ISO/TR12296
AUTOR: SUE HIGNETT, MIKE FRAY, NATALE BATTEVI, ENRICO OCCHIPINTI, ENTRE OTROS
Año: 2014
Organismo/Revista: International Journal of Industrial Ergonomics, publicación vinculada a ISO Technical Report 12296
Resumen en español:
El artículo “International consensus on manual handling of people in the healthcare sector: Technical report ISO/TR 12296”, publicado en International Journal of Industrial Ergonomics (2014), aborda el proceso de elaboración y contenido de un informe técnico internacional (ISO/TR 12296) sobre la manipulación manual de pacientes en el sector sanitario. Este documento surge como respuesta a la necesidad de unificar criterios y prácticas en torno a la ergonomía aplicada al manejo de personas, dado que la implementación de la Directiva Europea 90/269/EEC sobre manipulación manual había mostrado grandes variaciones entre países y persistían problemas en la práctica clínica.
El texto explica cómo, entre 2007 y 2012, el Comité Técnico ISO/TC 159 (Ergonomía), Subcomité SC 3 (Antropometría y Biomecánica), con la colaboración del European Panel on Patient Handling Ergonomics (EPPHE), desarrolló un consenso internacional. Participaron 23 países como miembros plenos y 12 como observadores, con múltiples rondas de revisión (seis en total) hasta alcanzar un documento final que sintetiza el “estado del arte” en la materia.
El objetivo central del TR es ofrecer un marco de gestión de riesgos para evaluar y reducir los problemas asociados al manejo manual de pacientes, mejorando simultáneamente las condiciones de trabajo del personal sanitario y la calidad, seguridad y dignidad de los pacientes. El informe se estructura en anexos temáticos que abordan dimensiones clave:
• AnnexA: Estimación y evaluación de riesgos. Presenta herramientas de análisis ergonómico (OWAS, REBA, MAPO, TilThermometer, PTAI, entre otras) y estudios de caso que muestran cómo estas metodologías identifican sobrecargas biomecánicas y proponen soluciones como la incorporación de dispositivos de asistencia y formación adicional.
• Annex B:Aspectos organizacionales. Subraya la importancia de la cultura de seguridad, la gestión de recursos humanos, las políticas institucionales y la evaluación de la rentabilidad de las intervenciones. Se destaca que un compromiso organizacional sólido reduce ausentismo y lesiones.
• Annex C:Ayudas y equipamiento. Detalla dispositivos como camas eléctricas, sillas de ducha, grúas móviles, sistemas de elevación de techo y pequeños dispositivos de deslizamiento. Se analizan beneficios, limitaciones y criterios de selección según contexto clínico y nivel de dependencia del paciente.
• Annex D: Edificios y entorno. Resume recomendaciones espaciales internacionales para garantizar áreas libres de obstáculos en hospitales, salas de higiene, quirófanos y unidades de cuidados intensivos. Se enfatiza la necesidad de diseñar espacios que permitan el uso seguro de equipos de asistencia.
• Annex E: Formación y educación del personal. Define competencias mínimas: conocimiento de políticas locales, capacidad de evaluar riesgos, uso seguro de dispositivos, habilidades de resolución de problemas y comunicación efectiva para fomentar la independencia del paciente.
• Annex F: Evaluación de la efectividad de las intervenciones. Introduce la herramienta TROPHI, diseñada para medir la complejidad de intervenciones multifactoriales. Incluye indicadores de cultura de seguridad, prevalencia de trastornos musculoesqueléticos, cumplimiento de competencias, ausentismo, calidad de atención, incidentes, salud mental del personal, condición y experiencia del paciente, carga física, reportes de accidentes y costos financieros.
El artículo también discute los retos y limitaciones del proceso: las diferencias entre sistemas de salud nacionales, la duración del proceso de revisión internacional y la exclusión de ámbitos como la atención domiciliaria. Sin embargo, se subraya que el consenso alcanzado trasciende las particularidades nacionales y constituye una referencia válida a nivel global.
En cuanto a la diseminación e impacto, el TR ya ha sido incorporado en agencias de normalización (ej. British Standards Institute, Japón), asociaciones profesionales (American Association of Nurses, AmericanAssociation for Safe Patient Handling and Movement) y fabricantes de equipamiento. Se plantea que el desafío futuro es integrar estas recomendaciones en la cultura organizacional y en la práctica clínica cotidiana, de modo que la seguridad del paciente y del personal se refuercen mutuamente.
En conclusión, el artículo presenta el TR ISO/TR 12296 como un hito en la ergonomía aplicada al sector sanitario. Ofrece un marco integral que combina evaluación de riesgos, estrategias organizacionales, equipamiento, diseño arquitectónico, formación y evaluación de resultados. Su propósito es reducir lesiones musculoesqueléticas en el personal, mejorar la seguridad y dignidad de los pacientes y establecer estándares internacionales que guíen la práctica clínica y la política institucional. El documento se convierte así en una referencia indispensable para gestores hospitalarios, profesionales de la salud, diseñadores de equipamiento y responsables de políticas públicas.
ThisarticleappearedinajournalpublishedbyElsevier.Theattached copyisfurnishedtotheauthorforinternalnon-commercialresearch andeducationuse,includingforinstructionattheauthorsinstitution andsharingwithcolleagues.
Otheruses,includingreproductionanddistribution,orsellingor licensingcopies,orpostingtopersonal,institutionalorthirdparty websitesareprohibited.
Inmostcasesauthorsarepermittedtoposttheirversionofthe article(e.g.inWordorTexform)totheirpersonalwebsiteor institutionalrepository.Authorsrequiringfurtherinformation regardingElsevier’sarchivingandmanuscriptpoliciesare encouragedtovisit: http://www.elsevier.com/authorsrights
Shortcommunication
InternationalJournalofIndustrialErgonomics44(2014)191 195
Contentslistsavailableat ScienceDirect
InternationalJournalofIndustrialErgonomics
journalhomepage:www.el sevier.com/l ocate/ergon
Internationalconsensusonmanualhandlingofpeopleinthe healthcaresector:TechnicalreportISO/TR12296
S.Hignett a, *,M.Fray a,N.Battevi b,E.Occhipinti b,O.Menoni b,L.Tamminen-Peter c , E.Waaijer d,H.Knibbe e,M.Jäger f
a EnvironmentalErgonomicsResearchCentre,LoughboroughUniversity,Leics.,UK
b EPM,FoundationIRCCSCàGranda,UniversityofMilan,Italy
c ErgosolutionsBCAb.,Turku,Finland
d ArjoHuntleigh,Lund,Sweden
e LOCOmotionBV,Bennekom,TheNetherlands
f LeibnizResearchCentreforWorkingEnvironment&HumanFactors,DortmundUniversityofTechnology,Germany
articleinfo
Articlehistory:
Received16April2013
Receivedinrevisedform 25July2013
Accepted9October2013
Availableonline31January2014
Keywords: Healthcare InternationalStandard Manualhandling Patienthandling
1.Introduction
abstract
In1990theEuropeanUnionintroducedadirectiveonmanualhandlinginthehealthandsocialcare industries.Areviewoftheimplementationin2004foundawidevariationinofficialnationalguidance onpatienthandling.ThispaperreportstheiterativedevelopmentofaTechnicalReport(ISO/TR12296) bytheinternationalstandardsTechnicalCommitteeISO/TC159, Ergonomics,SubcommitteeSC3, AnthropometryandBiomechanics representing23participatingand12observingcountrieswithexpert supportfromtheEuropeanPanelonPatientHandlingErgonomics.Theprocessincluded6reviewsover3 yearstoproduceaconsensusdocumentasastateofsciencesummary.Ithasanoverarchingframework ofriskmanagementwithsectionsonriskestimationandevaluation,organisationalaspects,aidsand equipment,buildingsandtheenvironment,stafftrainingandeducationandinterventionevaluation. Relevancetoindustry: ThisTechnicalReportprovidesaninternationalconsensusasastateofscience summaryaboutmanualhandlingofpeopleinthehealthcaresector. 2013ElsevierB.V.Allrightsreserved.
TheEuropeanPanelonPatientHandlingErgonomics(EPPHE) wasformedin2004asacollaborationofexpertsfromtheInternationalErgonomicsAssociation(IEA)TechnicalCommitteeson HealthcareErgonomics(HETC9)andMusculoskeletalDisorders (TC13)withrepresentationfrom13EUcountries(Denmark, Finland,France,Germany,Greece,Ireland,Italy,Netherlands, Poland,Portugal,Sweden,SwitzerlandandUnitedKingdom).The firstcollaboration(2004 2007)reportedonthevariationofthe implementationofEUDirectiveonManualHandling(Council Directive90/269/EEC)inthehealthandsocialcare(Hignettetal., 2007).Thispaperreportsasecondcollaboration(2007 2012)to provideexpertsupportfortheTechnicalCommitteeISO/TC159, Ergonomics,SubcommitteeSC3, AnthropometryandBiomechanics inthedevelopmentofanInternationalOrganizationforStandardization(ISO)TechnicalReport(ISO/TR12296,2012).Technical
* Correspondingauthor.LoughboroughDesignSchool,LoughboroughUniversity, Loughborough,Leics.LE113TU,UK.Tel.: þ44(0)1509223003.
E-mailaddress: S.M.Hignett@lboro.ac.uk (S.Hignett).
0169-8141/$ seefrontmatter 2013ElsevierB.V.Allrightsreserved. http://dx.doi.org/10.1016/j.ergon.2013.10.004
CommitteeISO/TC159, Ergonomics,SubcommitteeSC3has23 participatingcountriesand12observingcountries(ISO,2013) ISOisaworldwidefederationofnationalstandardsbodieswith technicalcommitteestopreparedraftInternationalStandards.In additiontostandardsTechnicalCommitteescanalsopublish TechnicalReports(ISO/TR12296,2012);theseareinformative documentswhichareavailableinatleastoneoftheofficiallanguagesandapprovedbyasimplemajorityvote.ThereisnoobligationforindividualmemberstoimplementaTechnicalReport (TR)soconflictingnationalstandardsmaycontinuetoexist.
1.1.Backgroundandmotivation
The firstEPPHEcollaborationconcludedbyidentifyingresidual problemsandbarrierstoimplementationofthemanualhandling directiveforpatienthandling.Theseincludedalackofscientific evidence(includingergonomicstandards)forspecificpatient handlingtechniquesandequipment;alackofstandardsfor educationalprogrammesincludinginter-agencyinterfacesforstaff training;andalackofstandardsforconstruction.Althoughsomeof theseissueshavebeenaddressedtherecontinuetoberesidual problemsrelatedtoimplementationofinterventions(Mitchell
Table1
TR
firstdraft:Annexcontent(December,2008).
AnnexA:Riskassessmentandrisk evaluation(NB/OM)
Hazardidentification
Identifyspecificmethodsfor differentsectorsincluding: differenttypesofpatients numberofnurses typeofavailableequipment environment trainingandskillofnursingstaff
AnnexD:Buildingsandenvironment(SH)
Placeswherethepatientismanually handled(hospitalroom,toilets, operatingtheatre,etc.)
Space,clearance(corridors, access/egress,turning)
Flooring,surfaces,level,elevators, stairs,ramps
Wallanddoorfurnituree.g.grab handles,rails
S.Hignettetal./InternationalJournalofIndustrialErgonomics44(2014)191
AnnexB:Organizationalaspectsofpatient handlinginterventions(MF)
Safetyculture Financial,costeffectiveness
Managementsystems,responsibility andaccountability
Staffinglevels/quantity/ ratios/competence Policiesandprocedures
AnnexE:StaffEducationandTraining(LT-P)
Riskassessmenttraining/skills Competency
Inclusioninclinicaltraining/competencies
Detailedminimumrequirementsinterms oftheoreticalcontents,trainingtouse devicesandduration
Effectivenesscheckingintimeandas partofapermanenteducationalprocess Indicationsandtoolsfor effectivenesscheck
etal.,2008),andmorespecificallytopatientinjuries(Tayloretal., 2012).TheaimofthesecondEPPHEcollaborationwastoaddress theseproblemsbysupportingthedevelopmentofaninternational consensusasastateofsciencesummary(TechnicalReport,TR)for patienthandlinginterventions.
TheTRwasproposedasaworkitemforTechnicalCommittee ISO/TC159,Ergonomics,SubcommitteeSC3,Anthropometryand BiomechanicsbyEPPHE(EO)in2007.Thiswasaccepted,withthe EPPHEmembersprovidingexpertsubjectareaknowledgeinpatienthandlingwithmanyyearsofexperienceofresearching, teachingandpractisinginthehealthcareindustry.
TheproposedscopeoftheTRwastoprovideaguideforpotentialusersincludinghospitalandnursinghomesmanagers, nursingstaff,healthandsafetystaffoperators,manufacturersof assistivedevicesandequipment,educatorsanddesignersof healthcarebuildings.
TheTRwasdevelopedfrom2009 2012(with6reviewstages) byISO/TC159/SC3/WG4Humanphysicalstrength Manual handlingandforcelimitsCEN/TC122/WG4Biomechanicsrepresenting23participatingand12observingcountrieswithexpert supportfromtheEuropeanPanelonPatientHandlingErgonomics. Thecommentsonthe first(February2009)andseconddrafts(June, 2009)includedsuggestionstoadd2annexestogiveriskassessmentexamples(AnnexG)withacasestudyonphysicalability personas(mobilitygallery)andguidelinesforpatienthandling (AnnexH).Thesewerediscussedbytheauthorsanditwas concludedthattheycouldbeincludedinAnnexA(Table1).Other reviewcommentsincludedrequestsforadditionaldefinitions, emphasizingaparticipatoryapproachinallaspectsespecially whenchangingworkpractices,definingtrainingneeds,selection guidanceforpurchasing,technology/equipment,designingwork environmentsandanemphasisontheuseofaidsandequipmentto supportpatientindependence.ThethirddraftwasreviewedinMay 2010,withchangesincludingnationalguidelines(AnnexA2),case studies(AnnexA3),andmoreinformationaboutpatientcharacteristics(personas)inthegeneralaspectsandAnnexC.Thefourth draftwasreviewedinNovember2010and fifthversionreviewedin May2011.A final(sixth)versionwascirculatedforcommentin September2011withminorchangesandeditsachievedbyMarch 2012.TheTRwaspublishedinJune2012(ISO/TR12296,2012).
AnnexC:Aidsandequipment(EW/HK)
Proceduresforselectingassistivedevices
Basicergonomiccharacteristicsforeachdevice
Functionsanduse
Beddesignanduseashandlingequipment
Ceilinglift&wall-mounteddevices
Mobilehoists
Smalldevices:slidingdevices,belts,boards
Showering&bathingequipment
Trolley/guerney,examinationcouches
Operatingdepartmentequipment
AnnexF:Theevaluationofinterventioneffectiveness(MF)
Effectivenessofmulti-factorialintervention
Training
Equipmentprovision
Riskmanagement
Buildingdesign/modification
Healtheffects
Qualityofcare/patientsafety
Organisationalbenefits
Costbenefits,productivity
Recommendationsofevaluationtools
TheagreedaimoftheTRistoprovideguidancetoassess problemsandrisksassociatedwithmanualpatienthandlingandto identifyandapplyergonomicstrategiesandsolutions.Thecontent providesaframeworkforriskassessmentandriskreductionmodel withdetailedinformation(byannexes)formethods,toolsand researchevidencetosupportthemanagementofdifferentaspects. ThefocusoftheTRismostlyforacutehospitals,butsomeofthe generalguidelinesmayalsobeusefulinotherareasofpatient handling(e.g.homecare).Themaingoalsaretoimprovecaregivers’ workingconditionsbydecreasingbiomechanicaloverload riskandimprovecarequality,safety,dignityandprivacyforpatientsincludingspecificpersonalcareandhygiene.
AsastateofsciencesummarytheTRstartsbydrawingon previousresearchonpatienthandling(Amicketal.,2006;Dawson etal.,2007;Hignett,2003a,b;Martimoetal.,2008).Thesefour systematicreviewsallfoundthatmulti-factorinterventions,based onariskassessmentprogramme,werethemostlikelytobesuccessfulinreducingmusculoskeletalinjuriesrelatedtopatient handlingactivities.Thissetsoutamodelofriskmanagementto includeassessment,organisationalaspects,adequateaidsand equipment,buildingandenvironmentdesign,trainingandeducationandanevaluationoftheinterventioneffectiveness.
The firststep,riskassessment,isrecommendedwhenanysystemsofwork,equipment,organisationalaspects(staffinglevels) andbuildings/layoutsarechanged.Theidentificationofahazard willincludethedefinitionofthetypeofpatienthandling(e.g. horizontallateraltransfer,insertingabedpan)anduseofany equipment(lifts,slidingdevicesetc.).Anumberofassessmenttools areincludedinAnnexA,togetherwithnationalguidelines(USA, UK,Australia,TheNetherlands)andpracticalexamplesofusing4 riskassessmentmethods.AnnexesB,C,DandEprovidesummaries onorganisationalaspects(includingchangestrategiesandsafety culture),aidsandequipment,buildingandenvironmentandeducationandtraining.Finally,AnnexFpresentsanewmultifactorial evaluationtooldevelopedandvalidatedin4EUcountries(Frayand Hignett,2013).
AnnexAsummarisesresearchonriskassessment.Itincludes detailedinformation(quantifiedriskfactors,benefits,limitations,
S.Hignettetal./InternationalJournalofIndustrialErgonomics44(2014)191 195 193
typeandlocationofuse)aboutspecificassessmenttools:OWAS (Karhuetal.,1977),BIPP(Feldsteinetal.,1990),REBA(Hignettand McAtamney,2000),PATE(Kjellbergetal.,2000),DiNO(Johnsson etal.,2004),PTAI(Karhulaetal.,2009),MAPO(Battevietal., 2006),TilThermometer(KnibbeandFriele,1999),Dortmund Approach(Jägeretal.,2010)aswellasotheranalyticalexamplesfor patienthandlingactivities(Stobbeetal.,1988;Radovanovicand Alexandre,2004).
Casestudiesareusedtoillustrate4ofthecommonlyusedrisk assessmenttools(DortmundApproach,TilThermometer,MAPO andPTAI).Thecasestudiesapplythe4methodstoaclinicalscenarioofamedicalward(25beds)witholderpatients(averagestay of10days)and2 4staffpershift(3shifts).Themostfrequent manualhandlingactivitiesarerepositioninginbed,bed wheelchair toilettransferandhorizontallateraltransfers(bed trolley). TheDortmundapproachfoundthatthelumbarloadwasoftenvery highforthecaregiversandthatusingsmallhandlingaidsina biomechanicallyappropriatemannercouldreducetherisk considerably.UsingMAPOthelackofequipment,lowstaffinglevels andinadequatetrainingprovisionwerehighlighted,withthe recommendationthattheprovisionofequipment(slidingsheets, lifts,andmorewheelchairs)couldreducetherisklevel.ThePTAI toolisusedforanindividualnurseratherthanawardarea.Overall therisklevelwasagainfoundtobeveryhighwithrecommendationstoprovideliftingequipmentandadditionaleducationand training.FinallytheTilThermometerfoundahighphysicalcare loadandrecommendedtheuseofelectricprofilingbeds(rather thanmechanical),provisionofaliftandslidingsheets.All4 methodsassessedthescenarioashighriskandgavesimilarrecommendationsforequipmentandtraining.
3.2.AnnexB.Organizationalaspectsofpatienthandling interventions
Organizationalinterventionsincludeawiderangeofinitiatives frompoliciesandproceduresthroughtoaudit,equipmentprovisionandpatientengagement.AnnexBdiscussestheimportanceof managementcommitmentandsummarisestheresearchon financialreturnasbothreductionsinstaffabsence(Engstetal., 2005)andabsenceclaims(Passfieldetal.,2003).Itisalsonoted thatthepresenceofapositive(strong)safetycultureindicates higherlevelsofcomplianceandknowledgeanddecision-makingin severalmanualpatienthandlingclinicaltasks(Hignettand Crumpton,2005).
3.3.AnnexC.Aidsandequipment
AnnexCprovidesaverydetailedsummaryofawiderangeof aidsandequipmentincludingbeds,slidingsheets,slidingboards, horizontalairdevices,standaids,mobileactivelifts,mobilepassive lifts,ceiling/wallmountedlifts,slings,showerchairs,showertrolleys.Foreachtheactivity,benefitsandlimitationsaresummarised toassistwiththeselectionofaidsandequipmentsuitabletospecificsituations(organisationalissues,staffinglevels,patientdependency,carelocationandsafetyandcomfortforthepatientand caregiver).Researchonselectionofaidsisincludedasalgorithms (Nelson,2009)andpersonas(KnibbeandKnibbe,2006).
3.4.AnnexD.Buildingsandenvironment
Thisannexsummarisesinternationalspatialrecommendations thatspecificallyaddressthe ‘freespace’ requiredformanualpatient handling(incompressiblespacewhichcannotbeencroachedon). Thesummarisedrecommendationsareforpurposebuiltand adaptedbuildings;homecareenvironmentsandvehicles
(ambulances)areexcluded.Mostofthespatialrecommendations (dimensions)areexpertopinionorconsensus,withonly2research sourcesreferenced(NuffieldProvincialHospitalsTrust,1955; Hignettetal.,2008).
Dimensionsaregivenforacuteadultwards,intensivecare (adultandneonatal),hygienefacilities,operatingrooms,ambulatorycare,elderlycare,bariatriccare,obstetrics,diagnosticdepartments,primarycareandemergencycare.Additional informationisgivenforcirculationspaces,elevators,stairs, floor surfaces,anddoor/wallfurniture(handlesandrails).
3.5.AnnexE.Staffeducationandtraining
AnnexEdiscussestheuseofeducationandtrainingaspartofa riskmanagementprogramme,includingeducationalprovisionand evaluationofeffectiveness.Fewcountrieshavedefinedstandards andguidelinesforpatienthandlingbutsoAnnexEsummarises corecompetenciesforcaregivers.Theseincludeaknowledgeof localpoliciesandprocedures,understandingriskfactorsinpatient handlingactivities,theabilitytocarryoutariskassessment,being abletoselectandsafelyuseappropriateequipment,problemsolvingskills(e.g.whenanunexpectedeventoccurs)andtheuse ofverbalandtactileinteractionskillstooptimisethepatient’sown resourcesandencouragetheirindependence.
3.6.AnnexF.Theevaluationofinterventioneffectiveness
AnnexFdiscussesthedifficultyincomparinginterventions (organisation,physicalandpersonnel)duetotheuseofdifferent outcomemeasurementtools.Itincludesinformationaboutanew evaluationtool(TROPHI, FrayandHignett,2013;previouslyknown asInterventionEvaluationTool,IET)whichwasdesignedspecificallytoaddressthecomplexityofmulti-factorialpatienthandling interventions.TROPHIhas12components:
1.Safetycultureauditofproceduresratherthanbehaviour (HignettandCrumpton,2005)
2.ShortenedversionoftheNordicQuestionnaire(Dickinson etal.,1992)toprovideameasurementofthelevelof musculoskeletaldisorders(MSD)intheworkingpopulation
3.CompetenceCompliance(DiNO; Johnssonetal.,2004)to evaluateindividualstaffbehaviourwhencarryingoutpatienttransfers
4.Sicknessabsencedatatorecordthetimeawayfromworkor lostproductivityduetopatienthandlingrelatedMSD,days/ shiftslost,staffonreducedworkcapacity,staffturnover
5.Evaluationofwhetherpatientneedsarebeingconsideredfor dignity,respect,safety,andsecuritywhentheyaremovedor handledduringahospitalstay(qualityofcare)basedon Nelsonetal.(2008)
6.Incidentnumbersasanunder-reportingratiofromthe managerandself-reportsofunsafepracticebythestaffas wellasaccidentsornearmissesfrompatienthandling
7.Staffmentalhealthstatus,psychologicalstress,strain,and jobsatisfaction(Evanoffetal.,1999)
8.Patientcondition(lengthofstay,treatmentprogression, levelofindependence)usingaquestionnairetostaffand management
9.Patientexperienceinasingletransferormobilitysituation (Kjellbergetal.2004)
10.Physicalworkloadfactorsmeasureusingdatafrom Knibbe andFriele(1999),Cohenetal.(2004) and ArjoAb(2006).
11.Accidentreportssystemsforpatientharm(bruises,lacerations,tissuedamage,falls,etc.)andpressureulcerprevalence scoresrelatedtothemovementandpositioningofpatients.
S.Hignettetal./InternationalJournalofIndustrialErgonomics44(2014)191 195
12.Financialimpactduetoloststafftime,lostproductivitycosts, compensationclaims,litigation,andalldirectandindirect costsagainstthecostsofanypreventionprogrammeusing theOSHAformula(Charney,1997;Charneyetal.,2006; Collinsetal.,2004)andasacostbenefitmodel(Siddarthan etal.,2005).
4.Discussionandconclusion
Thisdiscussionwillconsider firstlythechallengesandlimitationsoftheTRandsecondlytheplannedandpotentialimpactwith disseminationthroughprofessionalgroups,governmentagencies andmanufacturers.
4.1.ChallengesandlimitationsinthedevelopmentoftheTR
Achievingconsensusforastateofsciencesummaryonmanual patienthandlingwasanambitiouschallenge.Thereareknowndifferencesinhealthcaresystemsacrosstheworld; Burnettetal.(2013) identified7challengesincomparingthequalityofhospitalsin5EU countries(England,Portugal,TheNetherlands,SwedenandNorway). Theseincludeddifferentdefinitionsforindicators,mandatoryversus voluntarydatacollectionrequirements,differentlevelsofaggregationofdata,anddifferingaccreditation(andlicencing)systemsin eachcountry.Fourofthesecountriesparticipatedinthe1stEPPHE collaborationsoitissuggestedthattheconsensusforresidual problemsinpatienthandlingtranscendthecountrydifferencesand arethereforevalidforinternationalconsensus.
ThelimitationsoftheTRincludethelengthoftheinternational reviewprocess.Thishasbeenaddressedbyincludinghistorical recommendations(e.g.AnnexD,tableD1)andpointingthereader inthedirectionofmanyriskassessmenttools(andreferencesto originalresearch)aswellasnationalguidancedocumentation (AnnexA).
TheTRgivesacleardefinitionforthelimitationofscope; ‘primarilyapplicabletothemovementofpeople(adultsandchildren)in theprovisionofhealthcareservicesinpurposelybuiltoradapted buildingandenvironments’.Thechallengeofdeliveringhealthcare servicesincommunity(domestichousing)settingsisrecognised andisbeyondthescopeofthisTRalthoughitissuggestedthat ‘somerecommendationscanalsobeappliedtowiderareas(e.g.home care,emergencycare)’
4.2.Disseminationandimpact
ThenextstepistointegratetheTRguidancewithotherclinical, organisationalandoccupationalstandards(andpoliciesandprocedures)toembedsaferpatienthandlingpracticeinternationally forthebenefitofbothcarereceiversandcaregivers.Thishasstarted tobeachievedwiththedisseminationoftheTRthroughtheinternationalstandardscommunity(e.g.BritishStandardsInstitute andJapanesestandardsagency http://www.mhlw.go.jp/stf/shingi/ 2r98520 00002shqg-att/2r9852000002shy0.pdf);discussionof theTRbyprofessionalgroupse.g.AmericanAssociationofNurses (http://www.americannursetoday.com/article.aspx? id¼9574&fid¼9534),AmericanAssociationforSafePatient HandlingandMovement;andinclusionasaresourcereferenceon manufacturerwebsites(http://www.arjohuntleigh.com/Page.asp? PageNumber¼4518).
TheTechnicalReportISO/TR12296providesaframeworkfor riskmanagementwithafocusonoccupational(staff)injury.The needtoembedtheframeworkaspartoftheorganisationalsafety culture(patternsofvalues,beliefs,attitudesandbehavioursthat shapeanorganization’scommitmenttopatientsafety; Halligan andZecevic,2011)isaddressedinAnnexB.Howeverthereisa
furtherstagerequiredtoembedbehaviours(useofequipmentetc.) aspartofthesafetyclimate(individualperceptionsofpriorityof safetyatagivenpointintime; HalliganandZecevic,2011).Thisis animportantissueforimplementationoftheTRandwepropose thatitcanbeevaluatedusing,forexamplethetooldescribedin AnnexF(FrayandHignett,2013).Thisoffersthepotentialto measureandachieveperformanceandefficiencybenefitsthrough systemsimprovementsbyintegratingstaffandpatientsafety (Hignettetal.,2013). HofmannandMark(2006) foundthatastrong safetyculturewassignificantlyassociatedwithbothfewernursing injuriesandfewerpatientsafetyevents(e.g.medicationerrors). Thisrelationshipwasfurtherinvestigatedby Tayloretal.(2012) describingalinkbetweendecubitusulcersandnurseinjuries fromincreasedmovingandhandling(‘lifting’)ofrelativelyimmobilepatients.Futureresearchisneededtolookmorecloselyatthe linksbetweenstaffandpatientsafetyandembedtherecommendationsoftheTRwithinfutureintegratedinterventions.
Amick,B.,Tullar,J.,Brewer,S.,etal.,2006.InterventionsinHealth-careSettingsto ProtectMusculoskeletalHealth:aSystematicReview.InstituteforWorkand Health,Toronto ArjoAb,2006.TheResidentsGallery. http://www.arjo.com/uk/Page.asp? PageNumber¼817 (accessed14.02.13).
Battevi,N.,Menoni,O.,Ricci,M.G.,Cairoli,S.,2006.MAPOindexforriskassessment ofpatientmanualhandlinginhospitalwards:avalidationstudy.Ergonomics 49(7),671 687
Burnett,S.,Renz,A.,Wiig,S.,etal.,2013.ProspectsforcomparingEuropeanhospitalsintermsofqualityandsafety:lessonsfromacomparativestudyin five countries.Int.J.Qual.HealthCare25(1),1 7
Charney,W.,1997.Theliftteammethodforreducingbackinjuries:a10hospital study.AAOHNJ.45(6),300 304
Charney,W.,Simmons,B.,Lary,M.,etal.,2006.Zeroliftprogramsinsmallrural hospitalsinWashingtonState:reducingbackinjuriesamonghealthcare workers.AAOHNJ.54(8),355 358
Cohen,M.,Village,J.,Ostry,A.,etal.,2004.Workloadasadeterminantofstaffinjury inintermediatecare.Int.J.Occup.Environ.Health10(4),375 383 Collins,J.W.,Wolf,L.,Bell,J.,etal.,2004.Anevaluationof ‘bestpractices’ musculoskeletalinjurypreventionprograminnursinghomes.InjuryPrev.10,206 211 CouncilDirectiveofthe29May1990(90/269/EEC)ManualHandlingofLoads Directive,1990. https://osha.europa.eu/en/legislation/directives/provisions-onworkload-ergonomical-and-psychosocial-risks/osh-directives/6 (accessed 14.02.13).
Dawson,A.P.,McLennan,S.N.,Schiller,S.D.,etal.,2007.Interventionstoprevent backpainandbackinjuryinnurses:asystematicreview.Occup.Environ.Med. 64,642 650 Dickinson,C.,Campion,K.,Foster,A.,etal.,1992.Questionnairedevelopment:an examinationoftheNordicMusculoskeletalQuestionnaire.Appl.Ergon.23(3), 197 201 Engst,C.,Chhokar,R.,Miller,A.,etal.,2005.Effectivenessofoverheadliftingdevices inreducingtheriskofinjurytocarestaffinextendedcarefacilities.Ergonomics 48(2),187 199 Evanoff,B.A.,Bohr,P.C.,Wolf,L.D.,1999.Effectsofaparticipatoryergonomicsteam amonghospitalorderlies.Am.J.Ind.Med.35(4),358 365
Feldstein,A.,Vollmer,W.,Valanis,B.,1990.Evaluatingthepatienthandlingtasksof nurses.J.Occup.Med.32(10),1009 1013
Fray,M.,Hignett,S.,2013.TROPHI:developmentofatooltomeasurecomplex, multi-factorialpatienthandlinginterventions.Ergonomics. http://dx.doi.org/ 10.1080/00140139.2013.807360
Halligan,M.,Zecevic,A.,2011.Safetycultureinhealthcare:areviewofconcepts, dimensions,measuresandprogress.BMJQual.Saf.20(4),338 343
Hignett,S.,McAtamney,L.,2000.Rapidentirebodyassessment.Appl.Ergon.31, 201 205
Hignett,S.,2003a.Systematicreviewofpatienthandlingactivitiesstartinginlying, sittingandstandingpositions.J.Adv.Nurs.41(6),545 552
Hignett,S.,2003b.Interventionstrategiestoreducemusculoskeletalinjuries associatedwithhandlingpatients:asystematicreview.Occup.Environ.Med. 60(9),e6(electronicpaper) http://wwwoccenvmed.com/cgi/content/full/60/9/ e6
Hignett,S.,Crumpton,E.,2005.Patienthandlingsafetyculture:anassessmenttool. Int.J.Ther.Rehabil.12(4),178 181
Hignett,S.,Fray,M.,Rossi,M.A.,etal.,2007.ImplementationoftheManualHanding DirectiveinthehealthcareindustryintheEuropeanUnionforpatienthandling tasks.Int.J.Ind.Ergon.37,415 423
Hignett,S.,Lu,J.,Morgan,K.,2008.EmpiricalReviewofNHSEstatesErgonomic Drawings.DepartmentofHealthEstatesandFacilitiesManagementResearch ReportB(02)13.TheStationaryOffice,London
S.Hignettetal./InternationalJournalofIndustrialErgonomics44(2014)191
Hignett,S.,Carayon,P.,Buckle,P.,Catchpole,K.,2013.StateofScience:Human FactorsandErgonomicsinHealthCare.Ergonomics. http://dx.doi.org/10.1080/ 00140139.2013.822932 (availablefromSept.2013).
Hofmann,D.A.,Mark,B.,2006.Aninvestigationoftherelationshipbetweensafety climateandmedicationerrorsaswellasothernursingandpatientoutcomes. PersonnelPsychol.59,847 869
ISO,2013. http://www.iso.org/iso/home/standards_development/list_of_iso_technical_ committees/iso_technical_committee.htm?commid¼53362 (accessed11.02.13).
ISO/TR12296,2012.TechnicalReportErgonomics ManualHandlingofPatientsin theHealthcareSector.ISOCopyrightOffice,Geneva,Switzerland
Jäger,M.,Jordan,C.,Theilmeier,A.,Luttmann,A.,theDOLLYGroup,2010.Lumbarloadquantificationandoverload-riskpreventionformanualpatienthandling theDortmundapproach.In:Mondelo,P.R.,Karwowski,W.,Saarela,K.L., Swuste,P.,Occipinti,E.(Eds.),Proceedingsofthe8thInternationalConference onOccupationalRiskPrevention,CreatingValuethroughRiskPrevention Management5 7May,Valencia,Spain
Johnsson,C.,Kjellberg,K.,Kjellberg,A.,Lagerström,M.,2004.Adirectobservation instrumentforassessmentofnurses’ patienttransfertechnique(DINO).Appl. Ergon.35,591 601
Karhu,O.,Kansi,P.,Kuorinka,I.,1977.Correctingworkingposturesinindustry:a practicalmethodforanalysis.Appl.Ergon.8(4),199 201
Karhula,K.,Rönnholm,T.,Sjögren,T.,2009.AMethodforEvaluatingtheLoadof PatientTransfers.OccupationalSafetyandHealthAdministration. http:// tyosuojelujulkaisut.wshop.fi/documents/2009/04/TSJ_83.pdf (accessed14.02.13). Kjellberg,K.,Johnsson,C.,Proper,K.,etal.,2000.Anobservationinstrumentfor assessmentofworktechniqueinpatienttransfertasks.Appl.Ergon.31(2), 139 150
Kjellberg,K.,Lagerstrom,M.,Hagberg,M.,August2004.Patientsafetyandcomfort duringtransfersinrelationtonursesworktechnique.J.Adv.Nurs.47(3),251 259 Knibbe,J.,Friele,R.,1999.Theuseoflogstoassessexposuretomanualhandlingof patients,illustratedinaninterventionstudyincarehomenursing.Int.J.Ind. Ergon.24,445 454
Knibbe,J.J.,Knibbe,N.E.,2006.Monitoringtheeffectsoftheergonomicscovenants forworkersinDutchhealthcare.In:Pikaar,R.N.,Konigsveld,E.A.P., Settels,P.J.M.(Eds.),ProceedingsoftheXVTriennialCongressoftheInternationalErgonomicsAssociation,MeetingDiversityinErgonomics11 14July, Maastricht,Netherlands
Martimo,K.P.,Verbeek,J.,Karppinen,J.,etal.,2008.Effectoftrainingandlifting equipmentforpreventingbackpaininliftingandhandling:systematicreview. Brit.Med.J.336,429 431
Mitchell,T.,O’Sullivan,P.B.,Burnett,A.F.,Straker,L.,Rudd,C.,2008.Lowbackpain characteristicsfromundergraduatestudenttoworkingnurseinAustralia:a crosssectionalstudy.Int.J.Nurs.Stud.45,1636 1644
Nelson,A.,2009.SafePatientHandlingandMovement.Springer,NewYork Nelson,A.,Collins,J.,Siddharthan,K.,Matz,M.,Waters,T.,2008.Linkbetweensafe patienthandlingandpatientoutcomesinlong-termcare.Rehabil.Nurs.33(1), 33 43
NuffieldProvincialHospitalsTrust,1955.StudiesintheFunctionsandDesignof Hospitals.OxfordUniversityPress,London Passfield,J.,Marshall,E.,Adams,R.,2003. “Nolift” patienthandlingpolicyimplementationandstaffinjuryratesinapublichospital.J.Occup.HealthSaf. Austral.N.Z.19(1),73 85
Radovanovic,C.A.T.,Alexandre,N.M.C.,2004.Validationofaninstrumentforpatienthandlingassessment.Appl.Ergon.35,321 328
Siddarthan,K.,Nelson,A.,Weisenborn,G.,2005.Abusinesscaseforpatientcare ergonomicinterventions.Nurs.Admin.Quart.29(1),63 71 Stobbe,T.,Plummer,R.,Jensen,R.,Attfield,M.,1988.Incidenceoflowbackinjuries amongnursingpersonnelasafunctionofpatientliftingfrequency.J.Saf.Res. 19,21 28
Taylor,J.A.,Dominici,F.,Agnew,J.,Gerwin,D.,Morlock,L.,Miller,M.R.,2012. Donurseandpatientinjuriessharecommonantecedents?Ananalysisofassociationswithsafetyclimateandworkingconditions.BMJQual.Saf.21,101 111
