PURPOSE: POLICY: FACTS:

Transcription

1 Revised Date: 03/13/2018 Page 1 of 14 PURPOSE: It is responsibility of each individual employed at the Black Hills Surgical Hospital to promote employee health and safety. In order to maintain and promote a safe environment for staff and patients, Black Hills Surgical Hospital has adapted the following guidelines: POLICY: 1. All applicants will need to satisfactorily complete a pre-work physical examination prior to employment. Appropriate restrictions shall be identified by the medical provider. The applicant may be hired when restrictions will not impede them from performing the essential functions of their intended position. 2. All employees shall participate in back safety training upon hire. 3. Departments that use patient transfer devices including powered lifts shall require employees to complete training on the lift/transfer equipment prior to them being authorized to use the equipment independently. 4. Essential lift and transfer equipment shall be maintained and readily accessible to the staff in each department where lifting occurs. Forklift equipment shall be available in the support services department. Powered lifts and assistive devices shall be available in the patient care areas. 5. Lockable safety ladders with railings shall be accessible to the inventory staff when stocking and retrieving supplies from tall shelving. 6. During all lifts and transfers, appropriate body mechanics shall be used. 7. Transfer carts shall be used to avoid carrying heavy surgical instruments or food trays. 8. Staff has the right to refuse to perform any lift or transfer if by performing such action the staff member will be injured or be in violation of the lifting and transferring guidelines. 9. Should an injury occur, the department manager or supervisor must be notified promptly. 10. Failure to comply with the application of lifting and transferring guidelines may result in disciplinary action. FACTS: 1. Repeated use of poor body mechanics is a major contributing factor of injuries and worker s compensation claims each year. 2. Back injuries are the most common injuries among health care employees. Most injuries to patient care providers are cumulative in nature. The sheer volume of repeated lifting and turning of patients leads to fatigue, muscle strain, and injury. Bending and twisting is the leading cause of disc problems. 3. Regardless of the department, all lifters should take lifting precautions during the first day of the work cycle and during the first quarter of the shift.

2 Revised Date: 03/13/2018 Page 2 of 14 GENERAL GUIDELINES: GOOD BODY MECHANICS: 1. Always plan ahead. Is the pathway clear? Do you need help? Do you need equipment? 2. Keep the load as close to the body as possible. Avoid lifting overhead. 3. Maintain slightly arched posture in low back (power position). 4. Tighten the abdominal muscles slightly before and during the lift/transfer. 5. Keep your feet apart for a wide base of support with the knees bent. Wear supportive, non-slip footwear. One foot may be ahead of the other (staggered stance). 6. Keep the shoulders and head up as the lift/ transfer begins. 7. Keep elbows inside the knees. 8. Lift with your legs, not with your back. Use smooth, controlled movements. Do not jerk! 9. Never twist your back, move your feet! If a direction change is needed Pivot! 10. When pushing or pulling an object is necessary, get a low center of gravity and push parallel to the surface on which the object is moved. SAFE PATIENT LIFTING AND TRANSFER GUIDELINES: Goal: It is important to promote patient independence while at the same time maintaining safety for the patient and the caregiver. It is important to reduce manual lifting and transfers as much as possible to avoid caregiver lifting injuries. The most appropriate lift or transfer should be safe for both the patient and the caregiver. Allow the patient to assist as able and provide the least work for the caregiver by making use of good body mechanics and equipment. 1. Assess the patient and the situation! Each RCC patient shall have a fall risk assessment completed upon admission and each shift. 2. Check the patient s chart and physician s orders for weight bearing status and documentation on previous transfers. 3. Ask for help! Good communication between staff is important when two or more assists are required for the lift/transfer. 4. Let the patient help and do as much for them self as possible. Do not let the patient hold onto you. The patient should be pushing off the surface to assist you with the transfer. 5. Avoid unnecessary bending and reaching. When possible, adjust the height of the bed to waist level. 6. Use a draw sheet for patients that are large and/or unable to assist. 7. Always use a gait belt! 8. Always move the patient toward their stronger side. 9. Instruct the patient on what you want them to do. Give them clear simple instruction with adequate time for response. 10. If the patient is obese and/or has limited ability to help, request assistance and consider a mechanical lift or assistive device.

3 Revised Date: 03/13/2018 Page 3 of 14 TYPES OF LIFTING AND TRANSFER TECHNIQUES/EQUIPMENT: 1. Manual Lifting: Lifting transferring, repositioning, and moving patients using a caregiver s body strength without the use of lifting equipment or aids to reduce forces on the caregiver s musculoskeletal structure. 2. Powered Patient Lifting Equipment: Equipment used to lift, transfer, reposition, and move patients. Examples include: A. Total Body Lifts These devices are designed to lift or move patients that are totally dependent by supporting their entire body weight during the transfer. Typically, they can lift a patient from the floor to the bed or cart. Currently, the BHSH total body lift (Medline Hoyer ) can move patients up to 600lbs. B. Powered Sit to Stand, Standing Assist Devices, or Ambulation lifts These devices are used for transferring patients that are 1) partially dependent; 2) has some weight-bearing capacity; 3) has some upper body strength and control; 4) cooperative; 5) able to sit up on the edge of the bed with or without assistance; and 6) able to bend hips, knees, and ankles. The ambulation lifts supports a patient during ambulation. The patient pushes or is assisted to push the lift along as they walk and a strap in the back prevents them from falling backwards. The BHSH EZ Stand can support patient weight up to 500lbs. 3. Patient Transfer Aids: Equipment used to assist in a lift or transfer process. Examples include, gait belts with handles, stand assist aids, slide boards, and surface frictionreducing devices. A simple clean plastic garbage bag underneath the draw sheet will decrease friction during the transfer allowing easier movement and decreasing musculoskeletal stress when a slide board is unavailable. PATIENT ACTIVITY CATEGORIES: 1. Total Dependence: Cannot help at all with transfers. Full staff assistance for any activity. Require total transfer at all times. 2. Extensive Assistance: Can perform part of activity, usually can follow simple directions, may require tactile cueing, can bear some weight, sit up with assistance, has some upper body strength, or may be able to pivot transfer. 3. Limited Assistance: Highly involved in activity, able to pivot transfer and has considerable upper body strength, and bears some weight on legs. Can sit up well, but may need some assistance. May need guided maneuvering of limbs or other non-weight bearing assistance. 4. Minimal Assistance/Supervision: Oversight, encouragement, or cueing at times. 5. Independent: Can ambulate normally without assistance; however, in unusual situations may need some limited assistance.

4 Revised Date: 03/13/2018 Page 4 of 14 SELECTING APPROPRIATE EQUIPMENT FOR SAFE PATIENT HANDLING AND MOVEMENT: Under ordinary circumstances, the following are examples of situations where specific lifts may be used. This list is not inclusive of all circumstances. 1. Powered Total Body Lifting Device (Medline Hoyer ): Use this device for total dependent patients up to 600lbs. Use when patient has fallen and they are unable to get up without limited assistance. 2. Powered Sit to Stand, Standing Assist Devices, or Ambulation Lift (EZ Stand): Use this device for patients that need extensive or limited assistance. Use this device for any patient requiring more than 2 staff to transfer at any time. Consider for patients 1 st POD with getting up for the 1 st time or whenever they are generally weak. Obese/morbidly obese patients up to 500lbs. Patients with high potential for falls, i.e., post epidural/intrathecal/orthostatic hypotension. Consider stature of patient in relationship to stature of assisting staff. Consider wellness of assisting staff. Staff that have experienced previous back injuries are at increased risk of re-injury should any unanticipated event occur. Patients who are fearful of falling or are unsure of their ability to ambulate. LIFTING EQUIPMENT POLICIES TO REFERENCE: Total Transfer of patient to bed from cart/cart to bed, refer to: Lateral Slide Board Transfer Device - NURS76 Medline Hoyer Patient Lift Device - NURS93 Stryker Glide Air Mattress Transfer System NURS8 Assisting Devices used with Patient Transfers, refer to: EZ Stand: Sit to Stand and Ambulating Lift - NURS5 PROPER MANUAL LIFTING AND TRANSFER TECHNIQUES: Moving patient up in bed: (2 or more assists): Place a draw sheet under the patient before beginning this move. 1. Explain the process to the patient. 2. Bed flat, raised to pelvis level with side rails down. 3. Patient bends knees or the staff member may place a pillow under the knees if the patient is unable to assist.

5 Revised Date: 03/13/2018 Page 5 of Remove head pillow. 5. Stand on either side of bed. 6. Back in power position, maintain a wide base of support, and flex your knees and hips. 7. Keep elbows close to your side. 8. Grasp draw sheet with palms up hand position. Have patient cross their arms on their chest. On the count of 3, patient lifts head and bottom then pushes with their heels while the staff members shift weight to the leg closest to the head of the bed while sliding the patient towards the head of the bed using the draw sheet to assist. 11. When patient is in a comfortable position, return patient s head pillow and make sure all wrinkles have been smoothed from draw sheet. Return upper side rails to up position. 12. Lower bed to the lowest position. Turning patient: (2 or more assists): Place a draw sheet under the patient before beginning this move. Patients may need to be moved up in bed prior to turning. (Refer to previous technique.) 1. Explain process to the patient. 2. Bed flat, raised to pelvis level, leave side rail up on side that patient will face. 3. Stand on either side of bed. 4. Back in power position, maintain a wide base of support, and flex your knees and hips. 5. Keep elbows close to your side. 6. The staff member that the patient will face will grasp the draw sheet with palms down hand position. Have patient reach with far arm across chest to grab the side rail to assist with turning. Unless contraindicated, have patient flex knee and hip of side opposite to the direction they are turning. 7. On the count of 3, the patient reaches with arm and pushes with foot while the staff member facing the patient grasps the draw sheet to assist patient to side. The staff member that is toward patient s back will gently assist patient with hands on the patient s back. 8. The staff member at patient s back will align patient s hips and shoulders if patient is unable to reposition them. 9. Once the patient is in a comfortable position, make sure all wrinkles have been smoothed from the draw sheet. Return the upper side rail at the back of the patient to up position. 10. Lower bed to the lowest position. Assisting patient from lying to sitting position (1 or more assist): 1. Explain the process to the patient 2. Bed flat, raised to pelvis level with side rails down. 3. Patient is turned to side lying position (as previously stated). 4. Patient should be positioned close to the edge of the bed. 5. Stand in front of the patient. 6. Your hand that is closest to the patient s head (or head of bed) will be placed on the bed around mid-chest level of the patient.

6 Revised Date: 03/13/2018 Page 6 of Back in power position, maintain a wide base of support, and tighten abdominal muscles. 8. Patient pushes the upper body off the bed with the upper extremities and at the same time, the lower extremities are slid off the edge of the bed all in one motion to assist the patient into a seated position. Steady patient. 9. Lower bed until patient s feet rest on the floor in preparation to stand/transfer to chair. USE OF TRANSFER (GAIT) BELT: The gait belt allows the caregiver to control the movement of the patient during transfers. The belt provides a handle on the patient. The belt is placed around the patient s waist and secured snugly. Use correct size of belt. Use the loops on the belt for holding onto the patient. Correct application of a gait belt: Loop the end of the gait belt through the clip with the teeth end first to grasp the belt. Tighten securely. Indications for use of the gait belt: 1. Patients who are able to bear weight but require assistance with transfers or walking support. 2. Unless contraindicated, the gait belt should be used for all: a) 1-person and 2-person pivot/knee block transfers. b) 2-person side-by-side transfers. 3. RCC patients who are assessed to be at high risk for falls. Contraindications: 1. Pregnancy. 2. Recent abdominal surgery (place gait belt under arms). 3. Pain in the abdomen. 4. Ostomies. 5. Unable to tolerate the pressure of the belt. Cautions: 1. The patient should have on supportive non-slip footwear. 2. Do not use the belt to catch the patient. If the patient starts to fall, gently ease them to the floor while bending your knees, go down to the floor with the patient. 3. Never allow the patient to hold around your neck. 4. Do not use the belt for lifting the patient. Assisting patient to stand from sitting (1 or more assist): Apply gait belt prior to this move unless contraindicated 1. Explain process to the patient. 2. Stand on either side of the patient or in front of patient. 3. Back in power position, maintain a wide base of support, and flex your knees and hips. 4. Patient s feet should be flat on the floor if possible and hands on the bed/chair.

7 Revised Date: 03/13/2018 Page 7 of Assist the patient to scoot forward toward the edge of the seat. 6. Instruct patient to lean forward nose over toes and push up to a stand using hands on bed/chair and feet on floor on the count of Assist patient to stand using the gait belt for leverage. If patient has poor quadriceps strength, caregiver may need to block the patient s knees to prevent buckling. Stand pivot transfer: Apply gait belt prior to this move unless contraindicated. 1. Explain process to the patient. 2. Clear pathway. 3. Lock wheels of bed/wheelchair brake. 4. Closely position bed/chair so that the patient will transfer to their stronger side. 5. Remove leg rests of the wheelchair if needed. 6. Assist patient to a sitting position (as previously stated). 7. Stand in front of the patient for 1-person transfer or on either side of patient for the 2- person transfer technique. 8. Block patient s weak side knee or foot with your knee or foot. 9. Hold the back loops of the belt and keep your shoulder up against the patient s shoulder. 10. Back in power position, tighten abdominal muscles. 11. Instruct patient to lean forwards and stand on the count of 3. Gentle rocking motion for momentum may assist with the transfer. 12. Once patient is standing, pause. 13. Pivot until the patient is in front of bed/chair. 14. Ask patient to reach back to the bed/chair to assist and sit down slowly. Side by side 2-person transfer: Apply gait belt prior to this move unless contraindicated. 1. Explain process to the patient. 2. Clear pathway. 3. Lock wheels of bed/wheelchair brake. 4. Closely position bed/chair so that the patient will transfer to their stronger side. 5. Remove leg rests of the wheelchair if needed. 6. Assist patient to a sitting position (as previously stated). 7. Stand on either side of the patient. 8. Stabilize patient s weaker leg if necessary. 9. Hold the back loops of the belt and keep your shoulder up against the patient s shoulder. 10. Back in power position, tighten abdominal muscles. 11. Instruct patient to lean forwards and stand on the count of 3. Gentle rocking motion for momentum may assist with the transfer. 12. Once patient is standing, pause. 13. Slowly walk patient to the chair/bed. 14. Ask patient to reach back to the bed/chair to assist and sit down slowly.

8 Revised Date: 03/13/2018 Page 8 of 14 This policy is not all inclusive of all known lifting and transfer techniques. Those listed will be the most common actions used at BHSH. LIFTS FROM THE FLOOR: A patient who has fallen or been eased to the floor by staff should be assessed for injury prior to being moved. 1. When a patient that has fallen can regain a standing position with minimal assistance, a gait belt can be used as a lifting aid, provided an adequate number of staff members are available. 2. If a patient cannot assist, a full body sling and mechanical total body lift should be used. Select the transfer method that allows the patient to be as independent as possible while promoting safety for the patient and caregivers. Date Chief Nursing Officer Date Employee Health Nurse Date

9 Revised Date: 03/13/2018 Page 9 of 14 ADDENDUM: Safe Patient Handling and Movement Algorithms: To provide patient care staff assessment criteria in the planning for safe handling and movement of each patient, the algorithms should be used as guidelines when planning the following patient transfer and re-positioning. Algorithm 1: Transfer to and from Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair Fully Caregiver assistance not needed; Stand by for safety as needed. Can Patient bear Weight? Partially Is the Patient cooperative? Stand and pivot technique using a gait/transfer belt (1 caregiver) or powered standing assist lift (1 caregiver) Is the Patient cooperative? Use full body sling lift and 2 caregivers Does the Patient have upper extremity strength? Seated transfer aid; may use gait/transfer belt until the Patient is proficient in completing transfer independently. For seated transfer aid, must have chair with arms that recess or are removable. For full body sling life, select a left that was specifically designed to access a patient from the car (if the car is starting or ending destination. If partial weight bearing, transfer toward stronger side. Toileting slings are available for toileting. Bathing mesh slings are available for bathing.

10 Revised Date: 03/13/2018 Page 10 of 14 Algorithm 2: Lateral Transfer to and from Bed to Stretcher, Trolley Caregiver assistance not needed; stand by for safety as needed. Can Patient assist? Partially able t at all able Partially able t at all able If patient is < 100 pounds, use a lateral sliding aid and 2 caregivers. If patient is pounds, use a lateral sliding aid or a friction-reducing device and 2 caregivers. If patient is > 200 pounds, use a lateral sliding aid and 3 caregivers or a frictionreducing device and lateral transfer device and 2 caregivers or a mechanical lateral transfer device. Surfaces should be for all lateral patient moves. For patients with Stage III or IV pressure ulcers, care must be taken to avoid shearing force.

11 Revised Date: 03/13/2018 Page 11 of 14 Algorithm 3: Transfer to and from Chair to Stretcher or Chair to Exam Table Is the Patient cooperative? Use full-body sling lift and 2 or more caregivers. Fully Caregiver assistance not needed; stand by for safety as needed. Can the Patient bear weight? Partially If exam table/stretcher can be positioned to a low level, use a non-powered standassist aid. If not, use a full-body sling lift. Use full-body sling lift and 2 or more caregivers. High/low exam tables and stretchers would be ideal.

12 Revised Date: 03/13/2018 Page 12 of 14 Algorithm 4: Reposition in Bed Side to Side, Up in Bed Fully Caregiver assistance not needed; patient may/ may not use positioning aid. Can Patient assist? Partially Encourage patient to assist using a positioning aid or cues. Use full-body sling left or frictionreducing device and 2 or more caregivers. If patient is > 200 pounds, use a friction-reducing device and at least 3 caregivers. If patient is < 200 pounds, use a friction-reducing device and 2-3 caregivers. This is not a one person task: DO NOT PULLFROM HEAD OF BED. When pulling a patient up in bed, the bed should be flat or Trendelenburg position to aid in gravity with the side rail down. For patients with Stage III or IV pressure ulcers, care should be taken to avoid shearing force. The height of the bed should be appropriate for staff safety (at the elbows). If the patient can assist when repositioning up in bed, ask the patient to flex the knees and push on the count of three.

13 Revised Date: 03/13/2018 Page 13 of 14 Algorithm 5: Reposition in Chair Wheelchair and Dependency Chair Can Patient assist? Fully Partially Caregiver assistance not needed; stand by for safety as needed. If Patient has upper extremity strength in both arms, have Patient lift up while caregiver pushes knees to reposition. If Patient lacks sensation, cues may be needed to remind Patient to reposition. Does chair recline? Recline chair and use a friction-reducing device and 2 caregivers. Is patient cooperative? Caregiver assistance is not needed; stand by for safety as needed. Use full-body sling lift and 2 or more caregivers. This is not a one person task: DO NOT PULL FROM BEHIND CHAIR. Take full advantage of chair functions, e.g., chair that reclines or use of arm rest of chair to facilitate repositioning. Make sure the chair wheels are locked.

14 Revised Date: 03/13/2018 Page 14 of 14 Algorithm 6: Transfer a Patient Up from the Floor Was patient injured? Was the injury minor? Depends on type and severity of injury (follow Standard Operating procedures). Can Patient assist? Full-body sling lift needed with 2 or more caregivers. Caregiver assistance is not needed; stand by for safety as needed. Use full-body sling that goes all the way down to the floor (most of the newer models are capable of this). REFERENCES: Lessons Learned and Best Practices: Preventing Injuries Related to Patient Handling. Audry Nelson, PhD, RN, FAAN. Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Patient Safety Center of Inquiry, Tampa, FL, Veterans Health Administration and Department of Defense. Safe Patient Handling and Movement. American Journal of Nursing. Audrey Nelson, PhD, RN, FAAN, March 2003, pg. 32.