Jillian Adams Staff Development Nurse: Research (P24, Wednesday, NZI 4 Room, 4.30-5)

1. Predicting and Preventing
Manual Handling Injuries
Jillian Adams
Linda Slack-Smith
Rina Cercarelli

2. Background:
• Mixed methods study - association between
decisions and MH injuries (Nurses)
• Health Belief Model – explain and predict
health behaviour
• Epidemiological approach

3. The Health Belief Model …
To adopt a health message individuals
must perceive it to be a health threat
i.e. a serious problem to which they
are susceptible

4. Injury Epidemiology claims …
“as injuries are predictable they are
also preventable … and …
to a large extent society (hospitals)
chose the injury rate it has”
(Christoffel et al 1999)

5. Injury Epidemiology uses …
• Host-agent-
Host
(human)
environment triad
to identify
problems,
interaction and
where to direct
Environment
interventions Agent = mechanical
energy (physical, social)
(vector, vehicle)

6. Injury Epidemiology uses …
The Haddon Host Agent Environment
Matrix to (human) (vehicle (social
vector) physical)
analyse injury
and plan Pre-event
interventions
Event
Post-event

7. Injury Epidemiology uses …
A structured approach to injury prevention
Haddon’s 10 countermeasures
Passive or Active
Engineering, Education, Enforcement

8. Aim of this presentation …
• To consider the findings of manual
handling research
• From an injury prevention framework
perspective

9. Mixed Methods Study
• Focus groups (x5)
• Case-control questionnaire (n=368)
– Analysed injuries (n=82)
– Analysed Comments (n=90)
MH decision and their effect on injury
RN/EN in clinical positions

10. Triangulation …
• Combines research methodologies
• To strengthen results
• Improve accuracy and interpretation
• Identifies consistent, convergent results
• Correlations demonstrate strong
relationship

11. • Host – those most at
risk, i.e. who to target
• Environment –
hazards to eliminate
from the injury area
• Agent - what delivers
the energy

12. Host (those most at risk)
• Did not perceived MH as a health threat
• Pre-injury less likely to aches/pain related
to MH
• Post-injury
↑ awareness of susceptibility to injury
Safer MH practice
Ongoing exercise programs

13. Agent (transfers energy)
• Patients – primary agent (vector) 74%
(↓mobility, ↑weight, AMS, v sick, anxious)
• Equipment – 17% (n=14) incidents
faulty equip (n=5)
equip only (n=9)

14. Environment (hazards to eliminate)
Physical
workspace
Social
staffing numbers
time limits / workload
expectations (problem in 21% injuries)

15. Injury prevention interventions
• By Haddon’s countermeasures (x10)
• If passive or active
• By approach: education, engineering,
enforcement
• If in the pre-event or event phase

16. #1: prevent the initial creation of the hazard
• Cannot avoid patients – but can avoid routine
manual lifting
• No-lift, minimal lift, safe lift, zero-lift etc. policies
Requires enforcement (pre/event - passive)
Requires equipment (pre/event)
Requires education (pre)
• Substantial evidence base

17. #2 reduce the amount of energy in the hazard
• Reduce the energy transferred by using MH
equipment (event - active)
e.g. Hoists, slide sheets, etc.
• Equipment alone ↓ risk factors
• More effective in multifaceted approach
• Substantial evidence ↓injuries ↓costs

18. #3 prevent release of a hazard that already exists
Contain the hazard by:
• Assess hazards and how to manage them
(algorithms, Red Dots)(pre/event - active)
• Dedicated wards for specific pt – spinal,
bariatric etc. (pre - passive)
• Close beds if staffing unsafe (pre - passive)
• Some evidence (assessment), dedicated
wards – cautious recommendation

19. #4 modify the rate of spatial distribution of the hazard
Change how the hazard is delivered
• Optimal floors - minimise resistance to
wheels (pre - passive)
• Large wheels (pre - passive)
• Share the load – work as a team (event -
active)
• Substantial evidence

20. #5 separate in time and space, the hazard from
that to be protected
Separation prevents transfer of energy
• Dedicated lift teams – remove 95% of
routine MH from nurses (event - passive)
- Are a team, use equipment with MH
their priority
-↓ MH injuries to nurses + v few injuries
to lift teams personal
• Substantial evidence (from USA)

21. #6 separate the hazard (by a material barrier) from
that which is to be protected
Form a barrier between hazardous equipment
and the nurse (pre – passive)
• Remove faulty or inappropriate MH
equipment and replace with appropriate
equipment
• Automatic process to maintain equipment
Provision/maintenance required by MH codes

22. #7 modify relevant basic qualities of the hazard
Amend unsafe aspects of hazards
(equip + environ)
• Equipment: “state-of-the-art” (pre-event,
passive)
• Work areas: de-clutter bed space, > space
for bariatric pt and their equipment - modify
existing or design new facilities, flooring.
(pre-event, active and passive)

23. #7 modify relevant basic qualities … cont
• Social environment: work expectations,
safety climate of organisation and the
influence of manager/supervisor (event –
active)
• Policy implemented at ward level,
overseen by managers group to target
with education
• Substantial evidence re influence of Mx

24. #8 make what is to be protected more resistant
to damage from the hazard
Make nurses more resilient and better able
to withstand MH (pre-event, active)
• Exercise - strengthens muscles and ↑
flexibility of trunk
• Short-term benefits (voluntary/mandatory,
40-60 mins, x2/week for 3-12 months
• Substantial evidence

25. #9 begin to counter the damage done by the hazard
Managing the injury in a way that prevents
further damage (post-event, active)
• Best Practice - early aggressive managed
care, by a team led by occupational physician
Includes: assessment, assurance, education,
involves manager
• Substantial evidence, international best
practice, legal requirement

26. #10 stabilise, repair and rehabilitate the object of
the damage
Aims to return injured persons to work ASAP and
undertake rehabilitation in the workplace if possible
• Psychosocial issues related to the injury (yellow
flags) may obstruct return. Must be identified and
resolved in conjunction with the manager
• Physical demands assessed modified duties
• Successful programs for general MSD and LBP
include exercise programs

27. Passive Countermeasures
Countermeasures Event Phase Approach
1.Optimal floor surface Pre-event
2. Optimal wheel size Pre-event
3. Re-design physical environment Pre-event
4. Update to ergonomically improved Pre-event
“state-of -the-art-equipment”
5. Removal of faulty, inappropriate Pre-event
equipment
6. Maintenance of MH equipment Pre-event
7. Close bed when staffing is unsafe Pre-event
8. Dedicated lift-teams Event
9. Dedicated ward for specific patients Pre-event

28. Active Countermeasures
Countermeasures Event Phase Approach
1. Exercise Pre-event
Post-event
2. Practice aligns to NLP Event
3. Equipment to move, position and Event
transfer patients
4. Assessment and decision making Event
tools
5. Teams of nurses (and aides) to Event
MH
6. Safety climate for MH practice Event
7. Assessment following injury and Post-event
address relevant workplace
issues

29. Planning injury prevention
• Injuries are predictable
• Occur as the result of a chain of events
• Intervention are planned to interrupt the
chain and address identified risk factors
• Principles are used to maximise prevention

30. Injury epidemiology principles
1. Active or passive interventions: prefers passive
- will always be effective
2. Single or mixed interventions: prefer mixed -
injuries have multiple causes with multiple
prevention opportunities. Must address host-
agent-environment in pre/event/post phases
3. Prioritise the most effective intervention rather
than relying on education to change behaviour

31. Injury epidemiology principles
4. Education efficacy increased if supported by:
-legislation /policy (enforcement)
-passive interventions in environment
-modification of psychosocial environment

32. Results of this study
• Host - did not perceive manual handling as
a heath threat. Problem - active
interventions may not be employed
• 10 agent - patients with obvious
constraints. Problem - cannot change pt
have to change approach
• 10 environment – social expectation to take
risks to complete work. Problem -
training and policy ignored

33. Implications for Practice:
• Multifaceted interventions are more effective
• Training/education are part of multifaceted
interventions (need infrastructure and
social support to use skills/knowledge)
• Develop + implement a safety climate
• Educate managers/supervisors
• Substantial evidence