Ron the following document has some of the info on the process that this hospital went through. The relevant infromation starts on about page 126. They used full coverage tracking not the single line tracking and had significant cost benfits in reduced premium.
You may also want to consider they different types of overhead tracking available and the pros and cons. As a physio you "may" be looking at a single tracking to enhance walking/mobility. This would obvioulsy run in a single line, but if you use this sort of tracking to transfer (which it often is) it has the disadvatage that a patient may slide down the bed and need to be tranfered up the bed to be able to be transfered which is obviously self defeating. Full room coverage OHT will allow the hoist to be located directly over the patient reducing this problem and also allowing more flexibility of room use and bed etc as they do not need to be in a fixed location. This type of tracking is unfortunately much more expensive to purchase. There have been cost benfit studies done that support the use of OHT when compared to the injury costs. I think the BC has done one. Also available is
Efficency of overhead tracking lifts in reducing musculoskeletal injury among carers working in long term instituions May 2008 Alamgir, H et al
Effectiveness of overhead lifting devices in reducing the risk of injury to care staff in extended care facilities Feb 2005 Engst et al
The impact of new lifting technology in long term care A pilot study
AAOHN journalDec 1994 Holiday et al
David Mc Farlane who is a regular contributor has written an excellent article entitled
Mearurement of the forces neede to tranfer patiens from bed to hospital trolleys
I am also seeking out a study done by a major hospital here that did a cost benefit analysis
Cost/benefit is often a major driver in this area as the
Obviously the above articles are not directly related to PTs but my general understanding of the stats are that PTs have similar levels of musculoseletal disorder to the nursing staff if not higher.
If you want to send on the guidance that you mentioned previously my details are below
Hazard Management Division
222, Exhibition St
That would be fantastic if I could see a copy. I am based in Victoria Australia which has very different expectations re:transfer equipment etc. The document I reccomended earlier is designed to integrate design and spatial requirements etc and put them in the one publication, if you have not had a look it may well be worth it. Also my understanding is that British Columbia has an excellent system re: hoist use, they may also be worth a look. As the entire system needs to support these endeaours for them to suceed. I would be great to see the documents you have porduced. Cheers Glen
The muscle wind up I am discussing is commonly known to result in issues such as brachial plexus compression etc resulting in change of sensation and loss of feeling etc. If it is not the muscles do you suggest bone?, scarring? etc. What do you believe is causing the entrapment? Is the surgical site presenting with keloid type tissue?etc
I think more information which would probably best achieved by as you say getting advise from a suitably qualified person.
I have not had the chance to read all of the other post so if I am repeating I apologise. Have you looked at any forms of mysofascial treatment? Are the muscles compressing your ulnar nerve as a result of the muscles being wound up? This could involve a number of areas as highlighted immediately above. Keeping the body in a relatively static posture can contribute to this muscle wind up.
From my experience it probably depends which type of hospital etc as to the goal and outcomes. Nursing use of hoists etc in rehab hospitals is usually based around rehab plans with the distinct of reinforcing mobility plans developed by therapists, nursing staff and medicos etc. This can often mean that they are using hoist or not etc to increase mobility etc more frequently than physios and O/Ts etc within settings such as personal care showereing as they have much greater contact with the patient. I believe that all of these roles are complex and demand the best support available and a commitment to all roles that have patient care in this area and through managment support. It is about changing hte system for all.
A recently updated document "A guide to designing workplaces for safer handling of people". I would strongly reccomend for anyone looking at suitable design to allow the use of transfer equipment with clients/patients.
May I suggest a document entitled Victorian Nurses back injury prevention project evaluation report. December 2004. It reviews the outcomes of the 1998 Victorian Nurse back injury prevention project (VNBIPP). A brief summary from the forward is a -24% reduction in the rate of standard back injury claims by nurses in public health services in Victoria -41% reduction in the rate of working days lost associated with the above -cost saving of est of $6.4 million (Mar-01 – jun-03) -reduction from 100 days per claim to 77 days per claim cost break even point is within 5 years plus many unmeasured benefits I am finding it hard to understand the people that support the view that allowing injury to your colleagues is acceptable. The lack of support for the use of equipment and improved environmental factors etc all impact on other staff that utilise transfer equipment. Cheers Glen
Have you tried marginally lowering the front of the chair. This can have the effect of tilting the top of the pelvis forward increasing the lumbar curve. This can also have the effect of balancing the body by moving the head to the rear more. I have also personally used a strap that hitched over the front of the knees with a support that runs to lower back which significantly reduced lower back pain. If you want the name of the product let me know as it was quite tranportable. Quite a common problem with chair adjustment is that the backrest drops and does not allow the persons bottom to locat under the backrest and utilise it effectively. Also the seat may be to deep and not allow the best use of the backrest
There has been some recent research that highlights the benefits of the small keyboard with full stroke keys. It reduces reach to the keys required by the fingers, removes the right numeric keypad. This allows the mouse to be bought closer to the keyboard reducing shoulder abduction. It also allows greater flexibilty in desktop use e.g. more space, increased ability to use the mouse on both sides and to centralise posture.
If it is CRPS she will quickly start losing bone density and this will probably show up on Xrays. Two of the common signs are the pain and the autonomic nervous system involvement e.g. swelling. You can also have sweating etc as another example. If it is this condition it involves changes to the brain and no changes at an ergonomic level will significantly impact on the condition. If it is this condition the sooner it is diagnosed the better (it obviously may also not be this condition)
You could be looking at a chronic regional pain syndrome. If this is the case you may want to get it checked out as soon as possible as these can be very persistent conditions. If this is the case Lorrimar Mosely developed a limb laterality retraining program that has been found to achieve some success.
David the following book stated that the Institute of Medicine found that between 44,000 and 98,000 patients die each year from medical errors. Handbook of Human Factors and Ergonomics in Health Care and Patient Safety By Pascale Carayon.
The HSE has done a cost benefit anaysis of potentially a similar probem in one of their studies that may be of benefit. You may also want to look at the other task the employees are performing as this may be contributing to the problem. Possible reductions in hose length depending upon how long they are. Maybe a system that presents the couplings to each other with less hose length and consequently less hose and distance to carry. Maybe locating the hose at about waist height. The HSE document showed a significant cost advantage by going through this process. Are ther other couplings that require less force that would do the job?
Dave i have the vague suspicion that ergonomists have always been talking out of sync with the medical profession. I don’t know how long the three month definition has been in place but it has been there a while. On the chronic pain side it is a complex area with a number of different timelines and outcomes. E.g. chronic regional pain syndrome (CRPS), neuropathic pain, myofascial pain (Muscle wind up) etc. A colles fracture (a fracture at the wrist) is the most likely to turn into chronic out of your common injuries. There are some theories why this might happen mostly to do with weight bearing. People usually have to keep walking and weight bearing on their legs so they maintain and normalise sensation in their legs. In contrast people may avoid using their hand and so the sensation pattern gets changed.
A simple breakdown of the types of pain (don’t take this too literally) is
1) CRPS there is a change in sensation and the bodies interpretation of that sensation. This can result in loss of bone density, abnormal sensation and sympathetic and parasympathetic response e.g. gross sweating, colour change, abnormal pain response, swelling
This results from changes in the brain post the original injury
2)Neuropathic/Neurogenic pain results from nerve damage. the outcome depends on the the nerve damaged and where it is damaged
3)Myofascial pain results from the muscles and fascia surrounding tightening up. These muscles can then impact on other muscles and wind them up. Typically treat with massage, myofascial treatment, movement therapies e.g feldenkrais. A good book on this area is called anatomy trains
They can all overlap and intermingle, common treatments depending on the condition (the wrong treatment can make conditions worse) include
Pain medication often opiod based
Occupational therapy to make the environment as friendly as possible and grade tasks
Current research has found that acceptance is one of the most important aspects of chronic pain, treatment, e.g.cognitive behavioural therapy (Psych O/T)
Again this is very complex field and I have grossly simplified the area and left out lots of detail. There are many specialised pain hospitals in australia and pain special interest groups e.g. Occupational therapy and physiotherapy and medical. It may be worth you while to contact them there is also pain societies that have regular conferences