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PHTY3280 > L1-2: Prevention Injuries in people handling industry > Flashcards

L1-2: Prevention Injuries in people handling industry Flashcards

1
Q

What is primary VS secondary VS teritary prevention?

A
  • Primary: prevent injury initially
  • Secondary: prevent from becoming chronic
  • Tertiary: maintain QoL for people who are chronic
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2
Q

What is people handling? What is the end goal?

A
  • Performed by carers, family members, volunteers, workers in funeral services, emergency services, day care centres, prisons, etc
  • End goal is safe transfer from A to B
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3
Q

What is therapeutic handling? What is the end goal?

A
  • Subset of people handling
  • Performed by a health professional
  • End goal may include functional independence, safety at home; specific therapeutic outcome eg greater knee control during sit-stand
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4
Q

What is material handling?

A

handling of inanimate objects and animals by people

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5
Q

What is the definition of bariatric (5)?

A
  1. the science of providing health care for those who are severely obese
  2. person with a body weight >140 kg
  3. person with a BMI >40 (severely obese), or a BMI >35 (obese) with co-morbidities
  4. person with restricted mobility, or is immobile, owing to their size in terms of height and girth
  5. person whose weight exceeds, or appears to exceed, the identified safe working loads (SWLs) of standard hospital equipment such as electric beds, mechanical lifters, operating tables, shower chairs and wheelchairs
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6
Q

What is people handling in the workplace?

A
  • Any workplace activity where a person is physically moved, supported, restrained, transferred, (lift, lower, carry, push, pull, slide)
  • May involve the use of sustained force, working in bent/twisted postures, supporting loads away from body, repetitive and long duration
  • Eg theatre work, aged care
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7
Q

What are the 4 roles of a physiotherapist in people handling?

A
  1. Assess patient prior to handling activity
  2. Perform safe handling techniques
  3. Teach safe handling techniques (health workers, carers)
  4. Settings – acute care, aged care, schools, child care, community care, mortuaries/anatomy labs

Teach and perform safe handling

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8
Q

What is the prevalence and risk factors for MSK injuries in health professionals?

A

Risk factors for work injuries:

  • Vibration

Serious claims: Off work >5days

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9
Q

What are MSD (injuries) in patient handlinbg in hospital workers?

A

Nurses, nurse aids have the highest incidence of MSD esp LBP & time off work – due to lifting, transferring patients; Patient handling injuries accounted for 31% (876) of the 2,849 musculoskeletal injuries reported over the 7 year time period

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10
Q

What are 2 hazardous tasks in MSD (injuries) in patient handling in nurses, nurse aides, students?

A
  1. Morning shift greater risk for back symptoms due to high number of nursing tasks
    • eg. showers, bathroom requirements
  2. Bending and frequent manual transfer of patients between bed and chair, manual repositioning of patients in bed, lifting patients in or out of bath with hoist
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11
Q

What are 3 common hazardous task for midwives, paramedics..etc?

A
  1. Awkward postures for prolonged periods of time (eg midwife)
    • Eg Hospital nurses spend about 20% of their working time in awkward postures
  2. Repetitive tasks (eg bagging)
  3. High forces to restrain, move patient/body parts
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12
Q

What is he ethical and legal obligation to catch a patient?

A

Ethical and legal obligation to catch patient:

  • DO NO HARM
  • If able to safely break the patient’s fall = yes, try and catch
  • If unable to safely break the patient’s fall = don’t catch

Bathroom and showers = high risk for falls

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13
Q

What are risk factors for MSD in physiotherapy?

A
  1. Repetitive high force
  2. Awkward sustained postures (usually holding ~30secs-1min)
  3. Vibrations
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14
Q

What are 4 reasons why people handling tasks are hazardous?

A
  1. Individual patient variability - size, shape, position, level of assistance, unpredictable, distance moved, condition of patient
  2. Individual worker factors – age, gender, strength, fitness, previous injury, training
  3. Work area design – cluttered, hot, slippery, steep, unstable
  4. Work organization – availability of assistance, workflow, incentive schemes, deadlines to meet, policies/procedures
    • Eg. warehouses –> higher and faster you work –> get more money (but increased risk of injury)
    • Take shortcuts
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15
Q

What are the weights of different body segments?

A
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16
Q

What are the 7 types of intervention for primary prevention of musculoskeletal injuries in people handling industry?

A
  1. Legislation
  2. Organisational Policies and Procedures
  3. Risk Management approach
  4. Work design/redesign and ergonomic equipment
  5. Participatory Ergonomics
  6. Training (L tomorrow on manual tasks training)
  7. Worker selection
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17
Q

What are the 3 legislation in Australia and QLD?

A
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18
Q

What is the QH (organisational) policy for the “No Lift Policy”?

EXAM QUESTION

A

“The manual lifting of most or all of a patient’s weight is eliminated in all but exceptional or life threatening situations (e.g. a building collapse or an area actually on fire or filling with smoke). Manual handling may only occur if it does not involve lifting most or all of the patient’s body weight.

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19
Q

What are 4 characteristics of Department Employment & Industrial Relations?

A
  1. Monitor workers compensation trends and statistics
  2. Implement the legislation
  3. Have an ergonomic unit – employ PTs and OTs
  4. Provide Codes of Practice, Advisory Standards, ‘How to’ guidelines
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20
Q

What is the safe lifting limit?

A

There is no safe lifting limit

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21
Q

How does the “No Lift” policy work?

A
  • An Australian hospital that implemented the ‘No lift’ policy demonstrated signif. fewer back injuries, less symptoms and less absence from work.
  • However, there was strong support for the No Lift system from management, union and staff
    • Need to have protocols to help manage the requirements
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22
Q

What are the 6 exmaples of QLD Health Banned Lifts?

A
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23
Q

What are 4 reasons why this technique is unsafe?

A
  1. Risk of injury to the patient’s shoulder joint
  2. Risk of injury to carer using asymmetrical posture (flexion and rotation)
  3. Carer posture is unbalanced with risk of falling
  4. Patient is moved quickly, may lose balance
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24
Q

What are 4 reasons why this technique is unsafe?

A
  1. Unsafe for the patient due to skin shearing on buttock and heels when carer drags patient up bed
  2. Unsafe for the carer working in a stooped position
  3. Carer has limited room to move the patient
  4. Hygiene issues
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25
Q

What are 3 reasons why this technique is unsafe for the patient?

A
  1. Normal pattern of movement is impeded by the carer standing in front of patient
  2. The patient is linked to the carer so if either becomes unstable, then both may fall
  3. May easily lose balance if movements performed quickly
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26
Q

What are 5 reasons why this technique is unsafe for the carer?

A
  1. Pull on the neck
  2. The carer often use a rocking motion (momentum) to initiate the transfer increasing the risk of over-balancing
  3. Difficulty moving in a confined space
  4. Carer is prone to bending in order to assist the transfer
  5. If patient canot take much weight, the carer ends up carrying/swinging the patient round and twisting spine
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27
Q

What is the risk management approach? What are 4 processes?

A

The systematic process of identifying, assessing, controlling, monitoring and reviewing risks in the workplace

  1. Identify hazards - what could cause harm
  2. Assess risks if necessary – understand the nature of the harm, how serious the harm could be and likelihood of it happening
  3. Control risks – implement the most effective control measure that is reasonably practicable
  4. Review control measures to ensure they are working as planned.
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28
Q

What is the hierarchy (level) of control measures?

A
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29
Q

What are Work design/redesign – MH equipment? What do those include?

A
  • Multifactor interventions based on a risk assessment program are most likely to be successful in reducing risk factors related manual tasks

These include: equipment provision, design, maintenance, education/training, work environment redesign, work organization/practices changed, feedback, group problem solving, team building, revision of policy/procedures (

30
Q

What are the 4 effects that patient handling devices + comprehensive ergonomics program (ie participatory ergonomics) reduces?

A
  1. Number of injuries by 60%
  2. Lost workdays by 86%
  3. Workers compensation costs by 84%
  4. LBP prevalence
31
Q

What are 2 intangible benefits of patient handling devices + comprehensive ergonomics program (ie participatory ergonomics)?

A
  1. Reduced fatigue, longevity in workforce
  2. Increase employee morale, reduced absenteeism
32
Q

What is a patient handling risk assessment?

A

The process by which a health professional decides what technique to use, how many people required and what equipment is required to safely undertake treatment or transfer a patient to minimise risk for injury to workers and patient

33
Q

What are the 6 components of people handling risk assessment?

A
  1. Preparation
  2. Assessment – subjective and objective
  3. Determine level of dependency
  4. Assess environment
  5. Interpret findings
  6. Execute Task
34
Q

What are the 3 characterstics of people handling risk assessment?

A
  1. Develop patient handling plan if necessary
  2. Conducted by nurse as part of routine nursing care
  3. Complex cases may require Therapist to assess
35
Q

What are 5 characteristics of “PREPARATION” in people handling risk assessment?

A
  1. Review medical chart – demographics (BMI), surgery notes, results of tests, X-rays, social & functional history, mobility history, aids used
  2. Review related assessments (Physio falls risk Ax; OT home Ax)
  3. Check bed chart – meds (what, when, route); pain relief esp timing; observations (HR, BP, T0 , RR)
  4. Gather necessary equipment and personnel
  5. Prepare environment (check brakes on bed/ wheelchair; clear path) and self, ensure others are safe to assist (non-slip shoes low heeled shoes, suitable clothes)
36
Q

What are 2 features that are comprimised in the initial patient handling assessment?

A
37
Q

What are 5 non-physical factors in the “initial patient handling assessment”?

A
  1. Cognition / Communication
  2. Cooperation / mood
  3. Medication
  4. Wishes and expectations
  5. Confidence
38
Q

What are 6 non-physical factors in the “initial patient handling assessment”?

A
  1. Condition
  2. Weight
  3. Pain
  4. Strength, range of motion, endurance
  5. Mobility and falls history
  6. Attachments (e.g. drips)
39
Q

What are 3 pieces of information/features that can be determined in the subjective assessment?

What are 8 other concerns from the subjective assessment

A
  1. Mental status, cooperation, confusion, influence drugs, asleep, unconscious, dementia, intellectual impairment
    • From patient, chart and staff
  2. Pain levels, ROM, Strength, tone, sensation, balance
  3. Communication concerns – language and cultural issues, vision or hearing impairment
  4. Dignity and privacy of patient/client
  5. IV, catheters, drains, continence
  6. Promotion of independence
  7. Footwear - shoes or compression stockings
  8. Pumps, slings, traction etc
  9. Effects of trauma; and prolonged bed rest
  10. If wound – check location, dressing clean?
  11. Sudden movement may frighten person with head injuries or dementia
40
Q

What are3 features that can be determined in the objective assessment?

What are 2 characteristics of functional assessment (in bed)?

A
  1. Circulatory system – check for DVT (swelling, redness of calf, local tenderness, increased T0 and positive Homan’s sign (calf pain on passive DF)
  2. Neurological and respiratory as required
  3. Functional assessment: In Bed:
    1. If able to bridge and use overhead ring/bed rail – supervision needed only
    2. If able to hold SLR for few seconds - able to wt bear through that limb
41
Q

What are the 5 steps of physical screening for on-bed mobility?

EXAM QUESTION

A
  1. Comprehend and cooperate?
  2. Use their arms to push or pull themselves up in bed?
    • this can be done with or without the use of aids e.g. monkey bar, bed stick.
    • a) Bend their knees
    • b) and bridge (raise / lift their bottom off the bed)?
      • this can be done with or without the monkey bar
  4. Raise his/ her leg straight?
    • Assess leg strength (required for weight bearing / standing)
    • Quads Gr 3
  5. Reach and roll?
    • Look to the side they’re rolling towards
    • Use their opposite arm to reach across their body and pull to roll (e.g. using bed rail or side of bed).
42
Q

What are the fnctional assessments for off-bed mobility?

A
43
Q

What are the 5 steps of physical screening for off-bed mobility?

EXAM QUESTION

A
  1. Comprehend and cooperate?
  2. Weight bear (perform a straight leg raise)?
    • a) Maintain sitting balance – turn?
    • b) Maintain sitting balance – reach to side?
    • c) Maintain sitting balance – reach to front?
    • a) Bring their weight forward over their feet… Off-bed mobility: Can the patient…
    • b) …lift their bottom off the bed / chair…
    • c) …to move sideways or off the bed?
    • a) Move from sitting…
    • b) …into standing (and back into sitting)?
  6. March on the spot?
    • a) Advance step…
    • b) …and return each foot?
44
Q

What are 2 warnings in the steps of physical screening to not mannualy transfer a patient?

A
  1. is unable to demonstrate sufficient trunk and leg muscle strength, balance and coordination to complete the task, or
  2. if the patient cannot follow commands/ is uncooperative

DO NOT MANUALLY TRANSFER the patient.

45
Q

What is COOEE?

A
46
Q

What are the 4 levels of dependency in a patient?

A
  1. Independent: can sit-stand, mobilise (± aid), transfer without manual assistance or verbal cues
  2. Supervision needed: and/or verbal cues to ambulate/transfer with/without the use of a self-help aid (eg walking stick, bed stick)
  3. Assistance required: Patient understands & cooperates; physically able to perform part of the activity but manual assistance required sit/stand (1A, 2A)
  4. Dependent: Patient unable to understand, cooperate or physically assist

Patient assessment may be done by PT, OT or nurse

47
Q

What are 6 characteristics when assessing the environment?

A
  1. Where is patient going? in/out bed, shower/toilet, walking, moving up bed, rolling in bed, mats, carpet tears/folds, animals/children likely to create a slip/trip hazard
  2. Height of beds, bath, shower chairs, do brakes work
  3. Floor surface – wet, slippery, uneven, spills (food)
  4. Doorways open in/out, shower hob
  5. Location of patient/furniture – moved/fixed?
  6. Community setting – person’s home, school, workplace, pool, shopping centre (rails, ramps)
48
Q

Why do doors open out?

A

Doors open out because if someone falls (eg. heart ache), they won’t block the door

49
Q

What are 2 hazards in this hospital bathroom?

A
  1. Broom
  2. Wet floor
50
Q

What are 4 characteristics of “assess environment - ability & availability of assistants”?

A
  1. Have you been trained in use of that equipment?
  2. Are you carrying any injuries? history of MSD, pregnant, age and fitness level
  3. Are you appropriately attired? No skirts, tight-fitting clothes, closed, stable, low heeled footwear
  4. PPE – may reduce effectiveness of lift eg gloves, gowns, waterproof boots/apron
51
Q

What are 4 levels of dependency? What are the aids/equipments?

A
52
Q

What are the 5 characteristics in the execution of technique?

A
  1. Collect and check equipment is in good working order (slings, brakes, battery)
  2. Request assistance if appropriate
  3. Explain procedure to Client and assists
  4. Perform task
  5. Reflect and if appropriate, document
53
Q

What are the 3 tips for the excution of technique?

A
  1. Constantly monitor patients status by talking and observing colour – fainting, ?hypotension, pale face (ears), sweaty, eyes glaze over
  2. Be prepared to sit patient in a hurry (chair behind)
  3. Allow patient to fall if you cannot break their fall safely
54
Q

When is a patient handling risk assessment conducted (3)?

A
  1. initially on admission to the ward or emergency department (documented)
  2. pre-activity screening immediately prior to each patient handling activity (often not documented)
  3. re-assessment when patients condition/needs change significantly and/or regular intervals as specified by the work area (documented)
55
Q

What are 3 activities that are done prior to each patient handling activity?

A
  1. Patients condition can rapidly change throughout day – pain, fatigue, illness, nausea, co-morbidities
  2. Before each patient handling activity by principal worker conduct an abbreviated version of initial assessment
  3. If changes to initial plan required, notify nurse on duty, document changes
56
Q

Mary is 110kg and 1.3m tall. She had ‘a turn’ at home last night and is in hospital for observation. She is in no pain, has diabetes, and hypertension. She has a PMS score of 28.

Develop a patient mobility plan

A
57
Q

What are the abbreviations/codes for equipments?

A
58
Q

What are equipments used for sit to stand transfers?

A
59
Q

What are equipments used for lateral transfers?

A
60
Q

What are the differences between slide sheets and bed sheets for transfers?

A
  1. Greater hand force and Lumbar compression and sagittal shear forces at L4- 5 and L5-S1 with bed sheet rather than a slide sheet
  2. Ratings of perceived exertion for repositioning patients on traditional sheets versus on slide sheets were more than double.
  3. Coefficient of friction was 65% less in the slide sheet system vs traditional sheets
61
Q

What does bed, chair, bath and toilet repositioning look like?

A
62
Q

What are passive hoists (lifting devices)?

A

Ceiling-mounted patient lift systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling manoeuvres. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems

63
Q

What are 5 characteristics of ceiling hoists as passive hoists (lifting devices)?

A
  1. Strong evidence they reduce number and duration of musculoskeletal injuries and physical stress for care-givers
  2. Less set up time and better manoeuvrability than mobile hoist
  3. Have limited coverage
  4. Expensive to install and not all homes/ceilings suitable
  5. But pay-back period is 1-2.5years
64
Q

What are active hoists (lifting devices)?

A
65
Q

What are 4 characteristics of equipment safety of lifting devices (hoists)?

A
  1. Check integrity of leads, slings, attachments
  2. Check battery function
  3. PUT ON THE BED BRAKES, when moving patient in bed or transferring to/from bed
  4. BRAKES ON WHEELCHAIR before transferring patient
66
Q

What are 4 characteristics of sling hoist transfers as equipment safety of lifting devices (hoists)?

A
  1. NEVER move client in hoist more than 2 m while in hoist sling as hoist can tip
  2. Use correct size sling
  3. Minimum of 2 people
67
Q

What are Bariatric equipments?

A

The Bariatric Stirrups have reinforced rod and joint assembly and the flexible boot make the system capable of positioning a patient weighing up to 800 lbs. (363 kg). Though designed for large patients, these stirrups are still appropriate for use with the general patient population.

68
Q

What does caring and transporting the bariatric patient look like?

A

Caring and transporting the bariatric patient

69
Q

What are Hovermatt and Hoverjack?

A
70
Q

Prevention of MS injuries due to _______ is essential component of our work

A

people handling

71
Q

Multifactor interventions based on ______ is most likely to be successful

A

RISK ASSESSMENT

72
Q

Only undertake what you feel you can _____ manage.

A

comfortably

PHTY3280 (17 decks)

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