Ergonomics’ Critical Role in Healthcare

Nursing safety and patient care become main selling points in new product purchases.
By: 
Maureen Leahy-Patano

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June 12, 2008
The TotalCare from Hill-Rom is an adjustable electric hospital air bed with features that allow the caregiver unrestrained access to patients and their needs.

Nurses are the primary healthcare providers in the U.S. today, taking on more and more responsibilities within the hospital and often working long, irregular shifts. A physically demanding profession, nursing is consistently listed as one of the top 10 occupations for work-related musculoskeletal disorders, according to the Bureau of Labor Statistics. By 2010, it’s estimated that 40 percent of nurses will be 50 years of age or older, potentially putting them at even greater risk for injury.

Recognizing the indisputable correlation between patient and nursing safety, hospitals are amping up initiatives to foster safer environments for staff and patients alike. A key contributor is the use of ergonomically designed products that address a variety of issues such as device maneuverability and patient handling.

A 27-year veteran of the nursing profession, Pat Stark, RN, ICU charge nurse at the Deborah Heart and Lung Center, Browns Mills, NJ, remembers the days when lifting the head of a patient’s bed required manually turning a crank at the foot of the bed. And she remembers the back and shoulder injuries that often resulted. Today, the center uses Hill-Rom’s motorized Total Care line of beds, and the nurses couldn’t be happier, says Stark.

“Our nurses absolutely adore these beds,” she said.

Features such as turn assist, head of bed alarm and trending, max inflate, and the rotation, percussion and vibration modules are some of the reasons why. These features eliminate awkward patient handling and movement, which benefits the nurses as well as the patients.

Stark said when the center made the change about nine years ago, they were determined to purchase a product that was the most beneficial for both the staff and the patient, and had a variety of surfaces that could be used throughout the hospital. She’s convinced safety and ergonomic features played a big part in the decision-making process.

“The max inflate feature makes it much easier to pull up patients and the chair egress position is fantastic for post-op patients, allowing them to ambulate easier and sooner,” Stark said. “We can also do chest PT without external devices. All we do is set the percussion, vibration and the rotation and raise the siderails — the bed does the rest.”

For sicker patients, such as open-heart patients who may have multiple drips or a balloon pump, the center relies on the TotalCare Sp02RT bed. Since these patients can’t increase their mobilization, the bed’s functions allow nurses to turn them and help increase their respiratory function, explains Stark. For extremely large patients — more than 400 pounds — the center has access to the TotalCare Bariatric Bed that features an extra-wide, 42-inch, three-layer surface for comfort and IntelliDrive power transport.

Nurses at Main Line Health in suburban Philadelphia recommend “try before you buy” when purchasing new devices. Several years ago the hospitals learned an expensive lesson when they purchased tablet PCs for their patient care technicians (PCTs) to use when performing vital signs documentation. The devices, which looked great at first glance, turned out to be very heavy and awkward to use, resulting in neck and shoulder pain. The tablets are now gathering dust while the PCTs collect their information by hand and transfer it into the hospital’s clinical documentation system from desktop computers.

As the result of their search for full-featured medication administration carts and computers on wheels that were smaller, lighter and easy to maneuver, Main Line Health went live four years ago with several of Infologix’s mobile computing workstations.

“In the past, we had injuries that resulted from pushing heavy carts. We also need to take into consideration that the nurses on the floor are getting older,” said Kristy Thompson, clinical IS educator for Main Line Health.

“When we evaluated the current market offerings, we liked the Infologix carts’ drawer size and wider base, which makes them easy to maneuver on floors,” said Nicole Talmadge-Kellet, PMP, IS application manager, Main Line Health. “However, some of the nurses tend to overfill the drawers, making the carts less easy to wield along the hospitals’ carpeted areas. The nurses also like that they can raise and lower the workstation and tilt the keyboard and monitor. There is a fairly large area between the monitor and keyboard where they can prepare meds or write notes, and there is a holder on the side of the cart for bar-code scanners.”

Recognizing that technology can change fairly rapidly, the nurses at Main Line Health have created a wish list for their next mobile computing purchase. The list includes increased maneuverability, smaller drawer size with a more individualized medication compartment and a hydraulic lift for adjusting the height of the workstation.

“This underscores the importance of real-life testing before you buy,” said Talmadge-Kellet. Just as important, is knowing exactly what you want and asking the right questions, she added. What MLH nurses really want, they say, is to test products backed by sophisticated design work and rigorous ergonomic research.


Better Design Leads to Better Outcomes

Ergonomics in healthcare goes way beyond comfort. Features that address not only ease of operation, but also optimized functionality, add to a device’s success. This is especially evident in the OR.

To help ease the hand fatigue many surgeons experience during electrosurgery procedures, MEGADYNE introduced a new line of disposable suction coagulators that boast a larger, ergonomic handle. Available in 8, 10 and 12 French sizes, the new line reportedly better enables the surgeon to correctly match the coagulator to the size of the patient’s anatomy and surgical procedure being performed. Available in both hand-switching and foot-controlled options, the coagulator is fully insulated to reduce the likelihood of injury to surrounding structures and tissue, and its integrated guard prevents user shocks.

Similarly, Medtronic’s Straightshot M4 Microdebrider is an ergonomically designed powered handpiece for sinus, nasal and laryngeal surgery. Its sculpted shape reportedly accommodates multiple hand positions and provides ergonomic comfort for small- and large-handed surgeons.

A 2006 Medical Device Excellence Award Silver Award winner, the Straightshot M4, said Medtronic, is designed to provide better, more comfortable access to sinus and airway anatomy, allowing surgeons to perform more precise, complete removal of obstructive or diseased tissue and help improve patient outcomes in chronic sinusitis and airway tumor surgery.

Sidebar

Barry H. Beith, Ph.D., president and CEO, HumanCentric Technologies Inc., and fellow and past president of The Human Factors and Ergonomics Society (HFES) discusses the importance of ergonomic medical devices in providing safe and effective care to patients.

1. How prevalent are workplace-related injuries in healthcare, and what are the implications for caregiver and patient safety?

Workplace-related injuries in the healthcare industry are a major problem and the implications for both caregivers and patients are huge. Such injuries are particularly acute among the nursing staff and orderlies who are asked on a regular basis to move patients or set up or move equipment. Caregivers suffer musculoskeletal problems that can be crippling, and back problems are epidemic among staff members. Patient safety is compromised when such problems plague the caregiving staff because incidents such as falls (or dropping a patient) become more common. There is always an eventual negative outcome when a caregiver must choose between the risk of injury to oneself or to the patient. Moreover, these situations are not unique to hospitals and institutions; as more and more patients move back to the home to recover or live out their days, the problem will become absolutely epidemic.

2. What is being done to address the problem, and what role do ergonomically designed devices play?

Hospitals and institutions do train their staff to some extent on how to minimize injuries, but the fact that these types of problems continue to occur and re-occur at fairly high levels within hospitals is indicative of how difficult a problem this is and will continue to be. However, I don’t believe it is an intractable problem. There are several areas in which tremendous gains can be made for relatively low cost; areas such as device design, device selection, device training and medical informatics — the way information is presented, both graphically and text-wise.

These ergonomic and human factor activities aren’t very costly, but ironically that is the reason they don’t get a lot of attention at the highest levels. As a result, human factors and ergonomics are only just beginning to be recognized as a low cost, positive set of methods, processes and techniques for dealing with many of the work-related problems in hospitals and institutions.

Ergonomic medical devices represent devices that are more usable, more acceptable and more effective, for institutional or home use. Such devices are more intuitive and more error tolerant. Error tolerance for medical devices means that fewer human errors occur with such devices and the errors that do occur are readily identifiable, more easily recoverable and have fewer or no negative consequences. These characteristics are often the difference between life and death. Human factors and ergonomics are critical disciplinary tools in the design of every aspect of healthcare.

3. What is The Human Factors and Ergonomics Society and what does it mean for healthcare?

The HFES is the primary and largest professional society for the fields of human factors and ergonomics in the world. It's membership represents approximately 5,000 professionals in the U.S. and 42 other nations around the world. As a nonprofit organization it is not allowed by U.S. law to conduct lobbying activities directly for itself or its causes. The society’s purpose regarding healthcare is to stimulate, facilitate and communicate among its membership so as to encourage their involvement in a wide variety of areas within the healthcare industry, including device design and usability, medical informatics, medical software development, healthcare training, telemedical applications, technology development and adaptation, environmental and institutional design, macroergonomic research and design (organizational design).

The Healthcare TG (technical group) is one of 21 technical groups within the HFES. This group focuses on all of these aspects of healthcare and more. The TG has approximately 500-600 HFES members among its own membership. The HFES as a society and represented by the Healthcare TG tries to communicate the importance of good design, from the aspects of usability, personal safety, human error tolerance and management and training effectiveness and retention. The society encourages and facilitates its members to provide high-quality professional input in the healthcare industry, and to communicate and propagate information and news about the profession of human factors and what its members can provide to the industry.