Sue Hignett

Rapid Entire Body Assessment (REBA)

This technical note details the preliminary stage in the development of a postural analysis tool, Rapid Entire Body Assessment (REBA). REBA has been developed to fill a perceived need for a practitioners field tool, specifically designed to be sensitive to the type of unpredictable working postures found in health care and other service industries. A team of ergonomists, physiotherapists, occupational therapists and nurses collected and individually coded over 600 postural examples to produce a new tool incorporating dynamic and static postural loading factors, human-load interface (coupling), and a new concept of a gravity-assisted upper limb position. Initial reliability for inter-observer coding shows promise but further work is needed to establish the validity of the tool.

Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review.

Aims: To report, analyse, and discuss the results of a systematic review looking at intervention strategies to reduce the risk factors associated with patient handling activities. Methods: A search strategy was devised to seek out research between 1960 and 2001. Inclusion/exclusion criteria limited the entry of papers into the review process. A checklist was selected and modified to include a wide range of study designs. Inter-rater reliability was established between six reviewers before the main review process commenced. Each paper was read by two reviewers and given a quality rating score, with any conflicts being resolved by a third reviewer. Papers were grouped by category: multifactor, single factor, and technique training based interventions. Results: A total of 2796 papers were found, of which 880 were appraised. Sixty three papers relating to interventions are reported in this paper. The results are reported as summary statements with the associated evidence level (strong, moderate, limited, or poor). Conclusion: There is strong evidence that interventions predominantly based on technique training have no impact on working practices or injury rates. Multifactor interventions, based on a risk assessment programme, are most likely to be successful in reducing risk factors related to patient handling activities. The seven most commonly used strategies are identified and it is suggested that these could be used to form the basis of a generic intervention programme, with additional local priorities identified through the risk assessment process. Health care providers should review their policies and procedures in light of these findings.

Rapid Entire Body Assessment

8.1 Background 8-1 8.2 Application 8-2 8.3 Procedure 8-2 Observe the Task • Select Postures for Assessment • Score the Postures • Process the Scores • Calculate REBA Score • Confirm the Action Level • Subsequent Reassessment 8.4 Example 8-7 Scoring Figure 8.4 — Correct Posture • Scoring Figure 8.5 — Poor Posture 8.5 Related Methods 8-9 8.6 Standards and Regulations 8-9 8.7 Approximate Training and Application Times 8-10 8.8 Reliability and Validity 8-10 8.9 Tools Needed 8-10 References 8-10

A review of environmental hazards associated with in-patient falls

Slips, trips and falls present the greatest risk to in-patients in terms of exposure (frequency of occurrence) but only present a low severity risk in terms of mortality. The risk factors have been categorized as intrinsic (individual to the patient, e.g. visual impairment, balance problems and medicine use) or extrinsic (environmental). Many recommendations have been made concerning the management of environmental hazards but, of these, only beds rails have supporting research evidence. Other recommendations include patient assessment, footwear, flooring, lighting, staffing levels and bed alarms. However, three systematic reviews and the current narrative review have all failed to find research evaluating the benefits of these recommendations. The most robust evidence relates to the use of bed rails. This research suggests that bed rails not only fail to reduce the frequency of falls, but may also exacerbate the severity of injury. As Maslows Hierarchy of Needs model has been used as a framework for nursing models of care, it was chosen as the basis for the development of an environmental hazard assessment model. The environmental hazards are revisited using this model in order to take an ergonomic or patient-centred approach for risk assessment.

Postural analysis of nursing work

Back pain in the nursing profession is an acknowledged wide spread occupational hazard. This study used OWAS (Ovako Working posture Analysis System) to measure the severity of the working postures adopted by nurses on Care of the Elderly wards when carrying out manual handling operations for animate and inanimate loads. Twenty-six nurses were observed on 31 occasions to obtain 4299 observations, these data were collected and processed using the OWASCO and OWASAN programs, and then analysed by grouping the results into defined patient (animate) handling and non-patient (inanimate) handling tasks. A statistical comparison was made between the two groups using the percentage of action categories two, three and four, to the total number of action categories. A significant difference (p < 0.05) was found, demonstrating that the percentage of harmful postures adopted during patient handling tasks was significantly higher than during non-patient handling tasks. This high level of postural stress and the poor track record of risk management within the Health Care Industry leads to the recommendation that an attitudinal change is needed to successfully address and reduce the manual handling burden which is currently being carried by the nursing staff.

Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK

Background Patient safety culture is measured using a range of survey tools. Many provide limited data on psychometric properties and few report findings outside of the US healthcare context. This study reports an assessment of the psychometric properties and suitability of the American Hospital Survey on Patient Safety Culture for use within the UK. Methods A questionnaire survey of three hospitals within a large UK Acute NHS Trust. 1437 questionnaires were completed (37% response rate). Exploratory factor analysis, confirmatory factor analysis and reliability analyses were carried out to assess the psychometric performance of this survey instrument and to explore potential improvements. Results Reliability analysis of the items within each proposed scale showed that more than half failed to achieve satisfactory internal consistency (Cronbachs α<0.7). Furthermore, a confirmatory factor analysis carried out on the UK data set achieved a poor fit when compared with the original American model. An optimal measurement model was then constructed via exploratory and confirmatory factor analyses with split-half sample validation and consisted of nine dimensions compared with the original 12 in the American model. Conclusion This is one of the few studies to provide an evaluation of an American patient safety culture survey using data from the UK. The results indicate that there is need for caution in using the Hospital Survey on Patient Safety Culture survey in the UK and underline the importance of appropriate validation of safety culture surveys before extending their usage to populations outside of the specific geographical and healthcare contexts in which they were developed.

Patient handovers within the hospital: translating knowledge from motor racing to healthcare

Introduction This paper expands the analogy between motor racing team pit stops and patient handovers. Previous studies demonstrated how the handover of patients following surgery could be improved by learning from a motor racing team. This has been extended to include contributions from several motor racing teams, and by examining transfers at several different interfaces at a non-specialist UK teaching hospital. Methods Letters of invitation were sent to the technical managers of nine Formula 1 motor racing teams. Semistructured interviews were carried out at a UK teaching hospital with 10 clinical staff involved in the handover of patients from surgery to recovery and intensive care. Results Three themes emerged from the motor racing responses; (1) proactive learning with briefings and checklists to prevent errors; (2) active management using technology to transfer information, and (3) post hoc learning from the storage and analysis of electronic data records. The eight healthcare themes were: historical working practice; problems during transfer; poor awareness of handover protocols; poor team coordination; time pressure; lack of consistency in handover practice; poor communication of important information; and awareness that handover was a potential threat to patient safety. Conclusions The lessons from motor racing can be applied to healthcare for proactive planning, active management and post hoc learning. Other high-risk industries see standardisation of working practices, interpersonal communication, consistency and continuous development as fundamental for success. The application of these concepts would result in improvements in the quality and safety of the patient handover process.

Embedding Ergonomics in Hospital Culture: Top Down and Bottom Up Strategies

In England there has been increasing emphasis on the use of ergonomics to tackle manual handling problems for the last seven years (MHO, 1992, 1998; HSAC, 1998). At Nottingham City Hospital NHS Trust, I have tried to incorporate an ergonomic approach throughout a wide range of activities since 1994. This paper does not seek to report a research project, simply to share the experience of trying to tackle hospital manual handling risks by taking an ergonomic approach. It will explain what this has involved, where it has been successful and where there have been difficulties. In the five years since the implementation of this strategy three measures have been used to monitor trends. These are (1) manual handling incidents: showing a 33% reduction; (2) days lost from musculoskeletal-related sickness absence: 36% reduction; and (3) completed risk actions: rising from 33% completion to over 75% completion.

The role for qualitative methodology in ergonomics: a case study to explore theoretical issues

The primary objective of the study reported in this paper was to look at the use of qualitative methodology in ergonomics research and practice. Qualitative methodology itself was chosen as a compatible approach to explore these aims, with ergonomics being seen as a socially situated practice. Semi-structured interviews were carried out using a prompt sheet which developed iteratively during the study. A four stage sampling procedure was used to gain access to 21 interviewees. These stages were (1) spreading the net (purposive sampling), (2) following up leads (snowball sampling), (3) focussing (intensity sampling), and (4) analysis sampling to seek out extreme/deviant cases. A total of 12 academics and 9 practitioners were interviewed from all areas of ergonomics, including cognitive (psychology), product design, engineering, human and health sciences, organisational management and sociology. The findings are represented by a model showing the interactions between multiple dimensions, including academia/practice, qualitative/quantitative and the internal and external environments of ergonomics. There was considerable interest in expanding the ergonomics toolbox to include qualitative methodology. However concerns were raised about a perceived lack of knowledge with respect to the process, which could be addressed through education and reflective practice.

State of science: human factors and ergonomics in healthcare

The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. Practitioner Summary: There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.