1. Assessing Facility & Patient Needs Towards Appropriate Selection of
Safe Patient Handling
and Movement
Assessing Facility & Patient Needs Towards Appropriate Selection of
Safe-Lift Equipment
Dana L. Root, MS, PT, CPE
Regional Ergonomics Coordinator
Chicago, IL

2. Terminology Caregivers: RNs, LPNs, CNAs PTs, PTAs, OTs, OTAs Aides
Transporters
Family members
Etc.

3. Where To Start Step 1: Collect Baseline Data
Step 2: Identify High-Risk Units
Step 3: Gather Data About High-Risk Units
Step 4: Identify High-Risk Tasks
Step 5: Conduct Team Assessments of These Tasks
Step 6: Analyze the Risk
Step 7: Involve the Caregiver and Patient in Selecting the Equipment
Step 8: Determine Recommendations
Step 9: Implement Recommendations
Step 10: Monitor Results

4. Step 1: Collect Baseline Injury Data
Focus on injuries related to patient handling/movement
Information from:
OSHA log
Nurse manager files
Facility accident stats
Office of Workers’ Comp Prog
For each unit assess:
Number of injuries
Work Days Lost
Modified Duty Days

5. Step 2: Identify High-Risk Units
How?
Using baseline data on the incidence and severity of injuries
Why?
Allows you to prioritize time and resources.

6. Step 3: Gather Data About High Risk Units
Patient Population/Staffing/Equipment Use
Staffing
Discuss projected plans
Describe the patient, including dependency level
0 Independent
1 Supervision
Limited Assistance
3 Extensive Assistance
4 Total Dependence

7. Step 3: Gather Data About High Risk Units
Space considerations
General facility layout
Doorway width
Angles and turns
Storage
Dining rooms
Hallway
Railings
Visiting rooms
Activity rooms
Common bathrooms

8. Step 3: Gather 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

9. Step 3: Gather Data about High Risk Units
Inventory of all patient care equipment
Describe working condition
How frequently equipment is used
Perception of problem areas

10. Step 3: Gather Data About High Risk Units
Current equipment/ furniture
Beds
Height
Type
Chairs
Wheelchairs
Geri chairs
Regular chairs
Recliners
Toilets
High rise
Regular
Tables
Height
Types
Life devices
Positioning and repositioning devices
Other equipment
Scales

11. Step 4: Identify 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

12. Step 4: Identify 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

13. Step 4: Identify High Risk Tasks
Frequency of
Task
H= high
M= moderate
L= low
Perceived Stress of
Rank Order
1= high-risk
10= 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
Repositioning patient in geriatric chair or wheelchair
Making bed an occupied bed
Feeding bed-ridden patient
Changing absorbent pad
Transporting patient off u
Other Task:

14. Step 5: Conduct 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

15. Step 6: Risk Analysis 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

16. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment
✲Obtain Patient & Healthcare Provider Buy-In ✲
Purpose:
To enhance effectiveness by increasing acceptance and adherence.

17. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment
Two end user groups:
Caregiver
Patient
Both participate in the
decision making process
Equipment fairs
Trial sessions

18. Step 7: Involve Healthcare Provider & Patient in Selecting Equipment
Patients can rate/rank the equipment using surveys
Family members can have input to selection

19. Step 8: Determine Recommendations
Achievable and simple
Constraints
Costs

20. Step 8: Implement Recommendations
4. 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

21. EQUIPMENT SELECTION: Engineering Controls
Eliminate the need to do the hazardous activity
Redesign the activity to reduce the hazard or minimize the hazard
Formal equipment selection and evaluation process
Selected at equipment fairs

22. EQUIPMENT SELECTION: Engineering Control Strategies
Devices are appropriate for the tasks to be accomplished
Devices must be safe for both the caregiver and the patient
Device must be comfortable for the patient
Device should be easily understood and managed
Device must be efficient in use of time
Maintenance should be minimal

23. EQUIPMENT SELECTION: Engineering Control Strategies
Storage should be reasonable
Device must be easy to maneuver in tight spaces
Device should be versatile
Device must be easy to clean
Device must be adequate in number
Cost

24. EQUIPMENT SELECTION: Engineering Control Strategies
Equipment availability
Adequate variety of slings
In a convenient location
Toilet and bathing mesh slings
Available and in accessible areas
Storage room
Empty room
Short term use in the hallway

25. EQUIPMENT SELECTION: What to Buy??
Total dependence Patients Level 4
Full sling mechanical lift device
Extensive Assistance Level 3
Use of aid of a mechanical device
Stand assist device
Supervision/Limited Assist Level 2 & 1
Depending on the patient’s condition
Stand assist lift
Walking aid device
Gait belts
Sliding board
Avoid manual lifting

26. EQUIPMENT SELECTION: What to Buy??
Independent Patients Level 0
Capable of bearing own weight
Walk without assistance
Lifts from Floor
A single full sling mechanical lift
If patient can regain standing with minimal assist: transfer gait with handles

27. Lift Aid Equipment Determination Grid
Patient Dependency Classification
Height Adjustable Bed
Full Sling Lift
Stand Assist Lift
Lift Walker
Stand Assist Aid
Gait Belt with Handles
Friction Reducing Aid
0 - Independent
Recommended
Never
Rarely
1 – Supervision
Occasionally
Normally
2 – Limited Assistance
Strongly
3 – Extensive Assistance
Required
Always
4 – Total Dependence
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.

28. EQUIPMENT SELECTION: What to Buy??
6. Repositioning
Bed:
Bed controls utilized
Trendelenberg positioning
Friction reducing devices
Chair:
Stand assist lift
Gait Belts
Hand slings

29. EQUIPMENT SELECTION: What to Buy??
7. Special Situations Devices
Bariatric patients ⇒ special equipment
Transfer chairs ⇒ stretcher chairs
Mechanical friction reducing
Sliding boards
Transfer belts
Special training

30. EQUIPMENT SELECTION: What to Buy??
8. Combative & Mentally Impaired Patients
Use the appropriate lifting aid device
Additional care providers as needed

31. EQUIPMENT SELECTION: What to Buy??
Equipment Availability
Should be available
Stored and available in accessible areas
Batteries charged
Slings available for all shifts
Variety of sling sizes
Toileting and bathing slings available
Friction reducing devices available
Sliding boards
Transfer belts
Gait belts

32. Key Questions
Are funds best utilized for the acquisition of new technologies, or for the upgrade or replacement of old equipment?
Should you purchase or to lease patient handling equipment?
Should you provide ceiling-mounted lifts or floor based lifts throughout the unit?
What accessories should be included?
What quantity of various devices is needed?

33. SAFE PATIENT HANDLING EQUIPMENT
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

34. SAFE PATIENT HANDLING EQUIPMENT
Powered standing assist and repositioning lifts
Standing assist and repositioning aids
Bed Improvements to support transfers
Dependency Chairs
Other ergonomic transfer devices

35. Monitor Results Ongoing success of process Established key indicators
Established time line

36. Information on OSHA’s Website – www.osha.gov
OSHA Home Page
OSHA Hospital/Nursing Home Pages
OSHA Ergonomics Page

37. Other Resources Patient Safety Center
Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement
CDC/NIOSH
Safe Lifting and Movement of Nursing Home Residents, publication #

38. QUESTIONS……………