Comparison of risk assessment tools of patient handling
L. Tamminen-Peter1, V. Fagerström1 and A. Moilanen2
1 Finnish Institute of Occupational Health, Turku, Finland;
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2 ARvire Ky;
Introduction
Manual patient handling is a well established high risk factor in health care work (Lagerström et al. 1998). Also associations between back symptoms and poor posture have been found (Engels et al 1996). A great part of back injuries in health care professionals is related to inadequate ergonomic condition of furniture, the workplace and the equipment used in daily activities. Good quantitative tools are needed to estimate the risks in order to prevent musculoskeletal symptoms and to measure effect in pre- and post-intervention studies.General methods such as REBA (Hignett and McAtamney 2000)can be used to detect risk factors or to assess patient-handling techniques (Kjellberg 1998),but nowadays, methods for risk assessment of patient handling are available. In this article, the usability of three risk methods is compared.
Aim
To compare three risk assessment tools in order to ascertain how laborious it is to use them, how well they detect different risk factors of patient handling and how sensitively they measure the risks and stress on musculoskeletal systems. Furthermore, the aim was to establish to what extent these measures correspond with nurses’ experienced physical exertion and musculoskeletal symptoms.
Material and methods
Risk assessments were done in January and February 2008 in nineteen geriatrics wards. Three tools were used: Movement and Assistance of Hospital Patients (MAPO) (Battevi et al 2006), Care Thermometer (Knibbe and Knibbe 2001) and Assessment method of strain in manual patient handling (Karhula et al 2007). Experienced strain and musculoskeletal symptoms of nurses (n= 272) was collected by means of a questionnaire in December 2007 and in January 2008.
Results
Data are collected in all methods by interviewing and observing (Table 1).The Care Thermometer method is carried out the fastest, circa 20-30 minutes, by an experienced user.In the Care Thermometer assessment,patients arecategorized into five mobility levels, how many of them need assistance in moving and what equipment is used to do so. The thermometer gives the total care load risk level by summing up the levels of risk in all the assessed activities without lifts and helping devices, and then with the available equipment. A short comment is given on each level of care load risk, as well as some guidance on how to improve the level of care quality in the unit.
Table 1. Goals and data collection of thecompared methods.
MAPO / Karhula et-al. / Care ThermometerGoal / Assess the risk exposure level of patient manual handling in ward / Assessment tool for strain of patient handling / Assessment tool for physical care-load and prevention policy in the unit
Data collection / Interview of head nurse + observation / Observation +
interview of nurse / Interview + observation
Time / 1 h / 45 min / 20-30min
Documentation / Manual or data machine / Manual / Manual or data machine
Outcome measure / Risk index (number)
index classified into 3 levels: green (0-1.5), yellow (1.5-5) and red (>5) / Strain index (%)
index classified into 3 levels: green (>80%), yellow (60-80%) and
red (<60%) / Care temperature (%) classified into3levels: green= safe, yellow = unsafe and red = unacceptable
Patient lifts and helping devices are also assessed in the MAPO method, but the method does not take into account the extent to which they are used. Patient-handling training is asked about, and if the training is not in order, thisadds high points to the calculation. In the Finnish method, it is recommended to observe five nurses performing a patient transfer and to ask their opinion about experienced physical strain.
In comparison of these three tools (Table 1), the Finnish tool, Assessment method of strain in manual patient handling, has the widest scope to assess different risk factors .
Table 2. Risk factors in three risk assessment methods
Exposure/ Method / MAPO / Karhula et al. method / Care ThermometerDisabled patients / a) Totally non-cooperative (NC) b) Partially cooperative (PC) / no / five mobility level (A-E)
Patient/ operator ratio / considered / no / yes
Environment factors
Temperature, breeze, light / no / yes / no
patient room
a) space / 90 cm and 120 cm / sufficient / no
b) height-adjustable bed / considered / considered / amount and usage
c) wheelchair / sufficient number; / no / no
bathroom
a) space / sufficient / considered / no
b) door opening / > 85 cm / no
c) floor resistance / no / considered / no
d) height-adjustable hygiene chair / no / no / amount and usage
e) height-adjustable shower trolley / no / yes / amount and usage
f) height-adjustable bath / no / no / amount and usage
toilet
a) space / sufficient
at side of WC-seat > 80 cm / considered / no
b) door opening / > 85 cm / no
c) seat height / > 50 cm / no
d) side handlers / considered / considered / no
Lifting devices
a) lift / 1 hoist / 8 NC -patients / usage of lift / amount and usage of active, passive and ceiling lifts
b) minor aid / min. sliding sheet or board + 2 of other minor aids / considered, but no amount criteria / usage of sliding sheet or board
service / considered / considered / no
Training
manual handling / at least 6 hours on site / training during last 2 years / no
performance / no / yes / no
Work organization
pauses, help / no / considered / no
Experienced work load
Mental / no / considered / no
Physical / no / no
Heavy loads frequency / considered
Time required for care on bed / no / no / considered
Compression stockings and aid to put them on / no / no / considered
The Care Thermometer gives the narrowest view, when it looks at the lifts, helping devices and beds and their height-adjustability. The method also takes into consideration the mobility of patients and the correct usage of devices and carefor every patient.
Environmental factors are most precisely looked at in MAPO; space requirements in patient rooms, bathrooms and toilets, also door openings, seat heights and handlers.
The data analysis is not yet complete, but preliminary results show that none ofthe risk indexes correlates with nurses' perceived exertion or musculoskeletal symptoms. The data analysis continues and the final results are expected to be ready at the end of May 2008.
References
Battevi, N. Menoni, O. Grazia Ricci, M. & Cairoli, S. 2006. MAPO index for risk assessment of patient manual handling in hospital wards: a validation study.
Engels, J.A., van der Gulden, J.W., Senden, T.F., Hertog, C.A. & van't Hof, B. 1996. Work-related risk factors for musculoskeletal complaints in nursing profession: Results of a questionnaire survey. Occup Environ Med 53: 636-641
Hignett, S. & McAtamney, L. 2000. Rapid Entire Body Assessment (REBA). Applied Ergonomics 31, 201-205.
Karhula, K. Rönnholm, T. & Sjögren, T. 2007. Assessment method of strain in manual patient handling. (in Finnish: Potilassiirtojen kuormittavuuden arviointimenetelmä.) Työsuojeluhallinto. Tampere
Kjellberg, K. 1998. Methods for description, analysis and assessment of work technique in manual handling tasks. Arbete och Hälsa, Vetenskaplig skriftserie 17. Arbetslivsinstitutet, Solna.
Knibbe,J.J. & Knibbe, N.E. 2001. TilThermometer, verantwoording, instructie en monitoring, Bennekom, The Netherlands, LOCOmotion.
Lagerström, M., Hansson, T. & Hagberg, M. 1998. Work-related low-back problems in nursing. Scand J Work Environ Health 24(6), 449-464.