Advocate Aurora Sherman Hospital Case Study - Arjo MOVE® Program

AASH has 255 beds and 1,600 clinical professionals delivering compassionate and high quality care to the community it serves. AASH prides itself on its ability to deliver effective healthcare while ensuring protection from injury for both patient and caregiver while keeping costs related to injury at a minimum. In support of this value, AASH chose to design and execute a Safe Patient Handling and Mobility Program (SPHM). The program identifies and mitigates patient handling risks and injuries to the healthcare providers and patients. The SPHM program has enhanced the mobility culture of the hospital while reducing costs. Pre-program staff related patient handling injury baseline was as follows:

In fourth quarter of 2019, AASH implemented their SPHM program. A thorough safe patient handling and mobility assessment was completed providing a mobility profile for each inpatient hospital unit, identifying risk, equipment, processes and training solutions.

As the program began so did the pandemic. Due to the health crisis, a quick shift in priorities occurred and the focus on the SPHM program diminished as contending with the dire challenges associated with COVID-19 appropriately capitalized the hospital’s focus.

A review of the first year program results indicated a reduction in incidents. Further analysis indicated the organization could realize even better results. To address this, the Chief Nursing Officer called for a gap analysis to identify areas for improvement and a plan to drive success. The assessment identified the following challenges imposed by providing care in the pandemic:

• Lack of awareness of tools available for staff to utilize to assist with safely mobilizing patients
• Skills gap on how to operate the patient handling devices competently
• Attrition of safe patient handling program champions
• Staff injuries due to continued use of manual means to assist with patient mobility
• Challenges in providing SPHM training during new employee orientation during a period of increased staff turnover
• Breakdowns in initial processes designed to review, design and implement action plans to improve participation and results of SPHM program

A comprehensive approach was designed to increase awareness, identify clear accountabilities and ensure the SPHM program was in the forefront of employees’ and managers’ attention.

The plan included the following:

SPHM kick-off

In April 2021, the SPHM Program kicked-off to re-energize team members of our purpose of keeping both patients and staff safe. An interactive dashboard was created that provided injury data per unit to bring awareness to challenge and logo placed on silicon wrist bands reading “one lift at a time with a speed limit of 35 lbs (based on guidelines of the National Institute of Occupational Safety and Health), were provided to all staff during a celebratory roll out event. Hospital leadership took their SPHM devices on a “road show” to each unit showcasing how it will aid in efficient, effective and safe care for patients.

Establish SPHM as standing agenda item in key meetings

A team charter with short-term and long-term goals was developed. The charter identifies the key stakeholders to participate in monthly SPHM meetings. The Chief Nursing Officer was present at these meetings and asked questions pertaining to action plans, challenges and successes in creating a safe environment for moving patients for both those providing and receiving care.

The safe patient handling program became part of the annual Falls Festival. During this event, use of safe patient handling devices was included as a means to help mitigate risks injuries associated with patient falls. Case scenarios were presented with a focus on extrinsic and intrinsic causes for falls with highlight on the use of key patient handling devices that can aid in the reduction of fall risk.

Initiate more robust team member injury investigation

A more structured, vigorous, and timely investigation process was initiated. Those involved in the incident were interviewed within 72-hours of incident report. A greater focus on root causes was explored. Inquiry ranged from caregiver knowledge and participation in mandatory training and potential breakdown in processes. Breakdown in process would trigger follow-up to ensure the supporting systems were functioning. Staff involved in the incident whether injured or considered a near miss would be re-trained and asked to complete an acknowledgement form. The acknowledgement form gained commitment to use of equipment and reviewed the positive and actionable consequences if the minimal lift policy was not followed appropriately. Managers of the unit were also expected to complete the Acknowledgement Form.

Monthly leadership focus on SPH initiatives

As part of the initiative, Touch-Base-Tuesday meetings were initiated. In these meetings, safe patient handling leaders would review program status, share successes, review breakdowns and actions being taken to rectify any constraints.

Development of New Hire Onboarding class

Employee safe patient handling orientation was re-designed and expanded. The time allocated to being trained on the safe patient handling devices was increased to two hours and was taught by scheduled transfer mobility coaches. In addition, safe patient handling refresher courses were provided to those who were involved in an incident, whether an injury was sustained or not.

Redefining the process for room readiness

This ensured that the appropriate soft goods (i.e., Maxislides™, etc.) were available in all patient rooms. In addition, a Super User/Transfer Mobility Coach™ Rounding tool was created. With this tool, a snap shot of unit safe patient handling readiness could be evaluated (i.e., safe patient handling devices have charge batteries, white board communicate patient mobility needs, par levels for safe patient handling soft goods accessible and maintained, etc.). The results of these audits would be reviewed in meetings.

In addition, to aid in ensuring more thorough safe patient handling device use, the Emergency Department was identified as a starting point for patient handling device use. All patients arriving at the Emergency Department requiring assistance with lateral transfers or repositioning were issued a set of Maxislides. These Maxislides would arrive with the patient when admitted to a unit that was to provide care for the patient.

Champion and focused intervention

Increased pre-site visit planning was completed jointly with the MOVE Clinical Consultant and Sherman Hospital Safe Patient Handling Champion.

Results

These interventions proved highly successful resulting in the following results and lessons learned:

The results of their work has resulted in the following phenomenal results associated to injuries to staff associated with patient handling:

• 87.6% reduction in their worker compensation cost
  • The 5-year pre-program worker compensation baseline associated to costs due to patient handling injuries to staff was: $171,080
  • After the re-launch of the SPHM program, the worker compensation costs were reduced to a two year average of $21,196
• The frequency of injuries decreased over the past 2 years of the program revealing:
  • A total reduction in frequency of injuries (those compliant and noncompliant with program) of 55.8%
  • A total reduction with the Arjo MOVE guarantee (those compliant with program) of 98.1%

The journey towards excellence has not stopped. The SPHM committee plans to continue to focus on ensuring a safe environment for both the caregivers and patients at AASH ensuring both are safe during transfers. In addition, the SPHM committee will begin to expand mobility initiative to aid in the improvement of identifying and reducing the risks associated with pressure injury, falls and other mobility outcomes.

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