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Guidelines for moving and handling people: Do they improve practice?
1. Guidelines for moving and
handling people:
Do they improve practice?
David R. Thomas Yoke Leng Thomas
Emeritus ResearchWorks NZ
Professor, University of
Auckland
dr.thomas@auckland.ac.nz
3. History of NZ Guidelines
1st version published in 2003 by ACC - 5 years
to complete
2nd version published March 2012 by ACC
24 month review process
Expert panel to guide development
Survey of 50 users of 2003 Guidelines
Draft version circulated for public comment
Multiple submissions or comments on draft
Formation of M&H Association of NZ – 2011?
4. Examples of Guidelines: Other
countries
UK – HOP6 (Handling of People v6, 2011)
Australia
Qld Health: Think Smart Patient Handling Better Practice
Guidelines 2010
Workcover NSW: Manual handling guide for nurses 2005
Worksafe Vic: Transferring people safely 2009
Canada
OSHA, BC: Safe Patient & Resident Handling 2000
Worksafe BC: Handle With Care: Patient Handling and the
Application of Ergonomics (MSI) Requirements 2006
USA - CDC Safe lifting and movement of nursing home
residents 2006
5. Why ACC funds Guidelines
ACC work-related entitlement claims for
employees in health services around $8
million pa
ACC injury prevention initiatives to reduce
injuries and their costs
Multiple workplace health and safety initiatives
– ACC & Department of Labour
The DPI (discomfort pain and injury)
framework used by ACC to address gradual
onset injuries, especially in workplaces
6. Questions regarding guidelines
effectiveness
1. What evidence is available about the impacts
of guidelines on practice?
2. What attributes of guidelines make them
more or less effective for specific audiences?
3. What organisational processes or procedures
facilitate or impede the use of guidelines in
everyday practice?
7. Types of guides and protocols
General guidelines (broad and extensive) covering a broad
area or set of topics in health and safety
Moving and handling guidelines to prevent injuries
Targeted guidelines for specific health problems or events
Preventing ladder injuries
Guidelines for treating depression
Guidelines for mild head injuries
Detailed protocols (brief & focused) for specific clinical
practice
Algorithms for specific movements when moving and
handling people
8. Review of literature: Impacts of
guidelines
Three frameworks or perspectives relevant:
Clinical trials framework favouring RCTs and
experimental trials, excluding non-experimental studies
(systematic reviews)
Evaluation framework using multiple types of evidence
for assessing effectiveness
Descriptive accounts based on interviews with
practitioners
No clinical trials or similar studies found for general
guidelines
Some experimental trials/RCT studies for clinical
protocols
Several commentaries on clinical guidelines and
protocols
Developing literature on evidence-based clinical
10. Algorithms for patient handling and
movement: Nelson et al 2003, 2006
Algorithms - Standardized processes for decisions
about equipment & number of staff to perform high-risk
activities safely (Nelson et al 2003)
Intervention included 6 program elements: (1)
Ergonomic Assessment Protocol, (2) Patient Handling
Assessment Criteria and Decision Algorithms, (3) Peer
Leader role (Back Injury Resource Nurses), (4) State-
of-the-art equipment, (5) After Action Reviews, (6) No
Lift Policy
The program elements resulted in a statistically
significant decrease in the rate of musculoskeletal
injuries as well as the number of modified duty days
12. Example: Cochrane review of printed
education materials (PEM) on clinical
practice
We did not locate any studies comparing
multifaceted interventions that included PEMs with
multifaceted interventions. Yet during our literature
search, we retrieved 82 studies that compared the
effects of PEMs with one or more interventions that
included PEMs. … [There are] difficulties in
separating the effects of PEMs when combined with
other interventions. …. some studies used PEMs
alongside other interventions for investigating
additive effects of interventions …. Future
intervention studies examining the effect of PEMs
should consider the impact of educational materials
13. Purposes of general guidelines
Improve knowledge about topic
Provide rationale for specific health and safety
practices (e.g. reduction of injuries)
Provide health and safety information for
managers
Describe specific techniques and procedures
for practitioners
14. Survey of users of NZPHG 2003
Survey of 50 users in 2010 - included M & H
coordinators, trainers and physiotherapists
Most used sections were: techniques (72%), risk
assessment (30%) and equipment (30%)
15/50 (30%) used external trainers
Some of the changes recommended
Remove 16kg limit
Simplify forms and audit tools
Clarify who are audiences for each section
More information about training
15. Context for M & H in NZ
Practitioners and trainers often hold strong
views about best practice for M & H people
Most views are consistent
Some conflicting views
Revised version of the Guidelines
endeavoured to take into account both
emerging consensus on best practice and
conflicting views, for example…
using brakes on mobile hoists
exclusion of unsafe techniques
16. Factors affecting clinicians’ compliance
with evidence-based guidelines (Gurses
2010)
1. Relative advantage: Is complying with the
guideline superior to not complying with it in
terms of its effectiveness and cost-
effectiveness?
2. Compatibility: Is the guideline consistent with
practitioners’ values, norms, and perceived
needs?
3. Complexity: How easy is it to integrate the
guideline into the current work practice?
4. Trialability: Can the practitioner test or try this
guideline with relative ease?
5. Observability: Can the practitioner observe
others that have incorporated the new guideline
17. Framework for assessing impacts
of M & H guidelines - 1
Regulatory Senior Management
environment Establish policy & programme
(DoL, ACC) Provide resources
Moving and Health and Safety Staff
Handling M & H Coordinators
Guidelines Operate M & H programmes
Organise training
Audit M & H practices
Outcomes
Reduced injuries, Carers
absenteeism and staff Training, risk assessment,
turnover techniques. use of equipment
18. Framework for assessing impacts
of M & H guidelines - 2
1. Features of Guidelines docs and resources
2. Health and safety regulatory environment in
NZ (e.g., legislation, compliance
requirements, resource
development, incentives)
3. Cultures in healthcare organizations
(e.g., DHBs, private providers)
4. Characteristics of practitioners (e.g., health &
safety awareness, professional
associations, union support)
19. Features of guidelines:
Presentation and writing styles
Multiple styles evident in existing guidelines and
manuals (UK, Australia, Canada, USA)
Move to pictorial styles (photos) to accompany
specific aspects (e.g., techniques, equipment)
Writing styles include; instructional/prescriptive,
technical/ academic and descriptive.
NZ Guidelines (2012) reduced instructional text
(compared to 2003) and used more descriptive
and technical text. Includes more photos, tables,
bullet points and examples (side boxes)
20. Enhancing guidelines use and
impacts
Target audiences identified
Awareness of guidelines – professional
associations, government agencies, health &
safety staff
Access to guidelines
Print, online & DVD docs (pdf), video of techniques
(DVD)
Print friendly format for electronic pdfs
Readability – multiple styles, multimedia versions
of key messages
Useability – can contents (techniques and
procedures) be easily used by practitioners and
21. Conclusions 1 – Key points
Extensive publication of guidelines for moving
and handling people in developed countries
Few studies on effectiveness of guidelines –
research on guideline effectiveness appears to be
a low priority
Impacts of guidelines likely to be similar to other
injury prevention/clinical practice initiatives
Readability and useability of guidelines likely to
be important
Need for research on enhancing influence of
guidelines on M & H practices
22. Conclusions 2 - Do Guidelines
improve practice?
Absence of evidence about effectiveness does not
mean absence of effectiveness
Guidelines probably do improve practice:
By providing information about specific
techniques and other resources
By providing a set of standards for moving and
handling people
Over time, through setting an agenda and context
for health and safety in moving and handling
people
23. References
Farmer, A. P., Légaré, F., et al. (2008). Printed educational
materials: effects on professional practice and health care
outcomes. Cochrane Database of Systematic Reviews, Issue 3.
Art. No.: CD004398 doi:10.1002/14651858.CD004398.pub2
Gurses, A. P., Marsteller, J. A., et al. (2010). Using an
interdisciplinary approach to identify factors that affect clinicians’
compliance with evidence-based guidelines. Critical Care
Medicine, 36(8 (suppl)), S282-S291.
doi:10.1097/CCM.0b013e3181e69e02
Nelson, A. , Owen, B., et al. (2003). Safe patient handling and
movement. American Journal of Nursing, 103(3), 32-43.
Nelson, A., Matz, M., et al. (2006). Development and evaluation
of a multifaceted ergonomics program to prevent injuries
associated with patient handling tasks. International Journal of
Nursing Studies, 43(6), 717-733.
Notes de l'éditeur
Many government agencies have produced manuals or guidelines for moving and handling people as part of initiatives to reduce injuries to carers. Given the increasing number of specialised guidelines appearing, it is timely to assess the evidence about the impacts that guidelines might have on moving and handling practices and injuries among healthcare staff. While there is some evidence of positive impacts from clinical practice guidelines on patient outcomes, there appears to be little information on the impacts of moving and handling guidelines. This presentation considers possible causal links between use of moving and handling guidelines and the reduction of negative impacts among carers. It covers the purposes of guidelines, primary audiences, writing and presentation styles and the uses of guidelines reported by practitioners. The session will draw on the presenters’ involvement as members of an ACC panel, which produced Moving and Handling PeopleSee refs in folderGuidelines impacts docs