Evaluation and benefits of ergonomically designed IV poles

Transcription

1 Evaluation and benefits of ergonomically designed IV poles Donna Murczek, Lakeridge Health Michael Holmes, University of Ontario Institute of Technology Notion Medical Inc. Session: Health and Safety Professionals

2 Why develop a new Ergonomic IV Pole? Injuries and Safety Concerns Feb 2006 safety concerns re IV pole tipping when pumps installed and/or during transport June 2006 return to work committee meeting with ONA concern raised about heavy (3L) IV bags October 2007 Manager of surgical unit please teach nurses correct body mechanics to avoid injury when hanging heavy 3L bags March nurse injured while attaching infusion pump to IV pole Feb 2009 Disability manager request assistance with RTW to review safe practices with (3L) IV bags May 2010 JOHSC request ergonomic review of IV poles 2

3 WSIB /NEER COSTS Incident Date ATTACH INFUSION PUMP TRANSPORT with Bed/Stretcher HANGING IV BAGS TIPPING IV POLES GRAND TOTAL , , , , , , , , , , , , Grand Total 10, , , ,

4 Oct 20, 2010 Thank you for meeting with us yesterday. The two visits we have had with you at Lakeridge Health has been very instrumental in identifying the issues that nurses and healthcare workers are faced with everyday. After yesterdays discussions we believe that we will create a new standard in such a simple thing as an IV pole. Regards: Notion Medical Team 4

5 Lakeridge Health Elevate: Ready for trial May

6 Partnership - May

7 The Neuromechanics and Ergonomics Laboratory Occupational Biomechanics considers the physical interactions of the worker with the job demands Goal is to quantify loads acting on the body Minimize injury risk, maximize productivity Risk Factors for Injury (the big three): Non-neutral postures High force High repetition 7

8 IV Poles Very little (no?) research! Injury risk due to patient handling has been well documented (Holmes et al., 2010; Hodder et al., 2010) Nurses are expected to move patients quickly as part of a fast-paced work environment The Canadian Nurses Association and the Registered Nurses Association of Ontario have advocated that action is needed immediately to address a nursing shortage, high rates of absenteeism and high injury rates Medical pumps and monitoring devices are bigger and more cumbersome IV pole design have not kept pace (Streamline, 2014) 8

9 Changing IV Bags Cornell University, 2003 REBA Evaluation (Hignett & McAtamney, 2000) Rapid Entire Body Assessment Used to convert whole-body kinematics into quantitative data scores Scores can be compared to and associated with predetermined injury risk 9

10 REBA 10

11 Changing IV Bags REBA Evaluation (Cornell University, 2003, unpublished) Action level 3 = Change may be needed Abdalla et al., 2014 REBA analysis demonstrated a level of high Average score of 8 Limitations to REBA: Only a screen shot in time, you have to guess the worst posture Subjective Limited bins Unilateral analysis Loose clothing/camera angles 11

12 Our Approach Purpose: To determining if using the Lakeridge Health Elevate IV pole (LHE) will lower the physical demands placed on the upper extremity when compared to a traditional IV pole (IVP) 12

13 Simple measure of stability How much force is required to tip the pole? LHE 32 N 3.26 kg 7.2 lbs IVP 8 N 0.82 kg 1.8 lbs Measured with a force transducer 50 inches 13

14 Biomechanics/Ergonomics Study (methods) 7 right handed participants (study is ongoing, more currently being recruited) 5 females (22.8 ± 1.2 years, 66.3 ± 15 kg, 165 ± 6.0 cm) 2 males (22.3 ± 0.7 years, 86.5 ± 12.0 kg, 173 ± 3.5 cm) Ethics approval from the UOIT research ethics board 14

15 Methods 2 IV poles: Lakeridge Health IV Pole (LHE) Traditional IV Pole (IVP) 4 conditions: Load IV bag (3000 ml) onto LHE Load IV bad onto traditional IVP Place pump on the LHE Place pump on the traditional IVP Distance and conditions were standardized for each subject 15

16 Methods 4 conditions: Load (unload) IV bag onto LHE Load (unload) IV bag onto traditional IVP Place (remove) pump on the LHE Place (remove) pump on the traditional IVP Participants lowered the traditional pole before placing the bag (this is probably not done in practice?) Load and unload instruction was to move at a comfortable (self-selected pace) 16

17 Time required to complete task Mean ± SD for all subjects to complete each task LHE IV bag sec ± 6.08 IVP sec ± 9.3 Difference sec Pump sec ± sec ± sec 17

18 Methods - EMG Electro myo - graphy Electrical Activity Muscle Graph Electrical activity from a muscle can be related to: Physical exertion Joint loading Fatigue Overall physical demands Keep in mind that less activity is better in this case! 18

19 Methods Muscle activity measured bilaterally from 6 muscles Standard EMG electrode preparation and processing Each signal normalized to a maximal voluntary contraction (%MVC) and expressed as a % of the persons maximum Delsys Trigno Wireless EMG system (Boston, MA) EMG Placement Biceps Brachii (BB) Medial Head Triceps Brachii (TB) Anterior Deltoid (AD) Posterior Deltoid (PD) Upper Trapezius (UP) Cervical Extensor (CE) 19

20 Methods 3D kinematics of the upper extremity Measured using a 3D motion capture system (NDI, Waterloo, ON) Head Trunk Upper and lower arms Hands Movements, postures, joint angles calculated Non-neutral postures can lead to injury Extreme postures should be avoided 20

21 Results Average EMG IV Bag Placement Muscle Activity (%MVC) IVP LHE 0 R BB L BB R TB L TB R AD L AD R PD L PD R UP L UP R CE L CE Muscles 21

22 Results Average EMG IV Bag Placement 60 IVP 50 LHE Muscle Activity (%MVC) % 41% 18% 20% 10 0 R AD L AD R PD L PD R UP L UP Muscles 22

23 Results Average EMG Pump Attachment Muscle Activity (%MVC) IVP LHE 0 R BB L BB R TB L TB R AD L AD R PD L PD R UP L UP R CE L CE Muscles 23

24 Results Muscle Activity EMG mean is just one aspect of this We are also exploring: Maximum (Peak) EMG Other measures of total muscle activity (integrals) To be determined 24

25 Results - Kinematics 25

26 26

27 Results - Kinematics Joint angles, velocities, accelerations for: Neck, shoulders, elbow, wrist and trunk Preliminary data appears to support Reduced shoulder flexion and abduction More neutral head/neck postures Less neck flexion 27

28 Summary/Discussion The LHE appears to: Be very stable Significantly reduce the time required to load an IV bag and pump Reduce activity of muscles that are most commonly injured Some muscles by over 40% Improve postures during the tasks The cumulative effects of the lower muscle activity and improved postures could significantly reduce the risk of injury 28

29 Summary/Discussion Stability is an important feature because it is directly related to patient safety Ergonomics is an important feature in relation to nurse safety Results indicate reduced physical (muscle) demands Improved postures 29

30 Thank you! Questions!? THE NEUROMECHANICS AND ERGONOMICS LABORATORY Michael W.R. Holmes, PhD Assistant Professor Kinesiology Faculty of Health Sciences University of Ontario Institute of Technology 2000 Simcoe St. North, Oshawa, ON, L1H 7K4 Office: UAB 347 Phone: x6584 Fax: