March 2006

Providing a Lift

By Sharon Brumbeloe, RN

New lifting techniques are explored in an effort to prevent injuries of both patients and health care workers.

Ceiling systems offer greater user mobility and safe transfer to multiple locations.

The American Physical Therapy Association’s recent member survey reports that the average age of a physical therapist now is 40.7 years versus 35 to 37 years in the mid 1990s.³ We are an aging health care force taking care of an aging population. According to statistics released by the National Institute on Aging, Baby Boomers are turning 50 at a rate of one every 7 seconds. Combine this with the fact that seven of every 10 Americans who will die each year suffer chronic disease, added to the increasing obesity factor—not to mention a recent study from the CDC that concluded that deaths due to poor diet and physical inactivity rose by 33% over the past decade; this soon may overtake tobacco as the leading preventable cause of death.⁴

But do not despair, there is hope and culture change on the horizon. A groundswell of resources is quickly becoming available to the country’s systems of health care workers. On a recent trip to Europe, Lynda Enos, president of the US consultant company Human Fit, was quoted in a Denmark newspaper as saying, “When it comes to the working environment [the United States is] 10 years behind Denmark and England. We still lift people manually. Ceiling lifts are completely new in the United States. However, it is not just a question of buying the right assistive technology. It is also a question of teaching the caregivers how to use them.”⁵

She believes that America’s health care workers are still in the “infant stage” while Europeans are already in junior high school. “It’s all about getting people to think differently,” says Enos. “It is about changing their habits. And that is hard.”

In travelling around the country to teach safe patient handling, I get to experience the “Aha!” moments of caregivers discovering new techniques, new equipment, and safer ways to accomplish the lifting tasks we all encounter during our daily shifts in health care. The patients, caregivers, and challenges vary only slightly in acute care, rehabilitation, and nursing home settings.

THE KEY IS EDUCATION

Education is the key to bring about true culture change. First, we as health care professionals must think differently and then adapt our environment to our new knowledge. One of my colleagues teaches that if you reach out a hand to a patient, you should first stop and think, “What else do I need?” When we are called to a patient’s room and find a new IV must be started or the linens need to be changed, we stop, make our mental list, think, gather the supplies or equipment needed, and then proceed with the intervention. The same process should be used when we are called to the room and a patient asks to be transferred, repositioned in bed, or for any other type of movement.

Front view of a patient supported by a ceiling mounted lift system.

Instead of thinking, “This 100-pound woman is light, I can easily transfer her to the chair,” we should be thinking, “What equipment is needed to transfer 100 pounds? How much space do I have? How do I make this happen without injuring myself?”

However, we have purchased equipment and had in-services before. If the education and culture change has not happened with your efforts in the past, your injury rate and data will not have changed either. You will often find the lift equipment gathering dust or well hidden (often with dead batteries and missing parts). Pulling them out and charging the batteries, while not a bad idea, do not result in the culture change needed to become a part of the future with regard to safe patient handling.

There are no short cuts. Every level of the health care system must be involved in the education and commitment needed to change attitudes and the working environment.

A commitment of time and resources with leadership in management and leadership in the working ranks is the only way to produce the results most of our workplaces desire and must have to hire and retain the best employees.

SAFE PATIENT HANDLING

The steps to launching a Safe Patient Handling Program include:

1. Create an ergonomics committee with representatives from every stakeholder, starting with top management, caregivers, purchasing, and housekeeping.

2. Survey employees concerning lifting issues and how things are currently being handled, and analyze the collected data.

3. Draw conclusions from your survey: Where are you at risk? Where are your injuries occurring? What aids are presently being used? What types of assessments go into your choices for using your current lifting aids?

4. Determine your best approach to your risk factors, including the input you received from your caregivers who perform these tasks.

5. Research, trial, and select lift aids, and always include your caregivers in each of these steps. When testing and choosing new devices, include mechanical lifts (portable and ceiling), lateral transfer aids, gait belts, hover mats, sit-to-stand aids, and transfer chairs.

6. Set your criteria for selecting new devices and include appropriateness for the task, safety, stability and comfort for the patient and caregiver, ease of management, user friendliness, and whether it works in the confined spaces of use, is efficient in use of time, and requires low maintenance and reasonable storage, as well as an adequate number of devices is available for staff, and cost-effectiveness.

7. Provide interactive and ongoing training for staff, including specific training for peer leaders who will be your front line leaders promoting culture change.

8. Devise a tracking system for injuries, satisfaction, and retention, and routinely analyze this data.

9. Upgrade your program; it will always be a work in progress. Keep top management and every level represented in the ongoing process.

10. Finally, after some positive experience, write a policy and keep it simple.

Before beginning, a small amount of research can eliminate reinventing the wheel. Find a facility that has already been over the above ground and is eager to share its successes and possible pitfalls. Resources for comparisons are plentiful.

ARE LIFTING DEVICES THE WAY TO GO?

There are nine primary benefits of using technical aids for lifting patients, thus saving the backs, necks, and shoulders of PTs, OTs, nurses, transporters, and aides. These benefits are realized when an organization has a complete program of technical aids—not just a few lifts added here and there. It also takes the compliance of all staff members. The benefits listed below are consistent in hospitals around the world when lift technology is used for every patient of any size who needs assistance—not just bariatric patients.

Among the benefits provided by assisted lift technologies are:

1. Staff Retention—especially experienced staff. The addition of technical aids helps keep experienced professionals on the job. Keeping any employee—particularly experienced PTs, OTs, and RNs—means higher quality patient care, improved outcomes, and cost savings. According to some human resource consultants, the recruitment, screening, hiring, and orientation of new employees can exceed several thousand dollars.

2. Recruitment—Newly trained health care professionals are technologically savvy and will work only where administrative commitment, policies, and equipment offer them maximum success for a long career. These new professionals are looking for technical aids.

3. Efficiency—Staff work more efficiently and effectively when they can perform the patient task immediately without waiting for one, two, or even three additional caregivers to come.

4. Patient Satisfaction—Patients say they feel safer and more comfortable in a lift hammock/sling.

5. Employee Satisfaction Employees say, “This is a great place to work because they really care about me and give it more than lip service; they prove it with the addition of technical aids.”

6. Reduced Costs—Costs due to employee sick days and light-duty days are reduced immediately when safe lifting policies and technical aids are available.

7. Reduced Costs—Workers’ compensation costs have been reduced in some cases 35% to 65%. Repositioning patients in beds and transfers from bed to chair cause most of the injuries to caregivers across this country. PTs and OTs are often called on to help nurses with these two types of transfers because, according to the nurses, “these professionals know how to do it right.” However, age, strength, and sex are irrelevant when calling for assistance—the issues are the same: a health care worker’s back will sustain irreversible injury over time if they repeatedly lift patients, or they must place their own backs in an awkward position to lift a patient.

8. Reduced Patient Falls—Adding lift technology significantly reduces the number of potentially injurious patient falls.

9. The Joint Commission on Accreditation of Healthcare Organiza-tions and other professional reviewing entities look favorably on a well-defined, system-wide program of lifting devices and training.

WHAT ARE THE FUTURE TRENDS?

As with any culture change, the learning curve is 20/20 in hindsight. The same is true with safe patient handling. Fortunately, in free enterprise, the answer is simple: Money is spent where there is the greatest benefit. The growing trend toward ceiling-mounted lifts is proving to be wise investments.

The use of lifts (above) to ensure the safety of health care workers is highly recommended by ergonomic experts. Lift and sling (below) suitable for lifting or transferring patients from a bed.

Denver-based Craig Special Hospital has experienced a marked reduction in the number of occupational injuries, and all indications are that this was brought about by an investment in a ceiling hoist system. Since 1999, Craig has had ceiling-mounted lifts in all patient rooms, in the rehabilitation gym, and over the pool. Its strong results have continued year after year.⁵

Christiana Care in Delaware looked at its numbers, looked at all types of equipment, and, after choosing ceiling-mounted lifts, reduced caregiver injuries due to patient transfers from 1,289 to 28 in the first year. Significant results were also clear with repositioning injuries. Even patient falls dropped by half.⁶

Shepherd Care in Atlanta has reduced caregiver injuries and improved efficiency. According to its president/CEO, “We have no doubt that our investment in ceiling hoists has paid for itself. But equally important is the fact that we have also realized a number of our visions for customer satisfaction and employee working environment.”⁷

Ceiling lifts—combined with a complete program of education—sit-to-stand transfer devices, turning discs, and friction-reducing devices in patient rooms and rehabilitation gyms are benefiting employees and improving patient care and satisfaction. Once these devices were thought of as an unaffordable luxury, but no longer; they are quickly becoming necessities.

The above-listed benefits translate rather quickly into bottom-line financial impacts. The return on investment from ceiling-mounted lifts is usually 12 to 18 months. Considering the fact that these lifts typically last more than 10 to 12 years, the question becomes not whether they are affordable but rather “How do we find a way to get this technology in at least one unit, so that we can measure the results for ourselves?”

The old adage still holds true: Beginning is half done. Each hospital, each unit, each person must decide to take the first step to safe patient handling.

Sharon Brumbeloe, RN, is a registered nurse and has 13 years of experience working in rehab, critical care, hospice, and assisted living settings. She has been working at the Oklahoma Heart Hospital, a specialty hospital, since its opening 3 years ago.

REFERENCES

1. Holder NL, Clark HA, DiBlasio JM, et al. Cause, prevalence and response to occupational musculoskeletal injuries by physical therapists and physical therapist assistants. Phys Ther. 1999;79:642-652.
2. Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks and responses. Phys Ther. 2000;80:336-351.
3. Health Resources and Services Administration, US Department of Health and Human Services. Changing demographics and the implications for physicians, nurses, and other health workers. Available at: http://bhpr.hrsa.gov/healthworkforce.
4. Chronic Disease Overview. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Available at: www.cdc.gov/nccdphp/overview.htm.
5. Dreschler A. Craig Hospital: Link Between Better Working Environment and Ceiling Hoist. Guldmann Agenda; 1999. Vol 4.
6. Christiana Care: The “PEEPS” Program: A Patient Handling Injury Reduction Initiative. Presented at: Safe Patient Handling; 2005; Tampa, Fla. Available at: www.guldman.com.
7. Maller AT. Shepherd: Leading Centre for Spinal Disorders in the USA; Ceiling Hoists a Good Investment. Guldmann Agenda; 1999; Vol 2.

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