Safety in the healthcare sector is a complex one. Rather than just thinking of the health and safety of patients, it is equally pertinent we pay attention to safety of healthcare workers. This month’s write-up will focus on patients handling task and ergonomics approach to management.
A systematic review of patient handling literature shows that a strategy for risk assessment, application of engineering controls and management must be comprehensive (multifactor interventions) to be successful. Consequently, a strategy for risk prevention based on analytical assessment of the risk itself, all of its potential determinants (organizational, structural and educational), and on some key aspects of risk management is outlined below (see Figure 1).
The strategy includes the use of managerial processes and systems for reducing causes and effects of musculoskeletal and other organizational losses from healthcare institutions. The participatory approach is emphasized in all aspects especially in changing work practices, defining training needs, purchasing technology/equipment and designing work environments.
Risk assessment is one of the pillars of preventive strategies. Risk assessment consists of the following steps:
- hazard/problem identification,
- risk estimation/evaluation.
It is emphasized that for the purposes of this article, hazard identification and risk assessment are related not just at health risk identification but also in problem identification and problem solving.
A risk assessment is recommended when new equipment is introduced, organizational issues are modified (number of caregivers, number of non-cooperating patients), spaces are reorganized from an environmental viewpoint (rooms, services) and whenever other changes could affect risk characteristics, even if the previous condition was found to be acceptable. It is sad to note that hardly would you find a Hospital practicing health risk assessments and evaluation in Nigeria.
A hazard is present when patients are manually handled. The number and type of these patient transfers should be quantified (e.g. on a daily average) in different ways according to the healthcare area considered. For example: in operating theatres it would constitute the number of operations needing patient handling; in outpatient operations, the number of access requests for patients; in hospital wards, the number of patients.
Patient quantification will be a preliminary factor to assess the time, number and frequency of handling. Also the presence of a hazard requires that other factors should be taken into account that may address the subsequent risk evaluation.
Type of handling
The type of handling is defined by the task to be performed (e.g. repositioning a patient lying in the bed, or emplacing the bed pan) as well as by the handling technique applied for task execution. Task execution may be biomechanically improved, in particular, if small aids are additionally used.
Furthermore, the type of patient (totally non-cooperating, partially or fully cooperating) and the type of assistive procedures will determine the handling method used by caregivers to a certain extent. The type of handling associated with patient’s functional mobility level will define different hazard levels.
A handling type used for cooperating patients may result in a low hazard while for a non-cooperating patient the same handling method may produce a much higher hazard. Analysing patient handling currently carried out in a given healthcare area should lead to quantification of different types of handling necessary to address both the choice of most appropriate handling mode and usage of aids in that situation and also the number of caregivers needed throughout the day.
The overall work organization can modify the risk of injury. The number of caregivers carrying out patient handling and their organization (one or more caregivers) over the day is a crucial factor to assess along with handling frequency and mode. Furthermore, caregivers should be trained to safely perform each task and how to recognize hazardous workplaces, tasks, equipment conditions and time allocated to the task.
Posture and force exertion
During patient-handling activities, the spinal column of caregivers, especially the lumbar section, is subject to high mechanical loading (i.e. compressive and sagittal or lateral shear forces at the intervertebral discs).
Biomechanical load through patient handling is regarded as one of the most relevant factors inducing low back pain and the development of degenerative disorders at lumbar spinal structures. Lumbar load strongly depends on the mobility status of the patient, equipment in use, posture adopted and the forces exerted by the caregiver to perform the handling action. Patient handling often coincides with postures and asymmetric forces with respect to the median sagittal plane that result in relatively high biomechanical load and an increased overload risk. abilities for force exertions and increased risk of injury from high loads being placed on body joints or segments. For postures, asymmetry may be due to arm position or lateral trunk flexion or torsion. Forces may act laterally or are bilaterally imbalanced. A reduction of high lumbar loads can be achieved by using biomechanically efficient transfer methods.
The lack, absence or inappropriateness, of aids and equipment is a hazard during patient handling. These patient handling aids are in most times not made available in the Nigerian healthcare sector. The application of appropriate aids and equipment is strongly recommended to obtain a vital load reduction for the lumbar spine and to limit the biomechanical overload risk for the caregivers. Equipment and facilities must be currently and properly maintained for safe usage. The equipment purchase process should be based upon clear task requirements (type of handling) and the environment where they are used, and thus result in the selection of equipment fit for the specific workplace and task conditions
The environment where patients are handled may be a hazard if inadequate. All spaces where patients are handled should be considered for equipment use and correct handling postures. Additional factors such as thermal constraints, steps, thresholds, obstacles and slippery floors should be considered.
Individual skills and capabilities, level of training, age, gender and health status of the caregiver should be considered when carrying out a risk assessment. Skill and experience are likely to benefit the caregiver when performing the task and reduce the risk of injury. Training may increase the level of skill and ability to carry out a task. Clothing and footwear should be functional and should facilitate movement and a stable posture.
The patient’s body weight may be a hazard by itself. In particular, bariatric patients require adequate
equipment and space for their needs. Handling of even a part of the body may produce biomechanical overload. Special hazards may arise in case patients oppose the motion for psychiatric or cognitive problems or issues due to medication. In this case, biomechanical load of musculoskeletal structures could be high.
From an operative point of view it is recommended to proceed with the next step (risk estimation/ evaluation) whenever there is a presence of non- (or partially) cooperating patients and one or more of the above quoted hazards/problems are identified.
The next step (risk estimation/evaluation) should include patient characteristics such as non- (or partially)
Durowoju Oluwatobi Solomon (CEO) (B. Physiotherapy, MSc Ergonomics, mNSP, mESN, mCIEHF) Email- Info@duergoltd.com, firstname.lastname@example.org Web- www.duergoltd.com Phone number – +2349084670000, +2348054382891, +447587758567