Patient Transfers in the Operating Theatre - Essay Example

Patient Transfers in the Operating Theatre: A Review of the Literature (Fill in with your information etc Patient Transfers in the Operating Theatre: A Review of the Literature Among healthcare workers injured at the workplace, 52% listed a transferring-related factor as the primary cause of injury. These workers also noted that not knowing how to deal with unforeseen circumstances was a major cause of these accidents, and that lack of knowledge in regards to the use of the equipment, along with lack of the equipment altogether, were significant problems. Lack of training in lifting techniques has also been shown to be a major contributor to the accident process within hospitals and poor patient handling skill is shown to be a risk factor for back injuries. A critical issue in ergonomic patient handling is the distinction between a patient or resident transfer and a lift. In order to come to a clearer and more understanding viewpoint on this subject matter, the following questions must be addressed: 1. What is the difference between patient transfers and patient lifts 2. What occurs in the situation of a patient transfer 3. Why do many staff members not use the proper equipment during a patient transfer 4. What conclusion can be drawn from this review By discussing these four questions, we can come to a more knowledgeable and intellectual viewpoint on this subject matter. This is what will be dissertated in the following. What is the Difference Between Patient Transfers and Patient Lifts There are many significant differences between patient transfers and patient lifts. "A transfer is a dynamic effort in which the client aids in the transfer and is able to bear weight on at least one legA lift involves moving a client who cannot bear weight on at least one leg. Lifts should always involve mechanical lifting devices." ("CCOHS", 2002). What Occurs in the Situation of a Patient Transfer The overall approach to a patient transfer must be taken into careful consideration before being attempted, and all factors must be realized, understood, and decided on before beginning the transfer. In addition to the actual physical layout of the workplace, there are other crucial factors involved: equipment, staffing, workload, and the approach itself to each transfer or lift are all crucial in reducing caregiver injuries. Proper documentation and communication should inform the caregiver of the client's abilities, transfer needs, physical stability, and tendency, if any, towards aggressive acts. Each caregiver should also anticipate what actions would be necessary if the client were to lose balance or fall. The actual procedure for the transfer should be clearly communicated and understood by any other staff assisting, as well as the patient or resident themselves. As well, the caregiver should assess the client, even if only briefly, before each and every transfer. The client should, respectively, be transported to the nearest possible distance by the lifting device. Any mechanical lifting device used should not be used to transport the patient or resident outside of the room. During the actual transfer, staff members are told to tighten their abdominal muscles, keep their back straight, and use their leg muscles in order to avoid injury. The overall approach to a patient transfer must be taken into careful consideration before being attempted, and all factors must be realized, understood, and decided on before beginning the transfer. In addition to the actual physical layout of the workplace, there are other crucial factors involved: equipment, staffing, workload, and the approach itself to each transfer or lift are all key elements to reducing caregiver injuries. Rotating or twisting the spine, and moving the entire body in the direction of the transfer should all be avoided, as well as grabbing the client under the underarms, as this could easily injure the client. Staff members are told to position themselves as close as possible to the client and assure that their footing is stable, and to try to maintain eye contact with the client and communicate while the transfer is in progress. This maintains a true level of communication and understanding between the caregiver and the client, and will assuredly allow for a smoother and more easily transitional transfer. The client should never be allowed to grasp the caregiver around the neck, as this could also easily result in injury. It is crucial that the timing of the transfer with the client and other caregivers count together, and that the path of the transfer is fully clear from all obstructions and that furniture and aids that the client is being transferred to are properly placed and secure. Aggressive patients are a common occurrence, and are a factor which must be completely understood before attempting a patient transfer of any kind. Injury to both the caregiver and the client can occur when transferring aggressive patients or residents, and caregivers have a legal right to know if the particular patient or resident they are caring for has a history of aggressive behavior. It is absolutely crucial that all caregivers receive proper training and have the assistance of other properly trained staff, especially when dealing with potentially violent clients. "Depending on the level of aggression the patient or resident may need to be placed in a facility designed for the care of violent individuals." ("CCOHS", 2002). Emergency procedures must be learned before they are needed, and must be followed out properly during the required situation if necessary. The reasons and explanations for client anger and hostility can be anywhere from subtly simple to intensely complex, and consequently, all staff should be properly trained to identify the signs of potential aggressive behavior, the triggers that can lead to violent outburst, means of deescalating an aggressive encounter, and emergency procedures to follow if retreat from an aggressive client is not possible or an attack occurs. The performance criteria, in regards to the transferring of an unconscious patient in the operating theatre, is as follows: 1. Apply standard precautions for infection control and take other appropriate health and safety measures when assisting in the transfer and movement of unconscious patients 2. Inform the patient (if possible) of the nature and purpose of the transfer or move in a manner which encourages their understanding and cooperation 3. Maintain the patient's privacy, dignity, and comfort as far as possible, and maintain their safety at all times 4. Prepare the immediate surroundings appropriately for the transfer and remove any potential hazards 5. Ensure the required transfer equipment is available and used correctly at all times 6. Coordinate all actions efficiently with all others involved in the transfer and ensure the required number of people are available to enable a safe transfer 7. Use safe and suitable moving and handling techniques for transferring the patient ensuring the avoidance of: Endangering the patient Exceeding your personal weight and reach limits Endangering other members of staff Causing damage to the equipment or the environment If it is known that the patient is incapable of being maintained safely with alternate therapy, the risks and benefit of transport are cautiously reexamined. Also on this note, if a transport ventilator is to be used, it must have alarms to indicate disconnection and/or excessively high airway pressures and must have a backup battery power supply. A more efficient engineering control strategy - other than the regularly used back belts - is the utilization of patient handling equipment and devices. The evidence supporting the use of mechanical and lifting devices within the health care industry is mixed, however, for one reason because some studies depend on retrospective data (Aird, Nyran, & Roberts, 1988). For example, the use of height-adjustable beds and electric beds have proven to have a positive effect in the handling and transferring of patients, and many studies concur that mobile mechanical devices have a positive impact on health care workers as well as on work related injuries. (Daynard et al, 2001; Evanoff, Wolf, Alton, Canos, & Collins, 2003; Garg, Owen, Beller, & Banaag, 1991a; 1991b; Yassi et al, 2001). The monitoring of patients during transfer is critical, and without careful watch even for a moment, the affect can be life-threatening. All critically ill patients undergoing transfer receive the same level of basic physiologic monitoring during transfer as they had in the (intensive care) unit. "This includes, at a minimum, continuous electrocardiographic monitoring, continuous pulse oximetry, and periodic measurement of blood pressure, pulse rate, and respiratory ratein additionselected patients may benefit from capnography, continuous intra-arterial blood pressure, pulmonary artery pressure, or intracranial pressure monitoring." (National Guideline Clearinghouse, 2006). Moving unconscious patients in the operating theatre is a constantly difficult task. It is tricky enough with a conscious patient, but when the patient is unconscious and cannot render any form of communication, or any means of assistance in the transfer, this creates problems, and this relates onto the staff in that they are left to deal with this significant problem. Monitoring an unconscious patient when they are in a bed can be difficult enough in itself as well, but during a transfer monitoring is one of the most key factors. When transferring an unconscious patient from a bed to a trolley or to another bed, all circumstances must be understood and closely watched. Even the smallest mistake could send the patient into an even more life-threatening situation, and so it is up to the medical personnel in control of the transfer to follow all instructions down to the tee. An unconscious patient cannot tell the medical personnel whether they are feeling pain, which is a crucially important factor. This means, that unlike a conscious patient, the medical staff involved in the transfer must be especially careful when completing the transfer. Although medical machinery and equipment are most often a constant, the physical pain - if any - cannot be explained by the patient in this situation, which means that this could produce a dangerous situation, if not acted out correctly. Why do Many Staff Members not use the Proper Equipment During a Patient Transfer The distinction of manual patient handling specifically refers to tasks such as lifting, transferring, and the repositioning of patients without the use of assistive devices. The performing of manual patient handling places nurses at an alarmingly increased risk for musculoskeletal disorders. Patients' bodies have an asymmetric distribution of weight and therefore simply do not possess available, stable areas to grip, which as an end result makes it incredibly more difficult to hold a patient's weight close to the nurse's own body. Also, there may be occasions when patients are agitated, combative, non-responsive, or can only offer limited levels of assistance - all of which increase the potential of injury. A laboratory study was conducted (Garg, Owen, Beller, & Banaag, 1991a) in an effort to reduce back stress for nursing personnel while performing the patient handling tasks of transferring the patient to bed to wheelchair and wheelchair to bed. These handling techniques were studied through the use of five manual techniques and three hoist-assisted techniques. The manual techniques, on the other hand, involved one-person and two-person transfers. "One manual technique involved a two-person lift of the patient under the arms; while the others used a rocking and pulling action and included the use of assistive devices (a gait belt using a two-person transfer, a walking belt with handles using a one-person and a two-person transfer, and a patient handling sling with cutout areas to allow for a hand grip (Medesign) for a one-person transfer)" (Garg, Owen, Beller, & Banaag, 1991a). The static biomechanical evaluation showed that pulling techniques, as compared to lifting the patient, required significantly lower hand forces and produced significantly lower erector spinae and compressive forces at the L5/S1 disc (P greater than or equal to 0.01). As well, patients found the pulling techniques to be more comfortable and more secure than the lifting method. "However, a number of subjects believed that the patient handling sling (Medesign) and the walking belt with one person making the transfer would not work for those patients who could not bear weight and those who were heavy, contracted, or combative." (Garg, Owen, Beller, & Banaag, 1991a). However, there may be occasions when manual patient handling cannot be avoided, such as when nurses are presented with exceptional of life-threatening situations prohibiting the use of assistive patient handling equipment. Also, manual patient handling may be performed if the action does not involve lifting most or all of a patient's weight. In any and all cases, effort towards patient handling should be minimized as much as absolutely possible, without comprising patient care or exceeding the abilities and skills of the healthcare workers involved. Injuries to caregivers often occur during patient and resident transfers, especially so when a patient transfer suddenly becomes a patient lift. A detailed assessment of the client's capabilities is therefore so crucial, and truly becomes a critical component of any ergonomic patient-handling program. Clients who find themselves suddenly losing their balance must be identified to determine then whether two caregivers are necessary to affect a transfer or whether a mechanical device is instead necessary. The physical size of both the caregiver and the client must be carefully taken into consideration, not only for the transfer itself but for determining the need for additional staff to aid in a transfer or the need for a mechanical lift. The weight and height differences may also dictate the necessity of mechanical assistance. During the past decade, the injury rate among healthcare workers across the world has skyrocketed. In fact, it is now second only to that of the meatpacking industry. "Patients/residents are becoming heavier and more cumbersome to handle than before. As our population ages, this trend will only continue." (Strong, 1999). In order to address this situation, most facilities have purchased at least some form of patient handling equipment and many have also even tried body mechanics training, although a major problem is that many staff members continue not to use the equipment provided - injuries and worker's compensation costs continue to rise. Many facilities have tried desperately to urge caregivers to use the equipment provided, and some have even already - or begun to - enforce rules and regulations regarding the use of proper equipment during patient transfer. Most of these facilities have basically failed in their attempts, with the overriding deterrent to success seeming to be, rather simply, the reluctance of staff to use the proper transfer equipment provided. "In most facilities, the procedure used to perform a lift or transfer is decided upon by the caregiver - and often the caregiver will elect to perform the transfer manually because it is 'fastest'." (Strong, 1999). Even if the proper equipment is provided and readily available, many personnel continue to perform transfers manually for several commonly used reasons, such as: "Not enough equipment", "Not the right type of equipment", or "The manual cranking takes too much time," - just to name a few. In the eyes of many, these are very costly attitudes, which are even more unfortunate considering how easily many injuries could be avoided simply if proper procedures were followed. It is the staff reluctance to actually use the equipment which is the primary reason for the lack of its use, and although there seems to be varying different excuses as to the exact reason, the fact of the matter is that if a decrease in employee injuries is expected, the proper patient transferring equipment absolutely must be used. The use of patient transfer assistive devices are not only assistive and beneficial to the healthcare worker, but also to the patient. Patient adverse events related to patient handling and movement include pain and injury, but the use of assistive equipment directly contributes to preventing such adverse events as well as improving patient safety. Through the elimination of manual patient handling, patients are afforded both more secure and stable means to progress through their care. Alongside this, assistive equipment can be designed to incorporate patient comfort and dignity considerations as a way to respect patients' rights and to improve the overall quality of care. Getting started can often be the most difficult part, both in regards to the caregiver participating, but also to the actual facility outfitting itself with the proper transfer equipment. Facilities realize first and foremost that providing themselves with the equipment is most certainly not a total solution, and that each facility must first decide to set a lifting 'policy'. It is common in today's world to hear sayings such as 'zero-lift' or 'lift-free' in association with facilities in regards to client lifting policies. For this, a 'lift-free' policy is usually a document written by the faculty, specific in all regards to that particular facility, setting tight guidelines in the addressing of transfers of clients. Each facility must decide how strict a 'lift-free' policy they wish to set. "For example, a fairly strict policy would require a piece of mechanical equipment to be used on every client who requires manual lifting and/or transferring. This can be worthwhile because, generally, the stricter the policy, the higher the injury reduction attained. With a comprehensive, structured program, injury reductions can be as great as 80 to 100%." (Strong, 2002). Safe patient transfer requires proper staffing, the right mix of personnel, and appropriate, readily available, well-maintained patient lifting equipment. All staff need to receive training in safe lifting procedures and the proper use of lifting equipment - before completing any sort of patient transfer. The establishing of a policy is only considered to be the first step. There are many other essential factors which must be brought together with the policy, and only when all are put together can the expected outcome occur. These factors include things such as the types of equipment available, assessment of needs, the appropriate equipment supplier, training, compliance monitoring and proper case management. Equipment is certainly one of the most important and critical factors in this situation, and it is essential that the proper number and types of equipment be purchased, which would therefore allow the correct mix of total lifts (used on non-weight-bearing clients) and sit/stand lifts (for weight-bearing clients) to be available for use in each care area. When selecting the sort of equipment to be used in this particular type of environment, it is absolutely critical to purchase electrical battery-operated lifts rather than manually operated ones, mainly because this reduces the risk of repetitive strain injuries to the neck and shoulders of caregivers. Things such as training and ongoing compliance monitoring are often overlooked when implementing any sort of injury prevention program. It has been noted that because staff turnover often times actually exceeds 100% a year, training and re-training is a major issue. "It is extremely important that all staff (full-time, part-time and all shifts) be fully trained on the use and application of transfer equipment and are made fully aware of all policies." (Strong, 2002). Compliance must also be addressed, but it must be understood how much compliance enforcement is actually required. If staff members are expressing willingness to change for instance, one might require a less vigorously managed compliance program. Conversely, if they are more reluctant to accept a new policy, a stronger compliance program would have to be implemented. A major discussion is that of weight (as briefly previously discussed), and how the weight of the general population is steadily increasing, and how that affects strain on an already stressed healthcare system. There is an estimated 64 million adults in the UK alone that suffer from obesity, with the prevalence of the morbidly obese, those at least 100 lbs. over their ideal body weight, has increased steadily over the past few decades. According to Sandy Wise, RN, MBA, senior director of medical and surgical services at group purchasing organization Novation, notes that, "I'm hearing that we're seeing more patients over 1000 lbs. And we've had several member hospitals that have had patients at 1200 lbs." Wise continues by saying that "You don't know they're coming, and they could show up at the ER. And that's why all facilities need to have at least some basic equipment." ARJO Inc.'s injury prevention programs include a Back Injury Prevention Program (BIPP) thin offers up to a 60% guaranteed reduction in transfer related incidents and an AHA-endorsed Diligent program that offers a long-term, comprehensive, hands-on approach to injury prevention. "We are very concerned with educating our customers on transferringobese patients. We recognize the unique needs this creates and have modified our 'Guidebook for Architects' with a chapter on this very issue," notes Amy McCaw, Marketing Coordinator, ARJO. The World Health Organization (WHO) has actually identified the epidemic of obesity as one of today's most significant health problems. "It affects three times as many adults today than it did 20 years ago and the number of morbidly obese patients with a body mass index (BMI) above 40 (bariatric patients) has almost doubled in the last decade." (Nilsson, 2005). If using and working with inappropriate equipment when transporting bariatric patients, there is an increased risk for acute musculoskeletal disorders for nursing staff and also a long-term risk for over-exertion injuries. Specialized equipment is required when moving individuals who are morbidly obese, and when the correct equipment is not used, lifting injuries, especially back injuries occur commonly among health care workers. In an institutional setting, obese patients cannot be lifted and transferred in the same way as other adults. The task requires equipment - along with proper use of that equipment - which is specifically designed for people who are overweight. What Conclusion can be Drawn From This Review There are many examples of medical personnel who suffer permanently from not using the provided equipment. This includes Linda Salvini, RN, and Maggie Flanagan, RN, who both sustained a painful, serious musculoskeletal injury while caring for patients. In both cases, the injuries were preventable. In Salvini's case, she and the other RNs on the unit were accustomed to moving patients by themselves, without additional staff to assist them, and many of their patients came from the ICU and were unable to move, and many were heavy - some up to 500 pounds. The injuries suffered by these two women are all too common among the medical workplace personnel. Thousands of RNs sustain similar injuries each year, and many more are at risk every day. It has been calculated that nearly half of all healthcare workers will have at least one work-related musculoskeletal disorder during their careers, many of which will be back injuries. In fact, the rate of back injury among hospital workers is higher than among manufacturing or construction workers. Patient handling tasks - lifting, transferring, and repositioning patients - are the primary cause of musculoskeletal disorders among nurses. These tasks, which are most times performed manually without the use of assistive devices - although this is of course entirely discouraged - are so much a part of their routine that they barely even stop to think about it. Patients must be transferred from bed to wheelchair, wheelchair to toilet, wheelchair to bathtub, and back again. They must be raised, lowered, repositioned, even lifted off the floor, and the patients may or may not be able to assist with these maneuvers. If the patient is unconscious, for example, it is obvious that they will be unable to assist with the transfer, leaving even more weight on the healthcare worker. Injuries are most likely to occur when a nurse is performing a task that requires forceful exertion, repetitive movements, or maintaining an awkward or static posture, with the most serious injuries occurring when a nurse twists and lifts at the same time and moves a patient by herself without other personnel or an assistive device. The most obvious conclusions are perhaps the most important - that the use of proper equipment during patient transfer greatly reduces the rate of injury among staff. By providing the proper equipment, fully training the staff in the methods and proper procedures, and earnestly attempting to enforce one's particular patient transfer policy, facilities have been able to statistically prove a significant decrease in staff injury, although clearly members of staff cannot be constantly be monitored, and therefore, depending on each member's own personal point of view, even with an unlimited amount of information and demands, they may still opt to manually transfer their patients. Studies have found that using mechanical lifting devices and other assistive patient handling equipment, such as roller boards, sliders, friction-reduction pads, transfer chairs, and gait belts, will significantly reduce the number of healthcare workers' injuries. This is because these devices work by taking on the energy and force that would otherwise be imposed upon the nurse during the lifting or transferring of a patient. The point that manually transferring patients is 'quicker' can of course be taken into consideration, but conversely to this - and surely more relevant on all terms - is the health and safety of both parties: the caregiver and the client. Regardless of how quick the manual transfer may be, the relevance of safety is clearly at stake, and the caregiver must think of not only the patient, but of their own safety and how an injury would consequently affect not only their own personal life, but the allowance of their participation in the workplace altogether. Back injuries are a serious problem, especially for the nursing personnel who perform frequent patient-handling activities. Common prevention strategies should include that of: body mechanics education, technique training, and ergonomic interventions such as the introduction to assistive equipment. The use of assistive equipment, however, is not the only answer. An investigation was done (Nelson & Baptiste, 2004) to compare and assess the effectiveness of two patient-handling approaches to reducing injury risk. One involved using improved patient-handling technique with existing equipment, and the other aimed primarily at eliminating manual patient handling altogether. The results of this investigation showed greater compliance with interventions that incorporated new assistive patient-handling equipment, as opposed to those consisting of simply education and technique training alone. Patient handling tasks are performed in diverse clinical settings and there is no one solution available for this problem. High-risk patient handling tasks are characterized by significant biomechanical and postural stressors imposed on the caregiver. "Not surprisingly, factors such as the patient's weight, transfer distance, confined workspace, unpredictable patient behavior, and awkward positions such as stooping, bending, and reaching significantly contribute to the risk of performing patient handling tasks." (Nelson & Baptiste, 2004). The use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations. No single intervention can be recommended; instead all patient-handling tasks should be examined separately in order to be able to determine which methods maximize reductions in both peak and cumulative lumbar forces during a maneuver. References Aird, J. W., Nyran, P., & Roberts, G. (1988). Comprehensive Back Injury Program: An Ergonomics Approach for Controlling Back Injuries in Healthcare Facilities. In F. Aghandeh (Ed.), Trends in ergonomics/ human factors v. Amsterdam: Elselvier (North Holland Division). Akridge, J. (2005, March). Weighty Issues require careful planning. 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