Managing and Monitoring Ergonomic changes in Health Care in The Netherlands

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1 Managing and Monitoring Ergonomic changes in Health Care in The Netherlands The Network Hanneke JJ Knibbe MSc. Nico E Knibbe MSc.

3 1. DATA driven approach 2. Joint effort of all parties

4 Practical Guidelines short and simple All health care sectors involved: Ranging from Home care to Ambulances

5 All transfers - within bed - outside bed

6 Guideline source 1: repositioning / transfers in bed: For all patients that need any assistance a hi-lo bed and sliding sheets need to be used

7 Evidence: Forces during activity potentially reduced by > 80%, but technique still matters quite a lot = > protocols & training 1. Proper use for clients: leaflets provided 2. Proper use for carers: instruction and info 3. ErgoCoaches: one-on-one on the job

1. Proper use for clients: leaflets provided 2.

8 Source 2: Transfers from bed etc. <-> (wheel)chair, toilet

9 Guideline: For all patients that need any assistance a lifter (active or passive) needs to be used. For lateral transfers a patslide may be used.

11 Source 3: Anti-Embolism Stockings

12 Guideline : For all patients with AES special aids need to be used.

13 Source 4: Static load: bending over. longer exposure to static load (trunk flexion over 45 degrees) is especially related (RR of 3.18) to more serious, disabling back pain among health care personnel (Jansen, Morgenstern and Burdorf, (J.Occup.En.Med, 2004).

14 Static load f.e. during surgery, washing, bathing etc.

15 Static load:

16 Static load:

17 Guideline: For all activities lasting longer than 1 minute hi-lo equipment needs to be used and/or an adequate working chair or support for the nurse.

18 Assessment tools Were provided on facility level Some compulsory Data also used on a national scale for monitoring purposes Data used on ward level Now endorsed by the HSE

19 4 Assessment tools covering guideline implementation 1.Exposure assessment: Lift-Thermometer (ward & facility) 2.PolicyMirror (ward & facility) 3.Workers Questionnaires (caregiver and facility) 4.National statistics on sick leave in health care (Vernet)

20 1. Til(Lift)Thermometer Knibbe et al., 1999 based on (patient/residents) assessment exposure assessment 100% guideline correlation tailored to each health care sector software modules offered for free Management tool

21 The Lift-Thermometer Based on the NIOSH Equation and Classification of Mobility According to ICF Versions available for all Health care sectors including ambulances

22 With the Excel Module of the Lifting Thermometer => Calculating the results see also: Knibbe & Friele, 1999, Scand. Journal of Industrial Medicine

24 Degree of implementation (powered hi-lo beds) in nursing homes (1= max. implementation of non-lifting, 0=full risks) 1 0,9 0, , ,6 0,5 0, Guidelines issued 0,3 0,2 0, Early innovators and slow starters. (Diffusion of innovations, Rogers, 1983)

25 2. BeleidsSpiegel ( Policy Mirror ) assesses your policy and identifies potential weak spots or points for further improvement

27 Progress in preventive policy (1999, 2003, 2005, 2007) Nursing Homes and Homes for the Elderly (> 500 per survey, > 60%) annual training eq. no maintenance assessments always in care plan ergocoaches in all teams

28 3. Workers surveys progress on last 12 months back pain prevalence (n= nurses and nursing aids : source ATOS/ )

29 And, finally, 4. sick leave statistics a steady decrease can be seen on a national level (external validation)

30 National Statistics on % of sick leave from baseline onwards (approx. 90% of health care workers included)(source: Vernet, )

31 Additional assessment tools: sometimes relevant Provided for individual use Provided for specific professions Provided for specific areas (OR, ICU, ambulances etc.) 5. StaDyMeter 6. RiskRadar And of course in every care plan a transfer protocol with individual assessments (compulsory)

32 StaDyMeter Diary (nurse level)

33 RiskRadar Survey (nurse level) Selfregistration 17 questions about physical load and perceived exertion

35 RiskRadar

36 Conclusions (Partly) converging results of the assessment tools: exposure, policy, survey s and sick leave statistics Effective and practical to use, also on a national scale Implementation of guidelines is a slow process Implementation proceeds step-by-step...

37 => Implementation channel? key-workers, peer leaders, ErgoCoaches > registered now!

38 ErgoCoaches are team-members with an additional responsibility for - prevention of MSD and - reduction of exposure to physical overload - ensuring Quality of Care and Patient Safety

42 National assistance & support for ErgoCoaches > registered

44 Magazine etc. ErgoCoach Forum

46 Businesscase: calculate your own pain/gain

47 Passport Competency management

49 Acute Care Hospital Meander PREGO! the ergonomic improvements driven by PreGo! : nieuwe bedden, elektrisch verstelbaar, nieuwe matrassen, hoog/laag wiegen, tilliften actieve (en) passieve, nieuwe tilapparatuur, aanpassingen hoogte in verband met tillen, onderzoekbanken hoog/laag, verstelbare douchestoel, brancards voor dagverpleging patiënten, nieuwe rolstoelen, draaischijf, glijmatten,glijzeilen, Turner, voetenplank, zware monitoren zijn verdwenen, nieuwe verrijdbare in hoogte verstelbare krukken, kussens (borstvoeding), rem op alle wiegen, afschaf van vaste couveuse (geen hoog/laag), handsteunen in kleine douches, andere indeling voorraadkasten, scanlabels zijn lager gehangen, groter beeldscherm, plat beeldscherm, infuusstandaard met vijf wielen in plaats van drie, elektrische ponsapparatuur, remmen op de babywiegjes, vernieuwd bureau, printer verplaatst, kopieerapparaat verplaatst, computer op goede hoogte, betere bureaustoel, head-set telefoon, elektrisch ponsapparaat, in alle formulieren, worden nu standaard vier gaten geponst, mappen laag leggen, minder bedden op zaal, waardoor meer werkruimte ontstaat, automatische zonneschermen, nieuwe koffie/thee kannen, kast weggebroken - meer licht en ruimte, houding + instelling stoel, meer aandacht voor Arbo door middel van functioneringsgesprekken en klinische lessen, er is naar mijn werkplek gekeken door fysiotherapeut, bewustwording van fysieke zwaarte bij bepaalde handelingen, op elkaars houding letten, elkaar erop aanspreken, er zijn nu vier late diensten in plaats van drie, dit maakt het werken 's avonds minder zwaar/hectisch, meer personeel in avonddienst, aanstellen van extra ZEA, kantelbed, voetensteuntjes bij wondzorg, scharen worden op verzoek geslepen of vervangen, iedereen heeft oordoppen of ze worden vervangen, beeldschermtachograaf, er staan wat minder rolstoelen op de gang, kleinere tafels op zaal, lengte van de stethoscoop, verrijdbare bloeddrukmeters, vaatwasmiddel in kasten onder aanrecht in plaats van op schouderhoogte

50 There is still a long way to go.. Innovations? Can they do the trick and reduce exposure without compromising Quality of Care? F.e. washing without water: enormous reduction in exposure F.e. bedlinen F.e. special beds F.e. incontinence pads F.e. special types of wound care Etc.

51 Monitoring Riddle... How do you eat an elephant? Bit by bit...

52 The only trouble is... this elephant is growing.

53 CIAO!!

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