; .001). Conclusions: Physical therapist education programs should consider SPHM training prior to students’ first clinical experience to increase student confidence in inpatient settings.

Guideline Quick View: Safe Patient Handling and Movement.

Guideline Quick View: Safe Patient Handling and Movement.

Risk assessment of healthcare workers’ exposure to physical load in relation to patient handling and movement: a feasibility study of the instrument TilThermometer

BackgroundWork-related musculoskeletal disorders are common among healthcare workers (HCWs) but might be prevented by risk assessment and further promotion of occupational safety and health.The aim of this study was to investigate if the risk assessment instrument TilThermometer can be used to identify risk profiles of physical exposure in HCWs working with patient handling and movement (PHM). Further aims were to describe HCWs’ perceptions and experiences of using the TilThermometer.MethodsThis feasibility study has a mixed design methodology. In total, 54 HCWs from 17 Swedish care units participated and performed risk assessments with the TilThermometer. Data collected from the risk assessments were used to identify risk profiles of physical exposure. HCWs’ experiences of using the TilThermometer were collected from activity logs and analysed qualitatively. Three questionnaires were used to assess perceived acceptability, appropriateness, and feasibility of the risk assessment, and eight study specific questions were used for perceived usefulness.ResultsThe TilThermometer was used at the care units by assessing each care recipient, and when compiling the data at a group level, a summarized risk profile for the care unit could be provided. Risk for physical exposure was reported as high in two work tasks; no care unit used the high-low adjustable seat when showering care recipients sitting down, and 13% used the recommended assistive devices when putting compression stockings on. However, 99% used high-low adjustable assistive devices when caring and bathing care recipients lying down. TilThermometer was described as easy to use, enabling team reflections and providing an overview of the care units’ recipients and workload, but difficulties in categorizing for mobility groups were also reported. The TilThermometer was, on a five-point scale, perceived as acceptable (mean 3.93), appropriate (mean 3.9), and feasible (mean 3.97). These scores are in line with questions evaluating usefulness.ConclusionThe risk assessment provided risk profiles with potential to contribute to care units’ development of a safe patient handling and movement practice. The findings suggest that the TilThermometer can be used to assess risks for physical exposure in relation to patient handling and movement in care units at hospital and nursing homes.

Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1.

Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period. As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers. Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures. Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common. Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

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.

Guideline for Safe Patient Handling and Movement.

Guideline for Safe Patient Handling and Movement.

Prevalence of Work Musculoskeletal Disorder in Patients Handling Tasks Among Nursing Staff in Critical Care-Unit

Awkward postures imposed by nursing duties are a main source of work-related musculoskeletal disorders among nursing staff. The purpose of this article is to describe the prevalence of work-related musculoskeletal disorders among critical care nurses, in two patient handling tasks, transferring and repositioning of patients, and assess their training level and acquaintance of ergonomics rules and principles in patients’ handling tasks. Results of the study revealed a large number of nurses in intensive care unit exhibit musculoskeletal disorders symptoms. Nurses knowledge of safe patients handling technics are superficial and lacking basic human factors /ergonomics principles. The study recommended the immediate hiring of an adequate number of physically able nursing staff and providing the necessary work equipment to assist nurses perform patient handling tasks. In the near future, a human factors/ergonomics intervention program should be launched, incorporating a "Safe Patient Handling Training Program” for the critical care-unit staff

Safe Patient Handling and Pressure Injury Prevention for Patients With Delayed Sternal Closure.

Pressure injuries are associated with increased morbidity, mortality, and cost. Patients with delayed sternal closure after cardiac surgery are at increased risk of developing pressure injury because of their reduced mobility and inability to undergo complete skin assessment. Safe patient handling of patients with delayed sternal closure is challenging because of mobility restrictions, leading to increased risk for patient and staff harm. An interprofessional team composed of bedside nurses, ergonomic specialists, a wound ostomy continence nurse, and cardiothoracic surgeons developed a patient mobility protocol for patients with delayed sternal closure consisting of levitating the patient for thorough skin assessment and care. A multimodal educational strategy was used to disseminate the new protocol. Patient information was collected on the type of surgery, results of the levitation, completion of the skin assessment, and subsequent interventions. Staff injury related to this work was monitored. After implementation of the protocol, 84 levitations were performed including 50 patients. No staff injuries were reported. Comprehensive skin assessments and care were completed for 98% of patients. Five patients were identified with pressure injury development, and appropriate interventions were applied. A standardized patient mobility protocol for patients with delayed sternal closure that leveraged available equipment was successful in reducing the risk for injury among staff and patients. The protocol allowed assessment and care and thus also reduced the risk for pressure injury development in these patients. Development of an innovative protocol to safely mobilize patients with delayed sternal closure resulted in improved patient care and increased staff safety.

Early and progressive mobility in a community hospital: A new interdisciplinary safe patient handling and mobility model.

In Brief Associated Multimedia An early mobility program in a small community hospital resulted in high levels of staff engagement and decreased rates for falls and heel and sacral pressure injuries.

Evaluation of the implementation and effectiveness of a multifactorial intervention strategy for safe patient handling and movement in the healthcare sector: a study protocol of a cluster randomised controlled trial

IntroductionHealthcare workers with physically demanding work tasks, such as patient handling and movement (PHM), are at high risk of musculoskeletal disorders. To facilitate safe PHM and prevent musculoskeletal disorders, a...

Staff Low Back Injury Risk During Assisted Falls Virtual Reality Simulations.

Assisted falls occur when staff try to minimize the impact of falls by slowing a patient's descent. Assisting a patient fall may decrease patient injury risk, but biomechanical risk of injury to staff has not been evaluated. Assisted falls virtual reality (VR) simulations were conducted to examine staff low back injury risk during common assisted falls scenarios. VR simulations of a toilet to wheelchair transfer were developed with a male patient avatar for three assisted falls scenarios: standing up from toilet, sitting down on wheelchair, and ambulation. Patient avatar weight was modified to reflect normal, underweight, and overweight adult patients. The average spinal compression force at L5/S1 was calculated for each participant with five trials per three scenarios while utilizing physical ergonomic techniques and compared to the safe spinal compression limit of 3,400 Newtons (N). Six staff participants completed 90 VR simulations in total. The average calculated spinal compression force ranged from 7,132 N to 27,901 N. All participant trials exceeded the safe spinal compression limit of 3,400 N for every assisted falls scenario and avatar weight despite application of ergonomic techniques including wide stance, knees bent, and backs straight. Staff are at risk for low back injury if they assist falls regardless of the adult patient weight and application of ergonomic techniques. Safer alternatives like the implementation of mobility screening tools and safe patient handling and mobility technology are needed to help prevent assisted falls to decrease injury risk to both patients and staff.

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.