病人操作和行动安全

定义

安全文化: A culture of safety is an agreed upon commitment among clinicians and administrators to empower front line personnel to identify and report unsafe situations, 临床医生和领导之间皇冠6686官网不安全情况的对话, 并在组织各级支持的改进策略上进行合作. (皇冠6686官网安全病人处理和行动专责小组,2014).

人体工程学:协调工作场所和工作对工作人群的要求的科学, 目的是为了减轻工作压力, 以及与过度暴露于危险因素和危害相关的肌肉骨骼疾病(CDC, 2018).

起重设备:用于协助护理人员处理病人的机械装置, 其中包括取消, 转移, 伤口护理, 移动, 和其他人. 升降机分为两类:动力和手动坐立式升降机和全身吊带式升降机. 后一类又进一步细分为头顶/天花板, 龙门, 和地板电梯(设施指南协会, 2010).

手动处理:取消, 转移, 重新定位, and moving patients using a caregiver’s body strength without the use of lifting equipment/aids that reduce forces on the worker’s musculoskeletal structure (设施指南研究所, 2010).

病人操作和行动安全: Refers to the use of the hands and/or assistive devices to perform an activity and encourages more active involvement of the healthcare recipient and healthcare worker, in progressing the activity and mobility level of the healthcare recipient with the potential to improve health and safety outcomes (ANA & ASPHP, 2014).

介绍

Nurses and nurses’ aides are at high risk for musculoskeletal injuries related to lifting and maneuvering of patients (US 劳工统计局, 2013). Healthcare workers in acute rehabilitation hospitals are particularly challenged with musculoskeletal injury because of demanding work schedules, 人员短缺, 以及强化患者活动任务(Waters, 2010).而护士的疼痛和受伤的低报告是常见的(Siddharthan, 2006), 在背部受伤风险最高的10个职业中,有3个仍然包括护士助理, 执业护士, 和注册护士. 在一个典型的8小时轮班过程中,一名护士累计举起的重量相当于1.8吨. 根据疾病控制中心的说法, 2018), 肌肉骨骼疾病约占1.3亿人次的医疗护理. ANA报告说有23个,000 lost work time due to 疼痛 reported yearly in healthcare; and of those cases 44% are from healthcare occupations such as nurses and assistive unlicensed assistive personnel (UAP). 与护理人员背部受伤相关的直接和间接成本高达250亿美元(OSHA, 2014).Nursing assistants were among the highest occupations to experience more musculoskeletal disorders (MSDs) between 2013-2015 (BLS, 2016). 与工作相关的MSDs每年的影响在450亿至540亿美元之间(CDC, 2018).

除了护士和护士助手肌肉骨骼损伤的风险, there are many unintended patient adverse events associated with patient handling tasks including decreased patient comfort, 恐惧, 疼痛, 肩因手举技术造成的损伤, 髋部骨折, 瘀伤的武器, 在吊装过程中失去尊严, 增加的依赖, 皮肤的眼泪, 和压力区损害(Tuohy-Main, 1997; Nelson 2004). 研究 indicates reliance on manual lifting techniques and proper body mechanics alone is ineffective in reducing staff and patient injury. 而当使用机械设备时,患者可能会感到更安全、更舒适(OSHA, 2017).

Many acute care hospitals and long term care facilities have responded to the challenges in safe patient handling with lift teams and mechanical lifts. The rehabilitation field has the unique challenge to develop programs that protect our staff while maintaining a safe and therapeutic environment for our patients. Patient mobility is a primary functional need of patients admitted to an inpatient rehabilitation facility (IRF) and promotes safe discharge home and to the community.

Background

2003年1月,美国政府出台了政策.S. 劳工部 assembled a work group called the National Advisory Committee on 人体工程学 (NACE) with the task of advising the Secretary of Labor and the Assistant Secretary for the Occupational Safety and Health Administration (OSHA) on Ergonomic 的指导方针, 研究, 外展, 以及未来两年的援助. NACE组装后, OSHA在3月份发布了《皇冠6686官网》, 2003. The guidelines explicitly recommended that "manual lifting of patients be minimized in all cases and eliminated when feasible." In 2004, the 美国护士协会 (ANA) introduced safe patient handling as a priority and launched the Handle with Care® campaign.

响应OSHA和ANA的倡议, 皇冠6686官网(皇冠6686会员登录)的专责小组, 美国物理治疗协会, and the Veterans Health Administration (VHA) was convened in 2004 to proactively address the use of patient handling equipment not only for patient and staff safety, 但也有治疗的目的. 工作组发表了白皮书, Strategies to Improve Patient and Health Care Provider Safety in Patient Handling and Movement Tasks which was presented at the 2005 病人操作和行动安全 会议.

自从安全的病人处理和行动的概念被引入, the terminology has evolved to reflect the interprofessional collaboration and application across the full continuum of care, 其中包括康复. 另外, 提高了可用性和设备的使用, 该标准和原则超越了被动静态处理和涉及患者的运动活动. There is currently a more active partnership between the provider and healthcare recipient in order to progress the healthcare recipient’s achievement of positive mobility outcomes which is consistent with the rehabilitation goal. To date there have been several other publications and initiatives addressing safe patient handling and mobility including the passage of laws or regulations in 11 states requiring safe patient handling policies and ANA’s 2013 publication of 病人操作和行动安全: Interprofessional National Standards.

财务状况表

为护士和病人创造和维护一个安全的环境, 皇冠6686会员登录 supports actions and policies that result in the therapeutic use of equipment that engages the patient's effort in movement mobility while avoiding manual lifting techniques. 皇冠6686会员登录支持患者安全处理的原则和标准, referring to the use of hands and/or assistive devices to perform an activity when needed for the dependent patient and encouraging more active involvement of the healthcare recipient and healthcare worker in progressing the activity and mobility level of the healthcare recipient with the potential to improve health and safety outcomes as outlined in Advancing the Science and Technology of Progressive Mobility (ANA & ASPHP, 2014). 皇冠6686会员登录 also recognizes and supports the benefits of the principles to improve early mobilization safely for both the healthcare recipient and healthcare provider. 最后, 皇冠6686会员登录支持安全文化, 在行政层面得到认可,并在整个组织内得到支持.

建议

  • 使用ANA的患者安全处理和行动:国际专业国家标准(SPHM标准), 在2013年出版.
  • 进一步研究早期活动的益处, 比如减少伤害, 改善呼吸系统状态, 改进的尊严, 减少皮肤破裂
  • 在任何情况下都应尽量减少人工举升,可行时应取消人工举升
  • 利用技术使病人的耐心最大化
  • 评估病人的能力或依赖程度
  • 对环境进行评估,以确定在工作区域的限制范围内什么工作是安全的
  • 对员工进行适当的人体工程学培训
  • 提倡安全文化,鼓励员工多花必要的时间做正确的事情
  • 向学生传授安全处理病人的方法
  • Refer to and follow your state’s safe patient handling law if applicable as well as hospital/organizational policies and procedures

参考文献

美国护士协会 & 病人安全处理专业人员协会. (2014).

推进先进机动技术. 从检索 www.nursingworld.org.

劳工统计局. (2016年11月10日.S. 劳工部. 检索 http://www.美国Bureau of Labor Statistics.gov/news.release/pdf/osh2.pdf

疾病控制中心.d.). 工作相关肌肉骨骼疾病 & 人体工程学. 检索 http://www.cdc.gov/workplacehealthpromotion/health-strategies/musculoskeletal-disorders/index.html

设施指南研究所. (2010). 病人处理和运动评估:白皮书.
从www检索.fgiguidelines.org.

纳尔逊,.巴普蒂斯特,. 2004年9月30日. 安全处理和移动病人的循证实践. 护理问题在线杂志,9 (3).

职业健康与安全管理局. (2014). 病人安全处理. 从www检索.osha.政府.

职业卫生与安全(OSHA).d.)安全处理病人:打破神话. 检索 http://www.osha.gov/dsg/hospitals/documents/3.1_Mythbusters_508.pdf

Siddharthan K.霍奇森,米.罗森博格D.Haiduven D.纳尔逊,. (2006). 退伍军人管理局与工作有关的肌肉骨骼疾病的少报. 纳入卫生服务领导能力的国际卫生保健质量保证杂志, 19 (6-7), 463-76.

Tuohy-Main K. (1997). 为了居民和职业安全,为什么应该取消人工操作. Geriaction 15 10 - 14.

水域,T.R., & 洛克菲勒,K. (2010). 康复专业人员安全处理病人. 康复护理,35 (5),216-22.

其他资源

美国护士协会. (2013). 病人安全处理和行动:国际专业标准. 银泉,医学博士:作者.

纳尔逊,.哈伍德,K.J.,特蕾西,C.A., & 邓恩,K.L. (2008年1月/ 2月). 皇冠6686官网康复中安全处理病人的神话和事实. 康复护理,33 (1),10-17.

2014年10月皇冠6686会员登录董事会批准,2018年2月修订.

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