Healthcare workers’ awareness of patient safety issues with respect to patient handling within a long-term care facility

Abstract

Purpose The purpose of the study was to evaluate the awareness of Health Care Workers (HCWs) of patient safety risks while handling patients within a Long-Term Care facility (LTC). In addition to the evaluation of such risks during patient handling procedures, the author gained an insight into the HCWs’ and patients’ perspectives of the handling experience. The information gathered was used to make recommendations for addressing HCW awareness. Aim The aim of the study was to evaluate HCWs’ awareness of patient handling techniques and to identify any gaps and issues impacting patient safety. Methodology An inductive, cross sectional approach was adopted. The study was carried out in a LTC facility in Malta. The methods used were observation of fifteen patient transfers, semi-structured interviews with the lead HCWs and the patients involved in each transfer and the researcher keeping a reflective diary. Triangulation of data collected using different data collection methods and tools. The observation data was recorded and graded using the DINO risk assessment tool and the Handling of People (HOP6) guideline. Five types of transfers were observed, these were hoisted, sit-to-stand and shifting up in bed. Results The DINO scores ranged from six to sixteen out of a maximum score of sixteen. Shifting up in bed was graded lower for both the DINO and the HOP6 guideline. Comparison of the DINO scores for the different factors across the fifteen transfersshowed that there was a consistent lack of communication and interaction with patients and encouragement of patient participation and co-operation. Triangulation of the observation and the interview data showed that HCWs made compromises during day to day work and there was an awareness-practice gap, for example one HCW chose to transfer the patient alone instead of two HCWs to transfer a patient and not using any equipment in view of time restraints. This showed that the HCWs were not aware of the risk to patient safety resulting from these compromises. During the interviews some patients expressed a fear of falling or fear of being injured while being transferred. Conclusions In spite of being limited to fifteen transfers, the study showed a number of issues and gaps in the awareness of HCWs in relation to patient handling techniques. Triangulation of data enabled identification of an awareness-practice gap that was also reported in the literature. The study identified gaps where improvements were needed for safe practice. A recommendation from this study was to consolidate the items from the DINO tool and HOP6 guideline, to be used for training and for standard operating procedures (SOPs). Other recommendations for improvement of patient handling included training and the need to ensure adequate staffing levels and standardisation of equipment. Moreover, factors affecting communication and interaction with patients such as the language barrier needed to be addressed.