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
312-353-2220
414-297-3315
root.dana@dol.gov
 Terminology

 Caregivers:
– RNs, LPNs, CNAs
– PTs, PTAs, OTs, OTAs
– Aides
– Transporters
– Family members
– Etc.
 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
Step 1:
Collect Baseline Injury Data
1. Focus on injuries related to patient handling/movement
2. Information from:
• OSHA log
• Nurse manager files
• Facility accident stats
• Office of Workers’ Comp Prog
3. For each unit assess:
• Number of injuries
• Work Days Lost
• Modified Duty Days
Step 2:
Identify High-Risk Units

1. How?
• Using baseline data on the
incidence and severity of injuries
2. Why?
• Allows you to prioritize time and
resources.
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
2 Limited Assistance
3 Extensive Assistance
4 Total Dependence
Step 3:
Gather Data About High Risk Units
Space
considerations  Hallway
 General facility – Railings
layout  Visiting rooms
 Doorway width  Activity rooms
 Angles and turns
 Common bathrooms
 Storage
 Dining rooms
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
Step 3:
Gather Data about High Risk Units

1. Inventory of all patient care

equipment

2. Describe working condition

3. How frequently equipment is

used

4. Perception of problem areas

Step 3:
Gather Data About High Risk Units
Current equipment/ furniture
 Beds  Tables
– Height – Height
– Type – Types
 Chairs  Life devices
– Wheelchairs  Positioning and repositioning
– Geri chairs devices
– Regular chairs  Other equipment
– Recliners – Scales
 Toilets
– High rise
– Regular
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
Step 4:
Identify High Risk Tasks
•General observation •Quantitative evaluations

•Employee discussions •Previous studies

•Employee •Job consistency and fatigue

questionnaires
•Brainstorming and group
•Review of medical data activities

•Symptom surveys
Step 4:
Identify High Risk Tasks
Frequency Perceived Rank Order Patient Handling Tasks
of Stress of  
Task Task  
    1= high-risk
H= high H= high 10= low risk
M= moderate M= moderate
L= low L= low

      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
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
 Step 6: Risk Analysis
1. Review data for each unit: 2. Identify problem areas
• Baseline injury data
• Other data 3. Set priorities
• Staffing
• Equipment inventory
• Anticipated changes
• Rank high risk tasks
• Frequency
• Stress
• Observation data
 Step 7: Involve Healthcare Provider &
Patient in Selecting Equipment
✲Obtain Patient & Healthcare Provider Buy-In ✲

Purpose:
To enhance effectiveness by increasing acceptance and
adherence.
 Step 7: Involve Healthcare Provider
& Patient in Selecting Equipment
 Two end user groups:
1. Caregiver
2. Patient
 Both participate in the
decision making process
– Equipment fairs
– Trial sessions
 Step 7: Involve Healthcare Provider
& Patient in Selecting Equipment

 Patients can rate/rank the equipment using

surveys
 Family members can have input to selection
Step 8: Determine Recommendations

1. Achievable and simple

2. Constraints

3. Costs
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
EQUIPMENT SELECTION:
Engineering Controls
1. Eliminate the need to do the
hazardous activity

2. Redesign the activity to reduce the

hazard or minimize the hazard

3. Formal equipment selection and

evaluation process

4. Selected at equipment fairs

EQUIPMENT SELECTION:
Engineering Control Strategies

1. Devices are appropriate for the tasks to be accomplished

2. Devices must be safe for both the caregiver and the
patient
3. Device must be comfortable for the patient
4. Device should be easily understood and managed
5. Device must be efficient in use of time
6. Maintenance should be minimal
EQUIPMENT SELECTION:
Engineering Control Strategies
7. Storage should be reasonable

8. Device must be easy to maneuver in tight spaces

9. Device should be versatile

10. Device must be easy to clean

11. Device must be adequate in number

12. Cost
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
 EQUIPMENT SELECTION:
What to Buy??
1. Total dependence Patients Level 4
 Full sling mechanical lift device

2. Extensive Assistance Level 3

 Use of aid of a mechanical device
• Stand assist device

3. 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
 EQUIPMENT SELECTION:
What to Buy??
4. Independent Patients Level 0
 Capable of bearing own
weight
 Walk without assistance

5. Lifts from Floor

 A single full sling
mechanical lift
 If patient can regain
standing with minimal
assist: transfer gait with
handles
 Lift Aid Equipment Determination Grid

Patient
Height Adjustable Stand Assist Stand Assist Gait Belt with Friction
Dependency Full Sling Lift Lift Walker
Bed Lift Aid Handles Reducing Aid
Classification

0 - Independent Recommended Never Rarely Rarely Rarely Rarely Rarely

Recommended Rarely Rarely

1 – Supervision Occasionally Occasionally Normally Occasionally

Strongly
2 – Limited Rarely
Recommended Normally Normally Normally Normally Normally
Assistance

3 – Extensive Rarely Rarely

Required Normally Normally Normally Always
Assistance

4 – Total Never Never Never Never

Required Always Always
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.
 EQUIPMENT SELECTION:
What to Buy??
6. Repositioning
– Bed:
• Bed controls
utilized
• Trendelenberg
positioning
• Friction
reducing devices
– Chair:
• Stand assist lift
• Gait Belts
• Hand slings
 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
 EQUIPMENT SELECTION:
What to Buy??
8. Combative & Mentally Impaired
Patients

 Use the appropriate lifting

aid device

 Additional care providers

as needed
 EQUIPMENT SELECTION:
What to Buy??
9. 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
 Key Questions
1. Are funds best utilized for the acquisition of new
technologies, or for the upgrade or replacement of old
equipment?

2. Should you purchase or to lease patient handling

equipment?

3. Should you provide ceiling-mounted lifts or floor based

lifts throughout the unit?

4. What accessories should be included?

5. What quantity of various devices is needed?

 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
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
 Monitor Results
 Ongoing success of process
– Established key indicators
– Established time line
Information on OSHA’s Website –
www.osha.gov

OSHA
Home Page
OSHA
Hospital/Nursing
Home Pages OSHA
Ergonomics
Page
 Other Resources
Patient Safety Center
Patient Care Ergonomics Resource Guide:
Safe Patient Handling and Movement
www.visn8.med.va.gov/patientsafetycenter

CDC/NIOSH
Safe Lifting and Movement of Nursing Home
Residents, publication #2006-117
www.cdc.gov/niosh
QUESTIONS……………