Post on 19-Oct-2014
description
Introduction to Queensland Health’s Patient Handling Risk
Assessment ToolFacility/Unit Risk Assessment
Tool (FURAT)
Tony JohnstonPrincipal Health & Safety Adviser
Queensland Health
Outline
• Introductions– Who, Where, objectives– Experience with other
tools• Background
– History– Legislation– Patient Handling tools
• FURAT & profile– What is it; using it– Objectives
• Implementation strategies– Priority areas– Methodology– Issues and solutions
• Duration & frequency• Buy-in• recording
• Future enhancements• Key summary points• QH resources
Why Assess Patient Handling Risks?
Patient Handling: Through the ages…
1998 2001 2007 2012
Patient Handling: Through the ages…
Not so distant past
Patient Handling: Through the ages…
1998
Patient Handling: Through the ages…
1998 2001
2001
Patient Handling: Through the ages…
1998 2001 2007 2012
2007
Patient Handling: Through the ages…
1998 2001 2007 2012
What’s the problem?… with so much regulation and guidance material
around..
• Behaviours– High risk tasks– Training solution
• Equipment– Hoists– Slide sheets– Walk belts
• Risk Assessment– Individual patient Mobility
• Longevity– Individual dependent– Interpretation
• Banned Walk-belts
Objective
Develop and implement a comprehensive healthcare
patient handling risk management tool.
Activity
How many risk assessment tools do you know of?
ORGANISATIONAL RISK
Individual Patient
Task
Facility / Unit
Risk Management
Guidance from around the world…
Industry standards … Acceptable handling practices
Legislative Basis
Managing Health and Safety Risks
Regulations … 4.2 Hazardous Manual TasksPCBU must have regard to all relevant matters that may
contribute to a musculoskeletal disorder … (a) postures, movements, forces and vibration relating to the
hazardous manual task; and
(b) the duration and frequency of the hazardous manual task; and
(c) workplace environmental conditions that may affect the hazardous manual task or the worker performing it; and
(d) the design of the work area; and
(e) the layout of the workplace; and
(f) the systems of work used; and
(g) the nature, size, weight or number of persons, animals or things involved in carrying out the hazardous manual task.
Risk Assessment Principles
POSTURE
TIMEFORCE
Work Area - Design / Layout
Nature/Characteristics of Load –pt profile
Work Environment- Eg lighting, floor surfaces Work Practices
& Systems –- PH tasks performed- Design of work procedures
Work Organisation - staffing & training
Tools & Equipment - PH aids
Facility / Unit Risk
Assessment Tool(FURAT)
FURAT
Section 1 Facility/ Unit Description
• Persons completing risk assessment• Work area Key contacts• Communication arrangements
– District– Division– Ward
Facility Unit
Section 2 Patient Profile
• Age range• Service type• Dependency- I, SN,AN,D• Size (use BMI as guide)• Weight range• Primary diagnosis• Special requirements for patient handling
Section 3 Environment
• Floor surface• Access• Space• Overhead clearance• Noise• Lighting• Temperature• Other
Section 4 Equipment
• Includes equipment, aids and furniture• SWL• Quantity
– Existing– Future needs
• Condition, maintenance arrangements• Location/ access/ storage• Meets needs?
Section 5 Staffing and Training
• Skill mix• Capacity-
– PH experience– Functional limitations – Access to PH expertise
• Work organisation• PH training- number of trainers, training arrangements• Injury, absenteeism, turnover
Section 6 Patient Handling Tasks
• Patient Handling Transfer Table, adapted from:– WorkSafe Victoria Transferring People Safely 2nd edition 2006– Sir Charles Gairdner Hospital S.A.F.E.R Patient Handling (2006)
• Preferred, not preferred and not recommended methods• Range of patient dependency• Standard conditions apply
Observe Consult Past History
Section 7 Risk analysis
• From section 6: Pt Handling Tasks Performed, identify – not preferred methods– not recommended methods– Alternate methods– Additional tasks
• Frequency • Analyse the
– Direct risk factors– Contributory risk factors (from sections 1-5)
2. Patient Profile3. Environment4. Equipment5. Staffing & training
Section 8 Risk control worksheet
• Hierarchy of control explained and examples given
• Risk control table existing controls brainstorm others to be considered
• Risk control plan and evaluation short and long term controls to be implemented Evaluation
• Sign-off
Patient Handling Risk Profile Form
• Displayed in the work area• Updated as often as required to keep the information
current• A quick tool for
– Induction– Casual– Students etc
Patient Handling Risk Profile Form
• Patient profile; range of PH activities; precautions• Individual PH assessment procedure• Summary of risks and controls• Equipment register• Training and assessment program• Documentation• Compliance monitoring
Activity(1)
The Incident …• RN Smith was transferring Mrs Jones (bed 13) back to bed.
– Pt slipped and fell to the floor. – With the assistance of Operational Officer (Bill) lifted pt
back to bed.
• RN Smith – noticed a slight back twinge at the time of the incident but
was able to continue working. – Pain increased slightly by the end of the shift. – Woke Sunday morning in excruciating pain. – Went to LMO and was given pain relief and medical
certificate for 2 weeks leave.
Elements of a Facility / Unit PH Risk Assessment
POSTURE
TIMEFORCE
Work Area - Design / Layout
Nature/Characteristics of Load –pt profile
Work Environment- Eg lighting, floor surfaces
Work Practices & Systems –- PH tasks performed- Design of work procedures
Work Organisation - staffing & training
Tools & Equipment - PH aids
Systems Approach (Swiss cheese)
Activity(2)
Implementation Strategies
• Work Practice Directive (mandatory)– Facility or Unit level– Implementation plan with 6 months– Annual review– Re-assessment at least every 3 years– Team approach– Documentation
• Retained locally; copies centrally to OHS Unit• Profile Form
Implementation 2007 - Developed 2008 – Pilot 2009 - Approved
Service Level Agreements
• Timeline for Key Deliverables– 3mths gap analysis and plan– Prioritisation of work areas
• Performance Measures – Quarterly reporting– % staff trained– % FURAT completed– Ratio Trainers to Staff (target 1:10 in priority 1 areas)
2009 20122010 2011
Planning Priority 1 Areas Priority 2 Areas Priority 3 Areas
Strengths• Builds capacity• Encourages collaboration and participation• Risk management demonstrated• Consistent process• Clear accountability but shared responsibility• Covers direct and contributory risk factors• Highlights high risk practices• Prioritisation
Weaknesses• Significant shift in culture • Looks daunting• IT systems do not allow uploading to central monitoring
point• Benefits not immediately obvious• No one person has the skills/ knowledge to complete • Aimed at clinical managers- competing demands
Opportunities• Due diligence• Business outcomes- use of resources; costs• Safety culture• Improved physical and psychosocial aspects of work• Justification/ escalation of high risk issues• Sustainability and quality of risk management• Capability
Threats• Competing priorities• Budget• Reactive safety culture• Conflict over responsibilities• Fear about liabilities• Does not result in actual reduction of risk factors• Perceived effort vs return• Lack of capability
Outcomes• Anecdotal reports of improved success with business
cases• Gradually improving uptake, probably better in smaller
areas• OHS doing a lot of the work• ‘Once I actually gave it a go, it wasn’t that bad’ ‘I can see
the benefit now I’ve done it’• Quality issues- risk analysis and controls• Improved awareness of proactive approach- OHS and
managers
Future Enhancements• Usability and integration with
business systems
– Central collation and reporting
– Prioritisation and escalation
• Education
– Risk Analysis and higher order controls
• Relationships
• Culture
Future Direction
• Other Tools and guidelines available.– MAPO– Dortmund– PTAI– Care Thermometer
• ISO Ergonomics – Manual handling of people in the healthcare sector
• Legislation for Safe Patient Handling Laws– USA– Hospital Patient and Health Care Worker Injury Protection Act