Patient and Resident Handling
Introduction
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DISCLAIMER
This training material presents very
important, pertinent information. It should
not be assumed, however, that this program
satisfies every legal requirement of every
state. Some states require the training be
developed and delivered by an individual with
specific training and experience.
This training is AWARENESS LEVEL and does
not authorize any person to perform work or
validate their level of competency; it must be
supplemented with operation and process-
specific assessments and training, as well as
management oversight, to assure that all
training is understood and followed.
Your organization must do an evaluation of all
exposures and applicable codes and
regulations. In addition, establish proper
controls, training, and protective measures to
effectively control exposures and assure
compliance.
This program is neither a determination that
the conditions and practices of your
organization are safe, nor a warranty that
reliance upon this program will prevent
accidents and losses or satisfy local, state, or
federal regulations.
Introduction

• Nursing homes are the fastest growing part

of the healthcare industry.

• The number of people requiring care

continues to increase.

• Employees suffer over 200,000 work-related

injuries and illnesses a year. More than half
require time away from work.

• Worker's compensation costs the industry

nearly $1 billion per year.
Course Overview

1. Part 1: Risk Factors

2. Part 2: The Written Plan

3. Part 3: Equipment

4. Part 4: Transfer Guidelines

5. Summary
1
Part Risk Factors

What you need to know:

1. The general risk factors

2. Common injuries to the back and spine

3. Strategies to anticipate and avoid physical

strain
Risk Factors Common Types of Injury

Back injury:
• Back strain and sprain are extremely
common to the nursing industry: half
of injuries are to the back or shoulder.

• In the last ten years, the number of

back injuries has been rising.

• Even in general industry, one of four

injuries is a back sprain or strain.

• Injured back muscles can take 6 – 8

weeks to heal.
Risk Factors Common Types of Injury

Spinal disc injuries: Musculoskeletal disorders (MSDs):

• Spinal disc injuries are extremely
painful.
• Some problems may require surgery
before improving.
• Types of injury include:
‒ Disks slipping out of position.
‒ Discs rupturing.
‒ Bones grinding together.
• MSDs include back pain, carpal tunnel
syndrome, and rotator cuff injuries.
• Some MSDs develop gradually, but they
can also result from one event.
• Early signs of MSDs include persistent
pain, restriction of joint movement, and
soft tissue swelling.

Injury to ligaments:
Injured ligaments can take a few weeks or
more to heal, depending on proper rest and
treatment.
Risk Factors High-Force Tasks

Tasks that require a high level of exertion put you at risk for serious injuries.

Examples of high-force tasks: Sudden movements that require

high-force exertion (and will likely
• Lifting patients or residents who are:
cause damage):
‒ Unable to support their own weight.
‒ Uncooperative or confused.
• Trying to stop a patient or resident
from falling
‒ Particularly heavy.
• Transferring a combative resident
• Lifting by yourself when there is no
other help available
Avoiding overexertion:
• If a long distance must be traversed
while lifting or pulling an patient or • Limit lifting patients and residents
resident manually or bearing their weight.

• Maintaining control of equipment or • Know which tasks require multiple

tools caregivers, and do not try to perform
them on your own.

• Follow your fall management plan.

Risk Factors Awkward Postures

Awkward postures are positions that place stress on the body and make you vulnerable
to back muscle strain and ligament damage, such as reaching above shoulder height,
kneeling, squatting, leaning, or twisting.

Examples: Avoiding awkward positions:

• Bending over to feed a patient or
resident
• Stooping to bathe a patient or
resident
• Manually lifting a patient or resident
using just one side of your body
• Reaching and manually lifting a
resident from a Geri chair to a bed
• Always aim to keep your body in
neutral position (i.e., comfortable
and natural alignment).
• Learn how to perform tasks
ergonomically.
• If awkward positions are
unavoidable, alternate tasks to limit
the time spent in these postures.
• Avoid combining high-force tasks
with awkward postures.

• Use gait belts.

Risk Factors Repetitive Motion

Performing the same motion or series of motions frequently or continually weakens

your body and makes you vulnerable to muscle, ligament, and spinal disc injuries.

Example: Avoiding repetitive motion:

For caregivers, a common repetitive Avoid hand-cranked beds. The repetitive
motion is repeatedly cranking manual motion of cranking can lead to MSDs
adjustments on beds. or strains of the wrist and shoulder.
Risk Factors Fatigue

Fatigue, like repetitive motion, weakens your body and makes you vulnerable to injury.

Examples: Avoiding fatigue:

• Fatigue from overwork: Manually • Alternate tasks throughout the day
transferring many patients or residents in one
day (e.g., more than 20 lifts/shift)

• Fatigue from holding one position too

long: Feeding or bathing a patient or resident
Risk Factors Preventive Measures

Stop your activity if you feel any of the following:

• Aching • A hot, inflamed feeling
• Sharp pain • Tingling
• Dull pain • Unusual tightness
• Muscle weakness and fatigue
• Pain that comes and goes

If manual lifting is unavoidable, reduce or eliminate the following physical risk factors:

• Distance from the body • Twisting

• Reaching above the shoulders • Non-neutral posture

• Reaching below the knees • Repetition

• Overexertion (i.e., lifting too much

weight)
 2
Part The Written Plan

What you need to know:

1. The requirements of a patient and resident

assessment

2. Procedures for communicating patient or

resident needs

3. Training and organizational requirements

4. Hazardous situations that require the

attention of program administrators
The Written Overview
Program

Management must assure that written procedures are in place and that the staff is
qualified and trained.

The written program includes: Zero Lift Policy:

• Clearly-stated standard operating procedures
(SOPs) for patient or resident handling
• An assessment of each patient or resident
• A plan for how the patient or resident needs
and updates will be communicated and
reported
This means that an organization commits to
no manual lifts in order to prevent injuries
to caregivers and patients or residents. If an
organization makes this commitment, the
written program should reflect the decision.

• The responsibilities of everyone involved

• Accident response

• Required training and training records

The Written Program Training
Program

You must learn the following: Frequency of training:

• The program SOPs
• The needs of each patient or resident
• How to use all applicable equipment
• The Zero Lift Policy, if applicable
• Prior to starting duties for the first time
• Whenever lifting equipment, care plans,
or procedures change
• Annually, as a refresher course

• The codes used to communicate needs

and requirements

• How to report concerns

The Written Registered Nurses (RNs)
Program

A registered nurse (RN) is required to implement and execute critical elements of

the transfer care program.

RN Responsibilities
• Assessing patient or resident care
plans, transfer procedures, and
hazards
• Observing and directing patient or
resident lifts and mobilizations
NOTE:
When an RN is not available, the
SOPs for patient or resident
handling must guide transfer and
movement activities.
The Written The Assessment
Program

The RN must complete an assessment for each patient or resident before any lifting
or repositioning task occurs.

Gather information: Application:

• The level of assistance required
• Ability and willingness to understand and
cooperate
• Size and weight
• Any medical conditions that may influence
the facility’s choice of lifting or
repositioning methods
After determining the characteristics and
needs of patients or residents, the
assessment analyzes the safest methods of
transfer and other assistance.
The assessment is an essential part of a
crafting a care plan that provides
appropriate services.

• Any other needs or concerns

Assessments need to be done frequently and kept up to date.

The Written Care Plan
Program

A care plan is created for each patient or resident based on the assessment.

If it is determined that changes to the care plan

are needed:

1. Assure that there is a collaborative agreement

between doctors and nurses.

2. Assure that the patient or resident and/or

family or guardians are given the opportunity to
make an informed decision about the change.

3. Once steps 1 and 2 are complete, changes

may be made.

4. Thoroughly document changes.

 The Written Communicating Patient or Resident Needs
Program

The information contained in the assessments must be effectively communicated to

caregivers.

Patient or Resident
Dependency Levels
Program Components

Codes allow caregivers to quickly assess the type

of assistance needed.

• Standardized numbers correspond to the

patient dependency levels, which are shown
on the left.

• Lift requirements, posted at the bedside of

each patient or resident, should be color-
coded.
The Written
Program
Reporting Concerns

Notify the plan administrators or management

of the following situations or conditions:

• Lifting, repositioning, or transfer activities

that pose a threat to worker and patient or
resident safety

• The absence of trained team members

• Any concerns about the functional condition

of lifting equipment
The Written Caregivers
Program

Follow the care plan in regards to staffing requirements. For any questions or concerns,
consult the designated RN.

• Complete all required training.

• The amount of caregivers should be sufficient to

support the number of patients or residents.
‒ Segregate patients or residents based on
need.
‒ Stagger scheduling to provide additional
support for peak periods.

• Venders and care providers not employed by

the facility or company should coordinate
activities with the facility or company.
 3
Part Equipment

What you need to know:

1. Guidelines for selecting appropriate

equipment

2. Guidelines for using the equipment

Equipment Equipment Overview

This section will discuss the following The chart on the right will appear on the
types of equipment: following pages to indicate the
recommended level of dependence
• Repositioning equipment for each type of equipment.

• Mechanical lifts The recommended levels are highlighted

in yellow.
• Transfer devices
• Dark highlighting means the
• Shower and toilet equipment equipment will be ideal for patients
or residents of that dependence
level.

• Lighter highlighting means that the

equipment is not intended for those
levels, but still could be useful.

For all types of equipment, always follow manufacturer specifications.

Equipment Equipment Selection

Follow the care plan in regards to the correct type and amounts of equipment needed.
For any questions or concerns, consult the designated RN.

Requirements

• A variety of equipment types are • The equipment needed depends on:

needed to meet a range of needs. ‒ The specific needs of the facility,
• patients or residents, staff, and
The amount of equipment must be
management.
adequate to support the number of
patients or residents. ‒ The patient dependency level.
Equipment Repositioning: Height-Adjustable Electric Beds

Recommended Advantages
dependency level:

• The adjustable height enables:

‒ Easy transfers between beds and
wheelchairs.
‒ Easy repositioning in bed.

• These beds provide ergonomic adjustability

for the caregivers and patients or residents.

Remember: Avoid hand-cranked beds, due to the repetitive motion they require.
Equipment Repositioning: Trapeze Lift

Recommended A trapeze lift is a bar device suspended above

dependency level:
the bed which helps patients or residents with
sufficient upper-body strength to reposition
themselves.

This lift works well with adjustable beds and

armless wheelchairs.
Equipment Mechanical Lifts

Mechanical lift equipment makes transfer and handling tasks safer for caregivers and
patients or residents.

General Use Guidelines

Follow the care plan at all times.

Choose a lift that does not require manual

pumping in order to avoid possible repetitive
motion injuries to arms or shoulders.

There are two main categories:

‒ The full sling-type
‒ The stand assist
Equipment Overhead Track-Mounted Lift

This lift is a standard example of a full sling-type lift. It often built into the ceiling,
provides patient or resident mobility without manual lifting.
Recommended
dependency level:
Advantages
• They are frequently quicker to use than
portable options.

• It is accessible due to being in a fixed

location near the patient or resident.

• Many can be converted into both a sling

and a horizontal frame system.

• They are motor-operated by hand-held,

remote-control devices, as opposed to
being manually operated.
Equipment Stand Assist Device

This lift is a standard example of a stand assist. A stand assist device helps patients or
residents who lack the muscle strength to stand up from a bed, chair, wheelchair, or toilet.
Recommended
dependency level:

Advantages
• Standing assist devices provide patients
or residents with assistance to stand
and pivot without caregiver help.

• They are more maneuverable than floor

sling lifts.

• They do not take up much space for

use and storage.

Patient or residents must be cooperative, able to

bend knees, hips, and ankles, and able to sit up at
the edge of bed (with or without assistance).
Equipment Lateral Transfer Devices

A lateral transfer device is used to transfer a patient or resident horizontally, for

example, from a bed to a gurney.
Recommended
dependency level:

Common Types

Slip sheets and roller sheets reduce Sliding boards allow patients or
friction when laterally transferring or residents to be slid rather than lifted
repositioning patients or residents in during a lateral transfer.
beds. They also reduce the force that
workers need to exert to move the
patient or resident.

Advantages
• Some lateral transfer systems do not • Lateral transfer devices help to
require any lifting by the staff and are prevent back injuries.
completely mechanical.
Equipment Gait Belts

A gait belt is used for manual transfers and for supporting the patient or resident while
walking. Handles on each side of the belt enable support from multiple caregivers.
Recommended
dependency level:

General Use
• Generally, position the transfer to the patient’s or
resident’s strongest side.

• Assure that the belt is securely fastened.

• Avoid direct contact with skin.

• When assisting a walking patient or resident, use

a rocking and pulling motion instead of lifting.

• Maintain a close distance to patient or resident

and avoid awkward postures.

• The belt may not be suitable for a patient or

resident who is too heavy or who is recovering
from back or abdominal conditions.
Equipment Shower and Toilet Equipment

Recommended Advantages
dependency level:
Devices such as shower chairs that fit over toilets
can eliminate the need for multiple transfers.

The devices allow the patient or resident to be

moved to the shower chair, toileted, showered,
and transferred back to the wheelchair.

Guidelines
• Install standard shower stalls with level floor
surfaces and no front lip. These allow
shower chairs to be pushed in and out.
• Use toilet seat risers to equalize the
height of wheelchairs and toilet seats.
This allows you to make lateral transfers
instead of lifts.
4
Part Transfer Guidelines

What you need to know:

1. Patient or resident transfer procedures

2. Care strategies for hard-to-handle patients

and residents
Transfer Bed to Chair, Chair to Toilet, Chair to Chair, Car to Chair
Guidelines

Start here

For a full body sling lift, if the car is the For seated transfer aid, you For toilet and bath transfers,
starting or ending destination, select a lift that must use a chair with arms that consider the use of toileting slings
was specifically designed to access the patient recess or are removable. or bathing mesh slings.
or resident from the car.
Transfer Lateral Transfer
Guidelines

Start here
Transfer Transfer From Chair to Stretcher
Guidelines

Start here
Transfer Reposition in Bed
Guidelines

Start here

Remember:
This is not a one
person task.

When pulling a patient or resident up in bed, the bed
should have the side rail down and either be flat or in the
“Trendelenburg” position to aid in the use of gravity.
Do not pull from the head of the bed!
For patients or residents with stage III or IV pressure
ulcers, care must be taken to avoid a shearing force.
The height of the bed should be at the level of the elbows”
which is appropriate for staff safety.
If the patient or resident can assist when repositioning “up in
bed”, ask the patient or resident to flex at the knees and push
on the count of three.
Transfer Reposition in Chair
Guidelines

Start here
Transfer Lifting Patients or Residents from Floor
Guidelines

Start here
Transfer Hard-to-Handle Patients and Residents
Guidelines

Difficult situations can arise with patients or residents who have dementia,
Alzheimer’s, or other illnesses.

Responding appropriately: Note: The care of hard-to-

handle patients or residents
Remember that these patients or residents do not
does not differ significantly
choose to be out of control.
from how other patients and
Remain calm, reassuring, and clear in directions. residents are handled. Their
care plans must be followed,
Make sure that dangerous objects are removed from the and they must be able to
area. make informed decisions
about their own care.
Maintain a safe distance if necessary.

Never turn your back on the patient or resident.

Position yourself between the patient or resident and

the room exit.

Call for additional assistance if you feel it is necessary.

Summary
Follow the Written Program
• Address patient or resident handling
hazards and establish patient or resident
handling criteria.
• The program must describe specific patient
or resident needs, the degree of assistance
required, special treatments, etc.
Use the Proper Equipment
• Proper equipment reduces
excessive lifting hazards.
Protect Yourself from Injury
• Minimize manual handling and lifting as
much as possible. If your organization has
a zero-lift policy, follow it.
• Identify risk factors for injury.
• Analyze all resident lifting and
repositioning tasks.
• Assess the needs and abilities of the
patients or residents involved with
each task.
• Choose equipment that meets the specific
needs of the patients or residents.
• Adhere to the patient and resident
handling guidelines.
• Listen to your body, and make your
health and wellbeing a priority.