Healthcare Disability & WRMSD PDF

US dept. of labor cites What is the leading sprains, strains, and other cause of disability musculoskeletal injuries/disorders as the for people in lead cause of disability healthcare? 600k employees = $50 bill...

US dept. of labor cites What is the leading sprains, strains, and other cause of disability musculoskeletal injuries/disorders as the for people in lead cause of disability healthcare? 600k employees = $50 billion per year What are 4 1) regular in-service training (CE & new tecniques) 2) improvements in equipment/technology factors that can 3) postinjury investigation into causes 4) establishment of "a culture of safety" (supports professionals' judgement/decisions) (ethical reduce issues if lack thereof) institutional policies should support a health professionals' decision about the safety of any incidents? task or risk to patient or themselves WRMSD (work related musculoskeletal disorder) Explain -range from minor discomfort to career ending disability -painful conditions affecting muscles, nerves, ligaments, tendons, and body bursas WRMSD, MSD, -develop from repeated trauma or lack of blood flow to joint structures (MOSTLY) -leading cause of long-term absences of health professionals MSI, MSKI, & -aka MSD, MSI, MSKI, & CTD (musculoskeletal disorder, musculoskeletal strain injury, musculoskeletal injury, cumulative trauma disorder) -arise from multiple factors (insufficient education, CTD maladapted behavior, poor workplace conditions, lack of support from hospital administrators) -can result in life-long pain/disability How are athletes -they cannot afford to be disabled -need didactic faculty and clinical instructors to and healthcare teach them how to maximize performance, develop skills, use less energy, and sustain less injuries professionals the -must develop physically and psychologically for profession same? -learn academic fundamentals, clinical skills, and professional values that limit injuries -utilize ergonomic body principles for safe 5 things interactions with the equipment & patients  -Imaging professionals must How do healthcare avoid WRMSDs professionals limit injuries, -avoiding injury begins with maximize performance, understanding the basics of the and what fundamentals MSK system (musculoskeletal) limit injury risks? -limit injury by practicing body 3 things mechanics, having limits, & recognizing early signs of injury TENDONS Explain tendons, their -white fibrous connective tissue that connects muscle to bone -enable motion of joint by exerting force on bones function, ways to avoid -surrounded by sheaths with synovial fluid that limit friction -avoid injury by recognizing early stages of disease, have injury, and causes/late limits, & seek treatment -limit stress and strain -tendons, tendon sheaths, and synovial fluid have limited effects of WRMSD blood supply and repetitive activity can affect circulation to MSK system (leads to metabolic waste buildup, muscle 7 things spasm, tendon microtears, scar tissue, & necrosis) -results in swelling, pain, & restricted blood flow (limits joint movement) MOBILITY (in 4 extremities) Describe -white muscles found in limbs (long white tendons) -cross 2 or more joints -upper bicep muscles/lower hamstring muscles mobility and -designed for movement -bicep femoris, biceps brachii, & gastrocnemius -for safe and effective patient moving/handling -used for lifting stability -bend and straighten knees & straight back or in lumbar lordosis position STABILITY -red muscles found in torso (large muscle expanses) muscles -used for support/support torso -postural stability -latissimus dorsi, abdominal group, & erector spinae Explain proper "Lift with your legs, not your back" -patient safe handling and positioning begins with applying law of physics (aka body mechanics) body mechanics -body mechanics= safe transfers of patient and equipment limiting WRMSDs -patients' physical and cognitive abilities determine their and patient required transfer assistance -some patients perform tasks alone, some need manual/equipment assistance (lifts, transfer devices) -professional decides type of transfer using clinical skills considerations (CE) continued education  Explain -Biomechanics is a physics component that is applied to living bodies at rest and in motion biomechanics -used to optimize exercise programs, promote greater athletic skills, and design safer work environments (Newtonian -proper lifting and transfer techniques for safety -fundamentals of patient handling include base of support, the center of gravity, & correct use of mechanics) mobility/stability muscles (limits work injuries) Explain -the foundation in which a body rests -narrow base = unstable and mobile systems base of -wide base = stable systems and preferred for clinical interactions -when transferring patient provider must establish stable base of support with feet support wide apart to limit injury and increase support/stability Explain -hypothetical point in which all mass is concentrated -gravitational forces act on the entire body from this point -anatomic position = center of gravity is at sacral center of level 2 (varies in men and women) -moving heavy items is easy and safe if held closely to the center of gravity -center of gravity is over base of support = gravity stability -center of gravity is beyond base of support = instability Describe the basic -introducing yourself to patient, give your title, and what you would like to do -let patient do as much of the transfer as possible -check chart for precautions such as restricted weight bearing, cognitive principles of lifting impairments, and joint diseases (minimize patient harm/discomfort) -choosing correct type of transfer, have correct equipment, and sufficient assistance to perform task safely If patient need assistance: and transfer -remove/swing away leg rests, position wheelchair 45-degree angle to table, and lock wheels -establish wide base of support -patients' center of gravity close to providers center of gravity (S2 level) techniques -holding patient with a transfer belt to minimize patient stress (shoulder girdle) loose clothing -lifting patient with legs, stationary back, avoid back bending/twisting -never lift more than able and ask for assistance if needed Box 13.1 -watching patient for orthostatic hypotension (taking precautions to minimize effects) Explain the cause, -develops when sudden drop in blood pressure occurs (standing too fast) -recumbent to upright position -patient has been supine too long, debilitated status, or taking medications signs, symptoms, -patient blood vessels have decreased vasomotor tone, compromised lymphatic vessels, & circulatory disorders -deprives oxygen rich blood to the brain SYMPTOMS: dizziness, fainting, blurred vision, and slurred speech & treatment of TO MINIMIZE EFFECTS: -patient should stand slowly and talk during transfer -asking patient open-ended questions -listening to patient for slurred/slow speech orthostatic -if signs occur slow speed of transfer, patient takes deep breaths, return patient to sitting position -provide verbal/physical help if needed DO NOT send symptomatic patient on their way and risk sincope (fainting/ hypotension loss of consiousness) -require teamwork Patient -one individual in charge making calls for transfer, controlling timing of transfer, and synchronizing transfer events transfers -each segment must be reviewed with all team members (Transfer personnel must NEVER kneel require what? or stand on radiographic table when performing transfers) Describe the 4 1) Standby assist -used for patients who can transfer on their own or may need assistance -talk to patient before to determine assistance if needed -provide step by step instructions to patient -position patient at 45-degree angle on their stronger side close to table 2) Assisted standing pivot -patient cannot transfer independently but CAN bear weight on legs types of -position wheelchair at 45-degree angle to stronger side close to table -lock knees and legs with your knees -for loose clothing use transfer waist belt 3) Two-person lift -patient cannot bear weight on lower extremities -lightweight patient is lifted by 2 people -stronger person behind patient lifting torso (directs 2nd persons actions) wheelchair -second person lifting leg thighs and calves -verbally plan procedure before executing for coordination with 2 people and patient/troubleshooting 4) Hydraulic lift -for heavy patients; require full transfer assistance -provider must practice with equipment before using lift on patients -has 4 wheels but no wheel locks transfers -base of support can be widened/narrowed with base lever -prior arrangements to be made with nurse/transportation staff for patient to be on sling -if patient arrives with no sling return patient to dept. or if scheduling allows place patient on sling -avoid injury risk by using equipment wrong/without sling What do you -determine if patient has strong side, weak side, or equal sides -always position patient to strong side -if patient has equal sides position to most begin with for convenient/space limitations -for ALL wheelchair transfers make sure wheels are locked and footrests are not obstructing wheelchair patient -observe and evaluate patient or check patient chart for restricted weight bearing, general transfers? weakness, arthritic conditions, cognitive impairment  Standy -move wheelchair footrests out the way, wheels locked, 1 "sit on edge of wheelchair", 2 "push down on arms of chair" for rising, 3 "nose over toes assist standing slowly", 4 "reach out with hand closest to table", 5 "turn slowly to feel table behind you", 6 " hold table with both detailed hands", 7 "please sit down", lower table if too high, or after 6 provide footstool for patient to step up Assited move wheelchair footrests, wheels locked, patient sitting on edge of chair, patient pushes down on arm rest to rise up nose over toes, provider bends knees and straight back grasping belt with hands, block patients' knees and feet for standing stability and weight bearing, patient and provider both rise, ask patient how they feel when standing for orthostatic hypotension symptoms (slow breaths), provider and patient pivot toward table for patient to feel table against the back pivot detailed of thighs, ask patient to support themselves on table with both hands and to sit down, help patient and lower them slowly on table with straight back and using leg muscles lock wheelchair wheels, remover 2 person armrest/leg rest if possible, ask patient to cross arms over chest, stronger person behind reaches under patients axillae grabbing crossed forearms, second lift detailed person squats grabbing patients' thighs in one hand and calves in the other, on command patient is moved to desired place avoid risk of patient injury by using equipment wrong or without sling, long chain for sling seat Hydraulic and short chain for sling back, adjust chain for patient size, hook chain inside out sling, check if release valve closed and patient is sat comfortably, raise patient with lift and remove wheelchair, place patient on table/bed, lower lift detailed patient with release valve slowly, make sure patient head does not hit spreader, remove chains carefully/chains swing hit patient, when patient is stable remove lift and leave sling under patient for return transfer  What factor -the patients' mobility and functional abilities determines which determine which type of transfer should be used -assessment includes evaluating their strength, transfer should be weight-bearing capacity, range of motion, cognitive status, and any medical conditions that affect the patients' movement used and how -health professionals involved in patient handling/movement decide what transfer is used patient is assessed? Explain -aka stretcher or gurney -position cart alongside table and on patients' stronger side -lock wheels/place sandbags over wheels -allow patient to assist in moving depending on their ability -stabilize cart/support weak body part -if patient CANNOT assist use moving device or draw sheet cart (transfer aids) -3 people perform cart to table transfers -transfer surfaces must be side by side and same height (lateral transfer) Moving Devices transfers -plastic transfer board -roller moving device -low friction plastic sheet (allows sliding patient) MaxiSlide, MaxiTube, & MaxiTransfer Performing -2 plastic transfer sheets needed -one under patient and second sheet under first sheet to help patient slide -if patient arrives with no transfer sheet place one by rolling lateral cart patient to side, placing double sheet under, and rolling patient over on top of sheets -both transfer surfaces must be at same height level and as close as possible -wheels locked so 2 surfaces cannot separate transfers -2 technologist at patient head/chest, tech at patients' pelvis/legs (3 techs) -grasp top sheet and slide patient into desired position Cart to table -use draw sheet -properly position draw sheet -roll up draw sheet on both sides -person directing at patients' head/chest, assistant at pelvic, assistant at legs -patients' arms crossed over chest (avoid injury/smooth transfer) WITHOUT -pelvic person at opposite side of cart to disable cart from moving, person at head in charge of directing transfer/commands -on command everyone grabs rolled sheet & pulls patient to edge of cart/slowly lifted and placed on table -assistant repositioning if needed moving device -can be difficult/cause injury due to no moving device and is NOT recommended for heavy/really injured patients TRANSFER PERSONNEL MUST NOT STAND OR KNEEL ON TABLE TO PERFORM TRANSFERS  -going from one surface What are some type to another skin damages -caused by several mechanical factors that result from -elderly patients are especially vulnerable to transfers? skin damages Describe -enables desired body part to be examined -before moving patient talk to them explaining steps -let patient assist as much as possible positioning -minimize patient trauma/discomfort by taking moment for patient to be ready to move -when moving patient ALWAYS roll patient towards you -provide positioning sponges for patient comfort/maintain position Most Common Terms terms and their 1)Supine = lying face up on back 2)Prone = lying face down on stomach 3)Lateral = lying on left or right side knees bent 4)Sims' = lying on left side, left knee/leg straight, right knee and hip bent descriptions 5)Fowler's = semi-sitting at 45‒90-degree angle with straight or bent knees -connected to bodies, beds, IV pole What are commonly -oxygen tubing, intravenous lines, central lines, postsurgical drains, and urine bags attached equipment -before moving/positioning patient check for attached equipment and how do they -patient chart/personnel can provide information over attached equipment -equipment should NOT block patient/provider affect patient movement -transfer should not damage equipment function positioning/moving? -training & in-service available for teaching safe handling What are the -includes multiple factors such as repetitive motions, poor posture, excessive/forceful leading causes of strenuous movements, improper body positions, age, gender, & exposure to vibrations (sonographers mostly at risk) work related Listed by OSHA: the occupational safety and health administration musculoskeletal SDMS: the society of diagnostic medical sonography NIOSH: the national institute of occupational disorders? health and safety  -follow proper ergonomics/limiting time How do you spent in risk-producing postures reduces WRMSDs -employers, equipment manufacturers, reduce the risk industry organizations, educational programs, & rad imaging professionals of WRMSD? foster ergonomic-friendly working conditions (educating/training/providing equipment/exercising practices) Industry DECREASING -have both increased & decreased the risk of WRMSDs in ultrasound -SDMS established industry standards for the prevention of WRMSDs in sonography (2016) -the document provides guidelines for equipment manufacturers, employers, changes for sonographers, and educators to limit WRMSDs in profession -the document has improved designs of ultrasound equipment & sonographers work environment INCREASING -emphasis changed from patient care to workflow practices and productivity -increased patient volumes & decreased rest times between patients -using computer causing poor posture/tendons & muscles do not rest WRMSD? between patients -prolong computer use leads to eye strain, back injury, & WRMSDs (carpal tunnel syndrome, epicondylitis) SYMPTOMS (usually gradual but can persist for days/years) -most common symptom is dull focal pain that persists for hrs or days -swelling, reduced motion range, reduced function, muscle tightness, paresthesia (abnormal touch sensation WRMSDs tingling/prickling) pins and needles, and erythema (skin reddening) -symptoms have slow progression so monitor, identify, and take action in early stages of disease -suspected symptoms to be evaluated by health experts and reported to employer ASAP STAGING -classified as early, intermediate, and late EARLY -early stage develop symptoms at work but no pain after work or on off days symptoms, -does not affect work productivity but can progress to intermediate stage INTERMEDIATE -symptoms occur at work and after work -reduced productivity and repetitive activities LATE -symptoms consistently persistent staging, and -performing light work is painful/impaired MANAGING RISKS (scanning while maintaining good posture) -to limit risk of WRMSD for imaging professionals especially sonographers -head facing forward, spine alignment in sagittal/frontal/transverse -keeping upright spine no twisting/bending -hands and arms in front of body; no excessive reaching -arm abduction less than 30-degrees managing risks -elbow flexion at 90-degrees -forearms close to body and parallel to floor; well supported -when sitting; feet supported by floor/chair rung/ultrasound machine -when standing weight should be even on feet with wide base of support Considerations for Sonographers to AVOID -prolonged static postures -excessive reaching -awkward wrist, elbow, and shoulder positions (flexion/extension/rotation)