1. Safe Patient Handling

2. High risk patient care activities
Objectives
Ergonomics
Risk factors
High risk patient care activities
Conditions that result in high risk environments
Best solutions for moving and handling patients

3. The Basic Problem Fundamental ergonomics
The National Institute of Occupational Safety and Health (NIOSH) research:
Under IDEAL CONDITIONS, 90% of males, and 75% of females can safely lift 23 kilograms (~51 pounds), MAXIMUM.
Healthcare settings do not provide ideal conditions (straight back, no bending, no twisting, positive grasp, infrequent lifts, etc.)
Conclusion
One healthcare worker cannot safely lift an adult patient alone, and positioning tasks that require greater than 23Kg of exertion are also hazardous.

4. What Makes Patients Risky?
They are bulky—adults are > 51 pounds
No handles! (Technical term is “coupling” = good grasp)
The unpredictable occurrence
Possible lack of help from patient
Possible consideration of wounds

5. Risks of Job Tasks
What factors contribute to a healthcare worker being hurt during patient positioning?
Awkward postures
Lifting heavy loads
Length of lifting (supporting the patient over a period of time)
Reaching
Frequency of positioning tasks

6. OSHA “Regulations” Regarding Patient Positioning
OSHA recommends minimizing manual lifting of patients/ residents in all cases and eliminating lifting when possible.

7. Basic Safe Patient-Positioning Process
Identify
Characteristics of the patient to be positioned
Type of positioning to be accomplished
If movement, where the patient is being moved to.
Task-related Hazards
Environment/facility-related hazards
What personnel/equipment will be needed
How to move or lift the patient.

8. Possible Risks In Job Environment
Slip, trip, and fall hazards
Uneven work surfaces (bed to stretcher, chairs, toilets)
Space limitations—(i.e. patient fallen in the bathroom)
Equipment hazards (respirators, IV pumps etc.)

9. Help unavailable when needed (understaffed facility)
Other Risks
Help unavailable when needed (understaffed facility)
Patient handling equipment in poor working order
Combative patients
Others?

10. Assessing the Patient Before Moving
Always review the patient care plan before attempting to move the patient.
A patient care plan describes a specific patient’s needs, degree of assistance required, special treatments, etc.

11. Can they provide assistance? Can they bear weight?
Assessing a Patient
Next ask the following questions before moving or transferring the patient.
Can they provide assistance?
Can they bear weight?
Can they cooperate and follow instructions?
How big and heavy is the patient?
Note patient’s wounds, dressings, and any machinery.

12. Types of Patient Moves and Lifts
Lateral transfers: Moving a patient sideways
Repositioning: Moving a patient up and down or side to side in a bed or chair
Transfers involving sitting position: bed to chair, bed to bed, chair to toilet, car to chair
Floor: Recovering a patient that has fallen on the floor

13. Why Use Patient Equipment?
When a patient weighs too much for safe manual positioning
Frequent unassisted lifting and movement of patients causes muscle and joint pain/damage.

14. Patient handling/moving equipment
Sling – for patients that are totally dependent
Lean Stand Assist – for patients that have some lifting ability
Ceiling Mounted Lift Device – for patients that are totally dependent

15. Patient Assist Devices
Sliding boards (also called back boards)
Slip sheet, roller sheet, or draw sheet
Trapeze lift attached to bed (mostly used on orthopedic patients)
Walking or gait belt
Shower chairs
Toilet seat risers
And many more…

16. Hospital & Nursing Home Systems
The following are systems utilized by hospitals to decrease the risk of work-related lifting injuries
Color Coding – color coding of patient’s lift requirements for posting at the patient’s bedside. By looking at the displayed color coding system an employee can know what kind of moving assistance the patient will need

17. Hospital & Nursing Home Systems
Segregation of patients based on need. This will ensure that equipment and staff are appropriately assigned
Staggered Staffing – Provide additional staff for peak periods. This would usually be during the day shift, patient baths, physical therapy etc.

18. Lifting and Moving Algorithms
What are lifting and moving algorithms?
They were developed by a group of nursing experts and tested in different patient populations
How do algorithms help you?
They give you a safe process to accomplish the task you are trying to perform
Ensure that you and the patient will not get hurt during the move
Now lets look at one example of a lifting and moving algorithm…

19. Reposition in Bed: Side-to-Side, Up

20. Discussion of Nursing Home mechanical lifting program:
Resources
Discussion of Nursing Home mechanical lifting program:
Full discussion and all algorithms:
OSHA’s Ergonomics Guidelines for Nursing Homes
guidelines/nursinghome/final_ nh_guidelines.html

21. Basic Lifting Techniques
Always remember basic safe lifting techniques while performing duties
Stand as close to the patient as possible
Keep back straight
Get a good grip on the patient
Lift with legs when possible

22. SUMMARY
Back injuries are among the most costly and disabling of all injuries.
A back injury now could cause pain for a lifetime – it is important to treat the back well.
Always use the proper lifting techniques and systems, doing so will allow a healthy back for tomorrow and years to come.