Patient Handling and Movement Assessments: a White Paper
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The Facility Guidelines Institute, April 2010 Patient Handling and Movement Assessments: A White Paper Prepared by the Martin H. Cohen, FAIA, FACHA, Chair Gaius G. Nelson, RA, Vice Chair 2010 Health Guidelines David A. Green Roger Leib, AIA, ACHA Revision Committee Mary W. Matz, MSPH, CPE Phillip A. Thomas, AIA Specialty Subcommittee et al. on Patient Movement Carla M. Borden, editor This document is intended for free public download and sharing. © 2010 The Facility Guidelines Institute 1919 McKinney Avenue Dallas, TX 75201 [email protected] Authors www.fgiguidelines.org Martin H. Cohen, FAIA, FACHA Healthcare Architecture and Design for Aging Vice Chairman, 2010 Health Guidelines Revision Committee David A. Green Center for Community Partnerships, University of Wisconsin Oshkosh Gaius G. Nelson, RA Nelson-Tremain Partnership Architecture and Design for Aging Roger Leib, AIA, ACHA Principal, Leib & Leib, Inc. Architecture & Product Design/Development Mary W. Matz, MSPH, CPE Safety and Occupational Health Manager, Office of Public Health and Environmental Hazards Veterans Health Administration, Department of Veterans Affairs Phillip A. Thomas, AIA Golden Ventures Design by: GLM Design, Falls Church, VA. Cover photograph: Deer River Health Care Center, Deer River, Minn. Courtesy of DSGW Architects, Duluth. Readers should note that the material in this white paper is advisory and is not intended to be used as regulatory or accreditation requirements. CONTENTS Preface . 4 Introduction . 6 AcknowledgmentsChapter 1: Rationale . .for . .Including . .the . .PHAMA . in. .the . 9 Illustration2010 Guidelines Credits for . .Design . and. Construction. of. Health. Care. Facilities. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..15 11 Glossary . 12 Hazards of Manual Patient Handling . .18 Impact on Risk of Caregiver Injury Impact on Quality of Patient Care Current Patient Handling and Movement Equipment Categories . 22 Benefits of Patient Handling and Movement Technology . 23 Improving the Workplace and Reducing Risk of Injury Improving the Quality of Care Design Considerations and the Provision of Safe Patient Care Environments . 24 Flooring Materials and Finishes Space Constraints Storage Space Door Openings Hallway Widths Floor/Walkway Slopes and Thresholds ChapterElevator 2: Explanation Dimensions of PHAMA Components . 29 Headwalls/Service Utility Columns Weight Capacities of Toilets and Mounted Objects Chapter 3, Part 1: Establishing the Business Case for a PHAMAPatient HandlingText in the and 2010 Movement Guidelines Program . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 30 42 The Impact of Bariatric and Morbidly Obese Patient Care on Design . 39 Savings in Patient Health and Quality of Life . 42 Caregiver Savings . 43 Financing . 43 Grants and Similar Funding Sources Accrued Savings Based on Use of PHAM Equipment Out-of-Pocket Capital Investment Chapter 3, Part 2: Establishing the Business Case— Understanding and Increasing the Value of a PHAMP at Your Institution . 45 The Simple Answer and the Fly in the Ointment . 45 Decision Analysis Methodology . 46 The Decision Analysis Approach . 47 Decision Elements Framework for a Good Decision Understanding the Value . 49 Basis Development and Deterministic Structuring Probabilistic Analysis and Review ChapterInternal 4: FacilitatingRate of Return Acceptance of a PHAMP and PHAM Technology . 58 Increasing the Value . 55 A Compelling Case . 56 Getting Started . 60 Promote the Safe Patient Handling Concept to Leadership Identify a SPHM Facility Champion/Coordinator Institute a Facility SPHM Advisory Team Promote Critical Connections Implementing and Maintaining a PHAMP . 61 Develop Strategic Plans Select and Implement PHAMP Elements ChapterDevelop 5: A Standard Vision of Operating the Futur Procedurese of PHAMPs (SOPs) . 69 Facilitate Change and Program Acceptance Evaluate the PHAMP . 67 Perspectives for Achieving Optimal Patient Handling and Movement . 69 Patient-Centered Focus Caregiver Focus Systems Thinking Rethinking Basic Elements IdeasChapter for 6:Improvement Patient Handling . and. .Movement . Resour. ces. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7072 Short-Term Solutions Future Developments in Technology General . 72 Design Guidance . 72 Clinical Guidance . 73 VA Toolkits/Resources . 74 Web Links . 74 Selected Journal Articles . 74 Appendices Chapter 1 Appendix A: High-Risk Manual Patient Handling Tasks by Clinical Area . 77 ChapterAppendix 2 B: Legislative Report . 79 Appendix C: PHAM Equipment Categories . 85 Appendix D: Sling Selection Chart . 93 Appendix E: Patient Care Ergonomic Evaluation Process . 96 Appendix F: Patient Care Ergonomic Evaluation: Staff Interview Template . 98 Appendix G: Equipment Evaluation and Selection Process . 99 Appendix H: Clinical Unit/Area Characteristics and Ergonomic Issues Survey . 106 Appendix I: Ceiling Lift Coverage Recommendations by Clinical Unit/Area . 112 Appendix J: Floor-Based Lifts Coverage Determination . 115 Appendix K: Design/Layout Considerations for Ceiling/Overhead Lift Tracks . 118 Appendix L: Storage Requirements for PHAM Equipment . 124 ChapterAppendix 4 M: Infection Control Risk AssessmentÑ Matrix of Precautions for Construction and Renovation . ..