Assessing Facility & Patient Needs Towards Appropriate Selection of

Safe-Lift Equipment

Safe Patient Handling and Movement

Dana L. Root, MS, PT, CPERegional Ergonomics CoordinatorChicago, IL312-353-2220414-297-3315root.dana@dol.gov

TerminologyTerminology

Caregivers:Caregivers:– RNs, LPNs, CNAsRNs, LPNs, CNAs– PTs, PTAs, OTs, OTAsPTs, PTAs, OTs, OTAs– AidesAides– TransportersTransporters– Family membersFamily members– Etc.Etc.

Where To StartWhere To Start

Step 1: Collect Baseline DataStep 2: Identify High-Risk UnitsStep 3: Gather Data About High-Risk UnitsStep 4: Identify High-Risk TasksStep 5: Conduct Team Assessments of These TasksStep 6: Analyze the RiskStep 7: Involve the Caregiver and Patient in Selecting

the EquipmentStep 8: Determine RecommendationsStep 9: Implement RecommendationsStep 10: Monitor Results

Step 1: Step 1: Collect Baseline Injury DataCollect Baseline Injury Data 1. Focus on injuries related to patient handling/movement2. Information from:

• OSHA log• Nurse manager files• Facility accident stats• Office of Workers’ Comp Prog

3. For each unit assess:• Number of injuries • Work Days Lost• Modified Duty Days

Step 2: Step 2: Identify High-Risk UnitsIdentify High-Risk Units

1. How? • Using baseline data on the

incidence and severity of injuries 2. Why?

• Allows you to prioritize time and resources.

Step 3: Step 3: Gather Data About High Risk UnitsGather Data About High Risk Units Patient Population/Staffing/Equipment UsePatient Population/Staffing/Equipment Use

– Staffing Staffing – Discuss projected plans Discuss projected plans – Describe the patient, including dependency levelDescribe the patient, including dependency level

00 IndependentIndependent11 SupervisionSupervision2 2 Limited AssistanceLimited Assistance33 Extensive AssistanceExtensive Assistance44 Total DependenceTotal Dependence

Step 3: Step 3: Gather Data About High Risk UnitsGather Data About High Risk Units

Space Space considerationsconsiderations

General facility General facility layoutlayout

Doorway widthDoorway width Angles and turnsAngles and turns StorageStorage Dining roomsDining rooms

HallwayHallway– RailingsRailings

Visiting roomsVisiting rooms Activity roomsActivity rooms Common bathroomsCommon bathrooms

Step 3: Step 3: Gather Data About High Risk UnitsGather Data About High Risk Units

Space/Maintenance/Storage• Identify anticipated changes

in the physical layout• Describe space constraints for

patient care tasks• Focus on patient rooms• Bathrooms• Shower areas

• Describe process for equipment maintenance

Step 3: Step 3: Gather Data about High Risk UnitsGather Data about High Risk Units

1. Inventory of all patient care equipment

2. Describe working condition

3. How frequently equipment is used

4. Perception of problem areas

Step 3: Step 3: Gather Data About High Risk UnitsGather Data About High Risk UnitsCurrent equipment/ furnitureCurrent equipment/ furniture BedsBeds

– HeightHeight– TypeType

ChairsChairs– WheelchairsWheelchairs– Geri chairsGeri chairs– Regular chairsRegular chairs– ReclinersRecliners

ToiletsToilets– High riseHigh rise– RegularRegular

TablesTables– Height Height – TypesTypes

Life devicesLife devices Positioning and repositioning Positioning and repositioning

devicesdevices Other equipmentOther equipment

– ScalesScales

Step 4: Step 4: Identify High Risk TasksIdentify High Risk Tasks

• Identify and assess nursing staff perceptions of high-risk tasks.

• Identify variation between units• Patient characteristics• Availability of equipment• Physical layout• Work organization

Step 4: Step 4: Identify High Risk TasksIdentify High Risk Tasks

•General observation

•Employee discussions

•Employee questionnaires

•Review of medical data

•Symptom surveys

•Quantitative evaluations

•Previous studies

•Job consistency and fatigue

•Brainstorming and group activities

Step 4: Step 4: Identify High Risk TasksIdentify High Risk TasksFrequency

ofTask

 H= high

M= moderate

L= low

Perceived Stress of

Task 

H= high M= moderate

L= low

Rank Order  

1= high-risk10= low risk

Patient Handling Tasks

      Transferring patient from wheelchair to toilet to toilet

      Bathing a patient in a shower chair

      Repositioning patient in bed from side to side

      Transferring a patient from bed to stretcher

      Lifting a patient up from the floor

Step 5: Step 5: Conduct Assessment by the teamConduct Assessment by the team

Purpose: •Include staff input in assessment and solutions.

•Recognize the many direct and indirect factors that may contribute to potential risk

•Identify potential solutions that will serve to minimize risk of injury to the caregivers and patients

Step 6: Risk AnalysisStep 6: Risk Analysis1. Review data for each unit:

• Baseline injury data• Other data

• Staffing• Equipment inventory• Anticipated changes

• Rank high risk tasks• Frequency• Stress

• Observation data

2. Identify problem areas

3. Set priorities

Step 7: Involve Healthcare Provider & Step 7: Involve Healthcare Provider & Patient in Selecting EquipmentPatient in Selecting Equipment

✲✲Obtain Patient & Healthcare ProviderObtain Patient & Healthcare Provider Buy-InBuy-In ✲✲

Purpose: To enhance effectiveness by increasing acceptance and adherence.

Step 7: Involve Healthcare Provider Step 7: Involve Healthcare Provider & Patient in Selecting Equipment& Patient in Selecting Equipment

Two end user groups:Two end user groups:1.1. CaregiverCaregiver

2.2. PatientPatient BothBoth participate in the participate in the

decision making processdecision making process– Equipment fairsEquipment fairs– Trial sessionsTrial sessions

Step 7: Involve Healthcare Provider Step 7: Involve Healthcare Provider & Patient in Selecting Equipment& Patient in Selecting Equipment

Patients can rate/rank the equipment using Patients can rate/rank the equipment using surveyssurveys

Family members can have input to selectionFamily members can have input to selection

Step 8: Determine RecommendationsStep 8: Determine Recommendations

1. Achievable and simple

2. Constraints

3. Costs

Step 8: Implement RecommendationsStep 8: Implement Recommendations4. Approaches

• Engineering Controls • Reduce or eliminate hazard

• Equipment• Furniture• Tools

• Administrative Controls • Work practices changes• Management policies

• Staffing levels• Staff needed for each type

of transfer• Lifting schedules• Lifting teams

EQUIPMENT SELECTION: EQUIPMENT SELECTION: Engineering ControlsEngineering Controls

1. Eliminate the need to do the hazardous activity

2. Redesign the activity to reduce the hazard or minimize the hazard

3. Formal equipment selection and evaluation process

4. Selected at equipment fairs

EQUIPMENT SELECTION: EQUIPMENT SELECTION: Engineering Control StrategiesEngineering Control Strategies

1. Devices are appropriate for the tasks to be accomplished

2. Devices must be safe for both the caregiver and the patient

3. Device must be comfortable for the patient

4. Device should be easily understood and managed

5. Device must be efficient in use of time

6. Maintenance should be minimal

EQUIPMENT SELECTION: EQUIPMENT SELECTION: Engineering Control StrategiesEngineering Control Strategies

7. Storage should be reasonable

8. Device must be easy to maneuver in tight spaces

9. Device should be versatile

10. Device must be easy to clean

11. Device must be adequate in number

12. Cost

EQUIPMENT SELECTION: EQUIPMENT SELECTION: Engineering Control StrategiesEngineering Control Strategies Equipment availabilityEquipment availability

– Adequate Adequate varietyvariety of slings of slings In a convenient locationIn a convenient location Toilet and bathing mesh slingsToilet and bathing mesh slings

– Available and in Available and in accessibleaccessible areas areas Storage roomStorage room Empty roomEmpty room Short term use in the hallwayShort term use in the hallway

EQUIPMENT SELECTION:EQUIPMENT SELECTION:What to Buy??What to Buy??

1.1. Total dependence Patients Level 4Total dependence Patients Level 4 Full sling mechanical lift deviceFull sling mechanical lift device

2.2. Extensive Assistance Level 3Extensive Assistance Level 3 Use of aid of a mechanical deviceUse of aid of a mechanical device

• Stand assist deviceStand assist device

3.3. Supervision/Limited Assist Level 2 & 1Supervision/Limited Assist Level 2 & 1 Depending on the patient’s conditionDepending on the patient’s condition

– Stand assist liftStand assist lift– Walking aid deviceWalking aid device– Gait beltsGait belts– Sliding boardSliding board

Avoid manual liftingAvoid manual lifting

EQUIPMENT SELECTION:EQUIPMENT SELECTION:What to Buy??What to Buy??

4.4. Independent Patients Level 0Independent Patients Level 0 Capable of bearing own Capable of bearing own

weightweight Walk without assistanceWalk without assistance

5.5. Lifts from FloorLifts from Floor A single full sling A single full sling

mechanical liftmechanical lift If patient can regain If patient can regain

standing with minimal standing with minimal assist: transfer gait with assist: transfer gait with handleshandles

Patient Patient Dependency Dependency ClassificationClassification

Height Adjustable Height Adjustable BedBed

Full Sling LiftFull Sling LiftStand Assist Stand Assist

LiftLiftLift WalkerLift Walker

Stand Assist Stand Assist AidAid

Gait Belt with Gait Belt with HandlesHandles

Friction Friction Reducing AidReducing Aid

0 - Independent0 - Independent RecommendedRecommended NeverNever RarelyRarely RarelyRarely RarelyRarely RarelyRarely RarelyRarely

1 – Supervision1 – SupervisionRecommendedRecommended RarelyRarely

OccasionallyOccasionally OccasionallyOccasionally NormallyNormally OccasionallyOccasionallyRarelyRarely

2 – Limited 2 – Limited AssistanceAssistance

StronglyStrongly

RecommendedRecommendedRarelyRarely

NormallyNormally NormallyNormally NormallyNormally NormallyNormally NormallyNormally

3 – Extensive 3 – Extensive AssistanceAssistance

RequiredRequired NormallyNormally NormallyNormally NormallyNormallyRarelyRarely RarelyRarely

AlwaysAlways

4 – Total 4 – Total DependenceDependence

RequiredRequired AlwaysAlwaysNeverNever NeverNever NeverNever NeverNever

AlwaysAlways

Lift Aid Equipment Determination Grid

For a typical patient with the dependency status classification as shown, this grid indicates normal equipment requirements to conduct a safe transfer. Some patients may have special characteristics

and not exactly match a typical profile. In those situations, special consideration will be required.

EQUIPMENT SELECTION:EQUIPMENT SELECTION:What to Buy??What to Buy??

6.6. RepositioningRepositioning– Bed:Bed:

• Bed controls Bed controls utilizedutilized

• Trendelenberg Trendelenberg positioningpositioning

• Friction Friction reducing reducing devicesdevices

– Chair:Chair:• Stand assist liftStand assist lift• Gait BeltsGait Belts• Hand slingsHand slings

EQUIPMENT SELECTION:EQUIPMENT SELECTION:What to Buy??What to Buy??

7.7. Special Situations DevicesSpecial Situations Devices

• Bariatric patients Bariatric patients ⇒⇒ special special equipmentequipment

• Transfer chairs Transfer chairs ⇒⇒ stretcher stretcher chairschairs

• Mechanical friction reducingMechanical friction reducing

• Sliding boardsSliding boards

• Transfer beltsTransfer belts

• Special trainingSpecial training

EQUIPMENT SELECTION: EQUIPMENT SELECTION: What to Buy??What to Buy??

8.8. Combative & Mentally Impaired Combative & Mentally Impaired PatientsPatients

Use the appropriate lifting Use the appropriate lifting aid deviceaid device

Additional care providers Additional care providers as neededas needed

EQUIPMENT SELECTION: EQUIPMENT SELECTION: What to Buy??What to Buy??

9.9. Equipment AvailabilityEquipment Availability Should be availableShould be available Stored and available in accessible Stored and available in accessible

areasareas Batteries chargedBatteries charged Slings available for all shiftsSlings available for all shifts Variety of sling sizesVariety of sling sizes Toileting and bathing slings Toileting and bathing slings

availableavailable Friction reducing devices Friction reducing devices

availableavailable Sliding boardsSliding boards Transfer beltsTransfer belts Gait beltsGait belts

Key QuestionsKey Questions1. Are funds best utilized for the acquisition of new

technologies, or for the upgrade or replacement of old equipment?

2. Should you purchase or to lease patient handling equipment?

3. Should you provide ceiling-mounted lifts or floor based lifts throughout the unit?

4. What accessories should be included?

5. What quantity of various devices is needed?

SAFE PATIENT HANDLING SAFE PATIENT HANDLING EQUIPMENTEQUIPMENT

•Sliding Boards•Air Assisted lateral sliding aids•Friction reducing devices•Mechanical lateral transfer aids•Transfer chairs•Gait belts with handles•Powered full body sling lifts

SAFE PATIENT HANDLING SAFE PATIENT HANDLING EQUIPMENTEQUIPMENT

•Powered standing assist and repositioning lifts

•Standing assist and repositioning aids

•Bed Improvements to support transfers

•Dependency Chairs

•Other ergonomic transfer devices

Monitor ResultsMonitor Results Ongoing success of process

– Established key indicators– Established time line

Information on OSHA’s Website – Information on OSHA’s Website – www.osha.govwww.osha.gov

OSHA Home Page

OSHA Hospital/Nursing

Home Pages OSHA Ergonomics

Page

Other ResourcesOther Resources Patient Safety CenterPatient Safety Center

Patient Care Ergonomics Resource Guide: Patient Care Ergonomics Resource Guide: Safe Patient Handling and MovementSafe Patient Handling and Movement

www.visn8.med.va.gov/patientsafetycenter

CDC/NIOSHCDC/NIOSHSafe Lifting and Movement of Nursing Home Safe Lifting and Movement of Nursing Home Residents, publication #2006-117Residents, publication #2006-117

www.cdc.gov/nioshwww.cdc.gov/niosh

QUESTIONS……………QUESTIONS……………