McKenney - MAR WOCN• Heart disease stroke type 2 diabetes and certain types of disease, stroke , type 2 diabetes and certain types of cancer, some of the leading causes of preventable

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SPHMSPHMTeresa McKenney BA, RN, WOC Nurse

Clinical Liaison Sizewise

OBJECTIVES

• Identify current attitudes/trends regarding bariatric patient mobilityId tif th i k f t i t d ith • Identify the risk factors associated with immobility

• List the essential components of a successful SPH program

• Describe Medical Device related pressure injuries and how to prevent

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Compliance

It’s the duty of all employees

to take reasonable care of their own h l h d f health and safety,

as well as that of their co-workers and their patients

during patient handling activities.

Healthcare Injuries

Musculoskeletal injuries in healthcare occupations are among the highest of all US industries. The overall average for injury was 38 per 10,000. g j y p ,The injury for hospital workers was twice the overall average, nursing home workers were 3 times and ambulance workers were 6 times the average.

Bureau of Labor Statistics (BLS), 2015

Musculoskeletal Disorders (MDS)

Healthcare workers often experience MDS at a rate exceeding workers in:

C t ti Construction

Mining

Manufacturing

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MSD Injuries causes

• Repeated manual patient handling activities.• Heavy manual lifting associated with

transferring, and repositioning.W ki i t l k d t• Working in extremely awkward postures.

• Increasing weight of patients (Obesity Epidemic)

• Rapidly increasing number of older people that need care

• The average age of the working nurse is 44 years old

The Reality

• Many of us try to function independently in our attempts to mobilize patients

• Reality is the average age of a nurse is

50yrs old

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The Reality

• By the year 2020 it is estimated the workforce of nurses to be down by 1million

• We are dealing with an aging population W d li ith i i l b l ti• We are dealing with an increasingly obese population

• 440,000 Americans are dying annually from previous hospital errors with an increase relating to harm from falling

Nelson, 2014

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The Reality

Many Clinicians try to function independently in their attempt to move independently in their attempt to move their patients!

Yes they do! You know they do!

Biomechanical Evidence

National Institute for Occupational Safety and Heath (NIOSH) recommends a 35 lb.

i i ht li it f i ti t maximum weight limit for use in patient –handling tasks.

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Walters, 2007

Cost with MSD

• Direct and indirect costs associated with back injuries in the healthcare industry are j yestimated to be $20 billon annually.

• The aging nursing force is causing a future nursing shortage. 30% by 2020.

• Important to preserve the health and reducing staff injuries is critical.

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SPHM

Currently there are 11 states have enacted “safe patient handling” laws or promulgated rules/regulations.

The states require a comprehensive program in health care facilities in which there is established policy, guidelines for securing appropriate equipment and guidelines for securing appropriate equipment and training, collection of data and evaluation.

California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Rhode Island, Texas, Washington and Hawaii.

Safe Patient Handling

• Avoid hazardous patient handling and movement whenever possible.

• Use proper techniques, mechanical lifting devices and other approved patient handling aids for high risk patient handling and moving.

The Big Picture

It’s hard to talk about nursing care without talking about Obesity and Obesity Trends

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Obesity Trends

Obesity continues to be a significant problem in the US and around the world.

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Obesity Trends

The CDC recently predicted that 42% of US residents are expected to be obese, not just overweight by the year 2030.

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j g y y

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2014

CDC 2016

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Obesity prevalence in 2014 varies across states and territories

• No state had a prevalence of obesity less than 20%

• 19 states had a prevalence of obesity between 30%-35%

3 t t (A k Mi i i i d W t Vi i i ) h d • 3 states (Arkansas, Mississippi and West Virginia) had a prevalence of obesity of 35% or greater.

• Prevalence of obesity by region:

• Midwest(30.7%)

• South (30.6%)

• Northeast (27.3%)

• West (25.7%).CDC, 2016

Obesity is common, serious and costly

• More than one-third (34.9% or 78.6 million) of U.S. adults are obese.

• Obesity-related conditions include:• Heart disease stroke type 2 diabetes and certain types of Heart disease, stroke, type 2 diabetes and certain types of

cancer, some of the leading causes of preventable death. • The estimated annual medical cost of obesity in the U.S. was

$147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.

CDC, 2016

Obesity affects some groups more than others

• Blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), whites (32.6%), and Asians (10.8%)

• Obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults.

CDC, 2016

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Obesity and socioeconomic status

• Among Black and Mexican-American men, those with higher incomes are more likely to have obesity than those with low income.

• Higher income women are less likely to have obesity than low-• Higher income women are less likely to have obesity than low-income women.

• There is no significant relationship between obesity and education among men. Among women, however, there is a trend—those with college degrees are less likely to have obesity compared with less educated women.

CDC 2016

Childhood obesity is associated with adult head of household’s education level for some children

• Obesity prevalence differs among racial/ethnic groups and also varies by

• age,

• sex

• adult head of household’s and education level.

• Overall, obesity prevalence among children whose adult head of household completed college was approximately half that of those whose adult head of household did not complete high school.

• CDC, 2016

Basic Terms: Overweight and Obese

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Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory

Definitions

Obesity: Body Mass Index (BMI) of 30 or higher.

Body Mass Index (BMI): A measure of an adult’s weight in Body Mass Index (BMI): A measure of an adult s weight in relation to his or her height, calculated by using the adult’s weight in kilograms divided by the square of his or her height in meters.

Why is it hard to be a no lift facility?

• Policies require hallways to free and clear at all times.

• Equipment is stored in closets.

• Staff don’t take the time to get the correct equipmentStaff don t take the time to get the correct equipment.

• Equipment may be outdated or not in good working condition.

• Patients are larger and can require more than 1 staff to keep the patient safe.

Why Technique Doesn't Matter

"The bottom line is, there's no safe way to lift a patient manually," according to landmark studies on the issue.

"Th i d f h f h i "The magnitude of these forces that are on your spine are so large that the best body mechanics in the world are not going to keep you from getting a back problem.“

Marras, 2015

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Definitions

Distance. It’s much easier to lift something if it’s very close to your body. But nursing staff have to stand at the side of the bed to lift a patient. They can’t get much closer.

Bending. Although nurses are bending with their knees, any b di t h h th b d di t ib t i ht h bending movement changes how the body distributes weight when lifting. The majority of the force goes from bones along the spine directly to disks in the back, straining them.

Repetition. Each time a nurse must lift and move a patient, there’s a risk of developing small tears in plates designed to send nutrients to disks in the back. Over time, these tears grow scar tissue, and that stops the flow of nutrients. The result is that disks deteriorate faster, which makes injury more likely whenever a nurse lifts a patient

How to be a no lift facility

In response to the high risk of on-the-job injury for hospital workers, the Occupational Safety and Health Administration (OSHA) released a website hospitals

f t th i lifti ti f can reference to ensure their lifting practices are safe. The site has several toolkits and resources for hospitals to develop patient handling programs that boost safety for nursing staff

How to be a no lift facility

One key component to safe lifting that h i l h ld h M h i l every hospital should have: Mechanical

lift-assistance equipment. This is the only way to truly prevent nursing staff from being injured.

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Medical Device Injury

NPUAP

April 13th, 2016 announced the changes p , gmade to the terminology from pressure ulcer to pressure injury and updates of the stages of pressure injuries.

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Medical Device Related Injury

A Medical Device Related (MDR) Pressure Injury is defined as a localized injury to the skin or underlying tissue as a result of sustained pressure from a medical device. The skin/tissue injury will often have the same configuration as the device.

NPUAP 2016

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Questions?

[email protected]

References

Centers for Disease Control (2016)

Nelson, K. (2014) SPHM Annual Conference

Walters, T.R. (2007). When is it Safe to Manually Lift a Patient? American Journal of Nursing,(107), 8.

Marras, W. The Ohio State University’s Spine Research Institute

American Nurses Association (2016)

NPUAP 2016