- Email: [email protected]
Introduction to the Safe Patient Handling and Movement Series
Introduction to the Safe Patient Handling and Movement Series MARY J. OGG, MSN, RN, CNOR
ABSTRACT Musculoskeletal injuries can occur when the physical work demanded by a job exceeds a worker’s ability to respond safely. In perioperative nursing, and nursing in general, patient handling and movement demands commonly lead to injury and are considered high-risk activities. In 2005, the AORN Workplace Safety Task Force was charged with identifying high-risk tasks performed in the perioperative area and developing evidence-based solutions to help establish an ergonomically safe workplace. The work of the task force was incorporated into the “AORN guidance statement: Safe patient handling and movement in the perioperative setting,” which includes seven ergonomic tools to help determine best practices for safe movement and handling of patients, supplies, and equipment in the OR. Members of the AORN Perioperative Environment of Care Task Force have collaborated to author seven articles that help explain the rationale behind and use of these ergonomic tools. The articles will appear in the Journal beginning in this issue. AORN J 93 (March 2011) 331-333. © AORN, Inc, 2011. doi: 10.1016/j.aorn.2010.12.004 Key words: work-related musculoskeletal disorders, perioperative occupational injury, ergonomics, safe patient handling.
Acknowledgement: The author thanks Audrey Nelson, PhD, RN, FAAN; Thomas R. Waters, PhD, CPE; Deborah G. Spratt, MPA, BSN, RN, CNOR, NEA-BC; Carol Petersen, MAOM, BSN, RN, CNOR; and Nancy Hughes, MS, RN, authors of the article “Development of the AORN guidance statement: safe patient handling and movement in the perioperative setting,” whose work and research provided the background for a portion of this introduction. Their article is available in the AORN Guidance Statement: Safe Patient Handling and Movement in the Perioperative Setting. Denver, CO: AORN, Inc; 2007:5-9.
M
usculoskeletal disorders (MSDs) are among the most frequently occurring and costly types of occupational hazards for nurses.1-3 Musculoskeletal disorders may develop over a period of weeks, months, or years as a result of prolonged mechanical stresses imposed on the musculoskeletal system, resulting in injuries recognized as physical ailments or abnormal conditions.4 Generally, MSDs develop when work demands habitually exceed a worker’s capacity to respond to those demands. Musculoskeletal disorders can affect the back, neck, shoulders, elbows, wrists, hands, knees, ankles, and feet. In 2001, nurses
doi: 10.1016/j.aorn.2010.12.004
© AORN, Inc, 2011
March 2011
Vol 93
No 3 ● AORN Journal
331
March 2011
Vol 93
working in private health care facilities experienced a reported 11,800 MSDs, the majority of which (ie, nearly 9,000) were back injuries.3 Back injuries also comprised more than onethird of the injuries that required the nurses to take time away from work.3 Although back injuries are one of the most common occupational injuries in health care,5-7 the results of one study indicated that injuries to the shoulder and neck were even more likely than lower back pain to affect nurses’ ability to work.8 “The connection between risk factors and MSDs is stronger when exposures are intense and prolonged and when there are several risk factors present at the same time.”9(p5),10 The physical demands of the perioperative environment put perioperative nurses and other perioperative health care personnel at risk for developing MSDs.11,12 The consequences of MSDs can be severe. “Employees who experience pain and fatigue are less productive, less attentive, more prone to make mistakes, more susceptible to injury, and they may be more likely to affect the health and safety of others.”9(p5) “Workplaces with high incidences of MSDs report increases in lost/modified work days, higher staff turnover, increased costs, and adverse patient outcomes.”9(p5),13-15 A safe workplace is necessary to promote the health and well-being of both patients and health care providers. RISKS IN THE PERIOPERATIVE ENVIRONMENT In 2005, the AORN Workplace Safety Task Force was charged with identifying tasks performed in the perioperative area that pose a high risk for the development of MSDs and formulating evidence-based solutions to minimize the risks. This interdisciplinary task force included experts in perioperative nursing, ergonomics, biomechanics, engineering, industrial hygiene, and injury prevention and included representatives from AORN, the National Insti332
AORN Journal
OGG
No 3
tute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Florida, and the American Nurses Association.9 The task force identified the following high-risk perioperative tasks:
transferring patients on and off OR beds; repositioning patients on OR beds; lifting and holding patients’ extremities; standing for long periods of time; holding retractors for long periods of time; lifting and carrying supplies and equipment; and pushing, pulling, and moving equipment on wheels.
The task force members developed recommendations for each of these high-risk perioperative tasks using the principles of ergonomics, scientific evidence, and clinical trials conducted at the Veterans Administration Medical Center. These recommendations are incorporated into the “AORN guidance statement: Safe patient handling and movement in the perioperative setting,” which was introduced in 2007.16 Building on this work, in 2009, the AORN Perioperative Environment of Care Task Force produced a Safe Patient Handling and Movement Tool Kit, which is available on the AORN web site and is free to AORN members (http://www .aorn.org/PracticeResources/ToolKits/SafePatient HandlingMovementToolKit). The tool kit is based on the AORN guidance statement and algorithms to prevent MSDs associated with improper moving and lifting techniques and provides perioperative personnel with explanations about the correct way to move patients and equipment safely in the perioperative environment. The tool kit contains a two-part educational PowerPoint™ presentation, a pocket reference guide for use in the clinical practice setting, awareness posters, a gap analysis template to assess the current “gaps” in practice, and a bibliography of supporting articles and research.
SAFE PATIENT HANDLING SERIES INTRODUCTION NEW ERGONOMIC SERIES Members of the Perioperative Environment of Care Task Force have collaborated to author seven articles summarizing the tools in the “AORN guidance statement: Safe patient handling and movement in the perioperative setting” that will appear as a series in the Journal. The first of these articles, AORN Ergonomic Tool 1: Lateral Transfer of a Patient from a Stretcher to an OR Bed, appears following this introduction. In the coming months, additional articles will address the following:
Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed; Ergonomic Tool 3: Lifting and Holding the Patient’s Legs, Arms, and Head While Prepping; Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings; Ergonomic Tool 5: Risks Associated with Manual Retraction in the Perioperative Setting; Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting; and Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels.
These articles describe ergonomic solutions for high-risk patient handling tasks in the perioperative clinical setting and are intended to help perioperative personnel identify and prevent MSDs and injuries. Editor’s note: PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA. References 1.
Owen B. Preventing injuries using an ergonomic approach. AORN J. 2000;72(6):1031-1036. 2. Nelson A, Fragala G, Menzel N. Myths and facts about back injuries in nursing. Am J Nurs. 2003;103(2):32-41.
3. 4.
5.
6. 7.
8.
9.
10.
11. 12.
13. 14.
15.
16.
www.aornjournal.org
Converso A, Murphy C. Winning the battle against back injuries. RN. 2004;67(2):52-58. Lloyd JD. Cumulative Trauma Disorders of the Upper Extremities—Experiment Report. Boston, MA: Liberty Mutual Insurance Co; 1991. Stubbs DA, Buckle PW, Hudson MP, Rivers PM, Baty D. Backing out: nurse wastage associated with back pain. Int J Nurs Stud.1986;23(4):325-336. Owen BD. The magnitude of low-back pain problem in nursing. West J Nurs Res. 1989;11(2):234-242. Vasiliadou A, Karvountzis GG, Soumilas A, Roumeliotis D, Theodosopulou E. Occupational low back pain in nursing staff in a Greek hospital. J Adv Nurs. 1995;21(1):125130. Lusted MJ, Carrasco CL, Mandryk JA, Healy S. Selfreported symptoms in the neck and upper limbs in nurses. Appl Ergon. 1996;27(6):381-387. Nelson A, Waters TR, Spratt DG, Petersen C, Hughes N. Development of the AORN guidance statement: safe patient handling and movement in the perioperative setting. In: AORN Guidance Statement: Safe Patient Handling and Movement in the Perioperative Setting. Denver, CO: AORN, Inc; 2007:5-9. Musculoskeletal disorders (MSDs) and workplace factors. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/docs/97-141/. Accessed October 14, 2010. Owen B, Garg A. Reducing risk for back pain in nursing personnel. AAOHN J. 1991;39(1):24-33. Garb JR, Dockery CA. Reducing employee back injuries in the perioperative setting. AORN J. 1995;61(6): 1046-1052. Wicker P. Manual handling in the perioperative environment. Br J Periop Nurs. 2000;10(5):255-259. Corlett EN, Lloyd PV, Tarling C, Troup JD, Wright B. The Guide to Handling Patients. 3rd ed. London, England: National Back Pain Association and the Royal College of Nursing; 1993. Tuohy-Main K. Why manual handling should be eliminated for resident and career safety. Geriaction. 1997; 15(4):10-14. AORN guidance statement: Safe patient handling and movement in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2010:673-696.
Mary J. Ogg, MSN, RN, CNOR, is a perioperative nursing specialist in the AORN Center for Nursing Practice, Denver, CO. Ms Ogg has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal
333
ABSTRACT Musculoskeletal injuries can occur when the physical work demanded by a job exceeds a worker’s ability to respond safely. In perioperative nursing, and nursing in general, patient handling and movement demands commonly lead to injury and are considered high-risk activities. In 2005, the AORN Workplace Safety Task Force was charged with identifying high-risk tasks performed in the perioperative area and developing evidence-based solutions to help establish an ergonomically safe workplace. The work of the task force was incorporated into the “AORN guidance statement: Safe patient handling and movement in the perioperative setting,” which includes seven ergonomic tools to help determine best practices for safe movement and handling of patients, supplies, and equipment in the OR. Members of the AORN Perioperative Environment of Care Task Force have collaborated to author seven articles that help explain the rationale behind and use of these ergonomic tools. The articles will appear in the Journal beginning in this issue. AORN J 93 (March 2011) 331-333. © AORN, Inc, 2011. doi: 10.1016/j.aorn.2010.12.004 Key words: work-related musculoskeletal disorders, perioperative occupational injury, ergonomics, safe patient handling.
Acknowledgement: The author thanks Audrey Nelson, PhD, RN, FAAN; Thomas R. Waters, PhD, CPE; Deborah G. Spratt, MPA, BSN, RN, CNOR, NEA-BC; Carol Petersen, MAOM, BSN, RN, CNOR; and Nancy Hughes, MS, RN, authors of the article “Development of the AORN guidance statement: safe patient handling and movement in the perioperative setting,” whose work and research provided the background for a portion of this introduction. Their article is available in the AORN Guidance Statement: Safe Patient Handling and Movement in the Perioperative Setting. Denver, CO: AORN, Inc; 2007:5-9.
M
usculoskeletal disorders (MSDs) are among the most frequently occurring and costly types of occupational hazards for nurses.1-3 Musculoskeletal disorders may develop over a period of weeks, months, or years as a result of prolonged mechanical stresses imposed on the musculoskeletal system, resulting in injuries recognized as physical ailments or abnormal conditions.4 Generally, MSDs develop when work demands habitually exceed a worker’s capacity to respond to those demands. Musculoskeletal disorders can affect the back, neck, shoulders, elbows, wrists, hands, knees, ankles, and feet. In 2001, nurses
doi: 10.1016/j.aorn.2010.12.004
© AORN, Inc, 2011
March 2011
Vol 93
No 3 ● AORN Journal
331
March 2011
Vol 93
working in private health care facilities experienced a reported 11,800 MSDs, the majority of which (ie, nearly 9,000) were back injuries.3 Back injuries also comprised more than onethird of the injuries that required the nurses to take time away from work.3 Although back injuries are one of the most common occupational injuries in health care,5-7 the results of one study indicated that injuries to the shoulder and neck were even more likely than lower back pain to affect nurses’ ability to work.8 “The connection between risk factors and MSDs is stronger when exposures are intense and prolonged and when there are several risk factors present at the same time.”9(p5),10 The physical demands of the perioperative environment put perioperative nurses and other perioperative health care personnel at risk for developing MSDs.11,12 The consequences of MSDs can be severe. “Employees who experience pain and fatigue are less productive, less attentive, more prone to make mistakes, more susceptible to injury, and they may be more likely to affect the health and safety of others.”9(p5) “Workplaces with high incidences of MSDs report increases in lost/modified work days, higher staff turnover, increased costs, and adverse patient outcomes.”9(p5),13-15 A safe workplace is necessary to promote the health and well-being of both patients and health care providers. RISKS IN THE PERIOPERATIVE ENVIRONMENT In 2005, the AORN Workplace Safety Task Force was charged with identifying tasks performed in the perioperative area that pose a high risk for the development of MSDs and formulating evidence-based solutions to minimize the risks. This interdisciplinary task force included experts in perioperative nursing, ergonomics, biomechanics, engineering, industrial hygiene, and injury prevention and included representatives from AORN, the National Insti332
AORN Journal
OGG
No 3
tute for Occupational Safety and Health, the Patient Safety Center of Inquiry at the James A. Haley Veterans Administration Medical Center in Tampa, Florida, and the American Nurses Association.9 The task force identified the following high-risk perioperative tasks:
transferring patients on and off OR beds; repositioning patients on OR beds; lifting and holding patients’ extremities; standing for long periods of time; holding retractors for long periods of time; lifting and carrying supplies and equipment; and pushing, pulling, and moving equipment on wheels.
The task force members developed recommendations for each of these high-risk perioperative tasks using the principles of ergonomics, scientific evidence, and clinical trials conducted at the Veterans Administration Medical Center. These recommendations are incorporated into the “AORN guidance statement: Safe patient handling and movement in the perioperative setting,” which was introduced in 2007.16 Building on this work, in 2009, the AORN Perioperative Environment of Care Task Force produced a Safe Patient Handling and Movement Tool Kit, which is available on the AORN web site and is free to AORN members (http://www .aorn.org/PracticeResources/ToolKits/SafePatient HandlingMovementToolKit). The tool kit is based on the AORN guidance statement and algorithms to prevent MSDs associated with improper moving and lifting techniques and provides perioperative personnel with explanations about the correct way to move patients and equipment safely in the perioperative environment. The tool kit contains a two-part educational PowerPoint™ presentation, a pocket reference guide for use in the clinical practice setting, awareness posters, a gap analysis template to assess the current “gaps” in practice, and a bibliography of supporting articles and research.
SAFE PATIENT HANDLING SERIES INTRODUCTION NEW ERGONOMIC SERIES Members of the Perioperative Environment of Care Task Force have collaborated to author seven articles summarizing the tools in the “AORN guidance statement: Safe patient handling and movement in the perioperative setting” that will appear as a series in the Journal. The first of these articles, AORN Ergonomic Tool 1: Lateral Transfer of a Patient from a Stretcher to an OR Bed, appears following this introduction. In the coming months, additional articles will address the following:
Ergonomic Tool 2: Positioning and Repositioning the Supine Patient on the OR Bed; Ergonomic Tool 3: Lifting and Holding the Patient’s Legs, Arms, and Head While Prepping; Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings; Ergonomic Tool 5: Risks Associated with Manual Retraction in the Perioperative Setting; Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting; and Ergonomic Tool 7: Pushing, Pulling, and Moving Equipment on Wheels.
These articles describe ergonomic solutions for high-risk patient handling tasks in the perioperative clinical setting and are intended to help perioperative personnel identify and prevent MSDs and injuries. Editor’s note: PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA. References 1.
Owen B. Preventing injuries using an ergonomic approach. AORN J. 2000;72(6):1031-1036. 2. Nelson A, Fragala G, Menzel N. Myths and facts about back injuries in nursing. Am J Nurs. 2003;103(2):32-41.
3. 4.
5.
6. 7.
8.
9.
10.
11. 12.
13. 14.
15.
16.
www.aornjournal.org
Converso A, Murphy C. Winning the battle against back injuries. RN. 2004;67(2):52-58. Lloyd JD. Cumulative Trauma Disorders of the Upper Extremities—Experiment Report. Boston, MA: Liberty Mutual Insurance Co; 1991. Stubbs DA, Buckle PW, Hudson MP, Rivers PM, Baty D. Backing out: nurse wastage associated with back pain. Int J Nurs Stud.1986;23(4):325-336. Owen BD. The magnitude of low-back pain problem in nursing. West J Nurs Res. 1989;11(2):234-242. Vasiliadou A, Karvountzis GG, Soumilas A, Roumeliotis D, Theodosopulou E. Occupational low back pain in nursing staff in a Greek hospital. J Adv Nurs. 1995;21(1):125130. Lusted MJ, Carrasco CL, Mandryk JA, Healy S. Selfreported symptoms in the neck and upper limbs in nurses. Appl Ergon. 1996;27(6):381-387. Nelson A, Waters TR, Spratt DG, Petersen C, Hughes N. Development of the AORN guidance statement: safe patient handling and movement in the perioperative setting. In: AORN Guidance Statement: Safe Patient Handling and Movement in the Perioperative Setting. Denver, CO: AORN, Inc; 2007:5-9. Musculoskeletal disorders (MSDs) and workplace factors. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/docs/97-141/. Accessed October 14, 2010. Owen B, Garg A. Reducing risk for back pain in nursing personnel. AAOHN J. 1991;39(1):24-33. Garb JR, Dockery CA. Reducing employee back injuries in the perioperative setting. AORN J. 1995;61(6): 1046-1052. Wicker P. Manual handling in the perioperative environment. Br J Periop Nurs. 2000;10(5):255-259. Corlett EN, Lloyd PV, Tarling C, Troup JD, Wright B. The Guide to Handling Patients. 3rd ed. London, England: National Back Pain Association and the Royal College of Nursing; 1993. Tuohy-Main K. Why manual handling should be eliminated for resident and career safety. Geriaction. 1997; 15(4):10-14. AORN guidance statement: Safe patient handling and movement in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2010:673-696.
Mary J. Ogg, MSN, RN, CNOR, is a perioperative nursing specialist in the AORN Center for Nursing Practice, Denver, CO. Ms Ogg has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal
333