Safe Lifting and Moving in Health Care: Equipment Selection Process Safe Lifting and Moving in Health Care: Equipment Selection Process Lisa Murphy, RN Jesse Brown VAMC Safe Patient Handling Facility Coordinator

Equipment Selection Process ä Where to Start? ?? ? ? ?

Equipment Selection Process Determine high risk activities by caregivers.

What equipment will be most useful? ä Who, what, where, when, how…….. ä Who provides most of the physical care? ä What types of lifting, repositioning, and moving activities do they provide? ä Where do these activities happen? ä When is the care provided? ä How often do they engage in each activity?

Equipment Selection Process ä WHO?????? Provides most of the care. Talk directly to the caregiver(s) Others can only speculate

Equipment Selection Process What specifically are the high risk activities?What specifically are the high risk activities? Pushing/pullingPushing/pulling Lateral transfersLateral transfers LiftingLifting RepositioningRepositioning

Equipment Selection Process Where is the care provided?

Equipment Selection Process When is the care provided?

Equipment Selection Process How often are the tasks required? ä Knowing frequency assists in the purchase process. ä How many Stand Aids do you need? ä Staff and Residents find it difficult to wait at times for equipment.

Equipment Selection Process ä Now what ?????? ä Structure follows function! ä ä What are my resources? ä Do I have limited space(storage)? ä What construction is required? ä What do I really need?

Equipment Selection Process Lateral Transfer Devices ä Air mattresses ä Rollboards ä Slide sheets. Resources. Task - How many do I need? - Where am I going to store it? - How will I clean it? (reusable vs single patient use)

Equipment Selection Process Standing and Raising Aids Active lifting – consumer participates Active lifting – consumer participates Motorized raising with slings -All have legs that open ä Ability to bear some weight. ä Follow directions and cooperate. ä Ability to grasp with one hand. Un-motorized raising with/without slings Some have legs that open Some have legs that open ä Ability to bear some weight. ä Follow directions and cooperate. ä Pull self to a standing position.

Equipment Selection Process Passive Lifters Ceiling lifts Gantry Lifts Floor Based Lifts How do I choose??? - Is the ceiling /construction conducive to lift installation? - Do I have enough funds for many lifts or is a floor lift more useful? - Where can I store a floor based lift and how many would I need?

Equipment Selection Process - What else is available? - Can the equipment serve dual purposes? Specialized slings Specialized slings No-slip chair seats No-slip chair seats Turning discs Turning discs Helping hands poles Helping hands poles Liftseats Liftseats Motorized stretchers Motorized stretchers Inflatable chairs/mattresses Inflatable chairs/mattresses Wheelchair lifters Wheelchair lifters Hygiene/shower lifts Hygiene/shower lifts Shower trolleys Shower trolleys Wheelchair movers Wheelchair movers Automobile lifts! Automobile lifts!

Equipment Selection Process What’s next??? Now that I have equipment….. how do I choose what is appropriate for each situation?

Equipment Selection Process Safe Patient Handling Clinical Guidelines & Algorithms

Equipment Selection Process Assessment ä Completed on anyone needing assistance (per licensure and facility protocol). ä Includes… ä Individual Characteristics ä Medical Condition/s

Equipment Selection Process Assessment Includes items such as: ä Ability of the person to provide assistance ä Ability of the person to bear weight ä Ability of the person to cooperate and follow instructions ä Height and weight ä Special Medical/Physical Considerations

Equipment Selection Process Algorithms Algorithms ä Based on Specific Characteristics (from Assessment) ä Considers the task to be completed ä Assists caregivers in selecting safest Equipment ä Advises # of staff needed

What tasks do the Algorithms cover? 1. Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair 2. Lateral Transfer To and From: Bed to Stretcher, Trolley 3. Transfer To and From: Chair to Stretcher, Chair to Chair, or Chair to Exam Table 4. Reposition in Bed: Side to Side, Up in Bed 5. Reposition in Chair: Wheelchair or Dependency Chair 6. Transfer a Patient Up from the Floor

Patient Assessment and Algorithms for Safe Lifting and Moving. The Assessment and Algorithms go hand in hand What is the task to accomplish? 2. Assess the Patient. 3. Use Algorithms to determine equipment and # of staff needed for each high risk task. 4. Don’t’ forget space needs Plan your move! Plan your move!

How Do We Lift This Resident?

Let’s assess CLC resident: May Flowers ä 75 year old resident of a CLC (Continuous living center) who was at home with her family but her condition deteriorated. May has MS, progressive dementia, and has fallen a couple of times the past week. ä She is in the hospital for rehab and restorative care. ä Weight: 156 lbs. Height: 5’ 8” ä Some days May is cooperative. Other days she is combative and fearful. ä When she is cooperative, she can bear weight and ambulate on occasion. Otherwise, she resists standing. ä May has upper body strength & can grasp with both hands. ä She has daily rehab and is to be out of bed every day in a chair.

Ergonomic Algorithm 1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair Start Can the patient bear weight? yCare giver assistance not needed: Stand by for safety. Motorized Standing and raising aid or non-powered stand aid if patient has upper body strength with 1 caregiver. Use ceiling lift/floor based lift with sitting sling and 2 or more staff. Is the patient Is -To remove patient from car, select lifter designed for that purpose. -Utilize motorized Standing and raising aid or non- powered Stand Aid for transfers for toileting as appropriate. -If exam /procedural table or stretcher can be positioned to a low level, utilize Standing and raising aid. If not use Ceiling lift or floor based fully body lift. -Patient to utilize transfer board if trained by Rehab Service and board is available. yes yes IIs the patient cooperative? No No Partially Here Fully No

Take a few minutes and complete a Patient Lifting Plan for May Flowers. (Refer to handout)

Know When Algorithms Should be Used Use the Algorithms for every patient who needs help moving ä Remember…. ä The Algorithms provide general direction ä Caregiver must use their professional judgment in applying Algorithms

Know When Algorithms Should be Used Use varies by clinical settings and present circumstances! ä Evaluate on initial admission ä Re-evaluate frequently in clinical situations where patients status can change daily. ä Re-evaluate weekly/monthly when similar status exists in longer term situations. Example…………… Example…………… May ambulates periodically during the day but after rehab is too tired to walk to the bathroom or get out of the chair on her own. May ambulates periodically during the day but after rehab is too tired to walk to the bathroom or get out of the chair on her own.

Know When Algorithms Should be Used Use varies by clinical settings Use varies by clinical settings ä SBAR/Care Plan updates not feasible in some clinical settings where status changes quickly Attach algorithms to lifts for easy Attach algorithms to lifts for easy access access Post algorithms in patient rooms Post algorithms in patient rooms

Equipment Selection Process Summary 1. Evaluate high risk tasks and the environment (ask the users)! 2. Consider resources, site prep costs, storage, maintenance, as well as who will utilize and care for the equipment before purchasing. 3. How many and what types of devices do I need? Can the equipment serve dual purposes? 4. Who will determine what is used? 5. How will we standardize this so everyone is consistent, (what process, documentation and transfer of information will be utilized)?

Equipment Selection Process Thank you! Safe lifting & moving - NOT