Deer Lodge Centre
Education Day
Review Package
2012
Compiled by: Project Coordinator
Information provided by:
Clinical Educator, General Educator & Physiotherapist
Revised December 14, 2011
Table of Contents
Session A and B
A. Restraints
B. Choking Victim
C. Routine Practices
D. Abuse and the Legislation
E. WHIMIS
F. Code Red-Fire Orders
G. Safe Feeding & Swallowing
Session A Only
H. Lifts and Transfers
*The contents of this package should be reviewed prior to attending an education
session
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Session A and B
A. Restraints
REGIONAL PROGRAM
Applicable to all sites and facilities where the intended WRHA program services are delivered
Policy Name: Restraints & Protective Devices in Personal Care Homes (Use of) Policy
Number 110.130.050
1.0 PURPOSE:
1.1 To promote and facilitate the safe use of restraints in Personal Care Homes in Winnipeg.
1.2 To reduce and/or discontinue the use of any methods of limiting freedom of movement in
Personal Care Homes in Winnipeg.
2.0 DEFINITIONS:
2.1 Restraint: Any restriction/reduction of voluntary movement or freedom implemented to ensure
safety of self, others or the physical environment is a restraint. All elements of
this policy are intended to apply to each category of restraint.
2.2 Physical or Mechanical Restraint: A manual or physical device that the individual
cannot remove and which restricts freedom of movement. This can include arm
restraints, hand mitts, soft ties, mobility restricting chairs (e.g. Geri-chairs, Broda chairs,
Q-foam chairs, Beanbag chairs, Recliners, etc.) that prevent rising. This also includes
chair trays, seat and lap belts, bed rails, and wheelchair safety bars (this list is not
necessarily inclusive). It is not considered a restraint where a cognitively well resident
has a front closing seat belt that they can independently remove.
2.3 Chemical Restraints:
2.3.1 A Chemical Restraint means a medication administered for the primary or
explicit purpose of reducing an individual’s functional capacity, or used to
restrict the resident’s physical, mental or psychological functioning.
2.3.2 A Psychopharmacological Drug (PPD) means any medication, which is
prescribed with the intent of changing mood, mental status or behaviour.
2.3.3 Unacceptable Use of A Psychopharmacological Drug As a Chemical Restraint:
When any of the following conditions exist, the use of a PPD as a chemical
restraint is considered unacceptable:
• The use of the medication is not necessary to ensure the health or safety of
the resident, or to improve the quality of life of the resident; or
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• The medication is administered for purposes of discipline or convenience.
2.4 Environmental Restraint: Barriers to free personal movement which serve to confine
residents to specific areas e.g. removal of a cane or walker. Isolation (e.g. restricted to
their room with the door closed) is also included in this category. For the purposes of
this policy only, wanderguard, secured units and the use of brakes on a wheelchair will
not be considered a restraint.
2.5 Emergency Restraint: The occurrence of behaviour that is of imminent danger to the
resident or others and which necessitate and lead to the use of a restraint.
2.6 Substitute Decision-Maker: A third party identified to participate in decision-making on behalf of
a person who lacks decision-making capacity concerning restraint issues. The task of the Substitute
Decision-Maker is to faithfully represent the known preferences and/or the interests of the incapable
person.
The following, in order of priority, may act as Substitute Decision-Makers:
2.6.1 A Proxy named in a Health Care Directive.
2.6.2 A Court-Appointed Committee appointed under section 75(2) of the Mental Health
Act, or a Substitute Decision-Maker for Personal Care appointed under The Vulnerable
Persons Living with a Mental Disability Act. A
Committee or Substitute Decision-Maker for Personal Care may be an
individual(s) or the Public Trustee.
2.6.3 Others, including family and/or friends. This is likely to be the most common scenario.
Such a person will usually, but not necessarily, be a close relative, who speaks for all. He or
she may, however, be a supportive friend, when family is unavailable or nonexistent. On
occasion, an existing Power of
Attorney may be most appropriate to fulfill this role, since such an individual,
although limited to property decisions, has obviously been placed in a position
of trust.
For the health care team to feel confident in identifying a Substitute Decision-Maker within
the “other” category, it will be necessary, within reason to:
a) understand relationships, dynamics, hierarchy, and values.
b) ascertain that there exists acceptance from involved family/friends in the designation of the
Substitute Decision-Maker;
3.0 POLICY:
3.1 Based on the judgment of the Interdisciplinary Team, whose composition is determined by the
personal care home, a restraint may be applied for the protection of the resident who is at high risk of
harm to self or others.
3.2 A restraint shall be used only after all other alternative means of protecting the resident and/or
others have been exhausted.
3.3 When it is necessary to use a restraint, it shall be the least restrictive possible over the
shortest period of time possible.
3.4 A restraint shall be applied in accordance with the manufacturers’ directions where
applicable.
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3.5 Ongoing regular reassessment shall occur to trigger opportunity for reduction of use of restraint.
3.6 Restraints shall not, under any circumstances, be used or prescribed:
• for punishment or discipline
• for the convenience of the staff of the Home
• as a standing order
• while the resident is on a commode or toilet
3.7 Vest restraints or strapping mechanisms, including bed sheets, shall not be used under
any circumstance.
4.0 PROCEDURE:
4.1 A statement describing the Personal Care Home’s (PCH) policy on the use of restraints must be
included in the Resident Handbook and given to the resident and/or substitute decision-maker before
or on admission to the PCH.
4.2 Staff in a personal care home may not restrict the freedom of movement of a resident,
unless the following conditions have been met:
4.2.1 The resident and/or Substitute Decision-Maker has been involved in the
assessment and decision-making process whenever possible. When this is not
possible, the reason should be documented.
4.2.2 The resident has given consent, if capable. Family members should be
included in the discussions in the case of a competent resident only if the
resident is in agreement.
4.2.3 Written or verbal consent by the Substitute Decision-Maker has been obtained if the
resident is not competent. Verbal consent must be documented, dated, and signed in the
resident health record by the person receiving the verbal
consent.
4.2.4 The use of the restraint has been deemed as necessary by appropriate members of the
Interdisciplinary Team and is consistent with the overall therapeutic goal.
4.2.5 An Interdisciplinary Team assessment has been completed and documented.
4.2.6 The staff applying the restraint has received education in the prevention, use,
monitoring and documentation of the restraint use and is familiar with the PCH’s policy
before they take part in any restraint-related activity.
4.2.7 The PCH’s continuous quality improvement or risk management program
includes a mechanism for auditing the process involved in use of restraints.
4.2.8 The use of a restraint for a resident is time limited with a reassessment date as
determined by the Interdisciplinary Team (maximum quarterly).
4.2.9 In instances of use of a psychopharmacological drug, the physician and nurse have
assessed the resident at least quarterly or more often, with a goal to
reduce or discontinue the drug.
4.2.10 Staff can easily remove any mechanical device used.
4.2.11 When a concern is identified, i.e. frequent falls, sliding down in chair/wheelchair,
falling, climbing out of bed, positioning concerns, or
behaviour endangering the resident or others, a thorough interdisciplinary team
assessment of possible underlying causes has been completed and documented,
including:
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• A description of the behaviour.
• Environment in which the behaviour occurs.
• Time of day the behaviour occurs.
• Resident’s physical issues including pain management or nutritional state,
if applicable.
• The resident’s emotional state.
• Medication review (considers and monitors drug interactions).
• Alternatives that have been tried and exhausted.
• Psychosocial issues which may impact on the resident’s behaviour. Ethical
aspects of restraining each resident (benefits versus burdens).
4.2.12 The decision to implement a restraint has been made by the Interdisciplinary Team
based on its assessment.
4.2.13 At the request of the Interdisciplinary Team, an order for the use of a restraint has been
given.
• The order must be in writing on the resident’s health record with a
signature and designation.
• The resident’s physician or the responsible nurse (RN/RPN/LPN) may give
the order.
In the case of a PPD, it must be ordered by a prescriber.
4.2.14 The initial order must include the type of restraint to be used, the frequency of
monitoring checks to be done, and the reassessment date.
4.3 Documentation in the resident health record must include:
• The reason for the restraint.
• The assessment for the use of a restraint.
• Interventions and other methods tried to resolve the identified problem, before the restraint
is applied.
• A statement that identifies the benefits to the resident of using a restraint compared to the
burden of using a restraint. (The resident needs to achieve/maintain independence and selfcontrol in a dignified manner, while satisfying their need for safety and protection from
harm).
• The discussion with the resident/substitute decision-maker regarding the four points above
and the plan of care; example: (1) length of time the restraint will be used prior to
reassessment; (2) conditions under which the restraint is to be applied; and (3) the frequency
of monitoring checks while the restraint is applied.
• The written or verbal consent given by the resident/substitute decision-maker.
• The monitoring of the comfort and safety needs of the resident.
• The resident’s response to the use of the restraint.
• The reassessments completed at regular intervals (at minimum, quarterly and annual
resident care reviews) for evaluation of effectiveness, continued use or
discontinuation.
• The plan of care specific to the use of the restraint in the resident’s care plan.
4.4 An individualized plan of care, that deals with the use of a restraint and meets the
unique and specific needs of the resident, must be developed. The care plan should be
based on principles of best practice and include the following information:
• Name and designation of person initiating the plan of care.
• The type of restraint and method of application if mechanical.
• The reason for the use of the restraint.
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• The length of time the restraint is to be used for the resident. (examples: continuously,
intermittently, or when necessary based on set criteria).
• The frequency of monitoring checks based on the resident’s individual assessment of
need, the restraint being used, and the reason for the restraint.
• The care to be provided and monitoring checks to be done, based on assessment and
including change in level of consciousness, prevention of physical injury,
observation for skin breakdown, circulatory impairment, confinement anxiety,
confusion, positioning, active and/or passive exercise, offer of food and/or fluids,
reassurance, toileting etc. Documentation should be completed by the person
providing the care and/or completing the monitoring checks.
• The efforts to resolve the issue for which the restraint was initiated.
• The strategies to promote the return of independence and self-control.
4.5 The plan of care to be provided must be communicated to all care provider(s) in writing
and be easily accessible.
4.6 The need for reassessment for the continued use of the restraint must be done at a
specified time, at minimum quarterly and yearly reviews, or as indicated in the
individual plan of care. The continued use must be discussed thoroughly at the annual
interdisciplinary resident conference. The reassessment should include the following
information:
• Date of the reassessment.
• Name and designation of the persons completing the reassessment.
• An assessment of the need for continued use of the restraint.
• Changes to the plan of care.
• The resident’s response to the use of the restraint, including any side effects.
4.7 Emergency Use Of A Restraint:
4.7.1 A restraint may be applied in an emergency situation, when, in the judgment of a
RN/RPN/LPN or physician, a restraint is necessary for the protection of a resident who is at
high risk for harm to self or others.
4.7.2 A restraint applied in an emergency situation must meet the following criteria:
• The restraint must be the minimum necessary.
• The restraint must be a measure of last resort to protect the safety of the
resident or others and must not extend beyond the immediate episode.
• The Interdisciplinary Team must reassess the need for a restraint within 24
hours or as soon as reasonably possible after the onset of application of the
restraint.
• If continued use of the restraint is to occur, a full assessment as described
in this policy must be completed.
4.7.3 If a resident’s unanticipated violent or aggressive behaviour places him/her or others in
imminent danger, the resident/substitute decision-maker does not
have the right to refuse the use of a restraint. When a restraint is applied in an
emergency, the resident/family/substitute decision-maker must be notified as
soon as possible or at least within 24 hours. Appropriate consent should be
pursued as quickly as possible.
4.7.4 Emergency use of a psychopharmacological drug will not occur unless:
• A qualified health professional verifies that the behaviour is due to, or is
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likely to be due to, delirium, dementia or mental illness, and
• The symptoms do not appear to result from a readily correctable cause, or
assessment of the underlying cause is impossible until the behaviour
symptoms are temporarily managed while an evaluation is undertaken.
4.7.5 Duration of emergency use of a psychopharmacological drug:
• Cannot exceed 24 hours, and
• Cannot occur unless the resident is monitored closely to ensure that any
adverse drug reactions would be recognized and appropriate action taken
as soon as possible.
4.7.6 In the case of the need for emergency restraint, any type, the documentation
must include:
• A full description of the reason for the restraint and the events leading up
to the need for a restraint.
• The name and designation of the person ordering the restraint.
• The time the restraint was applied and the frequency of monitoring checks
to be done.
• The care provided during the course of the use of the restraint.
• Notification of the resident’s family/substitute decision-maker.
• When the reassessment is to occur.
5.0 REFERENCES:
5.1 American Society of Consultant Pharmacists (ASCP) and American Geriatrics Society (AGS)
comments to HCFA Draft Chemical Restraint Guidelines. (2001).
5.2 Manitoba Health (2002). Policy: Restraints in Personal Care Homes – Resident Safety. Approved
December 5, 2002. Health Accountability Policy and Planning, Seniors and Persons with Disabilities.
Policy Contact: Gina Trinidad, Executive Director, WRHA PCH Program
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B. Choking Victim
Relief of Choking Victims 1 Year of Age and Older
Early recognition of airway obstruction is the key to successful outcome. It is
important to distinguish this emergency from fainting, stroke, heart attack, seizure, drug
overdose, or other conditions that cause sudden respiratory failure but require different
treatment. The trained observer can often detect signs of choking.
Foreign bodies may cause either mild or severe airway obstruction.
Mild Airway Obstruction
Signs:
ƒ Good air exchange
ƒ Responsive and can cough forcefully
ƒ May wheeze between coughs
Rescuer actions:
ƒ As long as good air exchange continues, encourage the victim to continue
spontaneous coughing and breathing efforts.
ƒ Do not interfere with the victim’s own attempts to expel the foreign body, but stay
with the victim and monitor his/her condition.
ƒ If mild airway obstruction persists, activate the emergency response system.
Severe Airway Obstruction
Signs:
ƒ Poor or no air exchange
ƒ Weak, ineffective cough or no cough at all
ƒ High-pitched noise while inhaling or no noise at all
ƒ Increased respiratory difficulty
ƒ Possible cyanosis (turning blue)
ƒ Unable to speak
ƒ Clutching the neck with the thumb and fingers, making the universal choking sign
ƒ Unable to move air
Rescuer actions:
ƒ Ask the victim if he or she is choking. If the victim nods yes and cannot talk, severe
airway obstruction is present and you must activate the emergency response system
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* Universal Choking Sign
Caution:
Pregnant and Obese Victims
If the victim is pregnant or obese, perform chest thrusts instead of abdominal thrusts.
Use abdominal thrusts (the Heimlich maneuver) to relieve choking in adults and children
over 1 year of age. Do not use abdominal thrusts to relieve choking in infants. Give each
individual thrust with the intent of relieving the obstruction. It may be necessary to repeat
the thrust several times to clear the airway.
Fact: Abdominal thrusts may cause complications, such as damage to internal organs. A
victim who has received abdominal thrusts should be examined by a healthcare provider to
rule out any life-threatening complications.
Follow these steps to perform abdominal thrust on a responsive adult or child who is
standing or sitting:
1. Stand or kneel behind the victim and wrap your arms around the victim’s waist.
2. Make a fist with one hand.
3. Place the thumb side of your fist against the victim’s abdomen, in the mid-line,
slightly above the navel and well below the breastbone.
4. Grasp your fist with your other hand and press your fist into the victim’s abdomen
with a quick upward thrust.
5. Repeat thrusts until the object is expelled from the airway or the victim becomes
unresponsive.
6. Give each new thrust with a separate, distinct movement to relieve the obstruction.
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C. Routine Practices
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Routine Practices – What Are They?
Routine Practices are the basic precautions for preventing infection in any healthcare
setting, including hospitals or other acute care facilities, personal care homes and the
community, including clinics and clients’ homes.
Routine Practices recognizes germs are always present and can be transferred from one
person to another either directly or indirectly.
Routine Practices – Why Are They Important?
Routine Practices prevent transmission of germs among patients/clients/residents and
healthcare workers. Consistently following Routine Practices reduces the risk of
transmission.
Routine Practices (developed
How Do Infectious Agents Spread?
Infectious agents spread from a reservoir out of a portal of exit through various
means of transmission. They gain access through a portal of entry to a
susceptible host where colonization or infections occur. This sequence is called the
Chain of Infection. The links in the chain of infection are:
Infectious agent - A germ able to cause infection e.g. bacteria, fungi, viruses,
parasites
Reservoir - The place where infectious agents live or grow e.g. people, animals and
objects
Portal of Exit - The way the infectious agent leaves the reservoir e.g. sneezing,
wound discharge, bowel movements
Means of Transmission - The way the infectious agent is spread from one place to
another e.g. direct contact, indirect contact, droplet, airborne, common vehicle and
vector-borne.
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Portal of Entry - The way the infectious agent gets into a person, animal or object
e.g. breaks in the skin, breathing
Susceptible Host - Anyone who is not immune to the infectious agent.
Hand hygiene is the most effective way to prevent the spread of infection!
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ICEBERG ANALOGY
For Patients with Infectious Diseases
Routine Practices are the foundation for preventing transmission of infections in all
healthcare settings.
Using the above Iceberg Analogy, it is easy to see why it is often difficult to determine
when a patient has an infectious disease
.
Only 10% of an iceberg can be seen from a ship but the 90% below the water
level can cause even more damage to the ship!
The Iceberg Analogy reinforces why the use of Routine Practices is essential for contact
with all patients.
All patients are treated as if they were infectious each and every time contact occurs. In
this way, even if a patient who has an infectious disease has not been identified, the use
of Routine Practices will prevent the spread of the infection.
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Hand hygiene is also performed:
Before and after shifts and breaks.
Prior to eating food.
After using the bathroom.
After touching mucous membranes/using a tissue.
When you think that your hands may be soiled.
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Key Points About Hand Hygiene – Hand Washing
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Quick Check - Using Alcohol-based Hand Rubs
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Personal Protective Equipment (PPE) includes gowns, gloves, masks and face
protection.
PPE requirements vary depending on the clinical situation and the type of interaction
required with the patient, client or resident.
The choice of which PPE to use is based on an assessment of risk:
o The probability and amount of exposure to contamination and;
o The probable route of transmission of an infectious agent.
Key Points on Gowns:
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BED-SIDE POST MORTEM CARE
Appropriate PPE is used to prevent exposure to blood and body fluids.
Hand hygiene is performed before applying and after removing PPE.
PPE is removed immediately after performing tasks associated with postmortem
care.
Eye protection and masks are not routinely required unless there is a risk that activities are likely to
generate splashes, sprays, or aerosolations of body
fluids, secretions or excretions.
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Environmental surfaces that become contaminated during post-mortem care
(in patient room or morgue) are to be cleaned with a facility-approved
disinfectant.
Visitors and/or family viewing a deceased patient, client or resident shall
follow Routine Practices as instructed and demonstrated by the healthcare worker
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Site Specific Information
Contact Precautions at DLC are followed differently from the PCH Infection Prevention and Control
Manual in some situations and are due to the mixed patient/resident population. These differences
balance the risk of transmission while maintaining quality of life, and are explained in this document.
1. Antibiotic Resistant Organisms eg: MRSA, VRE, ESBL
Admission Swabs for VRE and MRSA are done on all admissions to DLC (see exception below) and must be taken
within 48 hours of admission
VRE
Known Positive
Notify ICP (via email or voicemail) on day of admission
Place on contact precautions and ensure chain of
transmission is broken prior to leaving the room (see next
page)
No admission swabs for VRE required
MRSA swabs of open wounds, lines and nares are still
required
Status Unknown
VRE swab
If swabs return positive notify ICP(via email
or voicemail) ASAP
MRSA swabs of open wounds, lines and nares
MRSA
Known Positive
Notify ICP (via email or voicemail) on day of admission
Place on contact precautions and ensure chain of
transmission is broken prior to leaving the room (see next
page)
If no antibiotics in the last 48 hours swab nares, all open
wounds and lines
If these results come back negative a message (via email or
voicemail) must be left for ICP and this can be considered as
the first negative in your set of 3 negative swabs need to
discontinue isolation
Reminder: consultation must be made with ICP prior to any
resident being taken off of isolation (ie: after 3 negative
weekly swabs)
Reminder: In cases where an individual is known positive
for MRSA and has been on antibiotics we must wait 48
hours after last dose of antibiotics in order to receive
accurate lab results on their MRSA status.
VRE swabs required
Status Unknown
MRSA swabs of open wounds, lines and nares
If admitted on antibiotics take swab within 48
hours and mark on the lab requisition any
antibiotics they have been on in the last 48
hours
If swabs return positive notify ICP (via email
or voicemail) ASAP
VRE swabs required
ESBL
Known Positive
Notify ICP (via email or voicemail) on day of admission
Place on contact precautions and ensure chain of
transmission is broken prior to leaving the room
MRSA swabs of open wounds, lines and nares
VRE swabs required
NOTES
Status Unknown
No admission swabs for ESBL required
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 Remember this is a critical piece in order for Infection Control to keep track of how many people
acquire an ARO within our facility
 If swabs are not taken within the 48 hours we cannot identify whether the individual acquired the
organism in our facility or had it prior to admission
Education
• Staff must provide Patient/ Resident and families with information on ARO’s including fact
sheet on specific ARO and the general “Patient/Resident on precautions due to ARO” and
the same should be documented in the IPN.
• All visitors visiting patients/residents with ARO must wear required PPE while in the
patient/resident room. Staff should provide education to visitors on how to don and doff the
PPE required.
2. Shingles (not disseminated):
• Suspected or confirmed should be placed on contact precautions until shingles is ruled out or until all
lesions are crusted and dried
• These patients can leave there room once the chain of transmission has been broken and the area with
lesions is covered with a dressing that can contain any discharge
Breaking the chain of transmission: Patients/Residents on contact precautions who are allowed to
leave their rooms to participate in activities can do so as long as hand hygiene has been preformed,
clothes must be visibly clean, transport medium (e.g., wheelchair, scooter, walker) must be cleaned and
disinfected (high touch areas), and these must be maintained as such. This is known as breaking the chain
of infection. For those with cognitive deficits and/or behavioral issues, the ICP should be consulted
3. Gastroenteritis:
Definition: 2 or more loose or watery stools above what is the normal for the patient/resident within
24 hour period
• Should be placed on contact precautions. If C-Difficile is suspected or confirmed write on the
contact precautions sign that ABHR should not be used
• Leave a voicemail for infection control to notify them of the precaution being implemented
• The patient/resident cannot be removed from precautions without consulting with the ICP
• Patient/Resident should remain in their room
4. Clinics, off-unit patient/resident care areas, and departments that function as both inpatient and
outpatient (e.g., PT/OT, SLP, X-ray)
• Use Routine Practices unless the Infection Control Practitioner or designate deems that Routine
Practices are insufficient to control transmission in these settings (e.g., scabies). Contact Infection
Prevention and Control for direction when these situations arise.
Note: MRSA, VRE, and ESBL can be effectively managed with diligent attention to Routine Practices
in clinics, off-unit patient/residents care areas, and inpatient/outpatient departments.
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D. Abuse and the Legislation
2011 Review
Protection for Persons in Care Act,
WRHA policy: Abuse (Reporting of) #80.00.010
Introduction
In Manitoba, it is everyone’s legal obligation to protect adults in health care facilities as outlined in
The Protection for Persons in Care Act (PPCA), even if the information about that person is
confidential. If you have any information that leads you to believe that an adult in a health care
facility is or is likely to be abused, you must report it to the Protection for Persons in Care Office
(PPCO).
The law protects all those who report alleged or actual abuse in good faith. It is an offence,
punishable by a fine, to fail to report abuse. A person who contravenes the PPCA is guilty of an
offence and is liable to a fine. Individuals may be fined up to $2,000.00 and facilities up to
$30,000.00. A person who makes a report of abuse knowing it to be false is liable to a fine of
$2,000.00.
The PPCA recognizes that the operator of a health facility has a duty to protect patients from abuse
and to maintain a reasonable level of safety for them.
The duty to report applies even if the information on patients is confidential and protected by The
Personal Health Information Act (PHIA) or The Freedom of Information and Protection of Privacy
Act (FIPPA).
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The PPCO is trusted with the information provided when an individual reports an allegation of
abuse. The PPCO will collect information from the reporter on the details of the alleged abuse
incident, personal information and personal health information of any patients involved. All of the
information provided is kept confidential within the PPCO records.
PHIA defines “personal health information” as recorded information about an identifiable
individual that relates to:
(a)
(b)
(c)
(d)
(e)
the individual’s health, or health care history, including genetic information about the
individual;
the provision of health care to the individual, or;
payment for health care provided to the individual, and includes;
the PHIN or any other identifying number, symbol assigned to an individual; and
any identifying information about the individual that is collected in the course of, and is
incidental to, the provision of health care or payment for health care.
FIPPA defines “personal information” as recorded information about an identifiable individual
including:
(a)
(b)
the individual’s name, home address, telephone, facsimile or e-mail; and
information about the individual’s age, sex, sexual orientation, marital or family status,
ancestry, race, color, nationality, or national or ethnic origin, religion personal health
information.
A request for information by a third party can only be made under FIPPA and on the prescribed
Application for Access Form from the FIPPA website. The PPCO and the Manitoba Health Privacy
and Access Coordinator prepare the documents for the FIPPA request.
The PPCO is disseminating information regarding awareness, prevention and reporting of abuse of
adults in Manitoba’s health care facilities. This learning package has been developed as an
additional resource for: facility staff; public and private agencies; general public; care providers;
resident councils; and senior centres, etc. The participants will gain awareness and knowledge about
abuse and learn how to identify it and when to report it.
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The Protection for Persons in Care Act (PPCA)
1) When was the PPCA introduced?
The PPCA was proclaimed on May 1, 2001. It is designed to protect Manitobans in
hospitals and personal care homes and Selkirk Mental Health Centre against physical,
sexual, emotional and financial abuse at the hands of family members, acquaintances or
caregivers. The PPCA is an extra safeguard built into Manitoba’s health care system.
On June 12, 2008, the Protection for Persons in Care Amendment Act received royal
assent. This amendment provided for the protection of the identities of both reporters and
witnesses or alleged abuse, and is now incorporated in the PPCA. The Protection for
Persons in Care Amendment Act (2010) was passed on June 17, 2010 and came into
force September 30, 2010. The Bill extends the requirement to report where there is
reasonable basis to believe that a patient of a geriatric day hospital or emergency room is or
is likely to be abused. It also allows the reporting requirement to be further extended by
regulation.
2) Who does the PPCA protect?
The PPCA protects all adults (persons aged of 18 years and older) who:
(a)
(b)
(c)
(d)
is a resident or an in-patient in a health facility or who is receiving respite care in
such a facility,
is receiving services in a geriatric day hospital that is managed by a hospital
designated by regulation under The Health Services Insurance Act,
is receiving services in an emergency department or urgent care centre of a health
facility, or
is receiving any other services provided by a health facility that are specified in
the regulations.
3) Who does PPCA not protect?
The PPCA does not protect persons:
(a)
(b)
(c)
who are out-patients in lab or X-ray departments or in day surgery:
who are living in the community;
who are protected by The Vulnerable Persons Living with a Mental Disability
Act; and
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(d)
who are protected under The Child and Family Services Act.
Definition of Abuse
The Protection for Persons in Care Act, (PPCA) defines abuse as:
• Mistreatment whether physical, sexual, mental, emotional, and financial or a combination of
any of them, that is reasonably likely to cause death or that causes or is reasonably likely to
cause serious physical or psychological harm to a person, or significant loss to the person's
property.
Specific definitions and examples of types of abuse are outlined as follows:
1. Physical Abuse
Physical abuse is physical mistreatment that is reasonably likely to cause death or that causes or
is reasonably likely to cause serious physical or psychological harm. Examples of physical
mistreatment include:
• hitting, pushing, pulling, rough handling, shoving;
• use of an object or weapon in a violent manner;
• slapping, kicking, beating;
• using physical restraint not following policy
• deliberate exposure to extreme weather
• misuse of medication, withholding medication
• use of chemical restraint (e.g., psychotropic medication for any purpose not
ordered by the physician); or
• neglect (see below).
Neglect can be broadly categorized into two types. Active neglect is the intentional withholding
of care or the necessities of life such as not providing for a patient’s basic physical needs. Passive
neglect is unintentional failure to give proper care because of lack of knowledge, attention,
experience or ability on the part of the caregiver(s).
Examples of neglect include but are not limited to:
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•
•
•
•
•
•
•
•
long-term failure to help patients maintain personal hygiene when they cannot
manage it themselves;
failure to provide adequate clothing or shelter;
failure to provide appropriate patient care for physical and mental health needs;
failure to protect patients from health and safety hazards;
failure to provide adequate food and prevent malnutrition;
failure to follow the patient’s individual care plan;
failure to follow established procedures; or
failure to treat recurring bedsores that may be preventable.
Physical signs of physical abuse may include but are not limited to:
• history if injuries over a period of time;
• unexplained bruises, broken bones, broken or missing teeth;
• loss of function permanently or for a significant period of time;
• neurological impairment, temporary or permanent; or
• injuries that do not match the explanation.
Behavioural signs of physical abuse may include but are not limited to:
• inappropriate fear response, aggressive behaviour;
• cringing or flinching if touched unexpectedly;
• hiding bruises or injuries or reluctance to change clothing; or
• depression, anxiety, withdrawal, sleep disorders.
2. Emotional Abuse
Emotional abuse is mistreatment that may hurt a person’s sense of identity, dignity or self
worth. Examples include:
• verbal assaults/ harassment/ bullying;
• threats/ instilling fear/ humiliation/ intimidation;
• social isolation;
• forcible confinement;
• name calling;
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•
•
•
denial of privacy;
restriction of contact with family members or friends; or
coercion, forced treatment.
Physical signs of emotional abuse may include but are not limited to:
• bedwetting, diarrhea, nausea; or
• frequent psychosomatic complaints of headaches, nausea, abdominal pains.
Behavioural signs of emotional abuse may include but are not limited to:
• withdrawal, depression, fear;
• aggressiveness; or
• mood swings.
3. Financial Abuse
Financial abuse is financial, mental, emotional or other mistreatment that causes or is
reasonably likely to cause significant loss to the person’s property.
Examples of mistreatment that can result in financial abuse include but are not limited to:
• theft;
• extortion;
• conning;
• forced changes of wills, titles;
• misuse of power of attorney;
• mismanagement of assets by a guardian, attorney, or other person in a position
of trust;
• all misappropriations or improper or illegal conversion of money or other
valuable possessions;
• use of patients’ property / money for purposes other than those intended by
the patient;
• convincing patients to give away money, property or possessions with threats
or coercion;
• having incompetent patients changing their wills or powers of attorney; or
• cashing patients’ cheques without authorization.
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4. Sexual Abuse
Sexual abuse is sexual mistreatment that is reasonably likely to cause death or that causes or is
reasonably likely to cause serious physical or psychological harm
Examples of sexual mistreatment include but are not limited to:
• Coercing a person through force, trickery, threats or other means into unwanted sexual
activity including:
• sexual assault;
• physically intrusive acts such as sexualized kissing/ fondling and oral/genital
contact;
• any act designed to use the patient for the perpetrator’s sexual gratification; or
• using the victim to produce pornographic material, or allowing others sexual
access to the individual.
•
•
Exhibitionism/voyeurism by the alleged abuser
Sexual harassment, including:
ƒ unnecessary physical contact, such as touching, patting or pinching;
ƒ demands for sexual favours in return for a promise of a reward or a threat of
reprisal;
ƒ unwelcome sexual remarks or jokes that denigrate one’s gender; or
ƒ displaying derogatory materials such as pictures, cartoons or printed matter.
Physical signs of sexual abuse may include but are not limited to:
• pain, redness, bruising, cuts or bleeding in genital area, difficulty walking or
sitting;
• bloody or torn clothing;
• evidence of sexually transmitted infection; or
• pregnancy.
Behavioural signs of sexual abuse may include but are not limited to:
• fear, withdrawal, or
• depression, anxiety, distress.
Situations may exist where a combination of any of the previously defined abuses are identified and
reported.
Patient-to-Patient Physical Abuse
In Manitoba, patient-to-patient abuse constitutes the majority of all reported alleged abuse incidents.
Most incidents occur between patients who are cognitively impaired.
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A. Risk Factors for Patients as Alleged Abusers
Several risk factors have been identified in determining if a patient is at risk to becoming an alleged
abuser. Prevention of patient-to-patient abuse is difficult due to risk factors such as:
• old age of the patients;
• past personal experiences of patients;
• mental health issues of patients;
• physical health factors of patients;
• design of facilities;
• noise;
• sensory overload;
• daily routine of institutional life;
• social isolation;
• shared living; and
• impact of chronic illness or infection on patient’s behaviour.
Caregivers must be aware of risk factors that lead to abuse and to be proactive in the reduction of
abuse incidents.
B. Causes of Patient-to-Patient Physical Abuse
Infections
Evidence shows that there is a significant relationship between episodes of patient-to-patient
abuse and the presence of infections, particularly urinary tract infections (UTIs). The presence of
infections may directly contribute to a patient’s irritability which in turn may increase the risk of
becoming an abuser.
The only recognized symptom of a UTI may be the aggressive or abusive behaviour of a patient
towards another patient, family or a staff member.
The presence of an infection in a patient with a history of abusing others should trigger
additional precautions to prevent the resident from abusing other patients. Caregivers should be
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sensitive to the subtlest changes in the patient’s behaviour. The earlier an infection is identified
and properly treated, the lower the risk of patient-to-patient abuse.
Other Causes or Triggers
Several triggers by themselves or in combination may contribute to some problem behaviours of
patients. The following are some examples:
1) Physical & psychological triggers:
• heart failure;
• hypoxia;
• cerebrovascular accident;
• dementia;
• chronic constipation;
• hip fracture;
• thyroid disturbances;
• hypoglycemia;
• psychiatric disorders;
• sensory deficit;
• hunger;
• fatigue;
• untreated or under-treated pain; and/ or
• depression, loneliness or fear.
2) Chemical triggers:
• over the counter medications;
• substance abuse; and/ or
• response or side effects to change in medication.
3) Other triggers:
• history of problematic behaviour;
• frustration with decline in functional status;
• seeing others as interfering in their lives;
• inability to verbalize discomfort; and/ or
• relocation issues.
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C. Prevention Strategies for Staff
Reducing the frequency of patient-to-patient abuse is important because these incidents are on
the rise. The PPCO advocates ongoing education for staff in effective management of patients
with multi-diagnoses combined with aggressive or violent tendencies.
It is also important to understand the causes. Prevention strategies can be developed to focus on
the cause of the behaviour. Isolating the possible causes can be done by:
• exploring the social, medical, mental and emotional history;
• performing a physical exam;
• reviewing the resident’s medication history;
• identifying behavioural trends and triggers;
• identifying activity preferences and dislikes;
• documenting all behaviours and observations; and/ or
• encouraging good communication among staff.
1) Infection Prevention Strategy:
There is a strong correlation between UTIs and resident aggression. Quick and effective
assessment, identification and treatment of UTIs may cause a decrease in patient aggression.
2) Enhanced Collection of Information on New Patients:
Prior to admission, patients should be screened closely in order to determine whether there is
a risk of abuse against others. The information can be collected from documented or verbal
history or observing their immediate response to care being provided.
Patients identified as having a history of potentially abusive behaviour upon admission, or
found to be abusive while residing at the facility, should have the history documented in both
nursing, social service histories and patient care plans.
This information should include:
• any physical or social maladaptive behaviour;
• person’s physical capacity;
• what and when the last altercation may have occurred;
• the course of behaviour and whether it has intensified or lessened;
• the determination of behavioural triggers;
• resident’s life history and temperament;
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•
•
cognitive, decision-making and communication skills; and
sensory impairment.
Strategies to prevent such incidents from occurring should be provided by the
interdisciplinary team and the patient’s family. A care plan should be created, identifying the
goals and approaches to prevent occurrences. The identified patients should be monitored on
an ongoing basis.
A psychiatric consultation can be ordered upon the identification of a resident who has a
history of abusive behaviour.
D. Action to Take When Abuse Occurs
Immediate actions to take when abuse occurs may include:
•
•
•
•
•
•
•
•
•
ensuring safety of all patients in the facility, especially those involved in the
incident;
notifying the immediate supervisor;
separating the patient by using a calm and non-threatening approach ;
speaking to the patient calmly and clearly;
manipulating the environment and removing the cause of the potential trigger
for the behaviour;
reporting the incident immediately to the PPCO;
redirecting the patient by involvement in activities, taking the resident for a
walk, etc…;
monitoring and adjusting care to reduce negative outcomes; and
involving the patient, social services, therapist, nursing and the family in
developing an appropriate care plan.
E. Intervention Strategies for Dealing with Agitated Patients
There are various ways to get an agitated patient to calm down. The goal for staff is to:
• keep the agitated patient safe;
• keep other patients around the patient safe;
• keep yourself safe;
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•
•
•
•
•
•
remove all unnecessary persons from the immediate environment as this will
decrease stimuli;
remove objects surrounding the patient that could be used as weapons;
remove bystanders who may inadvertently escalate the situation;
find a face-saving way to exit the situation as bystanders;
find the staff or family member the resident knows best; and
avoid getting angry as this makes the situation worse.
How to Approach an Agitated Resident
The following are suggestions for individuals when faced with an agitated patient:
Eye contact & facial expressions:
• glance intermittently at patient rather than staring;
• ensure face animation remains congruent with spoken words and behaviour
(avoid being deadpan or expressionless);
• be aware of and control any idiosyncratic winking or grinning which can be
misinterpreted; and
• be calm but serious, you want to get their attention.
Interpersonal space:
• maintain a distance, do not crowd;
• be at the same level as the patient , don’t stand above; and
• move slowly.
Posture:
• be relaxed, have open hands in front of you;
• avoid appearance of rigidity, which conveys fear;
• avoid clenched fists, which conveys hostility; and
• avoid face-to-face confrontations.
Touch:
• if possible, do not touch the patient; and
• always tell the patient if you are going to touch them, and
• explain to them what you are going to do every step of the way.
Comfort Measures:
• offer food and drink;
• offer adequate analgesia for pain; and
• lower the lights, provide soft music.
Verbal Interventions:
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•
•
•
repeat back to the patient what you observe about their behaviour and what
they say (i.e., if the resident says: “I am angry at my roommate because she
won’t turn the television down”. Your reply should be: “I understand you are
angry about the TV”);
be direct with the patient (i.e., If found angry, tell the patient that “it’s OK to
be angry, but that I will not let him/her hurt someone”); and/ or
redirect patients with dementia or Alzheimer’s disease related behaviours.
You may not be able to get the patient to change the way they think. Your goal is to change
the way they feel and the thinking will follow.
Who are the Abusers?
Abusers can include a spouse or partner, adult children, other family, primary caregiver,
companion, health facility staff, stranger, visitor, other patient or any other third party.
The following is a list of risk factors that may be associated with an abuser:
• alcohol abuse or drug use;
• gambling problems;
• diagnosed or undiagnosed mental illness;
• dependency on the victim;
• financial problems;
• chronic unemployment;
• history of family violence;
• caregiver stress;
• limited caregiver knowledge on needs;
• job stress or workplace conflict;
• staff burnout;
• staff shortages; and
• inadequate staff training.
Elder Abuse
Elder abuse is defined as any action or inaction by a person in a relationship of trust who has control
or authority which jeopardizes the health or well-being of an older person (The Manitoba Seniors
and Healthy Aging Secretariat website.)
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Some abuse of older adults occurs in relationships, such as
• between husband and wife or partner;
• between parent and adult child;
• between friends; and/ or
• between and older adult and someone they depend on such as an accountant or Power or
Attorney (POA).
Other abusers may actively seek out the elderly who they think will be easy to exploit.
Facts on Elder Abuse
No one ever deserves to be abused or neglected, so the responsibility for the abuse rests solely with
the abuser and not on the older person. The older person may feel like it is their fault, but it never is.
There has been little awareness of the fact that previous abuse between partners continues as the
couple ages. In some cases, abuse by family which had been occurring in the community may
continue after the older adult moves into a facility.
Older women may remain silent about the abuse because they are shameful of being victims or are
fearful of reporting.
Men also experience abuse. However, men may not disclose abuse or family violence because of a
misconception that men cannot be victims of abuse or their own belief that being identified as a male
victim of abuse is shameful. Abuse affects both women and men of all ages.
There are stereotypes about certain cultures that family violence exists or doesn’t exist. For
example, some may belie that if a culture in general shows respect for its older members, abuse and
neglect do not occur within that community. This is not necessarily the case.
Signs of Elder Abuse
•
•
•
•
•
•
•
•
•
repeated incidents of unexplained physical injuries or accidents;
unexplained delay in seeking treatment for injuries;
history of “hospital or doctor shopping”;
presence of a sexually transmitted disease in a senior not known to be sexually active;
care costs, rent, mortgage or utility bill(s) unpaid or in arrears;
lack of money to purchase food, clothing, medications or other necessities when income
appears adequate;
unusual activity in the bank account such as a change in the frequency or amounts of
withdrawals, withdrawals by bank card rather than in person, joint bank accounts being
opened up;
symptoms of depression, anxiety, fearfulness, low self-esteem;
withdrawal, a sense of hopelessness and resignation, suicidal ideation;
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•
•
•
•
malnutrition and/or dehydration;
deterioration in personal hygiene;
evidence of bedsores, untreated wounds, lack of wound dressings; and/or
inappropriate use of medication, lack of needed medication(s), over-sedation.
Critical Incidents vs. Abuse
There is a distinction between what constitutes abuse and what is defined as a critical incident.
The PPCA defines abuse as “mistreatment” and states that it is mandatory to report allegations of
abuse in hospitals or personal care and other designated health care facilities. The PPCO will
conduct an inquiry or an investigation into the allegation of abuse.
The Regional Health Authorities Amendment Act and The Manitoba Evidence Amendment Act
were amended (November 1, 2006) to enhance patient safety by providing a more secure
environment for the investigation and frank discussion of critical incidents that involve hospital
patients, residents of personal care homes and other people receiving health services. These
amendments require the regional health authorities, health corporations and certain health care
organizations to report and investigate critical incidents, to keep records about them, and to keep
the people affected fully informed.
A critical incident is defined as:
An unintended event that occurs when health services are provided to an individual and
results in a consequence to him or her that:
a) is serious and undesired, such as death, disability, injury or harm,
unplanned admission to hospital or unusual extension of a hospital stay,
and
b) does not result from the individual’s underlying health condition or from a risk
inherent in providing the health services.
If an alleged abuse incident is also considered a critical incident, the facility must still report the
incident to the PPCO.
Critical Incident:
• unintended event;
• occurs when health care services are provided;
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•
•
•
results in serious or undesired harm, death, disability, injury or an unplanned stay
in a hospital;
does not result from any underlying health condition or risk from having a health
condition; and
investigated by the Critical Incident Review Committee (CIRC)
Alleged Abuse:
• intent or competency of the abuser are not factors;
• mistreatment;
• physical abuse;
• sexual abuse;
• emotional abuse;
• financial abuse;
• reasonably likely to, or has already caused serious harm or death;
• not necessarily caused when providing direct care; and
• reported to the PPCO.
An example where an incident may be considered to be both a critical incident and abuse is:
A patient while being transferred break his/her hip because the staff person did not use a
mechanical lift and did not wait for a second staff person to assist with the lift as outlined in
the care plan.
Reporting Process
1) Inquiry Phase – Intake phase
Someone wanting to report an allegation of abuse to the PPCO can call the confidential
telephone number at any time during regular office hours (Monday to Friday 8:30 - 16:30).
Reporters will speak with an Intake and Database Clerk who collects information about the
incident and may request additional information, such as the reporter’s contact information,
personal information/personal health information about the patients involved.
The following information is required by the Intake Clerk at the time of the initial reporting:
• Details of the Alleged Victim (AV) as in name, date of birth, level of competency, past
behaviours, relationship to the Alleged Abuser (AA), name of committee or Power of
Attorney;
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•
•
•
Details of the AA as in name, date of birth, level of competency, past behaviours,
relationship to the AV, names of committee or Power of Attorney if a patient.
Reporter’s name and contact information including any relationship to the AV; and
Expectation expressed by the reporter.
The PPCO requires the reporter’s name and contact information in order for the abuse prevention
consultant to keep the reporter apprised of the outcome of the inquiry or the investigation.
2) Inquiry Process – Intake phase
The Intake and Database Clerk forward the alleged abuse report to an Abuse Prevention
Consultant. The following information will be collected by the Abuse Prevention Consultant as
s/he completes the inquiry:
• Specific details of the alleged incident;
• Intervention immediately taken by the facility to protect residents;
• Prevention measures taken by the facility in order to reduce the risk of a reoccurrence;
and
• Expectations expressed by the alleged victim.
The following are the inquiry disposition definitions that are presented to the PPCO team:
Below Threshold: Based on the information gathered, the alleged abuse was determined not
to have met the level of harm or financial loss to an alleged victim that would require an
investigation to be initiated.
Direct Referral or Contact: Contacts are made with external agencies like law enforcement
or the Public Trustee to request their involvement in a case. Referrals are made to
professional regulatory bodies for investigation.
Outside the Act: The incident is determined to be outside the mandate of the PPCO. This
may mean that the alleged abuse did not occur in a designated health care facility or the
incident was not determined to be abuse.
Competent Patient Declines Further Involvement: A competent patient has declined
further PPCO involvement.
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Unsupported: Information gathered support the decision that the abuse allegation was
unsubstantiated or there was insufficient information to support the allegation that abuse
occurred.
Open: The file is not closed because the inquiry process has not yet been completed.
3) Investigation process
Based on the results of the inquiry, the PPCO team decides if there is evidence to support
whether or not the incident meets the definition of abuse. If necessary, the matter will be
referred to an investigator to carry out a more extensive investigation. This investigation will
result in one of the following outcomes: founded, unfounded, or open.
The file will close after confirmation from the regional health authority that the facility has
complied with the ministerial directives or where there are no directives that the facility has
responded appropriately.
Duty to Report
If you have a reasonable basis to believe that a patient is, or is likely to be abused, you shall
promptly report the belief, and the information on which it is based to the PPCO. The PPCO will
always ensure the confidentiality of the reporter.
The law states that no action or other proceeding may be brought against a person for making a
report of abuse in good faith.
As an employee, an operator of a health care facility shall not take adverse employment action
against you.
As a patient, interruption of health care services is prohibited. No operator of a health care
facility shall alter, interrupt or discontinue, or threaten to alter, interrupt or discontinue, service to
a patient who has made a report of abuse under the PPCA. Relatives or visitors may not be
restricted to visit the patient.
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Glossary
A. DEFINITIONS
Abuse: Mistreatment, whether physical, sexual, mental, emotional, financial or a combination of
any of them, that is reasonably likely to cause death or that causes or is reasonably likely to cause
serious physical or psychological harm to a person or significant loss to the person’s property
(PPCA)
Below threshold: At the inquiry stage, based on the information gathered, the alleged abuse
was determined not to have met the level of harm or financial loss to an alleged victim that
would require an investigation to be initiated.
Critical incident: An unintended event that occurs when health services are provided to an
individual and results in a consequence that is serious and undesired, such as death, disability, injury
or harm, unplanned admission to hospital or unusual extension of a hospital stay, or does not result
from the individual’s underlying health condition or from a risk inherent in providing health
services.
Emotional abuse: Emotional or mental mistreatment that causes or is reasonably likely to cause
serious physical or psychological harm to a person.
Financial abuse: Financial, mental, emotional or other mistreatment that causes or is reasonable
likely to cause significant loss to the person’s property.
Founded: At the conclusion of an investigation, objective evidence supports that the alleged abuse
met the threshold of abuse.
Inquiry: After receiving an alleged abuse report, the PPCO’s Abuse Prevention Consultant will
gather all of the information needed to determine the next course of action. This process includes
reviewing and analyzing the report for validity and nature of complaint, assessing the severity of the
alleged abuse against the definition of abuse in the Act and presenting the information to the PPCO
team for review and an outcome decision.
Investigation: Based on the results of the inquiry, the PPCO team decides whether or not there is
evidence to support a case of abuse. If the PPCO team determines that there are reasonable grounds
to believe that a patient has been abused or is likely to be abused in the future, the matter is referred
to an investigator to carry out a more extensive investigation.
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Ministerial Directives: In selected founded abuse cases, the PPCO, acting as the designate of the
minister, may give the operator of the health facility involved any directions the minister considers
necessary to protect the patient from abuse.
In these cases, the abuse prevention consultant will prepare a directive letter which includes the key
findings and the recommended ministerial directives. The facility has 30 days from the date of the
letter to have their recommended actions to improve patient safety approved by the RHA. The status
report of the action plan is due to the PPCO 100 days from the date of the letter to the RHA.
Neglect: Mistreatment by neglect that is reasonably likely to cause death or that causes or is
reasonably likely to cause serious physical or psychological harm to a person is considered “physical
abuse”.
Outside the Act: At the inquiry stage, the incident is determined to be outside of the mandate of the
PPCO. This may meant that the alleged abuse do not occur in a designated health care facility or in
the incident was determined not to be abuse.
Personal Health Information: Recorded information about an identifiable individual such as the
individual's health, health care history, genetic information, provision of health care, payment for
health care, and any other identifying number, symbol and identifying information that is collected
in the course of the provision or payment for health care.
Physical abuse: Physical mistreatment that is reasonable likely to cause death or that causes or is
reasonably likely to cause serious physical or psychological harm.
Sexual abuse: Sexual mistreatment that is reasonably likely to cause death or that causes or is
reasonably likely to cause serious physical or psychological harm.
Unfounded: At the conclusion of an investigation, the investigator can conclude that objective
evidence supports the finding that abuse does meet the threshold of abuse or that the abuse allegation
was unsubstantiated.
Unsupported: At the inquiry stage, objective evidence supports the finding that the abuse
allegation was unsubstantiated or that there was insufficient evidence to support the allegation that
abuse occurred.
B. LEGISLATION
The Child and Family Services Act: Protects children from alleged or actual abuse.
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The Freedom of Information and Protection of Privacy Act (FIPPA): FIPPA allows any person a
right of access to records containing personal information about them in the custody or under the
control of public bodies, subject to the limited and specific exceptions as set out. A person can also
request corrections to his/her records. FIPPA also controls the manner in which public bodies may
collect personal information from individuals and to protect individuals against unauthorized use or
disclosure of personal information.
The Personal Health Information Act: Provides individuals with a right to access their
personal health information and to have their personal health information kept private.
The Protection for Persons in Care Act: (PPCA): The PPCA is a law to help protect adult
residents in personal care homes, hospitals and adult in-patients in hospitals or Selkirk Mental
Health Centre from abuse.. The PPCA includes the mandatory duty to promptly report abuse.
The Regional Health Authorities Amendment Act and Manitoba Evidence Amendment Act:
Amended (November 1, 2006) to deal with critical incidents. A critical incident is an unintended
event that harms a person while he/she is receiving health services. The legislation requires RHAs,
health corporations and certain health care organizations to report and investigate critical incidents,
to keep records about them, and to keep the individuals affected fully informed about the critical
incidents.
The Vulnerable Persons Living With a Mental Disability Act: Protects adults living with a mental
disability that are in need of assistance to meet his/her basic needs with regard to personal care or
management of his/her property from alleged or actual abuse.
Support For Staff: The Protection for Persons in Care Act
Manitobans benefit from a high-quality health care system that is among the world’s best. Regional
health authorities, professional associations, regulatory bodies, and health facility staff and
management co-operatively maintain this high standard of care.
Does the PPCO investigate every report?
No. When the PPCO receives a report, a staff professional reviews the situation and assesses
whether an investigation is required. The kind of action taken also depends on the type of report.
Some matters fall outside the scope of the legislation and may be referred back to the facility or the
regional health authority for follow-up.
Who is required to report?
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Abuse or suspected abuse must be reported promptly to the PPCO by anyone who has a reasonable
basis to believe abuse has occurred, or is likely to occur. As a health care facility staff person who
has witnessed an abuse situation, you should also notify your supervisor, but you are still ultimately
responsible for reporting the alleged abuse to the PPCO.
Can I make an anonymous report?
The PPCO needs your name and telephone number in case it’s necessary to call you back for more
information or to let you know about the outcome of the report. If you call the PPCO to report
alleged abuse, every effort will be made to keep your name confidential.
Am I protected if I make a report?
Yes. The PPCO will do everything possible to protect the confidentiality of your report. In addition,
the Act states that a staff person who makes a report is protected from adverse employment action
undertaken by the operator of a health facility, as long as the report is made in good faith.
INVESTIGATION PROCESS
What happens when the PPCO conducts an investigation?
A PPCO staff person contacts the health facility and provides the investigator’s name and expected
date of arrival. Upon arrival at the health facility, the investigator provides a Letter of Authorization
to conduct the investigation. He/she may want to meet with and/or obtain statements from people
who could have information about the reported incident. These interviews can be arranged at the
facility or off-site, depending on the wishes of the person being interviewed. The resident(s) or
patient(s) identified in a report may also have concerns that must be considered during the
investigation.
Who conducts the investigation?
Investigators are PPCO professional staff who look into reports of abuse for Manitoba Health and
Healthy Living. Their job is to collect information and facts, and then determine if abuse occurred.
Can I refuse to be interviewed?
If an investigator contacts you for an interview, your co-operation is essential to ensuring a fair
process for all involved. You can refuse to be interviewed; however, the investigator will continue
the investigation and make conclusions and recommendations without your input. It is important to
consider that the interview process gives you the chance to share your version of what happened. It
ensures that the situation is seen from all perspectives. Individuals identified as alleged abusers will
be given the opportunity for an interview to answer the allegations against them. Failing the
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scheduling of an interview, individuals will be advised that they have been identified as alleged
abusers.
Can I bring someone to the interview?
You may choose to have a union representative, supervisor, your lawyer or someone else present
with you during the interview as an independent observer, or you can meet with the investigator
alone. Independent observers will be informed of their role in providing support but may not
interfere or ask questions during the interview process.
Is there any protection for a staff person who has been interviewed as a witness?
Yes, similar to the protection afforded the reporter, the Act directs the PPCO to keep witness names
confidential.
What happens after the investigator finishes the investigation?
The investigator will forward a report to the PPCO for review. If the investigator determines that
abuse has occurred, the PPCO will send a letter to the health care facility confirming that the report
was founded. In some cases, the letter will also give specific direction about steps the facility must
take to address the situation. If the investigation concluded that there was no abuse, the PPCO will
confirm in writing that the report was unfounded. Before the PPCO sends a letter to confirm the
findings of the investigation, the health care facility will be notified if the results at a meeting. The
facility’s management team, along with representatives of the PPCO and the regional health
authority, are usually present at the meeting and are given a written summary of the investigation
findings and draft directives (if any) to review and discuss.
Can the PPCO recommend disciplinary action?
No. It can provide direction only about how to protect resident and patient safety. The facility is
responsible for handling human resource issues. The PPCO may, however, refer a person(s) to the
appropriate association(s) for review of their professional conduct.
SUPPORT FOR STAFF
Health facility employees have access to appropriate resources that provide support during or after an
investigation such as:
• Management support or referral to other resources (i.e., spiritual or ethical consultation)
• Employee Assistance Programs (EAP): 204-786-8880, toll-free 1-800-590-5553, TTY 204-775 0586.
Available 24 hours/day, seven days/week
• Your union representative
• Your professional association
• Canadian Nurses Protective Society (CNPS) 1-800-267-3390 (for Registered Nurses)
• Co-workers and friends
• Private counseling agencies
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Reporting of Abuse Regional Policy
1.0 PURPOSE:
1.1 To advise all WRHA Medical staff, employee, students and volunteers of the appropriate action
should they become aware of a client/ resident/patient who may be experiencing abuse and be in need
of assistance or protection.
1.2 To ensure that staff actions are in accordance with legislation or guidelines on identifying and
reporting situations involving abuse.
2.0 DEFINITIONS:
2.1 The Child and Family Services Act (Manitoba):
2.1.1 Abuse: An act or omission of a parent, guardian or person having care, custody,
control or charge of a child, where the act or omission results in:
a) physical injury to the child
b) emotional disability of a permanent nature or is likely to result in such a disability,
c) sexual exploitation of a child with or without the child’s consent
2.1.2
Child: A person under the age of majority or 18 years of age.
2.1.3 In Need of Protection: A child in need of protection may include, but is not limited
to, situations where the child:
a) is without adequate care, supervision or control;
b) is in the care, custody, control or charge of a person
i) who is unable or unwilling to provide adequate care, supervision or control
of the child, or
ii) whose conduct endangers or might endanger the life, health, or emotional
well being of the child, or
iii) who neglects or refuses to provide or obtain proper medical or other
remedial care or treatment necessary for the health or well being of the child
or who refuses to permit the provision of such care or treatment to the child
as recommended by a duly qualified medical practitioner;
c) is abused or is in danger of being abused;
d) is beyond the control of a person who has the care, custody, control or charge of
the child;
e) is likely to suffer harm or injury due to the behavior, condition, domestic
environment or associations of the child or of a person having care, custody or
control of the child/
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f) is subjected to aggression or sexual harassment that endangers the child’s life,
health or emotional well being of the child;
g) being under the age of 12 years, is left unattended and without reasonable
provision being made for the supervision and safety of the child; or
h) is the subject, or is about to become the subject, of an unlawful adoption or of an
unlawful sale.
2.2
The Vulnerable Persons Living With A Mental Disability Act (Manitoba):
2.2.1 Abuse: Mistreatment, whether physical, sexual, mental, emotional, financial or a
combination thereof, that is reasonably likely to cause death or that causes or is reasonably
likely to cause serious physical or psychological harm to a vulnerable person, or significant
loss to his or her property.
2.2.2 Neglect: An act or omission whether intentional or unintentional, that is reasonably
likely to cause death or that causes or is reasonably likely to cause serious physical or
psychological harm to a vulnerable person, or significant loss to his or her property.
2.2.3 Mental Disability: Significantly impaired intellectual functioning existing along with
impaired adaptive behaviour and manifested prior to the age of 18 years, but excludes a
mental disability due exclusively to a mental disorder as defined in section 1 of The Mental
Health Act.
2.2.4 Service Provider: A person who provides care, support services or related assistance for
a vulnerable person in the course of professional or employment duties, as a student in a
training placement, as a volunteer, or as an owner, operator or manager of a facility or
business which provides such care, support services or related assistance.
2.2.5 Vulnerable Person: An adult living with a mental disability who is in need of assistance
to meet his or her basic needs with regard to personal care or management of his or her
property.
2.3
The Protection For Persons In Care Act (Manitoba):
2.3.1 Abuse: Mistreatment, whether physical, sexual, mental, emotional, financial or a
combination of any of them, that is reasonably likely to cause death or that causes or is
reasonably likely to cause serious physical or psychological harm to a person, or significant
loss to the person’s property.
2.3.2
Health Facility:
a) A hospital designated by regulation under The Health Services Insurance Act;
b) A personal care home designated by regulation under The Health Services
Insurance Act;
c) An institution or organization designated as a health facility by regulation under
section 13 of the Act;
2.3.3
Mistreatment:
a) A single act or series of acts of physical aggression.
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b) A verbal or written threats (s) against a patient.
c) Use of patient/dependant finances/assets other than to support patient/dependant
d) Non responsive to patient needs
e) Intentionally giving the wrong treatment
2.3.4
2.4
Patient: An adult resident, in-patient, client, or person receiving respite care in a
Health Facility, but does not include a vulnerable person within the meaning of The
Vulnerable Persons Living with a Mental Disability Act.
Family Violence, Domestic Abuse and Elder Abuse:
2.4.1 Abuse: Mistreatment, whether physical, sexual, mental, emotional, financial or a
combination of any of them”.
2.4.2
Domestic Abuse: Abuse or violence that occurs between intimate partnerships.
2.4.3 Elder Abuse: Any act or lack of action by someone in a position of trust that harms
the health or well-being of an older person.
2.4.4 Family Violence: Abuse or violence that occurs in relationships of intimacy, kinship,
dependency, or trust.
2.4.5
Mistreatment:
a) A single or a series of acts of physical aggression.
b) A verbal or written threat (s) against the patient.
c) Use of patient/ dependant finances/assets other than to support patient/dependant.
3.0 POLICY:
3.1
General:
3.1.1 Under the mandatory reporting legislation below, the duty to report is an individual
responsibility and does not require staff consensus or the approval of any supervisor or
physician.
3.1.2 Where there is mandatory reporting legislation, the obligation to report supersedes any
restrictions respecting the disclosure of information, in legislation, including The Personal
Health Information Act (Manitoba), or otherwise. There may be a need for multiple reporting
based on the situation.
3.1.3 If unable or if uncertainty exists respecting the requirements or advisability to report,
the individual shall contact the program/team manager for consultation or direction. If
uncertainty still exists, legal counsel may be contacted for further direction.
3.1.4 For any of the reporting requirements below, the individual shall consult with the
appropriate agency, as identified below, regarding measures to ensure the safety of the
client/resident/patient
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3.1.5 The individual shall advise his or her supervisor/manager as soon as possible regarding
actions taken, as appropriate.
3.1.6 Confidentiality regarding the identities of the individuals involved in allegations of
abuse shall be maintained to the greatest extent possible. Information shall be shared only as
required for the investigation.
3.1.7 The individual shall complete appropriate documentation, including the assessment and
action. This can include but is not limited to:
a) description of the client/resident/patient, including any abuse that may be noted
(drawings may be useful to pinpoint the area, size, and colour of injuries for physical
abuse);
b) the client/resident/patient behaviour with and without the person suspected of
abuse;
c) the client/resident/patient statement of what happened to him/her, in their own
words. The interview should be in the absence of the persons suspected of
committing the abuse;
d) consultation with other health professionals;
e) the name of the agency and persons contacted.
3.1.8 This policy does not apply to situations where there is a complaint about the nature or
effect of a routine procedure performed by a responsible health care professional that has
followed established WRHA policies. The Client Complaint Management System Policy
10.50.010 should be consulted in such situations for further guidance.
3.2
The Child And Family Services Act (Manitoba):
3.2.1 An individual having information causing him/her to believe that a Child is or might be
In Need of Protection by anyone (including WRHA staff) shall:
a) Immediately report the information to the Child and Family Service agency; or to a
parent or guardian of the child. Where the individual reporting:
• does not know the identity of the parent or guardian of the child; or
• has information that leads the person recording to believe that the parent or
guardian is responsible for causing the child to be in need of protection or is
unable or unwilling to provide adequate protection; or
• has information that leads the individual to believe that the child is or might
be suffering Abuse by a parent or guardian or by a person having care,
custody, control or charge of the child, then the individual shall report only to
Child and Family Services.
b) Consult the Child Protection Centre or legal counsel if further assistance or
direction is required.
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3.2.2 If the Child is in a WRHA facility or WRHA funded facility, the individual shall inform
their immediate supervisor, who will ensure appropriate security measures are taken.
3.3
The Vulnerable Persons Living With A Mental Disability Act (Manitoba):
Any individual Service Provider who believes, on reasonable grounds, that a Vulnerable
Person to whom he or she provides service is or is likely to be Abused or neglected, shall
immediately report the belief and information upon which it is based to the Executive
Director appointed under this Act, by phoning the Family Services Intake for the Supportive
Living Program or Family Services After Hours.
3.4
The Protection For Persons In Care Act (Manitoba):
3.4.1 Any individual who has a reasonable basis to believe that a Patient is or is likely to be
Abused shall promptly report the belief and the information on which it is based, to the
minister or his/her delegate, by phoning the Protection for Persons in Care Office.
3.4.2 When reporting is based on a belief that the patient is likely to be Abused the individual
must have a reasonable basis on which the belief is based, including but not limited to
awareness of a verbal or written threat against a patient, actions though incomplete that are
suggestive of an intent to harm, (ie. raising a fist against a patient) or a combination thereof.
3.4.3 If unsure the Protection Office may be contacted in consultation. The Protection Office
will assure the anonymity of the person making the report if requested.
3.5
Family Violence, Domestic Abuse and Elder Abuse:
3.5.1 Reporting of Family Violence, Domestic Abuse or Elder Abuse is not mandated by
legislation, unless a mandatory reporting obligation applies.
3.5.2 In exceptional cases, reporting may be permissible under The Personal Health
Information Act (Manitoba) including under Section 22(2) by disclosure without an
individual's consent. Consult with your supervisor and/or WRHA in house legal counsel as
appropriate prior to disclosing such information.
3.5.3 Routine screening questions for Domestic Abuse, Family Violence and Elder
Abuse should be part of a client/resident/patient initial routine health assessment in all
WRHA programs and services, particularly when the presenting injuries are consistent with
the indicators of Family Violence, Domestic Abuse or Elder Abuse.
3.5.4 The health care providers primary responsibility should be to identify the problem,
provide information about appropriate resources, refer the client/resident/patient to an
appropriate resource and provide support if needed.
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59
E. WHMIS
Workplace
Hazardous
Materials
Information
System
WHAT IS WHMIS?
Workplace Hazardous Materials Information System (WHMIS)
WHMIS is a national communication system created to ensure that information about hazardous
materials in the workplace is made available to anyone who works with, or in the vicinity of, the
hazardous materials. WHMIS uses the term “controlled products” when talking about hazardous
chemicals
Health and Safety law gives you the “right to know” about the dangers of the products you are
working with, how to protect yourself from them and what to do in the event of an emergency.
In Manitoba, WHMIS is Part 35 of the Workplace Safety and Health Regulation. The Workplace
Safety and Health Act, the Regulation and safety bulletins can all be found at
www.gov.mb.ca/labour/safety or you can contact the Deer Lodge Centre Safety Coordinator or a
member of the Health and Safety Committee.
Deer Lodge Centre is required to educate and train you on - the content, purpose and significance
of information on supplier labels, workplace labels and MSDS sheets; procedures for the safe use,
storage, handling and disposal of controlled products; and procedures to be followed in case of an
emergency involving a controlled product. You can independently review the basics of WHMIS
through the completion of annual tests.
Your manager is responsible to give you the opportunity to test your WHMIS knowledge ever year
and you are responsible to use the opportunity to learn the WHMIS program and regularly refresh
your knowledge about WHMIS.
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The 3 Participants in a WHMIS Program
Supplier companies, employers and staff are all involved in WHMIS programs. Information on
WHMIS controlled products must be passed from supplier companies to the employer and then
made available to staff. The intent is to result in “informed staff” who know how to protect
themselves from product hazards and what to do in the event of an emergency situation.
Suppliers
• Provide up-to date MSDS sheets (not more than 3 years old) for all controlled products they
sell or produce
• Provide supplier labels on all containers of controlled products they sell or produce
The Employer – Deer Lodge Centre
• Ensure that all containers of controlled products have MSDS sheets and WHMIS labels
• Ensure that MSDS sheets are readily accessible to staff and less than three years old
• Ensure that staff understand information on MSDS sheets, supplier labels, and workplace
labels by providing effective worker education
• Provide training in specific safe work procedures to staff who work with or near controlled
products
Staff
•
•
•
Use the information they receive through education and training to handle controlled
products safely.
Know and understand the information on labels and MSDS sheets
Inform employers if labels are illegible or missing
The 3 WHMIS Elements
The three ways that information about hazardous materials is passed on in the workplace are:
•
Labels
•
Material Safety Data Sheets (MSDS)
•
Staff education and training.
Labels on controlled product containers alert staff to hazards and the necessary precautions they
should take and direct them to the MSDS.
Supplier Labels
Supplier companies are responsible for creating supplier labels and attaching them to containers
before delivery to your workplace. Supplier labels must contain the name of the product,
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classification symbols, risk phrases, precautionary measures, first aid, reference to the MSDS and
the name of the manufacturer.
Example Of Supplier Label:
Product Name
Risk Phrases
Precautionary
Statements
Hazard
Symbols
First Aid
Reference to
MSDS
Company
Name
Workplace Labels
If a product is decanted in the workplace (i.e. put into a spray bottle), a workplace label must be
attached to the new container. If a supplier label becomes damaged or is missing you may replace it
with a workplace label.
To create a workplace label, you simply copy three pieces of information from a supplier label onto
a blank workplace label. These are:
•
Product Name
•
Safe Handling Information (specific safe handling information and personal protective
clothing/equipment required)
•
Reference to the MSDS sheet.
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Example Of Workplace Label:
Product Name
Precautionary
Statement
Reference to MSDS
BLEACH 6%
Harmful if swallowed
Avoid contact with skin &
eyes
Avoid breathing vapours
Wear gloves & goggles
Refer to MSDS.
Material Safety Data Sheets (MSDS) are fact sheets about a chemical that gives more detailed
information on what it's made of, what the dangers are, how it can affect you, how to use, handle and
store the material safely and what equipment to use. WHMIS stations are located throughout Deer
Lodge Centre and contain Material Safety Data Sheets for all the products located in that area.
You should refer to a MSDS sheet (or your area’s safe work procedures) if you need more
information than a supplier label provides. All MSDS sheets are required to provide the
following 9 sections of information:
1. Product identification - the chemical name of the product, other names it is known by, the
name and address of the manufacturer/supplier, and the product’s common usage.
2. Hazardous ingredients - list of hazardous ingredients with chemical identifier numbers,
concentration of the hazardous ingredient found in the product, some toxicological information.
3. Physical data - information about the physical state of the substance, its colour, odour, boiling
point, specific gravity, etc.
4. Fire and explosion information - flashpoint, flammability limits in the air, conditions for
flammability, methods of fire extinction, dangerous products released upon combustion.
5. Reactivity data - descriptions of stability, types of reactions possible with certain other
substances.
6. Health Hazard information - Toxicological data of the product; routes of entry, effects of
various concentrations of the product, illness or injury produced.
7. Preventative measures - Proper handling, personal protective required, emergency response
to spills, special storage requirements, waste disposal, special engineering controls required.
8. First aid response - measures to take in case of exposure.
9. Preparation information - date of MSDS preparation, address and name of party responsible
for production of MSDS.
Some of the information on the MSDS sheets is very technical and you will not necessarily have to
understand all of the information in order to find these MSDS sheets very useful. A guide to
commonly used terms is found in each of the MSDS binders located throughout Deer Lodge Centre.
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To read the MSDS, it is usually best to start with the product information/name and the physical data
sections and verify that the MSDS corresponds to the product you are working with. A review of the
fire and explosion information, incompatibilities, health hazard information, and preventative
measures will explain how to work with these products safely. The sections outlining first aid
procedures will provide valuable instructions for responding to accidental exposures.
Read the MSDS before you use the product.
Training and Education
WHMIS education explains how WHMIS works, what an MSDS is, what information is on a WHMIS
label, and other information about WHMIS. These items can be found throughout this booklet.
¾ Education begins with an introduction to WHMIS through General Orientation or through the
Fundamentals of Safety and Health. This is a basic introductory course that explains the
WHMIS legislation, labels, classification etc. to staff and also includes training on how to
read MSDSs
¾ Departmental orientation provides detailed information about the specific hazardous
products that you may work with in your position. It covers safe handling and storage, first
aid, chemical spills, short and long term effects, personal protective equipment, and
incompatibilities.
Annual competency tests are completed each fall.
Staff who are successfully educated and trained in WHMIS should be
able to answer these four key questions:
1.
What are the hazards of the products you are using?
2.
How do you protect yourself?
3.
What should you do in case of an emergency or spill?
4.
Where do you get more information on this product?
Classification
The regulation requires all controlled products to be labeled according to their hazards.
Controlled products are divided into 6 classifications (one has sub categories) which are
represented by symbols. A chemical may fall into more than one classification based on
the hazards it possesses.
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These classifications are:
Class A
Compressed Gas
Class B
Flammable & Combustible
Class C
Oxidizing Materials
Class D1
Class D2
Class D3
Poisonous & Infectious Materials
Other effects
Poisonous & Infectious Materials
Biohazardous
Class E
Corrosive Material
Class F
Dangerously Reactive
Poisonous & Infectious Materials
Immediate and Serious Effects
Exemptions and Consumer Products
Some products are either partially exempt or completely exempt from WHMIS. This is usually
because they are covered by other federal legislation. However, employers are still required to
provide staff with hazard information and training. Partially exempt products include consumer
products, cosmetics, explosive, pest control chemicals and radioactive substances. Consumer
products have different symbols on their labels.
Class A
Compressed Gas
These are gases under pressure. Some compressed gases also exist as liquids.
Examples of compressed gases found at Deer Lodge Centre are: oxygen, carbon
dioxide, nitrogen, acetylene, and gases in certain types of fire extinguishers.
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Risks associated with compressed gases are:
• Could explode due to pressure
• Could explode if heated or dropped
• Possible hazard from both the force of explosion and the release of contents
• Contents may burn or freeze skin on contact.
Safe handling methods include:
• Keep containers secured (chained) at all times whether empty or full
• Keep container away from heat or changes of temperature
• Make sure container is closed tightly when not in use
• Handle carefully, avoid dropping
Class B
Flammable And Combustible Materials
Flammable substance burn readily at room temperature; combustible materials
burn when heated. In the Centre, flammable liquids such as cleaners are found in
Housekeeping, Dietary and Facility Management. Propane and hydrogen are
flammable gases and gasoline is a flammable liquid. Diesel fuel is an example of a combustible liquid.
Risks associated with flammable and combustible materials are:
• Material will continue to burn after being exposed to an ignition source with this class of
substances are fire and the toxic fumes that many substances in this class give off if burned.
Safe handling methods include:
• Keep these materials away from heat and sources of ignition
• Keep the containers tightly closed when not in use
• Avoid any possibility of sparks in areas where the materials are stored or used
• Store and use in well ventilated areas
Class C
Oxidizing Materials
Oxidizing materials react with fuels by accepting electrons. They can cause other
materials to burn or support combustion. Oxidizers (such as oxygen) can react with
combustible materials and produce heat.
Oxidizing substances in Deer Lodge Centre include laundry chemicals. The predominate substance of
this classification with the Centre is Medical Oxygen which is found throughout the building.
Risks associated with oxidizing materials are:
• Can cause burns to skin or eyes
• Increase fire and explosion hazard
• May cause combustible to explode or react violently.
Safe handling methods include:
• Store in cool place away from combustible
• Keep away from heat, flammable and combustible materials
• Store in proper containers which will not rust or oxidize
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WHMIS at Deer Lodge Centre
Class D1
Poisonous or infectious material
Substance causing immediate and serious toxic effects.
These substances may be immediately harmful to life and health; their effects are acute
and someone can be exposed to them by inhalation (breathing in), ingestion (swallowing), or absorption
through the skin.
There are not many of these chemicals at Deer Lodge Centre. Chemicals in this class may be found in
some products within Facility Management, Dietary and Laundry. Sometimes the combination of two
substances can produce a reaction, which results in a material belonging to this class. An example of
this would be chlorine gas, which can be produced by the reaction of mixing some types of cleaners
together.
Risks associated with this classification include:
• May be fatal if inhaled or ingested
• May be absorbed through the skin
• Small volumes have a toxic effect.
Safe handling methods include:
• Wear appropriate protective clothing such as goggles, gloves, lab coat, breathing apparatus,
etc.
• Use material correctly and in the proper area (i.e. fume hood, etc.)
• Never breathe the gases or vapours of these substances
• Avoid all contact with skin or eyes
• Wash hands thoroughly after use
Class D2
Poisonous or infectious material:
Division 2-Materials causing other toxic effects
These materials are poisonous but the effects are not acute or short-term. They are
chronic and long-term. These materials also can be inhaled, ingested and absorbed
through the skin.
At Deer Lodge Centre, examples include many cleaning chemicals, deodorizers, and asbestos fibers.
This is the largest grouping of controlled products at Deer Lodge Centre.
Risks associated with this classification include:
• Skin and eye irritation
• Sensitization
• Long term health effects such as cancer
• Toxicity to a fetus
Safe handling methods include:
• Avoid breathing gases or vapours
• Avoid skin contact
• Use adequate personal protection (gloves, goggles, lab coat, etc.)
• Wash hands thoroughly after use
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WHMIS at Deer Lodge Centre
Class D3
Poisonous or infectious material
Division 3- Bio-hazardous Infectious Material
This class includes organisms such as viruses, bacteria, and fungi, which cause
diseases; it also includes the toxins produced by these organisms and the
specimens (such as urine, blood, feces, sputum, etc.), which contain these organisms.
At Deer Lodge Centre, there are no controlled chemical products presently identified in this category.
The risks associated with this controlled products of this classification would more resemble the type of
health risks covered in Deer Lodge Centre’s Infection Control Manual.
Risks associated with this classification depend on what the organism is. Three categories of danger
are:
• Organisms, which may cause human disease, but are not likely to cause serious hazard to the
worker or the community. Treatments are available.
• Organisms that cause serious disease but are not spread by casual contact
• Organisms which cause serious disease, often not treatable, and spread easily
Safe handling methods include:
• Follow Routine Practices
• Wash your hands
• Follow policies and procedures in the Infection Control Manual
Class E Corrosive Material
Substances in this class may cause severe burns to the skin, eyes or even respiratory tract, if
inhaled. Most acids and bases, and some gases, are in this class.
In the Centre, many corrosive chemicals can be in found cleaning products within Housekeeping, chemicals used
in Dietary and Laundry and Field Test Reagents in the Powerhouse. Batteries and acid cleaners contain corrosive
substances.
Risks associated with corrosive materials include:
• Eye and skin irritation on exposure.
• Severe burns and tissue damage on longer exposure.
• Lung damage if inhaled.
• May cause blindness, if eye is contacted.
• Environmental damage from fumes
Safe handling methods include:
• Use of proper protective clothing, including gloves, goggles, and respirators etc.
• Use of proper facilities and equipment (fume hood in some cases)
• Work in well ventilated areas
• Avoid all direct body contact
• Use appropriate storage containers and ensure proper non venting closures
• Know proper emergency procedures
Class F
Dangerously Reactive Material
This class includes materials, which may change their characteristics to produce a violent
reaction. These reactions include violent composition or condensation, violent auto-pressure,
reaction when exposed to shock or heat or pressure, or reacting with water to produce to toxic gas.
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Deer Lodge Centre does not have any substances of this class; however, examples of controlled products
of this classification may be found in some hospital and university research labs.
Dangers include explosion and the production of toxic gases. Safe handling includes:
• Avoid shock, friction, and heat
• Avoid contact with water
• Wear proper protective clothing
• Handle in a safe area
WORKING SAFELY
Hazardous materials that enter your body by inhalation, ingestion or skin/eye contact and can
cause acute (immediate) or chronic (long term) health effects that may take many years to
appear. You must apply WHMIS information to prevent products from entering your body. For
information on the specific route of entry of a product into your body, refer to the ‘Toxicological
Properties’ section of the MSDS sheet.
•
Make sure that WHMIS controlled products delivered to your workplace have supplier
labels attached and that a MSDS is available for the product. Advise your supervisor if
supplier labels are missing of if the MSDS sheet is missing or more than 3 years old.
•
Ensure that you have been trained to receive, store, use, handle, and dispose of chemicals safely.
You must also be aware of emergency procedures related to each product.
•
Read labels and material safety data sheets carefully before using the product. Make special note of
incompatibilities, safe handling, safe storage, personal protective equipment and ventilation required
for safe use.
•
Always follow manufacturer’s directions
•
Wear personal protective equipment when advised by the manufacturer on labels or on material
safety data sheets or when required by Deer Lodge Centre.
•
Use the right personal protective equipment for the chemical you are using. i.e. consult the glove
chart or a reputable supplier.
•
Ensure that you have been trained in the proper use, cleaning, storage and limitations of your
personal protective equipment.
•
Store personal protective equipment separately from chemicals
•
Store chemicals in tightly closed, labeled containers.
•
Chemicals that are incompatible must not be stored close to each other.
•
Flammable and combustible chemicals or oxidizers must not be stored near any heat or
ignition source (this includes cooking equipment, furnace and hot water tank). These
products must not be stored on wooden shelves.
•
If an accident occurs, the supplier label is your nearest source of first aid information.
•
Products that are decanted into spray bottles or small containers must have a workplace label
applied. This label must contain the name of the products, the safe handling information (e.g.
wear gloves) and a reference to the MSDS. Once a spray bottle is designated for a chemical it is
for that chemical only.
•
Empty chemical pails/containers are to be discarded of appropriately – follow procedures.
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•
Remember, if a chemical can burn your skin or eyes, it will burn your lungs if inhaled.
•
Never mix chemicals – even if they are for the same purpose.
EYE WASH SAFETY
Proper emergency eye wash equipment is available throughout Deer Lodge Centre as a safety
precaution for emergency treatment for eye exposure to hazardous substances. Accidental
exposure in any form can result in irritation, temporary or permanent vision impairment or
blindness. The provision of engineered controls and personal eye protection that minimized the
possibility of exposure to harmful chemicals is the best protection against eye injury at our
workplace.
Personal eyewash equipment, such as squeeze bottles, support but do not replace proper
eyewash station treatment. The first few seconds following an eye injury are often crucial in
keeping the injury to a minimum. The main purpose of the squeeze bottles is to supply
immediate flushing. When this is accomplished, the injured individual then proceeds to the
plumbed eyewash station and flushes the eyes for required 15-minute period (or as outlined on
the MSDS sheet) prior to medical treatment. It is important to hold the eyelids open and the
eyeballs so water will flow on all surfaces and in the folds surrounding the eyeballs.
Plumbed eyewash equipment can be found throughout the Centre:
•
•
•
•
•
•
Kitchen - basement
Stores
Laundry
Housekeeping
Powerhouse
Occupational Health Nurse Office
Other work areas are supplied with squeeze bottles.
CHEMICAL SPILL PLAN – CODE BROWN
1.
Risk Assessment
Identify the hazards of the spilled material (MSDS).
Evaluate the spill and identify where the leak has occurred. This will also change
how the clean up is performed. The risk assessment will determine who may be
qualified to clean up the spill.
- Chemical Spilled (Material Safety Data Sheet, Hazard assessment of chemical,
reactivity of chemical, PPE requirement)
- Drains affected
- Location & Size of spill
- Knowledge of location of spill kit and that spill kit is not located in an area that may
be affected.
- Know limitations of spill kits (size of spill kit)
- If a fire involved, activate building fire alarm, and use fire extinguisher if you have
been trained to do so.
- Have paging system announce Code Brown.
- Ensure that properly trained personal are available to handle the spill.
70
2.
Look For Injuries
-
Attend to injured or contaminated persons and remove them from the
exposure if you can do so without endangering yourself.
3.
Seal Off Area
-
Notify people in the immediate area.
-
Evacuate the area if necessary and close the door behind the spill.
-
Post a person and signage outside the door to prevent anyone from entering the
spilled area. Inform supervisor or departmental head.
4.
Protective Equipment
-
Wear the appropriate protective gear for the situation as directed by the MSDS.
If the source or the material is not identifiable assume the worst.
As noted in the spill kit there are non-venting goggles and gloves. A respirator is not a
generic size and fit testing is required.
5..
Confine and Localize Spill
Cover any drains either with:
- socks provided
- UXT PAD over drain, or neoprene drain covers or drain plugs
- Use Soc’s to confine progression of spill if required
6.
Stop the Source
-
Stop the source of the spill where possible (shut off valves, over turned drums) to do
so check step 1 and assess the risk.
7.
Clean Up
-
Use the Soc’s to control the size of spill &
Use UXT Universal pads to absorb up chemical
Use Biohazard disposal bag for material.
Label bag with forms of identification (WHMIS label/MSDS)
8.
Disposal of Used Material
-
If the spilled material requires hazardous waste disposal.
Complete a Hazardous Waste Requisition Form.
Call Maintenance and state that you have spill material.
Absorbed materials take on the characteristics of what ever they absorb. Be sure
to dispose of used absorbents and spilt liquids immediately.
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9.
Decontaminate
-
Decontaminate and sanitize affected area if necessary.
10.
Document Spill
-
Inform all parties as required of the spill.
Complete the Injury/Near Miss Form
11.
Restock Materials
-
Place restocking order for any used material
Ensure that absorbent materials and safety equipment used in any clean up operation is
replaced.
12.
Review Contingency Plans and Procedures
DID YOU KNOW?
Chemical handling, storage, use and disposal is regulated provincially under the Workplace
Safety and Health Act and Part 36 of the Regulation. Workplace chemical safety is also part of
other standards and/or accreditation that govern healthcare facilities.
Personal Care Home Standards: Deer Lodge Centre must also meet the PCH Standards as
outlined below:
15.4
All chemicals that are potentially
dangerous to residents are securely
stored.
19.10 All potentially dangerous substances
are labeled and stored in a location not
accessible to residents.
19.11 Combustible materials are stored
separately and safely.
All chemicals must be stored in locked
cupboards, including on the housekeeping
carts. If they are stored in locked rooms or
closets, these must be secured in a way that
prevents resident access. This is assessed
by observation during the tour.
All chemicals in the tub rooms,
housekeeping carts and rooms and laundry
areas must be locked and inaccessible to
residents.
Combustible material such as oil based
paint must be stored in a metal cabinet and
separately from sources of fire.
72
Guidelines for Standards Review includes: Personal protective equipment is available for staff
in the tub rooms
CCHSA’s Accreditation Program – Environment Standards – includes references to WHMIS
and chemical safety in Sections 5 and 6, 7. For example,
7.2
Staff members who handle hazardous materials and waste are properly oriented,
educated and made aware of the risks associated with mishandling.
Deer Lodge Centre inventories of chemicals and all material safety data sheets can also be
found at
http://hschome.hsc.mb.ca/msds/
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Session A and B
F. Code Red-Fire Orders
Code Red – Fire Orders
Nursing Units
Lodge Building 2, 3,4, 5, 6, 7 and Tower Building 3, 4, 5, 6, 7 (including Special Care Unit)
As a healthcare facility, Deer Lodge Centre (DLC) has an obligation to ensure the safety of all
patients/residents, staff and visitors. It is the policy of Deer Lodge Centre to follow the standardized
Emergency Codes approved for use in WRHA facilities/sites. Code Red is used for Fire. Code Red
Policy is activated when there is any incident involving fire, smoke or fumes.
If you discover a fire of there is a fire in your area/unit
R = RESCUE
Rescue or remove anyone in immediate danger to a point of temporary safety
and close door.
Note: if fire is in a room, feel the door before entering. DO NOT ENTER if the
door is hot.
A = ALARM
Pull nearest alarm in your area. Shout “CODE RED” to your co-workers and dial
“55” to report Code Red and the exact location (building, unit, department,
area, room number).
C = CONFINE
Confine the fire by closing all windows and doors in the area.
E = EXTINGUISH
using the nearest fire extinguisher, attempt to extinguish the fire if it is safe to do
so.
If the fire cannot be extinguished. Refer to Code Green – Evacuation.
E – EVACUATE
Unit Staff will ensure that:
• All patients/residents and visitors are placed in patient rooms.
•
All patients/residents on the unit are accounted for (check bathrooms, closets, etc. for
patients/residents who may have hidden due to fear or panic.)
•
All room, stairwell, smoke barrier and windows are CLOSED AND KEPT CLOSED.
•
Shut off oxygen in the immediate area only and remove portable oxygen tanks to a safe location
(except for oxygen necessary for life support).
•
If deemed necessary, main oxygen valve, across from the Nursing Station in the Lodge Building,
may be shut off.
•
If unable to shut off main oxygen valve at Nursing Station, notify the Shift Engineer to close off
the main valve to the building. Response Team Leader will communicate quickly via a portable
radio, or a call can be made to local 2330.
•
The Unit Coordinator, or person in charge, will assume the position of Incident Commander and
directs the arrival of the Emergency Response Team and indicates actions needed.
•
Nursing staff will be assigned to the most seriously ill or at risk.
•
Patient/Resident records are readied for transport (including laptop, Kardex, Chart Rack and files)
What Do I Do If There Is an Alarm or A Code is Called? (The location of the alarm will be
announced in 1 minute.)
74
If you are in the area of alarm - remain and assist
If you are in another area and the alarm is for your normal place of work – return immediately and
assist.
If you are in your area/department and the alarm is for another area
• Immediately terminate all telephone calls. Lines should be open for emergency use.
• DO NOT use elevators in the building where the alarm sounds.
• Close all windows and doors, which have not been shut by the Automated Fire System, and
remain in your area.
• If the alarm is NOT in your building, carry on normal activities and await further instructions.
• Turn on all lights in your area.
• Personnel reporting for or going off duty shall immediately report to their department or follow
instructions.
Should an alarm sound while you are transporting a patient/resident to another area within the Centre,
your responsibility is to ensure their safety. Your goal is to assist the patient/resident and move them to a
safe area.
•
If still on the originating floor, return to the unit with the patient/resident and ensure that unit staff
are aware that the patient/resident is still on the unit.
•
If on any other floor, proceed to your destination, leave the patient and transportation equipment
in custody of the designated person on the unit and return immediately via the stairwells to your
department.
•
When a fire alarm sounds while transporting a patient/resident, listen to the public address
system for the fire location.
•
If the area of the fire is your destination, go to the nearest area away from the fire site instead.
For example If the fire is located in Lodge 6, take the patient/resident to Tower 6.
If the alarm sounds for your area and you are unsure why
Staff should check for: red light on smoke detectors, sprinkler system activation, disc off heat detector,
broken glass on manual pull station
Locked Doors
In addition, nursing staff should be cognizant of the fact THAT ALL NORMALLY LOCKED DOORS
securing the area MAY BE RELEASED on activation of the Fire Alarm. These doors should be checked
to make sure that they have released and are closed.
•
•
•
•
•
•
Interior and exterior doors on alarm:
2 West exit to North Pavilion
West exit to Lodge Building
Tower 3 exit to Lodge Building
Tower 7 exit to Lodge Building
2 South exit to Administration
Response to GENERAL ALARM (Pre-Evacuation Signal):
•
The General Alarm will be initiated automatically after five (5) minutes, unless the alarm is silenced
manually before hand. The General Alarm is the same beep as the Fire Alarm at a faster rate (120
beeps per minute).
•
Evacuation will be initiated at the sole discretion of the Incident Commander or Senior Fire
Department Officer.
75
•
On regular day shift staff will receive instruction from a Program Departmental Director as designated
by the Command Centre. At any other time direction will be received from the Incident Commander or
Senior Fire Department Officer.
•
Horizontal evacuation is to the other side of the nearest fire doors. Further evacuation/marshalling
areas will be determined by the Incident Commander and communicated to all employees.
Return to work duties ONLY when the" All Clear" is announced.
Be Prepared: know the location of fire pull stations, fire extinguishers, emergency exits and alternate
routes.
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Session A and B
G. SAFE FEEDING AND SWALLOWING
SPEECH LANGUAGE PATHOLOGY (SLP)
DYSPHAGIA = DIFFICULTY SWALLOWING
May be the result of reduced muscle strength, sensation, anatomical abnormalities,
or awareness of “how to swallow”.
CONSEQUENCES: malnutrition, dehydration, pneumonia as a result of aspiration, choking
SIGNS/SYMPTOMS ASSOCIATED WITH DIFFICULTY SWALLOWING
• Coughing or clearing the throat when eating or drinking
• Spilling food from the mouth
• Drooling
• Wet, gurgly voice after swallowing
• Difficulty chewing food
• Food remaining in the mouth after swallowing
• Holding food in the mouth for an unusually long period of time
• Reluctance or refusal to eat
• Unexplained weight loss
• Complaints of heartburn or reflux
• Throwing up regularly after meals
• Aspiration pneumonia
Standard care BEFORE the meal:
•
Check for and follow the feeding/swallowing care plan
•
Check resident’s tray to ensure the proper food, liquid textures and diet are provided
•
Assess the resident’s level of alertness to eat. Do not feed or encourage eating if the resident is not fully alert
•
Ensure the resident is seated at a 90-degree angle for the meal
•
Ensure the tray is adequately set up for the resident and any special utensils, cups, plates etc are available
•
Make sure resident is wearing dentures, hearing aid(s), and/or glasses
Standard care DURING the meal:
•
Reduce distractions in the dining room, as necessary
•
Avoid making negative comment about texture modification; be sensitive to the resident’s need for the modification.
•
For new residents, use the meal observation checklist to record observations
Standard care AFTER the meal:
•
The resident should remain upright for 30 minutes after eating and drinking
•
Ensure that proper oral hygiene is completed after each meal or snack
Always monitor for any changes in the resident’s ability to eat/swallow.
Immediately report concerns to the RN, or contact the SLP directly.
•
•
•
•
General Safe Feeding and Swallowing Guidelines:
Head should be neutral or slightly downward (not tilted back)
Encourage taking teaspoon sized bites/sips, one at a time
Encourage the resident to clear throat or swallow again if voice is gurgly or wet-sounding
If you are feeding the resident:
o sit at eye level and feed slowly
o ask the resident what they would like to eat next
o do not mix food on the tray unless the resident requests it
77
HOW TO REFER TO SPEECH- LANGUAGE PATHOLOGY AT DEER LODGE CENTRE:
REHAB UNITS, CHRONIC CARE AND DAY HOSPITAL:
Use form # CL0004-4 – The Consultant’s Referral Request and Report; mail it in interdepartmental mail to the SLP Department
PRIME:
Use form # AD0455 (Internal Consult) – mail it in interdepartmental mail to the Department of Speech-Language Pathology
PERSONAL CARE:
Use form #CL0197-W – PCH SLP Referral From – fax it to 831-2953
78
Session A Only
H. Lifts and Transfers
The Safe Patient Handling session on your Education Day will introduce assessment skills for
transfer and bed mobility status.
A large portion of your session will involve hands evaluation of skills.
You must come prepared to demonstrate proficiency in:
o
o
o
o
1 and 2 person transfers
Sit stand lift
Total mechanical lifts
Sliders. (Including Arjo sliders)
Please be aware that policies have changed regarding some aspects of our Safe Patient Handling
Program. They include (but are not limited to):
o Changes to the one person transfer technique
o Introduction of a turn with an Arjo slider
o Weight restrictions that limit patients/residents who are appropriate for 1and 2 person
transfers.
Should you wish, you may review Section 9 in your Lifts and Transfers Resource Binder (Green,
available on each unit) to view the competency lab checklist used by evaluators during the
evaluation component of the session.
We look forward to seeing you on Education Day.
Musculoskeletal Injury Prevention Physiotherapist
Deer Lodge Centre
831-2945
79
Logo system
DLC Policy Highlights:
o The Lifts and Transfers logo system shall be placed at each patient’s/resident’s
bedside following the transfer and bed mobility assessment at time of admission.
o The Lifts and Transfers Logo System will indicate the transfer method, use of
sliders for bed mobility, equipment, level of assistance needed for each
patient/resident and any other relevant information that may assist staff and
patients/residents to ensure a safe lift or transfer.
o The logo system must be updated each time the patient/resident transfer is
reassessed.
o The main card of the logo system is a 6 ½” x 8 ½” beige card should be posted at
the patient’s/resident’s bedside. The patient’s/resident’s name should be legibly
printed in the upper right corner. Black marker is recommended.
o Attach the small coloured card to the main card to indicate the appropriate
transfer method, lift or the use of slider if indicated.
80
o White cards are to be used whenever additional information is required. Information may
include:
ƒ Use of walking aid (and type) during transfer.
ƒ Sling type, size or loop selection
ƒ Transfer type if not available on a card (eg. Transfer board as assessed by
OT/PT)
ƒ Cueing required
81
One Person Transfer
‰ DLC Policy Highlights:
o
o
o
If the patient/resident weighs more than 70 kg (155 lbs) (even if they
require “minimal assistance”), a minimum of a 2 person transfer is
required. If they weigh more than 250 lbs. and require a “minimal
assist”, a sit stand or mechanical lift must be used.
During any transfer, staff cannot assist the patient/resident by lifting under the
patient/resident’s arms/shoulders as this may cause injuries to their joints and
muscles.
On the flip side, patients/residents cannot hold onto staff (no holding around
staff’s waist or neck or grabbing onto staff’s hands) to assist them during the
transfer as this may cause injuries to staff.
‰ Capabilities of the Patient/Resident for this transfer:
o
To ensure that this transfer method is safe, the patient/resident must be able to:
ƒ Weight bear consistently and reliably for the duration of the transfer
ƒ Maintain a standing position
ƒ Walk at least a few steps consistently and reliably (with a walking aid or
minimal assistance as required)
‰ Staff Members’ Responsibilities:
o Check logo system to ensure Transfer Belt 1 assist logo is displayed
o Check environment for obstacles/easy access to equipment
o Correct set-up of environment/equipment:
o Proper wheelchair preparation
o Correct placement and use of transfer belt
o Safe transfer technique following minimal lift policy
‰ Instructions to the Patient/Resident during the Transfer:
o Allow patient/resident to assist as much as they are able.
o Instructions to patient/resident:
ƒ Slide forward in chair
ƒ Lean forward
ƒ On a count, push up from chair with arms and legs into standing
ƒ Once in standing, allow time to gain balance
ƒ Walk and turn slowly
ƒ Back up to chair until back of legs touch the chair
ƒ Reach behind and place hands on chair
ƒ Slowly sit on a count
‰ Good Body Mechanics for Staff during the Transfer:
o In preparation for the transfer, staff will stand at the side of the
patient/resident with a wide based stance.
o
Hold onto transfer belt handles and as patient/resident moves from sitting to
standing, staff will weight shift from one leg to the other. Never thread your
wrist through the handles.
o Provide only minimal assistance.
o Staff will step and turn with the patient/resident towards the next sitting
surface to avoid twisting of the spine and knees.
o As the patient/residents moves from standing to sitting, staff will shift their
weight from one leg to the other and bend their hips and knees as
patient/resident lowers onto the sitting surface.
Two Person Transfer
DLC Policy Highlights:
o If the patient/resident weighs more than 250 lbs. (even if they require a
“minimal assist”), a sit stand or mechanical lift must be used. (Keeping
weight limits for lifts in mind).
o Staff cannot assist the patient/resident by lifting under the patient/resident’s
arms/shoulders as this may cause injuries to their joints and muscles.
o On the flip side, patients/residents cannot hold onto staff (no holding around
staff’s waist or neck or grabbing onto staff’s hands) to assist them during the
transfer as this may cause injuries to staff.
‰ Capabilities of the Patient/Resident for this transfer:
o
To ensure that this transfer method is safe, the patient/resident must be able to:
ƒ Weight bear consistently and reliably for the duration of the transfer
ƒ Maintain standing position
ƒ Walk at least a few steps consistently and reliably (with a walking aid or
minimal assistance as required)
‰ Staff Members’ Responsibilities:
ƒ Check logo system to ensure Transfer Belt 1 assist logo is displayed
ƒ Check environment for obstacles/easy access to equipment
ƒ Correct set-up of environment/equipment:
ƒ Proper wheelchair preparation
ƒ Correct placement and use of transfer belt
ƒ Safe transfer technique following minimal lift policy
ƒ
‰ Instructions to the Patient/Resident during the Transfer:
o Allow patient/resident to assist as much as they are able
o Instructions to patient/resident:
ƒ Slide forward in chair
ƒ Lean forward
ƒ On a count, push up from chair with arms and legs into standing
ƒ Once standing, allow time to regain balance
83
ƒ
ƒ
ƒ
ƒ
ƒ
Walk forward (+/- mobility aid)
Turn slowly
Back up to chair and sit when back of legs touch chair
Reach behind and place hands on chair
Slowly sit on a count
‰ Good Body Mechanics for Staff during the Transfer:
o In preparation for the transfer, staff will stand at either side of the
patient/resident, facing the side of the patient/resident with feet shoulder width
apart. Allow patient/resident to do as much as physically able.
o Staff holds onto transfer belt handles and as patient/resident moves from
sitting to standing, staff will weight shift from their back leg to their front leg.
o Provide only minimal assistance.
o Staff will step and turn with the patient/resident towards the next sitting
surface to avoid twisting of the spine and knees.
o As the patient/residents moves from standing to sitting, the staff will shift
their weight from the front leg to their back leg and bend their hips and knees
as patient/resident lowers onto the sitting surface.
Sling Selection & Maintenance
… DLC Policy Highlights:
o DLC residents who require the consistent use of the floor model mechanical
lift or ceiling track lift will be required to purchase their own sling.
o Patients on the Rehab units are exempt from purchasing their own personal
slings. Slings will be borrowed from DLC’s equipment pool
“Slings for new admissions can be accessed through the equipment pool during daytime hours at
2260 or Contact the Housekeeping Supervisor at ext. 2142 between the hours of 1530 – 2200
hours Monday – Friday and 0600 – 1415 hours Saturday and Sunday. The supervisor can be
paged through the Switchboard. During hours when the Housekeeping Supervisor is not in the
Centre, the Nursing Coordinator will be responsible for accessing the stores area.”
o
o
o
o
o
Patients/residents who consistently use a sit-stand lift will not be required to
purchase their own harness.
If determined that two slings are required for a patient/resident (i.e. hygiene
practices/standards), the patient/resident will be required to purchase both
recommended slings.
Patients/residents with special needs may require further assessment from
PT/OT to determine the appropriate sling for safe transfers.
Slings are not interchangeable between different lifts. Only slings designated
for a particular make/model shall be used on that lift. This also includes the
sit-stand lifts, as the harnesses are not interchangeable between different
manufacturer’s lifts.
It is the responsibility of all staff to ensure that the slings are visually
inspected before use.
84
o
o
Slings with tears or frays shall not be used. Return faculty slings to the
Equipment Pool when appropriate for evaluation with a Facility Equipment
Repair Form.
With regards to DLC owned slings, these slings shall not be shared between
patients/residents if visibly soiled or if the patient/resident is on precautions
for an infectious condition. Slings used by patients/residents on precautions
shall be sent to laundry following Infection Control Practices.
‰ Factors affecting decision of sling type and hook up for loops may include but
not limited to:
o Size of the patient/resident including abdominal girth, height and weight
o Presence of amputation; location of amputation; unilateral or bilateral
o Comfort of patient/resident in sling
o Adaptive seating in the wheelchair including but not limited to seat back,
presence of headrest, type of chair (i.e. tilt or recline)
o Positioning of the patient/resident in the wheelchair and frequency of
adjustment
o Head control of the patient/resident
o Abnormal muscle tone i.e. rigidity, spasticity or low tone
o Best position of the patient/resident to facilitate proper body mechanics and
minimize risk of injury to staff during the transfers
‰ Staff Members’ Responsibilities:
o Staff will visually inspect the sling to ensure it is in good working condition
before use.
o Remove a sling from use, if any tears, frays or signs of wear or heat damage
are noted on inspection.
o Use the specified sling for that particular mechanical lift.
Additional information:
‰ Battery Care (Applies to Arjo, Mediman, Golvo and Voyageur Lifts)
o Do not wait for the battery to run down completely. The batteries for the lifts
are much like car batteries and can be recharged safely at any time.
85
o
o
o
o
o
o
o
Note that the life of the battery will be maximized if the recharging is
completed before the low battery indicator turns on.
Prior to charging the battery, inspection of all parts of the battery
should be conducted to ensure there is not any damage (e.g. from
being dropped).
Do not attempt to recharge a damaged battery. Report damaged
batteries as soon as possible to Facility Management.
Batteries should be recharged as follows:
ƒ After the lift is no longer needed, return pack to its charger
ƒ When low battery indicator turns on
ƒ End of every work shift
ƒ Daily at minimum
Charge the battery pack for at least 8 hours whenever possible.
Charge the battery for a minimum of 15 hours once a week to
maximize the longevity.
If charged properly, the batteries should last for approximately 5 years.
… Brakes with Lifts (Applies to Arjo, Mediman and Golvo lifts
o Generally the rule is that brakes on lifts are only to be locked when in storage.
o During lifting of patients/residents, the brakes must remain unlocked to ensure
that the lift can balance and adjust to the weight/load applied to it.
o Occasionally brakes may be applied to the lift when attaching the sling loops
to ensure the lift does not move however, before lifting the patient/resident up
in the lift, the brakes must be unlocked.
‰ A minimum of 2 assists are required when using any mechanical lift (i.e. Floor
Model Mechanical Lift, Sit-Stand Lift, and Ceiling Track Lift).
The transfer may require more than 2 staff people if the following indicators
are present:
Š Size of patient/resident (guide: one person per 100 lbs)
Š Acute illness of the patient/resident
Š Patient/resident equipment i.e. IV poles, catheters, commodes,
shower trolleys, oversize wheelchairs or complex seating
Š Presence of a cast or brace
o Behaviour of a patient/resident
‰ Check the manual for the mechanical lift you are using or the green lifts and resource
binder for weight capacity. Not all mechanical lifts have the same capacity.
‰ Mechanical lifts should only be used to transfer patient/resident from one location to
another over the shortest possible distance.
86
Total Lift (Usually referred to as Mechanical lift)
-Floor model or Ceiling track
‰ DLC Policy Highlights:
o Liko, manufacturer of Golvo & Viking XL floor model lifts clearly state that
only the slings manufactured specifically for that lift should be used with that
lift.
o BHM slings and Mediman (BHM) slings are used interchangeably among the
Mediman floor model lifts, the Arjo Maxi 500 and the Voyageur ceiling track
lifts.
o When using the portable ceiling track lift units, an arm extension is available in
two lengths to assist staff to clip the extension strap to the ceiling track.
The pictures below illustrate the correct and incorrect method for
Both extension arms that are available.
ƒ The arrows indicate the direction/orientation of the handle of the arm
extension. The correct position of the handle is slightly angled or more
horizontal than vertical (up and down).
Correct
o
Incorrect
To prevent injuries to staff, it is recommended that portable ceiling track lifts
be transported from room to room using carts available on the units
… Factors affecting decision of transfer method/Capabilities of the Patient/Resident
for this transfer:
87
o
o
Unable to weight bear reliably or consistently through upper or lower
extremities
Other more independent transfers are unsafe
… Staff Members’ Responsibilities:
o Check logo system to ensure mechanical lift or ceiling track lift logo is
displayed
o Check environment for obstacles/easy access to equipment
o Visual inspection of sling
o Correct placement of sling (Midline of the body and the top of “U” at or
above the level of the coccyx)
o Ensure the loops of the sling are secured on the lift with good communication
between staff to ensure the same loop is used on each side of the sling.
o Whenever practical, the base legs of the lift should be open during lifting and
lowering.
o Lift the patient/resident only high enough to clear the surface (usually only a
few inches)
o Ensure the patient/resident faces the lift during the transfer.
o When using the Golvo lift, ensure the strap is vertical and parallel to the mast
during transfers.
o Ensure that the patient/resident remains over the base of support at all
times when suspended in the lift.
Base of support
o
o
o
o
Ensure the boom does not come into contact with the patient/resident
When positioning patient/resident in the wheelchair, ensure there is no
manual tilting of the wheelchair. Whenever possible the wheelchair
should be approached from the front. If it is necessary to approach the
chair from the side, a ceiling track lift should be used whenever possible.
Once the patient is positioned on the intended surface, remove the sling from
underneath the patient/resident. Only in some special circumstances, is it
acceptable to leave the sling underneath the patient/resident but this has to be
assessed and agreed upon by the IDT.
Once the transfer is completed, ensure the patient/resident is secured safely on
the intended surface.
88
‰ Instructions to the Patient/Resident during the Transfer:
o Provide the patient/resident with step-by-step instructions as to the procedure
of the transfer
o Patient/resident instructed to keep their arms in the sling with arms across
their chest if able.
‰ Good Body Mechanics for Staff during the Transfer:
o Allow patient/resident to do as much as physically able as far as turning and
sling placement, assistance with sling removal.
o Raise the head of the bed if difficulty attaching shoulder straps to lift
o To turn or move the lift, 2 assists may be required. Staff must ensure that their
spine does not twist during this action and that a weight shift from the legs
initiates the movement.
o To position the patient/resident in the wheelchair from the lift:
ƒ One staff member may stand in front of the patient/resident and push on
the patient/resident’s knees
ƒ The other staff member may stand behind the wheelchair, hold onto the
sling and guide the patient/resident back into the chair, ensuring they
remain over the base of support at all times. This will ensure that the
patient/resident is positioned properly in the chair.
Sit-Stand Lift
‰ DLC Policy Highlights:
o When using the lift, only raise the patient/resident can be lifted just high
enough to clear the surface.
o The patient/resident must be able to sit unsupported to use this lift.
‰ Factors affecting decision of transfer method/Capabilities of the Patient/Resident
for this transfer:
o Able to bear weight fully through one leg or partially through both legs
o Able to hold onto lift with at least one hand
o Able to sit unsupported (may need assistance to achieve position so long
as it is minimal assist-patient/resident must be able to do most of the
work themselves so a staff person is not lifting more than 35 lbs. of a
patient/residents weight)
o Able to tolerate transfer in lift
‰ Staff Members’ Responsibilities:
o Check logo system to ensure sit-stand lift is displayed.
o Correct placement of harness around patient/resident
o Ensure patient/resident’s arms/hands are outside of harness
o Harness loops are secured on the lift.
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o Patient/resident holds onto the lift with at least one hand, both hands if able.
o Ensure patient/resident’s knees are placed correctly against the knee support
plate
o Lift the patient/resident only high enough to clear the surfaces
o When positioning patient/resident in the wheelchair, ensure there is no
manual tilting of the wheelchair
o Correctly guide patient/resident onto intended surface
o Remove harness from underneath the patient/resident
‰ Instructions to the Patient/Resident during the Transfer:
o Provide the patient/resident with step-by-step instructions as to the procedure
of the transfer
o Patient/resident instructed to hold onto the lift with at least one hand, both if
able.
o Patient/resident may be instructed to lean backward slightly in the harness as
lifted.
‰ Good Body Mechanics for Staff during the Transfer:
o To turn or move the lift, 2 assists may be required. Staff must ensure that their
spine does not twist during this action and that a weight shift from the legs
initiates the movement.
o Ensure good body mechanics when moving the patient/resident from lying to
sitting and in reverse. Listed below are two possible options for achieving this
activity:
ƒ Patient/resident is instructed to assist if able. Roll patient/resident onto
their side and then from a side-lying position assist the patient/resident
into sitting. One staff member may assist with the patient/resident’s
trunk/upper body and the second assist with their legs.
ƒ The second option is to raise the patient/resident’s head of the bed to
achieve a partial sitting position and staff can then assist to move
patient/resident’s legs over the edge of the bed.
Sliders
‰ DLC Policy Highlights:
o A Deer Lodge transfer logo must be posted indicating the type of slider used.
o
Deer Lodge Centre policy states that a minimum of 2 assists are required
when using sliders. More than 2 assists may be required when:
o Patient/resident is obese/rotund in the abdomen or overly tall
o Low/high muscle tone
o Behavior which interferes with care
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… Bed Mobility Activities:
(Move patient/resident up in bed or move into the middle of the bed)
ƒ DLC Quilted sliders may be used for patients/residents under 200 lbs
however, if there are complicating factors with this patient/resident’s
transfer or condition, Arjo slider may be the appropriate choice.
• There are two sizes available of DLC Quilted sliders:
Small/Medium – Red; Large- Blue.
ƒ Arjo maxislide sheets will be used for patients/residents over 200 lbs.
• There are three sizes available: Single size – Purple; One &
one half size – Blue; Double size
Note: Blue and Orange sliders are a different weave and caution
should be used as they are very slippery.
ƒ
Mechanical lift will be used for patient/residents over 350 lbs. except
with rolling. (An Arjo Slider can continue to be used regardless of
weight).
‰ Staff Members’ Responsibilities:
o Check logo system to ensure slider logo is displayed.
o Provide patient/resident with appropriate instructions to assist with the bed
mobility activity.
o Correct placement of slider underneath patient/resident
o Safely move the patient/resident into the intended position
o Slider removal when appropriate.
… Instructions to the Patient/Resident during the Bed Mobility Activity:
o Provide the patient/resident with step-by-step instructions as to the procedure
of the transfer
‰ General Good Body Mechanics for Staff during the Use of Sliders:
o Initiate the movement with a weight shift from legs
o NO lifting should occur when sliding the patient/resident on sliders
‰ To Place Arjo Sliders:
*Always use 2 Arjo slider sheets together
There are two techniques that can be applied with using Arjo sliders:
1) Tuck Technique - to use when patient/resident can assist or can be rolled
o Same as sling placement. Patient rolls to one side, sliders are tucked, rolls to
other and the sling is flattened out. This is the only option when using a DLC
Quilted slider.
2) Fold Technique - to use when patient/resident is obese/round in the
midsection, unable to roll, when medical status may be compromised with rolling
or if patient/resident is near the edge of bed/on a tub stretcher.
o One staff member is on each side of the bed.
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o
o
o
o
o
o
o
o
o
Position one slider sheet on top of patient/resident with handles facing up. The
end of the slider without the handles should be positioned just below the
patient’s/resident’s chin.
Lay the second slider sheet over the first slider in the same position.
Staff grasp the end of both sliders at the patient’s/resident’s feet. Fold the
sliders into folds the width of your hand, leaving the last 4” to 6” of the sliders
(near the head) unfolded.
Grasp folded sliders and turn over with folds facing down.
Place sliders under the patient’s/resident’s head with open ends even with top
of patient’s/resident’s ears.
Staff should face toward the head of the bed where the sliders are positioned.
Bend hips and knees and position feet to point in that direction.
Grasp the bulk of the folds with inside hand. The outside hand will hold the
open end/top corner of the sliders.
On the count of three, both staff members pull inside arm straight backwards
once to begin unfolding the slider. Repeat as necessary. Continue to move
both hands down the sliders. The outside hand will stabilize as the inside
hand will assist to unfold the sliders
If a soaker is positioned underneath a patient/resident, hold soaker with
outside hand and reach underneath to grasp sliders folds. Continue to unfold
sliders until sliders go underneath soaker. If any resistance, depress surface of
bed with arm to assist with insertion of sliders.
‰ To Remove Sliders
o DLC Quilted Slider:
o Patient/residents with a history or potential risk for falls must not have
any type of slider left under them in bed.
o Removal the slider is similar to the removal of a sling from underneath
a patient/resident in bed.
o Roll the patient/resident onto each side in turn to remove the slider.
o Removal of Arjo Sliders:
o Arjo sliders must always be removed from under the patient/resident
after repositioning. They can be removed one at a time or together.
o One staff member will stand near the head or foot of the bed
from the side and reach underneath the bottom slider sheet and
grasp the opposite corner of both sliders.
o Staff member will pull both corners of the sliders at a 45o angle
in the direction toward them.
o Continue to pull the sliders out along the patient/resident
gradually removing the sliders from under the patient/resident.
… Lateral Transfers:
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(Move patient/resident from one horizontal surface to another with surfaces
approximately at the same height.) i.e. bed to stretcher or bed to tub
stretcher)
ƒ Arjo sliders will be used for all patients/residents weighing less than
350 lbs. (i.e. Do not DLC quilted sliders to move from bed to a stretcher.
ƒ Mechanical lift will be used for patient/residents over 350 lbs.
‰ Move Up in Bed:
Generally, the procedure to move a patient/resident up in bed is similar with both
the Arjo sliders and DLC Quilted sliders. Listed below is the general procedure
and included are any special instructions for each slider type.
o
o
o
o
o
o
o
o
o
Lower side rails.
If patient/resident is able to help, have them bend their knees and hips (if
range of motion at the knees and hips is available).
Place pillow against headboard.
Position patient’s/resident’s arms across their chest if possible.
Position one person on each side of the bed.
Grasp the slider/handles at the approximate level of the
patient’s/resident’s shoulders and hips with palms down, wrists in a
neutral position, elbows close to the body and back straight.
Bend hips and knees and position feet in a wide stance with feet parallel to
each other.
Staff to place weight on the leg closest to the foot of the bed.
When staff members are in the correct position and on the count of three, staff
will shift their weight from the back leg to the front leg to slide (not lift) the
patient/resident up in bed. If the patient/resident is able to assist, instruct them
to lift their buttocks off the bed and push with their heels during the sliding
motion.
The patient/resident will only move the distance equal to the weight shift
therefore this process may need to be repeated to achieve the final position
desired.
‰ Move Across in Bed
-Generally, the procedure to move a patient/resident across in bed/lateral transfer
(i.e. bed to stretcher) is similar with both the Arjo sliders and DLC Quilted
sliders. Listed below is the general procedure and included are any special
instructions for each slider type.
o Place bed flat if tolerated by patient/resident and position at a comfortable
working height. Lower side rails and put brakes on bed.
o Staff position on the same side of the bed as each other and as the direction of
the slide.
o Both staff members will grasp the slider on the same side of the bed as each
other. One staff will grasp the slider/handles at the approximate level of the
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o
o
o
o
patient’s/resident’s shoulders and trunk and the other staff will grasp the slider
at the approximate level of the trunk and hips. (A blue slider may be required
if you are using a DLC slider) Palms should face down, wrists in a neutral
position, elbows close to the body and back straight.
Bend knees and hips and position feet with one foot in front of the other in a
staggered stance.
Place weight on the front leg.
When staff members are in the correct position and on the count of 3, shift
weight from the front to the back leg to pull the patient/resident in the
direction toward staff. With this motion, the patient/resident will be slid to the
middle of the bed or laterally transferred from one surface to another (i.e. bed
to stretcher).
The patient/resident will only move the distance equal to the weight shift
therefore this process may need to be repeated to achieve the final position
desired.
‰ Bed Mobility: Turn in Bed with an Arjo slider
-Listed below is the general procedure. This should not be done with a DLC
Quilted slider.
o Place bed flat and position at a comfortable working height. Lower side rails
and put brakes on bed.
o Staff are positioned on the opposite sides of the bed.
o The slider will need to be placed with the fold technique.
o Each staff member faces the bed with one foot ahead of the other. Hips and
knees should be bent.
o Staff member ONE grasps the top slider handles with the palms up, wrists in
neutral position and the back straight.
o Staff member TWO places one hand on the patient/residents shoulder and hip.
The patient will roll towards this person.
o On a count, Staff member TWO pushes the resident’s hip and shoulder away,
the other gently pulls the slider towards them and assists in turning the patient.
o Always remove Arjo™ sliders from under the patient/resident after
repositioning.
Additional Highlights from DLC Safe Patient Handling & Movement
Policies
o
Documentation of transfer method and bed mobility techniques will be
recorded on the following:
ƒ Lift, Transfer and Bed Mobility Assessment Form (see attached
form following this section in the manual)
Š To be completed within the first 24 hours of admission and
updated at time of reassessment
ƒ Lifts & Transfers Logo System
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Š To be posted at patient’s/resident’s bedside following admission
transfer assessment and to be updated at time of reassessment
ƒ Patient/Resident Care Plan
ƒ Integrated Progress Notes
o Resources that may be consulted include, but are not limited to:
Occupational Therapy, Physiotherapy, Safety Officer, Occupational
Health and Safety Nurse.
Additional information is available. The green “Lifts and Transfers Resource Binder” is
available on each patient care unit.
Safe Work Procedures are available on the shared drive:
Administrative P & P →Health and Safety Manual→ MSI Prevention→ Safe
Patient Handling and Movement →Safe Work Procedures and Practices
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