• Risk assessment and process planning for bariatric patient handling pathways The obese population in the UK is growing, as is their use of health and social care services. The manual handling of these patients presents a specific challenge, partly due to individual factors but also due to the lack of policies, space, equipment and vehicles for safe care, treatment and transportation. Previously, risk factors associated with the bariatric patient pathway through the health and social care systems have not been investigated systematically. Source: Loughborough Univ. (UK) – 2007, 106 pp. Visit this link, and click on View the Report. For more information on this topic, visit the Hot Topic – Bariatrics and click on “Architectural and Design Considerations for bariatric patients”
  
  
• "When is it Safe to Manually Lift a Patient?" by Thomas R. Waters, PhD, August 2007, American Journal of Nursing. Tom Waters, a nationally acclaimed safety engineer in the Division of Applied Research and Technology at the National Institute for Occupational Safety and Health (NIOSH), provides an analysis and review of the revised NIOSH equation that yields a recommended 35-lb. maximum weight limit for use in patient-handling tasks. Refer to the August issue of AJN or click here.

Helen Tkalcic
Glenrose Rehabilitation Hospital

Question: "How do you address the "time factor" that staff find it faster to (manually) lift a patient from the floor & assist with transfers? Transfer belts are very available, as well as is the lift, yet staff continue to NOT use the resources available."

Dear Helen:

You win the prize for the most difficult question received by The Lift Doctor to date.

Let’s begin our answer by looking at the results of a poll we conducted in last November’s issue regarding nursing resistance to the use of patient lifts. More than 95% of respondents agreed that there IS nursing resistance to use of lifts, and the vast majority cited their reason as, "The time is takes to go get the lift equipment." Your concern is shared by most of your fellow readers!!

However, The Lift Doctor is somewhat skeptical. We believe the "time factor" may be being used as a convenient excuse, and perhaps the real reason for nursing resistance is a lack of awareness regarding the extreme risks involved during virtually every manual lift they perform. How else could one explain the following fact? "According to national statistics, six of the top 10 professions at greatest risk for back injury are: nurse’s aides, licensed practical nurses, registered nurses, health aides, radiology technicians, and physical therapists." Is Time the real culprit here? Do NONE of these highly trained professionals have the time to procure assistive devices? Or is there some deep-seated cultural issue that causes nurses and other medical caregivers to over-ride their common sense and attempt to perform super-human tasks such as manually lifting and repositioning patients weighing many times more than OSHA’s 53-lb recommended limit.

Perhaps nurses need to be constantly reminded that most work-related musculoskeletal injuries are cumulative in nature (and are therefore called "Cumulative Trauma Disorders -CTDs). By overexerting their spine - from lifting improperly or lifting patients who are too heavy for the nurse’s back to support - micro-injuries inevitably occur in the spinal disks. Because these small injuries usually do not cause pain, the nurse is unaware the disk has been damaged. Over time, the damage caused by repetitive micro-trauma will build up and result in a bulging or ruptured disk, and quite often it will result in a catastrophic injury marked by a lifetime of pain.

Obviously your facility has an inventory of patient lifting equipment, and probably you have conducted staff training sessions on the proper use of that equipment. However, getting nurses and caregivers to actually participate and use the lifts turns out to be a daunting task. Experience tells us that even if a facility has all the latest and most sophisticated patient handling equipment, lifts, slide sheets, and assistive aids…and even if every caregiver has been trained…there’s nothing that guarantees nurses will use the equipment or training in the manner intended.

To conclude, the logic behind development of our Safe Lifting Environment symbol was that nurses need to be constantly reminded that "Safe Lifting" is part of a global battle to raise caregiver participation rates and eliminate the needless, career-ending injuries incurred when caregivers lift and reposition their patients. The Lift Doctor is hopeful that today’s assistive lifting technology, in combination with the current regulatory landscape, the increasing cost of workers' compensation, and the growing support of administrators, will result in a cultural change that once and for all eliminates these totally unnecessary injuries to nurses and their patients.

Helen, thanks for raising this provocative issue. Is there anything else you and other readers can do to change this disastrous situation? Yes!! Please, constantly educate and inform patients and caregivers of the need to TAKE AN EXTRA FEW MOMENTS TO GET AN ASSISTIVE LIFT – BECAUSE YOUR SAFETY, YOUR CAREER, AND THE WELL-BEING OF YOUR PATIENTS SHOULD ALWAYS COME AHEAD OF YOUR DESIRE TO GET THE TASK DONE QUICKLY.

As a reminder, a gait belt is a heavy canvas strap which is placed around the waist of an individual to be transferred so that the assisting person can have a safe hold without pulling on clothes or arms. Basically the belt is used to help support and guide a weak individual while they walk. Placing this belt around a patient's waist allows the caregiver(s) to firmly grip the belt rather than holding the patient’s arms, thus the patient is prevented from falling and the chances of bruising the patient’s arms are lessened. Because it enables a secure grip, the gait belt decreases the chance of a caregiver hurting her back while helping a patient transfer or walk. As you point out in your question, many newer model gait belts have added handles for convenience.

Generally, we believe the addition of handles is helpful. Handles allow the caregiver to use better body mechanics (bending your knees and keeping your back straight; lifting with your arm and leg muscles, not using your back muscles; and avoiding twisting your body while transferring a person.) However, as we pointed out in last month’s Lift Doctor column, "Caregivers risk injury if their hands get stuck in a handle of the belt, particularly if the patient is unstable or starts to fall. The caregiver should always be prepared to withdraw the supporting hand if the patient begins to fall and use it to control the fall in as gentle a manner as possible." In other words, while handles are an added improvement, they also represent a potential risk if they cause the caregiver to injure herself during an unanticipated movement such as a fall. The bottom line is that caregivers should be trained in use of gait belts just as they are trained in use of more complex pieces of equipment.

Finally, here are a few additional suggestions regarding use of gait belts:

1. We believe it is important for readers to know that transferring with a gait belt is usually a task that requires 2 persons.
   
   
2. Users should be advised of sanitary and infection control policies when using gait belts – for example, belts should be laundered if they come into extensive contact with an individual patient’s skin, thus they should be applied over the patient’s gown if possible.
   
   
3. There are several assessment factors to consider when using a gait belt. Does the patient have weight bearing capabilities? Does the patient need any back or torso support? What is the mental status of the patient? Is the transfer realistic for use of a gait belt, or should a mechanical lift be used?

We hope this answers your question.

The Lift Doctor

Making an assessment for using both proper lifts and slings is an important part of Safe Lifting. The patient needs to be assessed for their dependent to independent status, and then other factors that may impact the transfer. You must consider the task being performed to determine the correct lift equipment, such as: sit-to-sit transfer, lateral transfer, bathing and/or toileting. Here is a list of considerations when choosing a sling: need for head support, back support, positioning, patient ability/disability, task to perform and patient size/weight. Factors that will influence the choice of sling are: design and construction, styles, materials, forces, infection control and sling bar attachment. You will need to remember to take in to account the patient capabilities, sling application, hip angles and whether the patient has any medical conditions that may influence the transfer, such as amputees or chronic disease.

Each lift manufacturer should have their own safe lifting assessment tools, some of which may be specific to their equipment. We suggest your users contact their principal manufacturer to find out whether they provide tools and checklists for patient assessments.

Stay safe.

The Lift Doctor

In order to answer your question authoritatively, we adjusted the weight of a utility cart to 141 lbs. The cart had 4-inch wheels in relatively good condition. The flooring surface was concrete. Using a push-pull or force gauge, we determined that the force required to push or pull the cart was consistently between 7 and 10 pounds depending on how rapidly we accelerated the cart. The force to maintain the cart in motion once it started moving was much less, consistently less than 5 pounds. Thus it would appear that your employee is working within his restrictions.

Of course, it is not possible for us to precisely duplicate the conditions described in your question. Therefore, to be completely certain of this and any other similar situation you encounter in the future, you might wish to acquire a push-pull gauge. These are not expensive and can be used for other purposes such as when measuring the force to move a patient in a wheelchair, or even pushing a utility cart, for example.

Stay safe,

The Lift Doctor