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

2. Equipment Selection Process
Where to Start? ? ? ?

3. Equipment Selection Process
Determine high risk activities by caregivers.

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

5. Equipment Selection Process
WHO?????? Provides most of the care.
Talk directly to the caregiver(s)
Others can only speculate
Low tech to high tech –
Low tech interventions would have been lost – no interest if high tech ones were instituted first

6. Equipment Selection Process
What specifically are the high risk activities?
Pushing/pulling
Lateral transfers
Lifting
Repositioning

7. Equipment Selection Process
Where is the care provided?

8. Equipment Selection Process
When is the care provided?
Michael Hodgson: Thanks. So, what can you say about learning?
Mary Matz: First of all, instead of using the term learning, I like to use the term “knowledge transfer”. This implies a more active role for both the giver and the receiver, and this is important, because knowledge transfer should be a two-way street. Certainly, a front line worker can learn from his supervisor, but very importantly, a supervisor can learn from his or her employees.
In all methods of knowledge transfer, a person learns from the experiences of someone else…. As you can see though, you can transfer knowledge before hand, proactively, in order to attempt to prevent an incident from ever occurring. And, you can also transfer knowledge after one occurs, as a reaction to an incident. Certainly, the former is preferred.
You can also transfer knowledge during an incident. This method has been used very successfully by the military for years and is called an After Action Review Process.
Michael Hodgson: Thanks Mary, now tell us more about After Action Review.

9. Equipment Selection Process
How often are the tasks required?
Knowing frequency assists in the purchase process.
How many Stand Aids do you need?
Staff and Residents find it difficult to wait at times for equipment.
Knowledge transfer – transfer in and transfer out.. It implies a two-way street..!

10. Equipment Selection Process
Now what ??????
Structure follows function!
What are my resources?
Do I have limited space(storage)?
What construction is required?
What do I really need?
Knowledge transfer – as implies… exchange of information, not just a one way process, a two-way street. Taps knowledge residing in staff’s head to reduce risk in the work environment.
BIRN – conduit for info ‘between’ staff and management. As such. fosters staff responsibility for safety of their work environment. New/Innovative way to teach/train patient care providers.
AAR – systematic brainstorming sessions – rationale is to tap knowledge residing in workers’ heads.
Pt care Ergo Process – brought in as many staff as possible to get their thoughts and ideas on safety problems/concerns as well as their ‘solutions’ to safety concerns… Two Benefits.. 1) Enhanced knowledge of unit – assisted in making good unit recommendations 2) promoted staff ownership, therefore their buy-in
Care Plan/algorithms – standardized way of determining how to handle & move patients. Use of written care plan ensures accurate transferring of information from staff to staff and shift to shift.
Policy – documents program information - available to all – puts teeth into program

11. Equipment Selection Process
Lateral Transfer Devices
Air mattresses
Rollboards
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)

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

13. 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?

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

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

16. Equipment Selection Process
Safe Patient Handling
Clinical Guidelines & Algorithms

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

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

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

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

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

22. How Do We Lift This Resident?

23. Let’s assess CLC resident: May Flowers
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.
She is in the hospital for rehab and restorative care.
Weight: 156 lbs. Height: 5’ 8”
Some days May is cooperative. Other days she is combative and fearful.
When she is cooperative, she can bear weight and ambulate on occasion. Otherwise, she resists standing.
May has upper body strength & can grasp with both hands.
She has daily rehab and is to be out of bed every day in a chair.

24. Can the patient bear weight?
Ergonomic Algorithm 1: Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair
Start
Here
yCare giver assistance not needed: Stand by for safety.
Can the patient bear weight?
Fully
Is the patient Is
IIs the patient cooperative? No No
Partially
yes
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.
-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.

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

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

27. Know When Algorithms Should be Used
Use varies by clinical settings and present circumstances!
Evaluate on initial admission
Re-evaluate frequently in clinical situations where patients status can change daily.
Re-evaluate weekly/monthly when similar status exists in longer term situations.
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.

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

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

30. Equipment Selection Process
Thank you! Safe lifting & moving NOT