Assessing the potential for work to injure employees in the healthcare setting is complex because typical operations involve the repeated lifting and repositioning of patients. Lifting and repositioning tasks can be variable, dynamic, and unpredictable in nature.
In addition, factors such as patient dignity and safety should be taken into account. Specific techniques should be used for assessing patient lifting and repositioning tasks.
An analysis of any patient lifting and repositioning task involves an assessment of the needs and abilities of the patient involved. This assessment allows staff members to account for specific characteristics while determining the safest methods for performing the task. Such assessments typically consider the patient’s safety, dignity and other rights, as well as the need to maintain or restore a patient’s functional abilities.
The assessment should include examination of factors such as:
The factors on the previous tab are critically important in determining appropriate methods for lifting and repositioning a patient. The size and weight of the patient could determine which equipment is needed and how many caregivers are required to provide assistance. The physical and mental abilities of the patient also play an important role in selecting appropriate solutions.
For example, a patient who is able and willing to partially support their own weight may be able to move from his or her bed to a chair using a standing assist device, while a mechanical sling lift may be more appropriate for those who are unable to support their own weight.
Let’s take a look at some examples of solutions for patient lifting and repositioning tasks.
Description: Powered sit-to-stand or standing assist devices.
When to Use: Transferring patients who are partially dependent, have some weight-bearing capacity, are cooperative, can sit up on the edge of the bed with or without assistance, and are able to bend hips, knees, and ankles. Transfers from bed to chair, or chair to bed, or for bathing and toileting. Can be used for repositioning where space or storage is limited.
Points to Remember: Look for a device that has a variety of sling sizes, lift-height range, battery portability, hand-held control, emergency shut-off, and manual overdrive. Ensure device is rated for the patient weight.
Description: Portable lift device (sling type); can be a universal/hammock sling or a band/leg sling.
When to Use: Lifting patients who are totally dependent, are partial- or non -weight bearing, are very heavy, or have other physical disabilities. Transfers from bed to chair, chair or floor to bed, for bathing and toileting, or after a resident fall.
Points to Remember: More than one caregiver may be needed. Look for a device with a variety of slings, lift-height range, battery portability, hand-held control, emergency shut-off, and manual overdrive. Having multiple slings allows one of them to stay in place while patient is in bed or chair for only a short period of time. This reduces the number of times a caregiver lifts and positions the patient.
Description: Variable position Cardiac chair.
When to Use: Repositioning partial- or non-weight-bearing patients who are cooperative.
Points to Remember: More than one caregiver is needed and use of a friction-reducing device is needed if a patient cannot assist to reposition self in chair. Caregivers must make sure they use good body mechanics. Wheels on chair add versatility. Ensure the chair is easy to adjust, move, and steer. Lock wheels on chair before repositioning. Remove trays, footrests, and seat belts where appropriate. Ensure device is rated for the resident weight.
Description: Ambulation assist device.
When to Use: For residents who are weight bearing and cooperative and who need extra security and assistance when moving.
Points to Remember: Increases resident safety during movement and reduces the risk of falls. The device supports patients as they walk and push it along. Ensure height adjustment is correct for the patient before movement. Ensure device is in good working condition before using and it is rated for the patient weight to be lifted. Apply brakes before positioning patient in or releasing him/her from the device.
Description: Ceiling mounted lift device.
When to Use: Lifting patients who are totally dependent, are partial- or non-weight bearing, very heavy, or have other physical limitations. A horizontal frame system attached to the ceiling-mounted device can be used when moving patients who cannot be transferred safely between two horizontal surfaces, such as a bed to stretcher or gurney while lying on their back.
Points to Remember: More than one caregiver may be needed. Some patients can use the device without any help. It may be quicker to use than a portable device. Ensure device is rated for the resident weight.
Description: Transfer boards made of wood or plastic. (some with movable seat).
When to Use: Transferring (sliding) patients who have good sitting balance and are cooperative from one level surface to another, such as a bed or toilet. Can also be used by patients who need limited assistance, but additional safety or support.
Points to Remember: Movable seats increase the patient comfort and reduce the possibility of tissue damage during transfer. More than one caregiver is needed to perform the lateral transfer. The seat may be cushioned with a small towel for comfort. Ensure wheels on bed or chair are locked and transfer services are at the same level.
Description: Electric powered height adjustable bed.
When to Use: For all activities involving resident care, transfer, and repositioning in bed, to reduce caregiver bending when interacting with a patient.
Points to Remember: Device should have easy-to-use controls located within easy reach of the caregiver. Some patients may be at risk of falling from the bed. Therefore, some beds may need to be lower to the floor to protect the patient. Beds raised and lowered with an electric motor are preferred over crank-adjust beds to allow a smoother movement for the patient and less physical exertion to the caregiver.
Description: Trapeze bar; hand blocks and push up bars attached to the bed frame.
When to Use: Reposition patients who can assist the caregiver during the activity. (i.e., patients who have upper body strength and can use their extremities).
Points to Remember: Patients use trapeze bar by holding the bar suspended from an overhead frame to raise themselves up and reposition themselves in bed. If a caregiver is helping, make sure the bed wheels are locked, bedrails are lowered, and bed is adjusted to the caregiver’s waist height. May not be suitable for heavier patients.
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