Vol. 3 - No. 1 - January 9, 2008
Welcome to the third year of Safe Lifting News, a pro bono electronic newsletter designed to keep you abreast of what’s happening in the world of safe patient lifting and caregiver injury prevention. Please check our new Help Desk, and why not consider participating in the "Safe Lifters" forum – it’s a great way to share your experience with others who are just starting out on their safe lifting journey. And, if you’ve got a specific question, just "Ask the Lift Doctor" in the link below. Finally, I hope you had an enjoyable holiday season, and may you have a terrific New Year!
Editor, Safe Lifting News
New Jersey Safe Patient Handling Act Signed into Law
Effective January 3, 2008, New Jersey’s Governor John Corzine signed a Safe Patient Handling law which requires healthcare facilities to establish guidelines to drastically reduce the risk of injury to patients and care givers. The law requires the state’s hospitals, nursing homes, developmental centers and psychiatric hospitals to establish and implement programs within 12 months to help protect patients and staff from injury. Safe patient handling committees must be formed and will be responsible for development, implementation, evaluation and possible revision of programs. Facilities will have three years to establish and begin training employees in safe patient handling guidelines. For more details visit http://www.politickernj.com/vitale-weinberg-safe-patient-handling-act-now-law-15036
And the winner is…
Margo "Lucky" Mello, a Vocational Rehabilitation Specialist at the UMass Memorial Medical Center in Worcester, MA, is the winner of our latest Safe Lifting Quiz. When contacted, Margo first refused to believe her good fortune because, in her words, she never wins anything! However, upon reflection she explained that her hospital is well along the path toward achieving a safe lifting environment. In her words, "We are in the process of developing a proposal for a safe lifting program. The staff at Liko, in addition to the resources available through Safe Lifting News, have been very helpful in providing us with the information and support needed to develop an evidence-based, comprehensive and persuasive proposal. In fact, committee members are now asking me for 6 lucky numbers for the next Powerball game, so maybe my luck has turned around." Next, Margo and her team will need to choose between either 3 months of OnLine Learning (a $5,000 value) or a $2500 credit toward a Liko lift! Congratulations to UMass and thanks to all quiz participants from the Safe Lifting Portal!
MN Health Center Creates "Super Users"
The Winona Health Center has adapted our familiar "safe lifting environment" symbol and inserted it onto a special pin for super users. In turn, the Super Users are working with Winona’s individual caregivers to help drive down injury rates.
New "Assessments" Hot Topic
Please check out our latest Hot Topic, Assessment Tools and Guidelines, in order to review sample guidelines, policies, procedures, forms, and related materials that might be helpful in support of your safe lifting program. Click here to view the index page.
From the Reading Room
- Connecting the dots – The connection between nursing injury rates and patient outcomes has not been totally grasped in the occupational health setting. This article, by William Charney et al, concludes that nursing injury rates are linked to the nursing shortage and less nursing time at the bedside, both of which have been scientifically linked to negative patient outcomes. To request a PDF of this benchmark article, click here.
- Staggering Statistics… — The vast majority of U.S. healthcare facilities are unprepared to meet the special needs of extremely obese patients in terms of facility design and equipment planning. Even hospitals not affiliated with bariatric surgical programs are being affected by the sharp increase in extremely obese patients. Just review the staggering statistics at the beginning of this article.
- Ultra Upsizing… — From extra-large hospital gowns and scrubs-like pajamas, to expansive waiting room chairs, more generous blood pressure cuffs, wider beds with motorized units to help move patients, larger, sturdier stretchers, wheelchairs and examining tables, and scales that can handle 1,000 pounds, hospitals are going XL.
- Why develop ergonomic patient handling policies?
— These Questions & Answers from Canada’s Centre for Occupational Health and Safety are very relevant for our readers to consider…
- Need statistics regarding injury frequency? — This presentation will provide a sound basis for establishing credibility for your own injury prevention program.
- Patient-handling innovations reduced injuries at this hospital — The battery-powered, ceiling-mounted lifts perform a variety of tasks, from lifting patients onto wheelchairs to taking them to the bathroom and repositioning them in bed.
- Did you know? — 64% of lateral transfers required greater than 13 minutes to perform, while only 10.7% of all other transfers required greater than 13 minutes. Read this article from the Dept. of Defense Working Group News to uncover lots of other interesting facts.
- Preventing a brain drain — Within the next five years, just as their peers need more health care, boomer nurses will begin leaving the workforce, taking with them years of experience and knowledge about how to get things done.
— This article presents an interesting perspective on the impending problem.
- Recruitment program eases nursing shortage at St. John Health System — A new nursing recruitment and retention initiative at St. John is paying off. Among its accomplishments: nearly 250 new nurses, a 28 percent improvement in job satisfaction among nurses, a 26 percent reduction in voluntary nurse turnover and a registered nurse vacancy rate of just 5.5 percent during fiscal 2007, versus 9.5 percent in 2006. The health system is also incorporating a safe-lifting program from its parent Ascension Health, in an effort to reduce the number of back injuries nurses suffer. Read more…
- Virginia initiative makes CE’s Available — As part of its minimal lift initiative, the Virginia Nurses Association (VNA) has collaborated with Nursing Spectrum to create a continuing education module designed to discuss the impetus for the safe patient handling movement, describe evidence-based standards for safe patient handling and movement, and to explain how architectural design affects the ergonomics of patient care space. With grant funding provided by the Center for American Nurses, VNA has embarked on an initiative to establish minimal lift environments throughout the state to reduce musculoskeletal injuries to nurses.
- Need a Draft Policy Statement on Safe Patient Handling? — The James A. Haley VA Hospital in Tampa has drafted a policy statement that you might wish to consider using as a model.
Ask the Lift Doctor...
Lift Doctor Question 1
Ray Graham Association
Question: I work with an individual who is mentally challenged. She is ambulatory, but sometimes she falls out of her bed, sofa, or chair. I work alone on the third shift. When she falls, I have to pick her up off the floor without any assistance. She is very slim, weighing only about 110 lbs., and she doesn’t help at all with getting off the floor. Since she is prone to fall, do you think that I need help in lifting her off the floor?
Not only is it unfortunate that you have to lift this patient off the floor alone, it is highly inadvisable for the safety of both yourself and your patient. NIOSH guidelines recommend any healthcare lifting task in which the patient weighs more than 35 pounds and the lift situation is not optimal (such as when lifting from the floor), is causing irreparable damage to your musculoskeletal system. At the moment when your patient is lying on the floor, it might seem that you have no alternative but to lift her yourself. However, you must realize that you are placing yourself at significant risk, even to the point of severely injuring yourself and being unable to work in the future. The Lift Doctor would recommend procuring a mobile lifting device capable of lifting from the floor and using it in all ensuing situations – plus it would be available to perform many other transfer tasks that might need to be performed on your unit. Typical considerations to cite when suggesting procurement of a lift include: tasks being performed, maximum weights being lifted, space limitations, and proper slings and accessories needed based on your patient population and clinical requirements.
The Lift Doctor
Lift Doctor Question 2
Bethany Care Society
Question: Is it appropriate to use a lift to transfer a resident from the bed and from there to another room (i.e bathroom). I have been told lifts are only to be used to transfer from a bed to a chair but not between rooms.
The issue of ‘Transport vs Transfer ‘ is a common concern.
— Patient safety and maintaining patient dignity are our first concerns. The ISO 10535 Hoists for the Transfer of Disabled Persons standard does not prohibit the use of mobile lifts for transportation. Liko recommends that each facility take into consideration their own circumstances to evaluate the appropriateness of mobile lifts and transport situations. Some of the important factors to bear in mind include: floor surfaces, thresholds, uneven surfaces, ramps and privacy concerns for the patient. Transferring a patient from their bed or chair in to the bathroom is a common transport task. As I mentioned above, the floor surface needs to be taken in to consideration.
— However, eliminating a manual transfer task provides safety for both the patient and the caregiver. The use of a mobile lift as an ‘off unit’ transfer device should be discouraged or at least substantially limited.
The Lift Doctor
Lift Doctor Question 3
Question: :We are struggling with safe "proning" in the OR. Any suggestions?.
"Proning," (i.e. Prone Repositioning) is a relatively new form of treatment used with ARDS patients who require high concentrations of inspired oxygen. Prone repositioning often improves oxygenation in patients who have ARDS by shifting blood flow to regions of the lung that are less severely injured and thus better aerated. Under close supervision of an attending physician, specially trained staff turn the patient face down from a supine position and may then be required to alternate between prone and supine repositioning as often as three times a day, or until the requirement for a high concentration of inspired oxygen is resolved.
Even with proper equipment, physically turning a critically ill patient has significant risks. For example, the patient may be connected to equipment with wires and tubes, or there may be a variety of clinical reasons to avoid the procedure. Patients whose heads cannot be supported in a face-down position, or very large patients, may not be recommended for the proning technique. It appears to the Lift Doctor that use of mechanical lifting equipment would be of limited value in most proning situations. However, it IS technically feasible to use an overhead lift in combination with a repositioning sheet to transfer a patient from a supine to a prone position when repositioning from a gurney to a surgical table (or vice versa). Ideally there would have to be pillows placed over the edge between the two surfaces to allow the patient to be rolled over. Obviously you should practice this technique in advance of its use in an actual surgical environment. While this is a procedure I have seen work with a ceiling lift, it would likely be difficult to accomplish using a floor lift.
Another alternative might be to investigate use of a dedicated device such as the Vollman Prone Positioner, a cushioned frame that straps to the front of the patient before turning and that has helped to minimize the risks associated with moving patients and maintaining them in the prone position for several hours at a time.
The Lift Doctor
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