Safe Patient Handling

1. Safe Patient Handling

2. Objectives • Ergonomics • Risk factors • High risk patient care activities • Conditions that result in high risk environments • Best solutions for moving and handling patients

3. The Basic Problem • Fundamental ergonomics • The National Institute of Occupational Safety and Health (NIOSH) research: • Under IDEAL CONDITIONS, 90% of males, and 75% of females can safely lift 23 kilograms (~51 pounds), MAXIMUM. • Healthcare settings do not provide ideal conditions (straight back, no bending, no twisting, positive grasp, infrequent lifts, etc.) • Conclusion • One healthcare worker cannot safely lift an adult patient alone, and positioning tasks that require greater than 23Kg of exertion are also hazardous.

4. What Makes Patients Risky? • They are bulky—adults are > 51 pounds • No handles! (Technical term is “coupling” = good grasp) • The unpredictable occurrence • Possible lack of help from patient • Possible consideration of wounds

5. Risks of Job Tasks • What factors contribute to a healthcare worker being hurt during patient positioning? • Awkward postures • Lifting heavy loads • Length of lifting (supporting the patient over a period of time) • Reaching • Frequency of positioning tasks

6. OSHA “Regulations” Regarding Patient Positioning • OSHA recommends minimizing manual lifting of patients/ residents in all cases and eliminating lifting when possible.

7. Basic Safe Patient-Positioning Process • Identify • Characteristics of the patient to be positioned • Type of positioning to be accomplished • If movement, where the patient is being moved to. • Task-related Hazards • Environment/facility-related hazards • What personnel/equipment will be needed • How to move or lift the patient.

8. Possible Risks In Job Environment • Slip, trip, and fall hazards • Uneven work surfaces (bed to stretcher, chairs, toilets) • Space limitations—(i.e. patient fallen in the bathroom) • Equipment hazards (respirators, IV pumps etc.)

9. Other Risks • Help unavailable when needed (understaffed facility) • Patient handling equipment in poor working order • Combative patients • Others?

10. Assessing the Patient Before Moving • Always review the patient care plan before attempting to move the patient. • A patient care plan describes a specific patient’s needs, degree of assistance required, special treatments, etc.

11. Assessing a Patient • Next ask the following questions before moving or transferring the patient. • Can they provide assistance? • Can they bear weight? • Can they cooperate and follow instructions? • How big and heavy is the patient? • Note patient’s wounds, dressings, and any machinery.

12. Types of Patient Moves and Lifts • Lateral transfers: Moving a patient sideways • Repositioning: Moving a patient up and down or side to side in a bed or chair • Transfers involving sitting position: bed to chair, bed to bed, chair to toilet, car to chair • Floor: Recovering a patient that has fallen on the floor

13. Why Use Patient Equipment? • When a patient weighs too much for safe manual positioning • Frequent unassisted lifting and movement of patients causes muscle and joint pain/damage.

14. Patient handling/moving equipment • Sling – for patients that are totally dependent • Lean Stand Assist – for patients that have some lifting ability • Ceiling Mounted Lift Device – for patients that are totally dependent

15. Patient Assist Devices • Sliding boards (also called back boards) • Slip sheet, roller sheet, or draw sheet • Trapeze lift attached to bed (mostly used on orthopedic patients) • Walking or gait belt • Shower chairs • Toilet seat risers • And many more…

16. Hospital & Nursing Home Systems • The following are systems utilized by hospitals to decrease the risk of work-related lifting injuries • Color Coding – color coding of patient’s lift requirements for posting at the patient’s bedside. By looking at the displayed color coding system an employee can know what kind of moving assistance the patient will need

17. Hospital & Nursing Home Systems • Segregation of patients based on need. This will ensure that equipment and staff are appropriately assigned • Staggered Staffing – Provide additional staff for peak periods. This would usually be during the day shift, patient baths, physical therapy etc.

18. Lifting and Moving Algorithms • What are lifting and moving algorithms? • They were developed by a group of nursing experts and tested in different patient populations • How do algorithms help you? • They give you a safe process to accomplish the task you are trying to perform • Ensure that you and the patient will not get hurt during the move • Now lets look at one example of a lifting and moving algorithm…

19. Reposition in Bed: Side-to-Side, Up

20. Resources • Discussion of Nursing Home mechanical lifting program: • http://www.cdc.gov/niosh/docs/2006-117/pdfs/2006-117.pdf • Full discussion and all algorithms: • OSHA’s Ergonomics Guidelines for Nursing Homes • http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

21. Basic Lifting Techniques • Always remember basic safe lifting techniques while performing duties • Stand as close to the patient as possible • Keep back straight • Get a good grip on the patient • Lift with legs when possible

22. SUMMARY • Back injuries are among the most costly and disabling of all injuries. • A back injury now could cause pain for a lifetime – it is important to treat the back well. • Always use the proper lifting techniques and systems, doing so will allow a healthy back for tomorrow and years to come.