OUTLINE SPH NEW HIRE TRAINING

INTRODUCTION OF SPH TEAM CURRENT INJURY GRAPHS OUTLINE SPH NEW HIRE TRAINING BACKGROUND OF SAFE PATIENT HANDLING AB1136 AREAS OF BODY EXPOSURE LIFTING POLICY REFUSAL TO PERFORM PATIENT MOBILITY TRAINING REQUIREMENTS ANNUAL ON-LINE TRAINING MODULE NEW HIRE HANDS-ON TRAINING ANNUAL DEPT/UNIT SPECIFIC REFRESHER TRAINING UNIT LEVEL RESPONSIBILITIES ROLE OF SPH COORDINATORS UD, RN, LIFT CHAMPIONS ROLE OF LIFT TEAM REHAB. SERVICES SAFE PATIENT HANDLING EQUIPMENT AVAILABLE LOCATION CLEANING DOCUMENTATION BMAT ROOM DOCUMENTATION RN INSTRUCTION -VERBAL, SUMMARY PAGE, ROOM DOCUMENTATION GENERAL BODY MECHANICS FUNCTIONAL TASKS APPLICATION USING EQUIPMENT

TRAINING REQUIREMENTS Initial Training Requirements On-line training module (mednet home page) New Grad Orientation (hands-on) Experienced staff New hire training scheduled by unit (hands-on) Annual Requirements On-line training module Dept. specific refresher training ( hands-on) HR TRACKING Safe Patient Handling Training on HR tracking Print certificate of completion for file

UNIT LEVEL SPH RESPONSIBILITIES (WHO IS IN CHARGE? WHO DOES WHAT?) UNIT DIRECTORS -Annually complete a Clinical Area Patient Handling Hazard Evaluation and Plan to identify the area s unique hazards. -UD should collaborate with safe patient handling coordinator to develop corrective actions to control patient mobility & handling hazards identified through injury/accident investigations, unit hazard evaluations, refusal to lift events, and staff reported hazards. Ensure all unit staff complete training in accordance with the training requirements outlined in this policy. -Ensure sufficient trained staff are available to perform mobility & handling activities at all times in your clinical area in accordance with the performance of Mobility & Handling Activities. -Provide necessary resources to support SPHM operations in your clinical area, including the supply and replacement of equipment, slings, and attachments used by staff in your area. -Designate equipment, sling, and attachment storage locations, which allow equipment to be readily available & accessible for use by staff, and ensure that equipment is stored correctly. -Encourage employee feedback and participation in the completion of the Clinical Area Patient Handling Hazard Evaluation and Plan. Encourage staff reporting of hazards and adhere to the Employee Right to Refuse Statement & Guidelines. RN-COORDINATOR OF CARE -Assess the mobility of all patients upon admission or transfer to your unit and as patient condition Changes thereafter. -Outline SPHM instructions for all anticipated mobility & handling activities after completing each patient s mobility assessment. -Communicate your SPHM instructions to other involved staff, the patient &/or their representatives. -Direct all movements of your assigned patients through your SPHM instructions, including movements through a transfer of care to another clinical area or unit. -Provide assistance or designate a responsible person to assist in complex patient handling tasks Mentoring existing staff in proper use of equipment located on unit. SPH UNIT CHAMPIONS Annual refresher training on equipment located on unit Maintaining competency records in SPH for unit staff Providing feedback to unit at staff meetings on injuries related to patient handling Encouraging staff to embrace safe patient handling practices, and ensure that equipment and supplies are available and in working order.

Proper Body Mechanics Allow the patient to safely assist with his/her own movement, whenever possible. If pushing or lifting over 35lbs. of force, use assistive device, get additional assistance and lift team. Maintain a straight back with a wide stable base and avoid trunk rotation. Keep your shoulders, spine and hips in line. Keep elbows tucked in and wrists facing down. Adjust beds, gurneys or other surfaces to waist height and as close to you as possible. When providing care or repositioning patients in bed/gurney, put the bed at hip or waist level of the shortest assisting person. Taller staff remember to separate legs, bend knees and maintain a neutral spine to appropriate surface level. When boosting, move the patient shifting your weight from one foot to the other. If not contraindicated, place bed in Trendelenburg to assist with transition. When pushing, keep load close to your body. Use an upright neutral posture, push with your whole body and keep elbows tucked in. When rolling patient, if not contraindicated, bend both legs or far leg of patient and rotate in direction of roll. Roll trunk by extending arms and use body wt. leaning back instead of shoulders and arms. Second person assisting by pushing trunk from opposite side. When lowering or lifting, use legs while maintaining hip and spine alignment. With any manual group lift in an emergency, first designate a team member to lead the turn/lift. Second, ensure team members know their roles. Lastly, ensure the objective is clearly communicated to all team members and the patient. Manual group lifting requires a minimum of 4 people or more. Depending on the patient s weight, a 2 layer sheet under patient works best when mechanical lift is not appropriate. Avoid lifting with just upper extremities.

CLEANING AND STORAGE PROCEDURE FOR LIFT -Before and after use EQUIPMENT -Clorox wipes for C-diff or Spore precautions (Contact time 3min. wet) -Peroxide wipes for all other cleaning (Contact time 5min. wet) -EVS wipe down weekly to prevent dust collection REMEMBER TO CLEAN ENTIRE MACHINE STORAGE OF LIFT EQUPMENT In use- use within 30 minutes Not in use- stored in designated areas

BMAT- Pediatrics Recommended patient population: Patients age > 4 years of age with ability to follow directions Ensure activity order in place and safety screening clearance before assessing with BMAT ASSESSMENT LEVEL 1 SIT AND SHAKE MOBILITY LEVEL 1 DEPENDENT From a semi-reclined position, ask your patient to sit upright and rotate to a seated position at the side of the bed. Ask patient to reach across midline to shake your hand ASSESSMENT LEVEL 2 STRETCH AND POINT MOBILITY LEVEL 2 MODERATE ASSIST Ask patient to extend leg forward until it is straight at the knee. Ask the patient to point and flex foot/toes. Repeat with other leg if appropriate. ASSESSMENT LEVEL 3 STAND MOBILITY LEVEL 3 MINIMAL ASSIST Ask your patient to elevate off the bed or chair using an assistive device if needed. Patient should be able to raise buttocks off bed and hold for a count of five. ASSESSMENT LEVEL 4 WALK MOBILITY LEVEL 4 MODIFIED INDEPENDENCE Ask your patient to march in place at bedside. Then ask patient to advance step and return each foot.

SAFE PATIENT HANDLING TIPS MaxiMove -REMEMBER MAXIMOVE SLINGS ARE DISPOSABLE AND SINGLE PT. USE -DO NOT LOCK BRAKES ON MAXIMOVE WHEN LIFTING A PATIENT FROM BED OR FLOOR -USE SLING ONE SIZE LARGER WHEN DOING A FALL RECOVERY LIFT -REMEMBER SMALL AND XXL SLINGS ARE AVAILABLE IN MATERIALS MANAGEMENT -REMEMBER TO TURN OFF LIFT AFTER EVERY USE -CHECK BATTERIES ONCE A SHIFT (8 HRS. TO CHARGE EMPTY BATTERY)

SAFE PATIENT HANDLING TIPS TENOR BARIATRIC LIFT PURPLE SLING WITH BLACK EDGES REMEMBER SLINGS ARE LAUNDRY ONLY 704 LBS WT LIMIT LEGS OF SLING MUST BE CROSSED WITHIN LOOPS DO NOT LOCK BRAKES ON TENOR WHEN LIFTING A PATIENT FROM BED OR FLOOR USE ONE SIZE LARGER WHEN DOING FALL RECOVERY LIFT SLINGS ARE AVAILABLE IN XL & XXL IN LIFT TEAM DEPT NOTIFY LIFT TEAM WHEN NEEDED REMEMBER TO TURN OFF LIFTS AFTER EVERY USE CHECK BATTERIES ONCE A SHIFT (8HRS. TO CHARGE EMPTY BATTERY)

SAFE PATIENT HANDLING TIPS LIKO GOLVO GREEN SLINGS WITH COLORED EDGES NEAR SHOULDERS SLINGS ARE LAUNDRY ONLY OR SINGLE PATIENT USE 440 LBS WT LIMIT LEGS OF SLING MUST BE CROSSED WITHIN LOOPS BRAKES REMAIN UNLOCKED WHEN LIFTING A PATIENT FROM BED OR FLOOR USE ONE SIZE LARGER WHEN DOING FALL RECOVERY LIFT CAN BE USED FOR CAR EXTRACTIONS SLINGS ARE AVAILABLE IN L, XL & XXL KEEP LIFT PLUGGED IN AFTER EVERY USE CHECK BATTERY ONCE A SHIFT (MAXIMUM CHARGE REACHED AFTER 6HRS) ALWAYS PERFORM WITH 2 STAFF FOR SAFETY

SAFE PATIENT HANDLING TIPS TOLLOS BARIATRIC STEDY AID (SIT TO STAND) REMEMBER TO LOCK BRAKES TO LIFT PATIENT AND UNLOCK BRAKES TO SIT PATIENT ALWAYS HAVE SOMEONE HOLDING LIFT TO CONTROL MOVEMENT DURING DESCENT 750 LBS WT LIMIT BRIGHT BLUE SLING W/COLORED LOOPS REMEMBER SLING IS WIPE DOWN/REUSABLE ALSO AVAILABLE IN WHITE DISPOSABLE SLINGS W/COLORED EDGES NOTIFY LIFT TEAM WHEN NEEDED SLINGS ARE AVAILABLE IN XL & XXL IN LIFT TEAM DEPT REMEMBER TO TURN OFF LIFT AFTER EVERY USE CHECK BATTERIES ONCE A SHIFT (8HRS. TO CHARGE EMPTY BATTERY)

SAFE PATIENT HANDLING TIPS SARA STEDY -REMEMBER THE SARA STEDY IS NOT A WALKING DEVICE -PATIENT MUST HAVE SITTING BALANCE -PATIENT MUST BE ABLE TO FOLLOW COMMANDS -PATIENT MUST BE ABLE TO PERFORM SIT TO STAND WITH MINIAML ASSISTANCE -PATIENT MUST BE AT LEAST WT BEARING AS TOLERATED OR FULL WT. BEARING WITH BOTH LE S AND AT LEAST ONE UE

SAFE PATIENT HANDLING TIPS RoWalker REMEMBER TO ENTER ROOM WITH ROWALKER AT THE LOWEST HT. REMEMBER TO TAKE OFF SAFETY LOCKS WHEN ADJUSTING REMEMBER TO TAKE OFF SAFETY LOCKS BEFORE ADJUSTING HT. AND SECURE LOCKS BEFORE USAGE REMIND PATIENT THE HT. ADJUSTING GRIP IS NOT A BREAK ROWALKER ABLE TO ACCOMMODATE PATIENTS FROM 5 1 AND ABOVE. WT. REQUIREMENT <400 LBS

SAFE PATIENT HANDLING TIPS QUICKMOVE WALKER SIT TO STAND TRANSFER AND WALKING DEVICE REMEMBER TO ENTER ROOM WITH QUICKMOVE WALKER AT LOWEST HT. PATIENT MUST BE ABLE TO PULL SELF UP TO STAND REMEMBER TO LOCK DEVICE PRIOR TO MOBILIZING PATIENT QUICKMOVE WALKER CAN ACCOMMODATE PATIENTS FROM 5 1 AND ABOVE WT. REQUIREMENT < 375 LBS FOOT PLATE IS USED FOR SIT TO STAND TRANSFER FOOT PLATE IS REMOVEABLE FOR AMBULATION CLEAN ENTIRE LIFT BEFORE AND AFTER USE

SAFE PATIENT HANDLING TIPS SEATED POSITIONING SYSTEM REMEMBER TO KEEP HIPS IN LINE WITH CHAIR USE BODY WT. AND SHIFT WT. BACKWARDS WHEN REPOSITIONING PATIENT ALWAYS PERFORM WITH 2 STAFF FOR SAFETY SEATED POSITIONING SYSTEM SHOULD BE IN DIRECT CONTACT WITH CHAIR (DO NOT PLACE CHUX OR SHEET BETWEEN CHAIR AND SEATED POSITIONING SYSTEM)

SAFE PATIENT HANDLING TIPS SAGE TAPS 2.0 REMEMBER EACH COMPONENT OF THE SYSTEM CAN BE REPLACED SEPERATELY AND IS LOCATED ON SUPPLY CART TOP SHEET PLACED AT PATIENTS SHOULDER WEDGES ARE TO BE USED BLACK SURFACE UP AND ANCHOR WEDGE BENEATH THE PATIENTS THIGHS REMEMBER TO MONITOR SKIN AT ALL AREAS OF CONTACT WITH WEDGES AND ANCHOR TAPS CAN BE USED FOR LATERAL TRANSFERS IF ACCOMPANIED BY A SLIDE BOARD OR ROLL BOARD REMEMBER TO ADJUST BED TO HIP LEVEL OF SHORTER PERSON, TIGHTEN ABDOMINAL AREA, STRONG WRIST (PALMS FACING DOWN), ELBOWS INTO BODY AND WT. SHIFT DURING REPOSITIONING OF PATIENT. Roll board Slide board

SAFE PATIENT HANDLING TIPS SAGE TAPS XL/XXL ORDER FROM MATERIALS MANAGEMENT COMES AS AN ENTIRE SYSTEM REMEMBER TO PLACE MATTRESS COVER PRIOR TO GLIDE SHEET TOP OF GLIDE SHEET IS PLACED AT PATIENT S SHOULDER ATTACH GLIDE SHEET STRAPS TO MATTRESS COVER REMEMBER TO MONITOR SKIN AT ALL AREAS OF CONTACT WITH WEDGES AND ANCHOR XL/XXL TAPS CAN BE USED FOR LATERAL TRANSFERS IF ACCOMPANIED BY A SLIDE BOARD OR ROLL BOARD AND ADDITIONAL ASSISTANCE REMEMBER TO ADJUST BED TO HIP LEVEL OF SHORTER PERSON, TIGHTEN ABDOMINAL AREA, STRONG WRIST (PALMS FACING DOWN), ELBOWS INTO BODY AND WT. SHIFT DURING REPOSITIONING OF PATIENT Roll board Slide board

SAFE PATIENT HANDLING TIPS MAXI AIR & PUMP REMEMBER TO ORDER FROM MATERIALS MANAGEMENT WHEN ANTICIPATING A PATIENT APPROPRIATE FOR DEVICE REMEMBER TO CENTER PATIENT ON MAXI AIR MATTRESS REMEMBER TO SNAP HOSE IN AND CLOSE VELCRO TAB FOR EFFICIENT MATTRESS INFLATION REMEMBER TO LOCK BRAKES ON BOTH SURFACES, RAISE BOTH RAILS ON BED AND TIGHTEN SAFETY STRAPS LOOSELY PRIOR TO INFLATION. TIGHTEN SECURELY PRIOR TO MOBILIZING PATIENT

SAFE PATIENT HANDLING TIPS MAXISLIDE FLITES FLITES ARE FOR REPOSITIONING PATIENT UP AND DOWN IN BED, SLIDING LATERALLY AND CAN ASSIST WITH TURNING 2 FLITES ARE NEEDED TO PERFORM REPOSITIONING FLITES ARE DISPOSABLE AND SINGLE PATIENT USE WHEN PERFORMING LATERAL TRANSFER, STAFF WILL PUSH AT SHOULDER/HIP OF PATIENT FROM DEPARTING SURFACES AND PULL FROM RECEIVING SIDE USING HANDLES AND APPROPRIATE BODY MECHANICS FLITES MUST BE REMOVED AFTER USAGE

SAFE PATIENT HANDLING TIPS SLIDE BOARD & ROLL BOARD REMEMBER TO CLEAN THE BOARD BEFORE AND AFTER USE ENGAGE BRAKES ON BOTH TRANSFER SURFACES ADJUST DEPARTING SURFACE TO HIP/WAIST LEVEL OF SHORTEST ASSISTING PERSON. REMEMBER TO ROLL PATIENT OVER COMPLETELY BEFORE PLACING SLIDE BOARD/ROLL BOARD USE A SLIDE SHEET BETWEEN PATIENT AND SLIDE BOARD PRIOR TO SLIDING PATIENT, ENSURE PATIENT S HEAD AND FEET ARE SUPPORTED USE SLIDE SHEET TO SLIDE PATIENT TO RECEIVING SURFACE RECEIVING SURFACE SHOULD BE SLIGHTLY LOWER MINIMAL 2 PERSON ASSIST REQUIRED TRANSFER BOARDS SHOULD REMAIN HUNG WHEN NOT IN USE

SAFE PATIENT HANDLING TIPS Limb Clip Disposable Sling Designed for single patient use Assists the caregiver with lifting, supporting and positioning the limb for easier access when performing activities such as dressing, foot care, wound care and venous wrapping Compatible with the Maxi Move lift Remember to fold plastic clip down and away from patient s skin when sliding under patient s limb Can use Maxislide/flite between patient and sling to assist with sliding Available in standard size only Sling s limb weight capacity 154 lbs

Floors at RR Location of Lift Equipment 8 North Core 8 East Core 8 West Core 7 North Core 7 East Core 7 West Core 6 North Core 6 East Core 6 West Core 5 PEDS Core 5 East Alcove near room 5137 5 L&D Removed 4 North Core 4 East Located in 4 North 3F Mattel Alcove across from room 3531 1 Gonda Alcove across from 1255x

Floors at SM Location of Lift Equipment 3NW (Ortho) Service Elevators: Sara Stedy, Sara Plus, Maxi Move Battery Charger(s): RM 3207 4NW (Med Surg) Near RM 4220: Sara Stedy, Sara Plus, Maxi move, Quick Move Battery Charger(s): RM 4209 5NW Geri Service Elevators: Sara Stedy, Sara Plus w/slings, Maxi Move Battery Charger(s): RM 5256 6NW (Peds) Service Elevators: (2) Sara Stedys, Sara Plus, Maxi Move Battery Charger: Treatment RM 4CWICU Near RM 4326 (Maxi Move) Near RM 4348 (RoWalker) Battery Charger: Storage RM Ante Partum RMs (4) Maxi Air Pumps 2MN (ROF) RM 2431A (belongs to L&D): Sara Stedy IOF POD 5 (belongs to PACU): Sara Stedy 4MN (Med/Surg) POD 5: Sara Stedy, Sara Plus w/sling, Maxi Move Battery charger: RM 4467 5MN (Telemetry) POD 5: Sara Stedy, Sara Plus, Maxi Move POD 9: Sara Stedy RM 5452 (Sara Plus slings) Battery Chargers: RM 5452 4SW (Onc) Middle of Unit: Sara Stedy, Sara Plus, Maxi Move RM 4537 (Sara Plus slings) Battery Chargers: RM 4537 3SW (PACU/PTU) POD 5: Sara Stedy 2SW (NICU) None. If in need, ask post-partum IOF POD 5 of PACU: Sara Stedy 2MN (L&D/Antepartum) Area 2431A: Sara Stedy OR No lifts ED Outside Ambulance Bay: (2) Sara Stedys GI Lab/MPU No lifts 1223 16 th St. (Surgery Ctr) Storage RM 20: Sara Stedy 1245 16 th St. (SMOC) Pathology lab: Golvo lift MOC RM 207: Sara Stedy, Sara Plus, Maxi Move, (1) Maxi Air Pump

Locating Safe Patient Handling Resources: Step 1: Step 2: Step 3:

U-Move SPH Equipment Cheat Sheets: Located just a bit lower: Then find the Cheat Sheet: Find your answers here!

Safe Patient Handling Summary of Available Equipment Mechanicals Lifts Maxi Move: For BMAT 1, full body lifts, fall recovery Weight limit 500 lbs Accessories: Single patient use blue lifting slings (M, L, XL, XXL) Rechargeable batteries Sling Size EMPAC# MFR s Product Full EMPAC Description MFR Catalog # Description Medium (yellow) 606183 Clip Medium Standard Flites Clip Medium Standard Flites MFA1000M-M Large (green) 606184 Clip Large Standard Flites Clip Large Standard Flites MFA1000M-L X Large (blue) 606185 Clip XLarge Standard Flites Clip XLarge Standard Flites MFA1000M-XL XX Large (orange) 606186 Clip XXLarge Standard Flites Clip XXLarge Standard Flites MFA1000M-XXL Tenor: For BMAT 1, bariatric full body lifts, fall recovery Weight limit 704 lbs Accessories: Laundered purple slings (XL, XXL) Rechargeable batteries Maxi Lite: For BMAT 1, full body lift, car extraction Weight limit 350 lbs Accessories: Single patient use blue lifting slings (M, L, XL, XXL) Rechargeable batteries Sling Size EMPAC# MFR s Product Full Description EMPAC Description MFR Catalog # Medium 606183 Clip Medium Standard Flites Clip Medium Standard Flites MFA1000M-M (yellow) Large (green) 606184 Clip Large Standard Flites Clip Large Standard Flites MFA1000M-L X Large (blue) 606185 Clip XLarge Standard Flites Clip XLarge Standard Flites MFA1000M-XL XX Large (orange) 606186 Clip XXLarge Standard Flites Clip XXLarge Standard Flites MFA1000M-XL

Golvo 7007 ES: BMAT 1, full body lift, car extraction Weight limit 440 lbs Accessories: Laundered green sling w/loops (L, XL) Sling Size EMPAC# MFR s Product Full Description EMPAC Description MFR Catalog # Medium (yellow) -- M-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports M-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports 3526115 Large (green) -- L-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports X Large (blue) -- XL-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports L-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports XL-Soft Original HighBack Sling, Polyester, Reinforced Leg and Back Supports 3526116 3526117 Sara Plus: For BMAT 2 sit to stand, transfer to chair, toilet, commode Weight limit 420 lbs Accessories: Green lumbar support (S, M, L, XL) Rechargeable batteries Tollos Steady Aid: For BMAT 2 sit to stand, transfer to chair, toilet, commode Weight limit 750 lbs Accessories: Wipe down blue full back sling w/loops (M, L, XL, XXL) Single patient use lumbar support sling available (XL, XXL)

Sara Stedy: For BMAT 3 sit to stand, transfers to chair, toilet, commode Weight limit 400 lbs No accessories RoWalker: BMAT 3, walking device w/built-in seat Transfer device from bed to chair Can hold 02 tank, cardiac monitor Accessories: wipedown red lumbar walking sling (S, M, L) Quick Move: BMAT 3 sit to stand transfers BMAT 3 patient who can walk and needs occasional seated rest breaks Weight limit 375 lbs Accommodates patients 5 1 and above Accessories: none

Lateral Transfer Devices Prevalon TAPS: BMAT 1 or 2, who need frequent bed repositioning Lateral transfer with a slide board Single patient use, stays under the patient Accessories: 2 wedges, incontinence pad Size EMPAC# MFR s Product Full Description EMPAC Description MFR Catalog # Standard 644093 Prevalon TAP system System Prevalon Turn and Position (For Bed) XL N/A 605130 Prevalon Micro Tab Body Pads PADS Body Micro Climate (under pads) PK of 5 5594007200 5594007250 MaxiSlide: BMAT 1 or 2 boosting, repositioning and lateral transfers without a slide board Single patient use, do not leave under patient 1 MaxiSlide per package Use 2 MaxiSlides together with handles facing up Size EMPAC# MFR s Product Full EMPAC Description MFR Catalog # Description XL 606182 MaxiSlide flite 45 - XL MaxiSlide flite - XL NPAV5260 Maxi Air: For bariatric boosting and lateral transfers without a slide board Single patient use Accessories: Use w/pump Size EMPAC# MFR s Product Full Description EMPAC MFR Catalog # Description L (Green handles) 606180 Maxi Air Maxi Air MAS014000-WW XXL (orange handles) 674101 Maxi Air Maxi Air -- 606181 Maxi Air Motor Maxi Air Motor AHAIR

Seated Positioning System Prevalon Chair Positioning System: Position patient up in the chair Place on chair prior to transferring patient to the chair Single patient use Accessories: Incontinence pad Size EMPAC# MFR s Product Full Description EMPAC Description MFR Catalog # Standard 605133 Seated Positioning System System Prevalon Seated Position (For Chair) 5594007530 Limb Sling Limb Clip: Single patient use Use w/maxi Move Standard size only, weight limit 154 lbs (600 lbs patient) Size EMPAC# MFR s Product Full Description EMPAC Description MFR Catalog # Standard 680078 ARJH Limb Clip Flite Limb Clip Flite VIG22000-L1

REFUSAL TO PERFORM PATIENT MOBILITY ASSESSMENT FORM It is the right of each employee to refuse to move a patient, but there must be a clear and objective reason for the refusal. If patient mobility assistance is part of an employee s job description, and the employee refuses to perform this job function, meet with the employee each time and document their reasons for the refusal. This form should be signed by both employee and manager, and placed in the employee s personnel file. EMPLOYEE NAME: UNIT: DATE: PATIENT: MRN: Assistance from other personnel was not available. Describe attempts made to locate other personnel: Lifting equipment was not available; describe: Lifting restrictions; physician documentation verified Yes Not on file Patient impulsive or combative Lack of training in proper lifting techniques Faulty or broken equipment; describe: Other: Signed: Date: Employee Signed: Date: Manager / Supervisor