Safe Patient Handling among STNAs in Nursing Homes: Compliance, Monitoring, and Continuous Quality Improvement of Best Practices: Co-PI

This proposed project addresses the following focus areas provided in the grant guidelines of the Ohio Occupational Safety and Health Research Program, and the mission of the Ohio Bureau of Workers Compensation:

1. Prevention of musculoskeletal disorders, especially those associated with back, shoulder, or knee;
2. Prevention of injuries in the health care sector including safe patient handling interventions;
3. Development and validation of innovative solutions to quantify the effectiveness and return on investment for implementing occupational safety and health and/or ergonomics interventions in the workplace;
4. Development of innovative tools to improve occupational safety and health management.

 

Study Design The two year project plan consists of one year to complete a formative evaluation, gathering quantitative as well as qualitative data assessing the facility’s existing patient handling program in relation to a current model of best practice as well as to develop a compliance monitoring and feedback system consisting of inexpensive Microsoft Kinect-based real-time motion tracking and smart watches. Both program design and implementation will involve collaboration between multiple health care disciplines and the community partners. At the beginning of the second year, an intermediate report of our findings will be reviewed with the Jennings Center staff including the Chief Executive Officer, the Director of Nursing, and representatives of other important staff (such as nurses, STNA’s, environmental health or building maintenance staff).   A pilot safe handling program will be developed, integrating the new Kinect-based monitoring system.  In addition, other recommended program updates into the facility’s existing program will be implemented.  For example, equipment that has evolved since the Jennings Center implemented their safe movement program in 2006 will be recommended and purchased.  This will be followed by implementation of the novel program with a group of select participants divided into three groups.  Specifically, 48 participating STNAs will complete training in the updated pilot safe handling program designed at the end of phase I. This will include training in postures and movement patterns used during patient bedside care that are deemed “unsafe” (movement violations). For example, it is “unsafe” to bend forward while rotating the back and lifting. Next, thirty-two of the 48 individuals will receive a smartwatch and will be monitored as they work.  The remaining 16 will not be monitored (control group), receiving their watches after completion of this part of the study. Of the 32 individuals who do receive a watch, 16 will be monitored but will not receive any form of feedback (no feedback group), while the other 16 will be monitored and receive real-time and cumulative feedback (feedback group).  For those individuals in the feedback group, when a movement violation is detected, a real-time notification will be sent from the motion tracking software to the smart watch worn by the monitored worker. The notification will trigger the smart watch to vibrate, alerting the worker about the wrong movement. In addition, a short text describing the wrong movement will also be displayed on the monitored STNA’s smart watch screen.  Finally, cumulative feedback about movement violations over time will be collected and presented to individuals in the feedback group.

We plan to equip about thirteen patient rooms with the monitoring system (equipped room) which collects stick-figure “avatars” rather than actual identifying video images.  The 32 participants wearing smart watches will be monitored for approximately 30 days during which they will be assigned to care for at least one patient in an equipped room.  Participants may be monitored in more than one equipped room on a given day.  It is assumed that they will also be assigned to care for patients in non-equipped rooms. The control group participants will work in equipped rooms and/or in other, similar rooms in the same neighborhood.  Regardless of whether or not a monitored STNA is in the feedback or no feedback group, the system will record the motions of the monitored STNA as long as she or he is in the equipped room and working near enough to the bed to be in the view of the camera system.  Thus, the tasks studies will be limited to those performed to assist the patient at bedside.  The system will record the amount of time spent in an unsafe posture or movement pattern (movement violation) and the number of alerts either sent (feedback group) or which would have been sent (no feedback group). 

Analysis of the number of movement violations and the time spent in movement violation as a portion of total bedside patient care time in each room will be used to examine the effectiveness of the feedback.   The recorded movement representations (avatars) of each participant will be assessed visually and movement patterns identified for further analysis. This post-hoc assessment of the participants’ motion data will be a rich source of information about the types and frequencies of movements STNA’s make as a part of their job, and will allow identification of tasks and motions of interest for future studies. 

Finally, a quantitative and qualitative summative evaluation will be completed for the control, no feedback, and feedback groups. It will assess the effectiveness of the pilot updated safe handling program as well as the new compliance monitoring and feedback system.  Specifically related to the monitoring system, it will address the perceptions of the participants about the impact of the monitoring on their safe movement during bedside patient care tasks, their perceptions of its effectiveness in cuing them to perform tasks more correctly, and their perception of the value of real-time versus summative feedback.  The summative evaluation will also provide the basis for recommendations for additional changes.  The findings of this study will be presented to the Ohio BWC, The Jennings Center Staff, one national and one state conference.  A manuscript for publication will be created reporting these findings.  The strengths of this proposal are:

 

1. Program assessment, including a qualitative component, providing a  rich data set exploring reasons for compliance problems in safe handling programs and allowing development of novel solutions;
2. The innovative  monitoring and feedback system to address compliance with patient handling programs;
3. Interprofessional collaboration (engineering, nursing, occupational therapy, physical therapy);
4. Collaboration with a BWC certified provider who has had previous experience implementing safe patient handling programs at Medina Hospital.
5. A strong community partner with a reputation for research and an institutional commitment to safe patient handling;
6. Potential for the monitoring and feedback system to be implemented at other facilities at low cost with reduction of injuries related to patient handling activities;
7. Implementation of the safe patient handling pilot program at other facilities interested in reducing workers compensation costs.
8. Dissemination of findings to multiple stakeholders and a national audience via conferences and a journal article.