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While the operating room is on the cutting edge in innovative technology and procedures, the ability to safely handle and reposition patients too often is stuck in the past. The Association of periOperative Registered Nurses (AORN) is emphasizing the risk of injury to healthcare workers in moving and handling surgical patients, and has issued guidelines and toolkits to address the issue.
“It’s estimated that almost half of all nonfatal occupational injuries experienced by perioperative nurses are musculoskeletal, and more than one-quarter of these are back injuries,” AORN emphasized in a recent report.1
Mary Ogg, MSN, RN, CNOR, a senior perioperative practice specialist, outlined the challenges at a recent AORN Resources webinar. “Injuries continue to rise for healthcare workers because of the increasing prevalence of obesity in our patient populations,” she said. “Our patients’ weight and size is increasing every year.”
These musculoskeletal disorders (MSDs) may include injuries to spinal discs, muscles, nerves, tendons, ligaments, and joints. “The lower back, shoulder, and upper extremities are typically involved in MSDs, with a gradual or chronic onset,” she said. “Most injuries are the result of overexertion, repetitive motion, manual lifting, and pushing and pulling.”
In a poll taken during the webinar, some 85% of participants said they have suffered an MSD, or know a co-worker who has been injured. Ogg also cited a study that that surveyed 116 operating nurses from eight different hospitals. Two-thirds reported MSD pain, with 53% pain in the lumbar, 38% cervical, and 21% in the knees and legs.2
“Many other respondents reported pain in more than one region,” she said. “The authors postulated that MSDs are the most common cause of long-term absence from work, which they defined as more than two weeks.”
Physical stressors include moving or lifting patients and equipment, prolonged standing, and awkward postures sometimes necessary for procedures. “Many of the patients undergoing surgical procedures are completely or partially dependent on their caregivers due to the effects of general or regional anesthesia,” she said. “Patients who are unconscious cannot move, sense discomfort, or feel pain, and they must be protected from injury. This also requires the team to manually lift the patient’s extremities several times during the procedure.”
Specialized lift equipment is needed for the unique OR environment, as devices used on hospital floors may not be adaptable to the surgical suite. For example, ceiling lifts for patients must be designed and installed in a way that protects the surgical field from contamination. Since this typically occurs during new construction or renovation, many ORs in the U.S. do not include ceiling lifts, Ogg said.
“You have to take into account the other things that are hanging from your ceiling, such as lights and booms, and all the different lines that go through the ceiling,” she said. “To my knowledge, right now, there are not many ORs with ceiling lifts. There are a few installed across the country.”
Many ORs still use rollerboards to transfer patients, but these are considered somewhat outdated. AORN is working with industry to implement updated equipment, Ogg said. If rollerboards with friction-resistant sheets are used, they should be long enough to extend down the entire length of the patient body, she said.
“Although rollerboards assist us with transferring patients, they may not be an ideal solution,” she said. “There is still a lot of pulling and pushing and awkward postures associated with moving that patient from the OR bed to a stretcher.”
That means more staff may be needed to safely move a patient, but adequate staffing to maintain that capacity is a challenge. Air-assisted lateral transfer devices that lift the patient through a hoverboard effect require fewer staff for use.
“The air transfer devices are great for moving a patient from one surface to another,” Ogg said. “I have seen them used quite well for lateral positioning, and maybe even into supine. It just depends on your needs. Probably one of the most cost-effective things is a slide sheet to help you move the patient laterally from one bed surface to another.”
In another survey question asked during the webinar, 83% of participants said they use rollerboards, and almost half of respondents use air-assisted lifts.
“‘There are some other technologies that are out there now, including a lift that is incorporated in a boom arm. But again, that would need to be added during renovation or new construction,” she said. “In the OR, we have multiple needs. There is not going to be one tool or piece of equipment that will solve all of our needs.”
AORN has issued safe patient handling and guidelines that incorporate ergonomic principles. “The science of this guideline is grounded in ergonomic principles,” she said.
Adapted from general guidelines by the American Nurses Association, the AORN Safe Patient Handling and Movement (SPHM) guidelines are designed to meet the unique needs of perioperative setting. The guidelines include the following recommendations for the healthcare organization and the perioperative team.3
• Establish a formal, systemized SPHM program. “The perioperative program team should perform an initial comprehensive assessment of the safe patient handling needs, current equipment, and handling technology available,” Ogg said. “[Review] adverse events data to determine the needs, priority, and frequency for reassessment.”
• Incorporate ergonomic design principles in the planning and design of the surgical suite. “The design team should include the perspective and input from frontline [workers] and the perioperative teams,” she said.
• Collaborate in the selection, installation, and maintenance of safe patient handling technology into the perioperative setting.
“What are your patient characteristics and procedure types?” Ogg said, suggesting questions to consider. “What are the staffing patterns in your facility? Do you have any existing patient handling equipment? In considering equipment, [determine] if it is efficient, reliable, and know what maintenance requirements are.”
• Collaborate to establish education, training, and competency verification in SPHM techniques and equipment. The AORN guidelines emphasize ergonomic principles, which should not be confused with the “body mechanics” training, Ogg emphasized.
“Body mechanics is defined as a system for positioning a healthcare worker’s body during patient handling and movement to prevent musculoskeletal injuries,” she explained. “Despite the fact that even perfectly implemented body mechanics do not protect nurses from injury, these practices continue to be widely taught in our schools of nursing. There is no scientific evidence that support body mechanics or manual lifting techniques as protection against back and other musculoskeletal injuries.”
• Assess the patient and the perioperative environment, and develop a plan for SPHM. “We start with a patient assessment,” she said. “The OR team should identify high-risk tasks associated with transferring the patient, positioning the patient, retraction, and equipment-handling activities.”
This AORN recommendation includes ergonomic tools and algorithms that outline various patient handling tasks, how many employees are needed, and when mechanical lifting devices should be used. For example, the ergonomic tool for lateral transfer of a patient from a stretcher to an OR bed includes the number of people needed to safely move patients and when to use equipment. If the patient weighs less than 53 pounds, lateral transfer can be safely accomplished with one team member and an anesthesia professional using a draw sheet. If the patient weights 53 to 105 pounds, two team members and an anesthesiologist can safely move the patient using a draw sheet. Patients weighing 105 to 157 pounds require four team members using a lateral transfer device.
“If the patient weighs more than 157 pounds, you should use assisted technology such as the air transfer system or a mechanical lift to move that patient,” Ogg said. “The number of team members needed to perform this is dependent on the type of technology used. Often with the air transfer device you may only need two team members.”
• Provide an injured employee with reasonable accommodations for post-injury return to work. Noting that healthcare workers often work in pain, Ogg said the “organization should establish a process to match the physical capability of the perioperative team member to those physical demands of the job.”
• Establish a quality assurance and performance improvement program. “A comprehensive evaluation of the program should include injury incidents and severity, perioperative team member performance, and patient outcomes and injuries,” Ogg said. “Team members should report and document hazards, near-misses, incidents, and accidents related to safe patient handling according to your organization’s policy.”
Financial Disclosure: Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Medical Writer Gary Evans, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.