November 2019 Member Newsletter
Editor: Beth Furlong, PhD, JD, RN
November 2019 Guest Column
What’s happening and vision for the immediate future
Stopping the Line: Making Safe Patient Handling Safer in the OR Carina Stanton
Mary J. Ogg, MSN, RN, CNOR
Here’s an update on activities from a VA perioperative national technical advisory group working to inspire innovative and applicable SPHM practices in perioperative care.
Clinicians are very good at work arounds, especially when under pressure to keep up with a busy schedule. Quick turnovers are characteristic in all OR settings where there is little time to wait or discuss what needs to be done during a busy day of surgical cases.
This lack of time can lead to nurses taking on heavy lifting and patient transfers that can cause injury. Nurses are known to put themselves before their patients and then they develop an injury. It is estimated that almost half of all nonfatal occupational injuries experienced by perioperative nurses are musculoskeletal and more than a quarter of these are back injuries, according to 2017 data from the Bureau of Labor Statistics.1
Patients also experience harm when movement and handling is unsafe, including falls or positioning and pressure injury.
For truly safe patient handling and mobility in the perioperative environment, “we need to be vocal about stopping the line when it comes to unsafe things we are doing to ourselves and our patients and start looking at what we can do,” says Tony Hilton DrPH, RN, MSN, FNP, CRRN, National Program Manager for Safe Patient Handling and Mobility for the Veterans Health Administration (VA).
Hilton thinks protective equipment for safe patient handling and for mobility in perioperative care should be considered personal protective equipment. “You have to have quality solutions to protect yourself and your patient.”
She believes it takes a village to implement the level of changes required to bring safer standards of practice and supportive technologies to reduce the high numbers of musculoskeletal injury in the perioperative setting. “We can and must make this better over time by working together and encouraging our colleagues to do the same.”
Understanding SPHM Risks in the OR
- Through the work of the national technical advisory group, Hilton and the VA are working to understand why occupational safety hazards around safe patient handling and mobility are so prevalent in perioperative care. The top high risks’ tasks identified in our simulation innovation conference and recommended solutions were:
a. Proning of patients
b. Limb holding
c. Lateral transfers
d. Positioning with special procedures.
e. Handling of instrument carts and other heavy equipment in confined spaces.
f. Appropriate management of surfaces to protect patient’s skin while integrating SPHM technology.
g. Prolonged standing and awkward positions
“We do a lot of manual lifting, pushing, and pulling,” says Lisa Warner, MHA, RN, CNOR, Surgical Quality Nurse at the Phoenix Veterans Affairs Healthcare System in Arizona and Perioperative Clinical Nurse Advisor for the Veterans Health Administration Office of Nursing Services. The OR has been a neglected area of focus when addressing safe patient handling technology to help mitigate risk of injuries to staff and patients. Technology that is working in one patient care area such as ceiling lifts does not always transfer over to another patient care area such as the operating room. We need to be creative, listen to our staff and challenge our vendor colleagues to develop OR specific safe patient handling equipment that assist us and not accept status quo.”
Through the work of the VA perioperative technical advisory group (TAG), several key trends have been observed in OR occupational injuries, including:
- Back and shoulder injuries caused by pushing and pulling heavy carts, beds and stretchers.
- Falls caused by tripping on the many cords and equipment in tight OR spaces.
- Shoulder, back and knee injuries caused by lifting patients and heavy instrument trays.
Beyond identifying these injuries, the TAG also has identified the following root causes for these injuries:2
- A lack of staffing—The minimum number of staff members required to transfer a patient or push/pull a heavy piece of equipment are often unavailable and nurses take on the task themselves.
- Lagging technology—Tailor-made technologies for safe patient handling and movement unique to the perioperative care environment haven’t yet been developed or are very early in application.
- Inefficient planning—Having the right equipment on hand to protect teams, conducting preoperative assessment and team planning to ensure safe staffing and standardizing practices to ensure team safety could be valuable to plan for in advance.
Bringing Quality and Safety to SPHM in the OR
To further understand high-risk tasks in perioperative care and what positioning aids could help, the VA perioperative TAG conducted a gap analysis and shared the data in a joint meeting in Spring 2019 hosted at a VA OR simulation center to bring together clinicians and vendors for a hands-on simulation of perioperative occupational safety products. The goal for this meeting was to brainstorm what an ideal OR suite safe patient handling and mobility collection of technologies and support devices would look like.
Several key findings from the meeting included the following:2
- Lifting devices attached to the ceiling pose challenges—These devices likely need to be installed during new build or reconstruction and these devices pose risks for infection control.
- OR beds provide a unique space for modification with attachments (think a Swiss Army Knife approach)—Such modifications could prevent nurses from having to lift and install heavy positioning equipment such as heavy leg stirrups. Automatic lifting of patient anatomy through modification could also prove valuable.
- OR surfaces and patient transfer devices could be more helpful—Perioperative teams often still use old technologies to transfer patients. The team is working with industry to explore development of more functional transfer devices. A focus on OR table surfaces that support safe patient transfer and also reduce the risk for patient skin and pressure injury are also being explored.
Delving Deeper to Refine OR Surface, Handling, and Transfer Devices
When patients are not handled safely, a major risk leading to injury is the likelihood of positioning and pressure injury caused by unsafe movement that can lead to skin shear and friction, and unsafe surfaces that can harm skin tissues due to moisture and compression of important venous return, according to Connie Garrett, MSN, RN, CNL, CNOR, Perioperative Clinical Nurse Leader and educator at James A. Haley Veterans’ Hospital in Tampa, Fla. Garrett also is a member of the VA perioperative TAG focused on sharing her expertise in the connection between patient pressure injury and safe patient handling.
At the Spring 2019 meeting, Garrett spoke with industry partners sharing concerns of OR table surface design in reducing and preventing skin pressure injury. Collaborating Garrett emphasized, since most inpatient surgical procedures in acute care facilities are >/=3hours from wheels in to wheels out “my hope is that ‘standard’ OR table pad surfaces will become a “term” from the past; while table purchase will progress to an evidence-based bundle purchase that benefits and reduces healthcare-acquired pressure and positioning injuries” aka “never events.”
Keeping the Conversation Going
Another pilot project initiated at the Spring 2019 meeting included work to understand overhead lifts and OR booms built into the ceiling.
In the Fall of 2019, the VA perioperative TAG and vendors convened to share findings from these respective pilot projects. Next steps for the group are to adapt standards of practice that incorporate pilot findings and also incorporate data on root causes of SPHM injuries, namely on unsafe staffing.
“My goal is to trial emerging technologies for SPHM tailored to the OR, as well as practice standards and then have conversations with health care leaders outside of the VA to disseminate what we have learned and partner with others to improve SPHM on a greater scale,” Hilton explains.
She says the most important goal for all members of the VA perioperative TAG is to keep the conversation going and support clinicians in the process. “It all comes back to speaking up,” Hilton stresses, “we want to hear from patients, clinicians, anyone with experiences and expertise to share that can help all health care facilities improve safe patient handling and mobility in daily practice.”
- Injuries, illnesses, and fatalities. Chart 5: Rates of injuries and illnesses for selected healthcare and protective service occupations, by ownership, 2015. US Bureau of Labor Statistics. Updated October 20, 2017.
- Advances in OR Safe Patient Handling on the Horizon. AORN Periop Today Newsletter, Sept. 11, 2019.
We Have More Work to Do
ASPHP participated as an exhibitor for the first time at the 2019 ANCC National Magnet Conference in October. ASPHP Certification is Magnet recognized, making this a great opportunity to spread the word about our organization and the importance of Safe Patient Handling and Mobility (SPHM) to nurses and other health care professionals.
During this, my first time at Magnet, I had a true sense of pride attending as an ASPHP Board of Director member and Certified Safe Patient Handling Professional (CSPHP). In addition, I was able to support and celebrate my own health care system, Advocate Aurora Health who has nine Magnet-designated hospitals, one just received its fifth designation and two others have each accomplished four this year. A number of other hospitals within the Advocate Aurora Health system are at different points on their Magnet journeys. That’s all very exciting!
Conference attendees from around the United States and Europe stopped at ASPHP’s booth, many echoing concerns and comments regarding the desire to reduce injury rates for team members and provide quality care for patients. Some key concerns noted were around utilization of SPHM equipment, accountability for caregivers to use SPHM equipment, and sustainability of SPHM programs.
Some attendees had never heard of ASPHP, but a fair number voiced awareness about our organization. A few even commented that someone within their organization had achieved a Certification through ASPHP. That was great news. Progress is being made in name recognition and awareness, but there is still much work needed!
This is where all of us can help: By spreading the ASPHP’s mission and message, we can help health care organizations grow SPHM programming and better address employee injury rates and poor patient outcomes across all service lines. We can help by asking…
- Do you know people who have SPHM responsibilities, but they are not ASPHP members? Take time to encourage them to join.
- Have you achieved Certification yet? Explore Certification options and share the information with your peers and employer.
- Do you want to have an active role in the direction and accomplishments of ASPHP? “Find Your Fit” and serve on one of our committees.
The more we as members are active and promote ASPHP and its SPHM awareness efforts, the more people we can reach and support. We are Stronger Together!
Tricia Jaworski, OTR/L, CSPHP
Patient Handling and Mobility Assessment (PHAMA), 2nd edition
Manual handling, moving and mobilizing patients and residents is hazardous work. In recognition of this fact, in 2010, the Facility Guideline Institute developed and approved design requirements for their Guidelines for Design and Construction of Health Care Facilities. The goal of these design requirements was to support safe patient handling and movement practices. The need to educate design professionals on safe patient handling, movement and mobility (SPHM) was apparent, so the FGI committee wrote the original PHAMA White Paper to provide information about the rationale for and relationship of the physical environment and safe patient handling techniques. Continuing and expanding on the original goal, the FGI published the second edition of this paper in 2019. The second edition updates information on Guidelines design requirements and incorporates those for care of individuals of size and to facilitate patient and resident mobilization. The second edition also provides detailed information to facilitate and implement SPHM programs as well as develop a business plan to assist organizations in ensuring appropriate technology and program elements are included for success. States that adopt these Guidelines are required to follow design criteria within, including the PHAMA. The Joint Commission has no specific criteria statements related to SPHM, but it does require facilities who are building new buildings or undergoing major renovations to use the FGI Guidelines, or the state construction guidelines, which are often FGI Guidelines. Since the FGI Guidelines include the PHAMA, such construction must then abide by the PHAMA.
Register for Our 2020 National SPHM Education Event Now and Receive a Chance to Win a FREE SPHM Book!
Many thanks to two esteemed Safe Patient Handling and Mobility professionals for the donation of their bestselling books in support of the 2020 ASPHP National SPHM Education Event.
- Susan Gallagher, PhD, MA, MSN, RN, CSPHP, CBN – A Practical Guide to Bariatric Safe Patient Handling and Mobility: Improving Safety and Quality for the Patient of Size
Do you have questions about care for the individual who is overweight or obese? If yes, this book is written for you! Within the pages of this book you will learn some of the hazards of immobility among those individuals who have a high degree of adiposity; you will learn about basic and complex assessment, types and par levels of specialized equipment, SPHM tasks, sensitivity, and policies and procedures to protect you and your facility. The most popular chapter pertains to ethical considerations when caring for the bariatric patient, where you will learn how and when to engage in ethical debates pertaining to moral courage, justice, beneficence, paternalism, autonomy and more!
- Ed Hall – Inside Looking Up – Inspiring Innovative Escalation in Healthcare Risk & Safety Ecosystems.
The first 50 Event registrants will be entered for a chance to win. Don’t miss this great opportunity and register now.
The 2020 ASPHP National SPHM Education Event will provide you with practical strategies and implementation tips that can be adapted and applied to your SPHM program, diverse SPHM educational topics, and up to 5 hours of “hands on” experiences. This event will provide the perfect opportunity to network, learn, and collaborate with peers.
Receive a 10% discount on main event registration when a minimum of five employees from the same organization register at the same time. Must submit by mail or fax with payment.
ASPHP Board of Directors Election
ASPHP is requesting nomination of candidates for the 2020 Board of Directors election. Two (2) seats will be vacated in March 2020. We are looking for passionate, committed SPHM practitioners to help move our organization forward as it strives to help achieve universal SPHM.
Our efforts make an impact in our places of work with our colleagues and employers, in our neighborhoods with those receiving care within the healthcare continuum and with legislators focused on improved patient and worker safety.
New Membership Benefit: Access Granted to Exclusive Email Discussion List
A new members-only discussion forum, called ASPHP Discussion Group, will provide an online space for those in the Association of Safe Patient Handling Professionals to address industry-related topics. This Discussion Group, also known as an electronic mailing list, allows ASPHP members to interact through the convenience of email messaging.
Log in to post comments, questions, clinical research or industry-related news to others who have a common interest in safe patient handling and mobility. Fellow members can respond or simply read what has been posted. The ASPHP Discussion Group is a way to socialize and network from anywhere around the world. Each member can decide if he or she wants to actively participate or be a ‘fly on the wall’ simply observing.
Get started by clicking here to read participation rules and etiquette tips, then head to the Discussion Group to join the conversation. We’re Stronger Together!
2020 SPHM Advocacy Award
ASPHP is actively involved in putting together an outstanding educational event for March, 2020 in San Diego. For several years now the ASPHP has annually recognized an individual for their advocacy efforts in the field of patient handling and mobility. Next year the Advocacy Award will be given out at the ASPHP educational event. We appreciate all of the hard work being done by everyone across the SPHM spectrum: healthcare organizations, equipment designers, risk management groups, and others.
As an association dedicated to improving the safety of caregivers and their patients by advancing the science and practice of safe patient handling, we want to acknowledge those efforts. If you or someone you know deserves to be recognized for their exceptional SPHM advocacy efforts, please take the time to fill out the nomination form found on this page and send it back to the ASPHP before January 6th, 2020. This individual will be notified and recognized during the ASPHP event.
Vancare’s Continued Sponsorship
VANCARE has been recognized as a leading manufacturer of ceiling and mobile floor lifts in the US for over 25 years. With our innovative products and exceptional commitment to service, Vancare is poised for robust growth. We are committed to providing the world’s best technologies and services for Safe Patient Handling professionals.
ASPHP Invited Only Session
The 2020 ASPHP National SPHM Education Event offers a special vendor-only event presented by a leading content expert Tony Hilton, DrPH, RN, MSN, FNP, CRRN, titled “Planning for the Future: What your Customers Need Today and Tomorrow”. In this presentation, Dr. Hilton will describe unmet needs in the VA and private section in terms of equipment, technology, soft goods, services and more. Take this opportunity to hear about ideas that can keep you and your company moving in a direction that meets your customers actual needs today and in the future.
Dr. Hilton is the Safe Patient Handling and Mobility (SPHM) National Program Manager for the Veterans Health Administration in Washington DC. Click here to learn more.
This presentation will only be offered to committed vendors of the national event. Don’t miss this opportunity to understand current gaps in safe patient handling technology and services.
Sign up now! Booth spaces and sponsorship opportunity will be sold out soon.
Exhibit To maximize your experience with ASPHP, we offer a variety of sales packages designed to suit your specific sales needs. Please feel free to contact us about our innovative strategy for getting you in front of prospective customers by partnering with ASPHP in this state-of-the-art event.
For more information, contact Annie Wiest at email@example.com.
Upcoming ASPHP Webinar Series
December 11th, 2019
Multidisciplinary Safe Patient Mobility – Interactive Webinar to Enhance Patient Outcomes
Nancy McGann PT, CSPHP, System Manager of Ergonomics and Safe Patient Handling, SCL Health
Margaret Arnold PT, CSPHP, CEES, Founder of Inspire Outcomes
January 8th, 2020
Rehab and SPHM
Presented by: Stephanie Bendinelli DPT, CSPHC from OhioHealth
February 12th, 2020
Recovery Models for Healthcare Workers
Presented by: Vicki Missar MS, CPE, SSBB, CSPHP, CHSP, AON