Advances in OR Safe Patient Handling on the Horizon

It’s estimated that almost half of all nonfatal occupational injuries experienced by perioperative nurses are musculoskeletal and more than a quarter of these are back injuries, according to 2017 data from the Bureau of Labor Statistics.

“We do a lot of lifting and pulling and we are noticing that a dedicated focus to address potential injuries and risks from these activities has been neglected,” notes Lisa Warner, MHA, RN, CNOR, acting OR nurse manager at the Phoenix Veterans Affairs Healthcare System in Arizona and the Veterans Health Administration Office of Nursing Services perioperative clinical nurse advisor. 

In her national work with the VA, Warner has been working with a team of experts in safe patient handling and movement, including Mary Ogg, MSN, RN, CNOR, AORN senior perioperative practice specialist and lead author of AORN’s Safe Patient Handling and Movement Guideline.

“There is an exciting national movement working through the VA to understand what is needed in the perioperative setting to make our workplace safer,” Ogg says. “Perioperative nurse leaders need to be tuned in to the ideas and developments coming from this group so they can consider how to apply these ideas in their own settings.”

Inspiring Leaders to Act for Occupational Safety

Warner and Ogg both agree that it will require strong leadership to make changes that protect nurses from common musculoskeletal injuries in the OR, such as:

• Shoulder, back and knee injuries caused by lifting patients and heavy trays
• Falls caused by tripping on the many cords and equipment in tight OR spaces
• Back and shoulder injuries caused by pushing and pulling heavy carts, beds and stretchers

Warner, Ogg, and the team working with the VA are diving deep to understand why musculoskeletal injuries are occurring in the perioperative setting. So far, they have identified three root causes:

1. A lack of staffing—too often the minimum number of staff members required to transfer a patient or push/pull a heavy piece of equipment are not available and nurses take on the task themselves.
2. Lagging technology—the unique environments within the OR require tailor-made technologies for safe patient handling and movement that haven’t yet been developed or are very early in application.
3. Inefficient planning—preoperative assessment and team planning could be a valuable way to ensure safe staffing and have the right equipment on hand to protect teams, as well as support standardized practices to ensure team safety.

Solving these challenges is no easy task for nurse leaders, Warner cautions. “Nurse leaders may not even know what they need to protect their team and if they have ideas of what could work, it can be very challenging, if not impossible to find such technologies and then make the case for purchasing these technologies.”

Emerging Technologies on the Horizon

Early on in the VA work to identify OR needs for safe patient handling and movement, a gap analysis was conducted for high-risk tasks in perioperative care and what positioning aids could help.

The team then conducted a hands-on simulation of occupational safety products and needs in collaboration with industry partners to brainstorm what an ideal OR suite safe patient handling and movement collection of technologies and support devices would look like.

Here's what they discovered:

• Lifting devices attached to the ceiling pose challenges—Such devices likely need to be installed during new build or reconstruction and pose risks for collecting dust and risking infection control.
• OR beds provide a unique space for modification with attachments (think a Swiss Army Knife approach)—This could prevent a nurse from having to lift and install heavy positioning equipment such as heavy leg stirrups. Other table functions such as automatic lifting of patient anatomy could also prove valuable.
• OR surfaces and patient transfer devices could be more helpful—Often teams still use old technologies such as the Davis Roller to transfer patients. The team is working with industry to explore development of more functional transfer devices, as well as OR table surfaces that support safe patient transfer and also reduce the risk for patient skin and pressure injury.

Warner and Ogg hope the work of the VA will provide a model that other perioperative teams and their organizations can follow to jumpstart new and more effective approaches to safe patient handling and movement for perioperative professionals.

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