Kirstyn Albrecht Safe Handling Advisor, Counties Manukau District Health Board (P29, Friday, NZI 5 Room, 2-2.30)

1. Design Considerations for
Safe Patient Handling in
Healthcare Facilities
Kirstyn Albrecht
Physiotherapist, Safe Handling Advisor
Counties Manukau District Health Board
Auckland, New Zealand

2. Overview
 CMDHB Clinical Services Building (CSB)
 Patient Handling Needs
 Considerations
 Equipment
 Dimensional
 Process
 Overcoming Challenges
 Learnings &
Recommendations

3. Clinical Services Building (CSB)
Patient Care Area Beds (117)
Theatres 14
Recovery Unit 23
Theatre Admission and Discharge Unit 20
Short Stay Assessment & Planning Unit 42
High Dependency Unit 18
Other Services
Sterile Supply Unit
Support Services

4. Design Phases
 Concept Design
 Preliminary Design: Meetings
– Architects
– Project Managers: CMDHB and External
– Clinicians and Physicians
– CMDHB Service Improvement Managers
– Other stakeholders eg OH&S, Infection control, Engineering
 Develop Design: More meetings…
 Detailed Design: Meetings & more meetings…
 Construction

5. Design Risk
 Risk: Design and build a clinical environment that doesn’t
support safe moving and handling practice
– Patient Moving and Handling challenges for the lifetime of the facility
Copyright CMDHB 2011

6. Impact of poor ergonomic design
 Clinical time
 Injury
 27% Patient Handling, 20% Manual Handling
CMDHB Injury Claims Data 2003-2011
 Cost
 Quality of care
 Model of care and practice
 57% of staff sometimes, infrequently or never
have sufficient space in room to safely use
equipment
CMDHB Staff Survey November 2011

7. Patient Handling Needs Analysis
Patients
 Medical condition
 Physical characteristics
 Mobility level
Moving and Handling Tasks
 High risk activities and scenarios
Environment
 Space in room
 Other equipment and Storage

8. CMDHB Adapted Tool
Concise Patient Ceiling Track Needs Assessment Tool for
CMDHB – October 2011
Adapted for CMDHB use from: Patient Care Ergonomics Resource Guide: Safe Patient
Handling & Movement, Department of Veterans Affairs (October 2001)
1) Patient Physical Characteristics and Dependency Levels
a. Describe the patients/residents on your unit.
b. Describe their level of cognitive participation.
c. Average Unit population characteristics (# hospice beds, Alzheimer beds, TBI beds,
etc.) and variability in this.
d. Discuss proposed changes in the average daily census over the next two years.
e. Identify typical distribution of patients by physical dependency level according to the
definitions below. (Base on PHYSICAL LIMITATIONS not on clinical acuity)
Note: This is not the same as patient acuity. The total for the 5 categories should
equal your average daily census.
____ Total Dependence – Cannot help at all with transfers, full staff assistance for activity
during entire seven-day period. Requires total transfer at all times.
____ Extensive Assistance – Can perform part of activity, usually can follow simple
directions, may require tactile cueing, can bear some weight, sit up with assistance, has
some upper body strength, or may be able to pivot transfer. Over the last seven-day
period, help provided three or more times for weight-bearing transfers or may have
required a total transfer.
____ Limited Assistance – Highly involved in activity, able to pivot transfer and has
considerable upper body strength and bears some weight on legs. Can sit up well, but
may need some assistance. Guided maneuvering of limbs or other non-weight bearing
assistance three or more times, or help provided one or two times during the last seven
days.
____ Supervision – Oversight, encouragement, or cueing provided three or more times
during the last seven days or physical assistance provided only one or two times during
the last seven days.
____ Independent – Can ambulate normally without assistance in unusual situations may
need some limited assistance. Help or oversight may have been provided only one or
two times in the last seven days.
Total Number of Patients on Unit : ____
f. Indicate the weight range of patients on your unit.
g. Indicate the number of patients over 137kg.
h. Indicate the number of patients over 200kg.

9. 2) Tool for Prioritizing High-Risk Patient Handling Tasks
Directions: For each task, consider the frequency of the task (high, moderate, low) and
musculoskeletal stress (high, moderate, low) of each task. Cross out tasks not typically
performed on your unit. Assign a rank (from 1 to 10) to the tasks you consider to be the
highest risk tasks contributing to musculoskeletal injuries for persons providing direct patient
care. A “10” should represent the highest risk, “9” for the second highest, etc.
TASK STRESS OF Task RANK PATIENT HANDLING TASKS
FREQUENCY
H= high 10= high-risk
H= high
M= moderate 1= low risk
M= moderate
L= low L= low
Transferring a patient: (includes reverse activity)
From bed to wheelchair or shower/commode chair
From bed to chair/arm chair
From wheelchair or shower/commode to toilet
From bed to stretcher/bed
Moving a patient:
Lifting patient to the head of the bed
Repositioning patient in bed from side to side
Repositioning patient in chair or wheelchair
Lifting a patient up from the floor
Weighing a patient
Bathing a patient:
In bed
In a shower chair
On a shower trolley or stretcher
Other handling activities
Undressing/dressing a patient
Applying antiembolism stockings
Making an occupied bed
Feeding bed-ridden patient
Changing absorbent pad
Transporting patient off unit
Other Task:
Adapted from Owen, B.D. & Garg, A. (1991). AAOHN Journal, 39, (1).

10. What and How Much Equipment
 Floor hoists - 1 hoist to 10 patients
 Sit to Stand - 1 hoist to 10 patients
 Other Equipment - PAT slides, Sliding Sheets, Handling Belts
 Ceiling Hoist Coverage
– Limited information available
– Patient Handling and Movement Assessments: A White Paper (2010)
 Comprehensive Risk Assessment

11. Ceiling Hoist Estimations
 Determine % of patients requiring lift
% Dependent + % Extensive Assistance = % Requiring lift
 Determine # of rooms requiring lift
# Patients x % Requiring Lift = # of Rooms with lift
The Facility Guidelines Institute 2010, Patient Handling and Movement Assessments: A White Paper (2010)
 Example:
30% Dependent + 20% Ext Assist = 50% Require lift
50 Patients x 50% Require lift = 25 Bed spaces have a lift

12. Equipment Considerations
 Where it will be used and stored
 Number of staff required
 Size and dimensions
 Maintenance
 Features
 Safe Working Load (SWL)
 Provision for Bariatric patients
 33% CMDHB adults are obese
 Compared with 23% for NZ
NZ Health Survey 2006/2007
www.liko.com

13. Turning Space
Sourced: ARJO Guidebook for Architects and Planners, 2005

14. Dimensional Considerations
 Width of the room – for turning space
 Room layout and adaptability – bathroom and bedroom
 Wide doorways and corridors - to fit equipment through
 Position of toilet - with space each side
 Location of services – storage of equipment
 Bariatric and other specialist areas
Copyright CMDHB 2011 NZ Patient Handling Guidelin es 2003

15. Process Considerations
 Stakeholder awareness of safe handling
 Specialist Resource Availability
 Meeting Format
 Stakeholders requirements and focus
 Layers of hierarchy
 Prioritisation of needs
– Clinical
– Functional
– Budgetary

16. Overcoming Challenges
 Research:
– Articles and resources
– Industry expertise
– Assessment Tools
 Moving and Handling network
 Supplier advice
___________________________________________________________________________________________________________________________________________________________________________________________________________________
 Work directly with clinicians
 Obtain senior management commitment
 Develop committee
 OH&SS team generic guidelines

17. Learnings
 Highly consultative process
 Project of this size needs clear:
– Process for specialist input into decision making process
– Prioritisation process to negotiate different stakeholder requirements
 More industry research required

18. Recommendations
 Early input from specialist
 Determine effective method for specialist input
 Business case as soon as possible
 Determine safe handling priorities
 Clearly establish patient handling needs and equipment
requirements
 Educate and liaise with stakeholders
 Hang in there!

19. CSB Stage 1, Phase 2 today

20. References
A Guide to designing Workplaces for Safer Handling of People, Worksafe Victoria, 3rd edition, Sept 2007
ARJO Guidebook for Architects and Planners – Elderly Care Facilities, 2nd Edition, 2005, Sweden
Australian Health Facility Guidelines Vol 1 – Vol IV 2009
CMDHB Risk Pro Incident reporting system 2011
CMDHB Staff Patient Handling Survey 2011
Cohen M.H, et al, Patient Handling and Movement Assessments: A White Paper. April 2010. Prepared by the 2010 Health
Guidelines REvison committee Specialty Subcommittee on Paient Movement. The Facility Guidelines Institute, April
2010.
ECRI Institute, Ceiling Mounted Patient Lifts, Health Devices, April 2009
FGI Guidelines for Design and Construction of Health Care Facilities 2010 edition
Joliff, J., The miracle of lifting technology. Nursing Homes Magazine. September 2006
Owen, B.D. & Garg, A. (1991), AAOHN Journal, 39 (4)
Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Department of Veteran Affairs (October 2001)
Ronald, L.A, Yassi, A, Spiegel, J., Tate, R.B, Tait, D. and Mozel, M.R., Effectiveness of Installing Overhead Ceiling Lifts. AAOHN
Journal, Mar 2002, Vol 50, No 3.
Spiegel, J., Yassi, A., Ronald, L.A., Tate, R.B, Hacking, P. and Colby, T. Implementing a Resident Lifting System in an Extended
Care Hospital. AAOHN Journal, Mar 2002, Vol 50, No 3.
The New Zealand Patient Handling Guidelines, The Liten up Approach, ACC Worksafe 2003
Weinel, D., Successful Implementation of Ceiling-Mounted Lift Systems. Rehabilitation
Nursing, Mar/Apr 2008: Vol 33, No. 2
Weitekamp, K., 2011. Just five years ago Gundersen Lutheran Health System, based in La Crosse, WI, was facing a challenge
that’s common among healthcare facilities. Advance for Nurses.

21. Thank you
 Kirstyn Albrecht
– Kirstyn.albrecht@middlemore.co.nz
– Occupational Health & Safety
– Middlemore Hospital
– Otahuhu, Auckland 1640
– New Zealand
– Ph: 0064 9 276 0044 extn 8570