Achieving Legislative and Regulatory Buy-In

• Sample Supporting Presentation

Injury Prevention and Safe Lifting

Prepared especially for
The State of xxxxxxx Legislature

Caregivers are exposed to risk of injury on a daily basis while…

• Helping patients on and off the commode several times a night
• Transferring them to and from bed for naps and nightly rest
• Getting them in and out of the bathroom several times a day
• Helping them get into their wheelchairs and lounge chairs
• Transporting them between their rooms and recreation or dining areas 

The State of xxxxxx  is considering legislation to help reduce injuries and encourage safe handling of all patients or patients, resulting in significant improvements in safety, improved clinical outcomes, greater caregiver safety, and reduced workers’ compensation and related costs.  Liko is sponsoring this document to assist interested parties in xxxxxx  in understanding contemporary patient lifting and repositioning technology and its relationship to injury prevention.

Why Safe Lifting Is Critically Important

A significant percentage of caregiver injuries occur during the process of lifting and repositioning patients.  In turn, programs designed to prevent caregiver injuries are highly dependent on use of the following: contemporary lifting technology, professional training of caregiver personnel, and universal participation in safe lifting awareness.  Further, all caregiver injury prevention programs require all three of these elements in order to be effective.

Again, the three indispensable elements of caregiver injury prevention are:

1. Equipment
2. Training
3. Caregiver Participation or “Buy-In”

Healthcare facilities can benefit from caregiver injury prevention programs in a number of ways.  These include workers’ compensation cost savings, reduced staff turnover, and improved caregiver performance and morale.  This document is designed to familiarize you with contemporary lifting technology and training requirements.  For more information on how you can encourage greater caregiver participation in your program we suggest you visit www.safeliftingenvironment.com  

Benefits of Safe Lifting

Improved Clinical Outcomes

Many patients experience significant clinical benefits as a result of periodically being lifted to a standing position and/or being repositioned on a regular basis.  Typical clinical benefits include improvements in overall hygiene, increased comfort and safety, avoidance of falls, reduction in bruises and skin shearing, improved bowel/bladder functioning, a greater sense of personal dignity, and overall acceleration of rehabilitation results. Avoidance of contractures or venous stasis are potential benefits as well. Other benefits may include improved balance, strengthened pelvic musculature, decreased UTI’s and calculi formation, and maintenance of good bone density.

In addition, rehabilitation and other activities may be equally important, including static weight-bearing, ambulation, gait training or prompted voiding. Ideally, by making the lifting process easier and safer for the caregiver, the overall quality of patient care can be enhanced and clinical outcomes can be improved accordingly.  In general, these improvements are largely due to the caregiver being able to more easily perform toileting, skin treatment and rehabilitation tasks.

Manual Lifting Can Be Dangerous to Patients

Manual lifting can cause physical and psychological effects on both the patient and the caregiver, yet these are frequently underestimated or completely overlooked.  For example, significant injuries to the patient can result from caregiver actions such as over-stressing the patient’s arms or shoulders. Limited range of motion due to old humeral head fractures, shoulder subluxation or arthritis can predispose the patient to pain and further injury. Skin tears or bruising can result from excessive grasping of the patient. Dropping of the patient can occur, with resulting head injuries, hip fractures, or other traumatic injuries. Even the fear of falling by itself is an unnecessary stressor that can adversely affect patient and caregiver alike.

Other adverse effects that can result from lack of adequate mechanical lifting assistance include pressures sores caused from too infrequent repositioning, or skin shear as a result of linen friction while being pulled rather than lifted up in bed. Loss of an individual’s dignity can also result from awkward manual lifts.  In brief, injuries or significant clinical regression can result from lack of proper use of lift and transfer equipment, sometimes even causing re-injury and/or requiring costly hospitalization of the patient.

Manual Lifting Can Also Be Dangerous to Caregivers

Injury to a caregiver caused by lifting patients can be disastrous. Such injuries are particularly prone to occur during transfer tasks such as during toileting, bathing or moving the patient between bed and wheelchair, and often they involve unanticipated movements caused by events such as when the patient begins to slip or fall. This is when the caregiver is most at risk.  Thus it is equally important to take into consideration the well-being of the caregiver and to encourage use of assistive devices and proper training as part of a conscious effort to avoid injuries.  Such training should encompass proper sling selection and usage, lift operation and maintenance, and use of accepted lifting procedures for commonly encountered situations. 

A Brief Overview of Contemporary Lifts

Mobile Floor Lifts

Depending on how you choose to categorize them, floor lifts fall into three major categories:

• General purpose mobile lifts
• Sit-to-stand Lifts
• Standing Assistance Devices
  
  
• General Purpose Mobile Floor Lifts  - these enable the caregiver to lift a patient from a bed, or even from the floor, and transfer them to a wheelchair or into another location such as a bathroom.   Some versions of mobile lifts are foldable or collapsible in design, permitting the patient to use them while traveling outside of the facility, while others are designed to assist with ambulation, gait training, automobile transfers, or other specialized functions.   The latest generation lift-and-transfer devices are dc powered via high capacity batteries and may be designed with electrically activated bases that can expand or contract in width to fit around commodes, shower chairs, recliners, wheelchairs, or under beds.   The primary advantage of these general purpose lifts is that they enable a single caregiver to meet the vast majority of a patient’s requirements while avoiding injuries and improving clinical care.
  
  
• Sit-to-Stand Lifts  - these lifts are designed to assist patients in standing from a seated position, and the caregiver can then wheel the patient to another location such as a bathroom. They can also be used for transferring patients between the edge of the bed and a wheelchair, particularly those who are frail or too weak to stand without assistance.  The mechanism assists the patient from a sitting to a standing position and enables the caregiver to wheel the unit to another location and lower the patient onto a chair or commode.  The advantage of this type of device over a conventional floor lift is it provides the patient a greater degree of independence and participation, promotes enhanced circulation, and facilitates enhanced clinical outcomes by enabling the patient to stand for a period of time.
  
  
• Standing Assistance Devices   - numerous other standing assistance devices are emerging onto the market.  They range from innovative chair lifts and commode lifts to hybrid standing assistance units designed to stabilize and roll the patient around the room.  These latter systems help the patient to stand by providing a stable leverage mechanism, enabling the caregiver to easily transfer the patient to another location such as a commode.  When using these devices it is important that the caregiver adequately assesses the patient’s ability to stand and bear his/her own weight. 

Overhead Ceiling Track Systems

Advantages of overhead lifts are numerous.  They have no “footprint” and do not require storage areas; they can cover virtually the entire area of a room; they may be easier for the caregiver to use; they require less maneuvering space within limited-size rooms; they may help to avoid issues such as furniture clearance or impediments in the floor; and they can generally avoid obstacles that may be encountered in a specific setting.  There are several styles of overhead rail and lift motor configurations available.  

Rail Configurations

• Single-rail, ceiling or wall-mounted – These basic systems can range from a single ceiling-mounted straight rail transporting a patient between bed and commode, to more elaborate configurations with multiple curves and covering multiple rooms.
• Single-rail mobile or freestanding – Some mobile overhead systems are not mounted to ceiling or wall but are on wheels to permit them to be moved within the room or to another room. 
• Traverse rail, ceiling or wall-mounted – These Gantry-style overheads permit X-Y positioning of the patient to virtually any location in the room.
• Traverse rail, mobile or freestanding – These have gantry style X-Y positioning capability and can be moved to another room with minimal disassembly.
• Room-to-Room Designs – These feature easily removable lift motors and are capable of transporting the patient from room to room through doorways, without cutting through the lintel.

Assessing Patients for Safe Lifting

Often two or more types of lifts will be available on a given floor, wing or unit.  It’s important that caregivers recognize the importance of adequately assessing patients in order to select the right lift and the right sling to get the job done in the easiest and safest manner.

Patient Dependence  -  The patient’s required “Level of Assistance” is generally considered to be one of the single most important criteria when selecting lift types  and accessories.  The fully dependent patient will be neither ambulatory nor weight-bearing.  The partially dependent patient may be determined by observing the patient’s ability to sit on a bedside unassisted, lean forward or backward, and follow simple instructions.

Patient Clinical Assessment – Many aspects of a patient’s clinical and mental condition can affect lift selection.  These include pain level, fractures or joint limitations, medication, recent surgery, muscle spasms, sensitive skin, ability to communicate, agitation, and cooperativeness.  In particular, be aware of any possibility of exacerbating the patient’s condition and avoid selections accordingly.  Pay particular attention to anything that might affect lifting, transferring, or repositioning the patient.

Patient Strength/Stamina – Both the patient’s upper and lower body strength must be taken into consideration before making a lift recommendation.  A primary determinant will be the patient’s ability to stand up from a chair unassisted.

Weight Bearing– Another primary influencer is the patient’s ability to bear their own weight for a period of time and to retain their balance.   The patient should be able to remain standing for at least one minute.

Physical Characteristics – Obviously the patient’s size, height and weight characteristics must be taken into account.  Weight will help to determine the type and model of lift, while size/shape will help to determine sling type. 

Special Circumstances – Among other factors that should be taken into consideration are physician’s orders, therapeutic recommendations, surgical dressings, attached medical equipment, or chronic conditions.  If the patient’s condition is incompatible with the capabilities of the lift(s) available, caregivers should consult with administrators to determine the best course of action.