At the onset of an injury requiring medical assistance, treatment may be provided through a variety of inpatient and outpatient facilities. Medical attention can be provided in ambulances, emergency rooms, acute care and long term care hospitals, the patient’s home, and in the case of the elderly, in nursing homes. In each of these settings, patient handling tasks occur that can require the medical caregiver to overexert themselves and put themselves into physically compromising positions. Ironically, the very population intended to treat our injuries are exposed to awkward-lifting related injuries at up to six times the average rate. In fact, in 2011 when overexertion injuries for all industries were reported at a rate of 38 per 10,000 full time workers, the same type of injuries resulted in the following rates for medical caregivers: (1) 76 per 10,000 workers for hospital workers, (2) 132 per 10,000 workers for nursing home workers, and (3) 238 per 10,000 workers for ambulatory care professionals (CDC, 2016). These figures are alarming and suggest a need for greater patient handling techniques that will reduce the risk of musculoskeletal injury. Before arriving at solutions for patient handling, it’s essential to understand the factors that contribute to these injuries and how to identify high risk patient care tasks.
The factors for patient handling that can contribute to injury are outlined in four categories. These categories include: (1) the work environment, (2) anthropometry of the patient and medical care provider, (3) the specific task (e.g. transfers, repositioning patients, etc.), and (4) work practice and engineering controls. To fully understand how and why injuries occur in medical care facilities, you must thoroughly consider all four categories.
Working environments in healthcare can range from static, inpatient settings with adequate patient handling equipment to ambulances with limited space and means to maneuver patients. The environment must be a consideration of an ergonomic analysis to outline the challenges (space constraints, height of work surfaces, floor surfaces, etc.) presented in each setting. Understanding the environment and challenges associated with patient handling will give greater insight into potential solutions that can be successful.
The second critical factor is the average size of the patients and the healthcare professionals who are challenged with moving patients safely. Patient size is directly correlated with the degree of difficulty to the caregiver to safely maneuver the patient. The larger the patient, the greater amount of force needed to move that patient safely. According to the National Health & Nutrition Examination Survey, 34% of adults over the age of twenty are considered overweight and 30% are considered obese.
The prevalence of overweight individuals in the United States increases the likelihood that medical care workers will overexert themselves during patient handling. Combined with other co-factors, such as cognitive and functional deficits that prevent patients from assisting with movements, puts healthcare professionals in high-risk situations. Additionally, the caregiver’s size plays a role into how effective and safe patient handling is. Caregivers are often substantially smaller in size than the patients they’re assisting. This disparity can inhibit the ability to move patients safely without adversely straining muscles, tendons, and the spine. An ergonomic solution cannot be based upon matching size for the task (e.g. fitting the person for the job) so the solution must be applicable to all caregivers regardless of body size. The tasks performed by healthcare professionals give insight into effective controls and those tasks that may require a change in the process. Some tasks, such as holding an arm or leg, may be at the lower end of the risk spectrum, whilst patient transfers from beds to chairs are much more likely to cause injury. Other high-risk patient handling tasks may include repositioning patients in beds or chairs and lifting and transporting patients on gurneys. A thorough understanding of how our medical care professionals are maneuvering patients is a key indicator when attempting to determine the best ergonomic solutions.
A review of any work-practice controls and implemented engineering controls will also give insight into the strengths and weaknesses in your ergonomic program. If the only control implemented in the environment is “safe-handling techniques” there may be missed opportunities to use engineering controls that will be more effective. However, even when engineering controls are provided there can be barriers that prevent appropriate use of those products. A few reasons caregivers cite as to why they avoid patient handling equipment includes: (1) equipment is inconveniently located or takes a substantial time to setup, (2) the equipment is poorly maintained and does not work properly, (3) there are an insufficient number of devices available, (4) the environment does not have adequate space to use the equipment (ambulances, restrooms, etc.), and (5) patients report discomfort when the equipment is used. This is not an exhaustive list of reasons caregivers avoid patient handling equipment, but, is intended to give some ideas of the barriers that must be overcome.
There are obviously a number of factors that come into play when determining the root-cause of patient handling injuries. To effectively reduce the frequency of injuries, it’s essential to determine the highest risk tasks and prioritize those as the first tasks to address. To properly identify these tasks, it’s recommended to:
Observation of each task will require the analyst to determine the amount of stress associated with the task. A variety of factors can be included when determining the overall risk category including the weight of the patient (force), working posture (awkward postures when moving the patient), length of time to move the patient (duration), etc. The combination of the frequency and risk category can then be used to prioritize the highest risk tasks that require additional controls. After you’ve determined the priorities for high-risk tasks, apply controls from the highest risk to the lowest risk until each is accounted for.