When most of us entered nursing practice, we recognized that lifting patients is an acceptable part of the job responsibilities, but rarely did we think of it as an occupational hazard. Before we started our professional careers, we understood that our patients would require some physical assistance from time to time, but never imagined that lifting could lead to debilitating career ending injuries.
It often amazes me to what extremes nurses are willing to go in care of a total stranger. There seems to be something in our professional DNA that transforms our mindsets once we’re assigned to the care of another human dressed in a hospital gown. Having been away from the bedside for some time now, when I look back it’s hard to understand why we allow people dressed in hospital inpatient attire to drive us to assume unnecessary injury risks when providing them care. We rarely consider ourselves to be victims of our own circumstances, yet we consistently jeopardize our most important asset, which is needed to competently perform our professional duties, our health.
As we pick up where we left off last month, the nuclear medicine department within one of my organizations was facing many challenges as the result of employee injuries related to patient lifting. As you recall, the manager of the department was working extra shifts to compensate for the loss of staff due to work restrictions created by these injuries. Several task related challenges that are inherent to departments such as nuclear medicine needed an injury prevention solution that could effectively prevent injuries both short- and long-term.
As you may remember, immediate recommendations were made to install overhead ceiling lifts in each of the department’s diagnostic rooms. Though ceiling lifts would be the ultimate fix, there were manual lifting processes that needed to be addressed while the department awaited ceiling-lift installations. Temporary solutions were necessary to effectively modify otherwise high-risk patient care tasks that staff were still expected to perform. Additionally, processes had to be created between ancillary services, such as laundry, biomed, and environmental services, all of which would have expanded roles in support of the nuclear medicine department’s safe patient handling program.
As we waited for the ceiling-lift installations, the first challenge staff addressed were patients who required vertical lifting. These are patients with minimal to no weight bearing capabilities who arrive in the department by wheelchair and need to be moved onto diagnostic tables. Although the staff was instructed to ask for lifting assistance from the department next door, I recognized that additional manual assistance only meant that more staff would be predisposed to musculoskeletal injuries—contrary to traditional logic suggesting that the more staff available to assist, the lesser the risk of injury due to the ability to divide the patient’s body weight between the number of staff participants. But because body weight is not evenly distributed, there is no way to divide body weight proportionally among staff members. Knowing that this task would eventually be eliminated altogether once the overhead ceiling lifts were in place, we decided to use a portable total assist lift temporarily to perform the lifting tasks. This patient lift was able to mechanically lift patients vertically out of wheelchairs, and safely place them onto the diagnostic table. Though it wasn’t preferred nor considered to be a long-term solution, the benefit of avoiding repetitive manual patient-lifting amongst staff far outweighed any short-term inconvenience.
The second challenge that had to be addressed within the department was the task of laterally transferring patients. These tasks were required when patients with minimal to no mobility arrived in the nuclear medicine department on stretchers or in hospital beds and needed to be transferred onto diagnostic tables. The danger in performing this task is directly related to the patient’s body weight, which increases the friction between the linen the patient is lying on and the transferring surface, resulting in excessive weight related workloads.
In these scenarios, it’s common to request extra staff assistance to “pull”(direct opposition to proper body mechanic techniques) patients onto the receiving surface using the sheet that the patient is lying on. Because the patient is being pulled against a surface that minimally decreases the friction created by the patient’s body weight, the risk for staff injuries is increased. To overcome this challenge, the department purchased inexpensive friction-reduction sheets, which were used to safely laterally transfer patients by sliding them from bed to table and back to bed, reducing the friction created by the patient’s body weight and the transferring surface.
Now that our temporary solutions were in place, we began working on long-term processes that aligned with the nuclear medicine department’s daily workflow. I devised a training schedule to establish competencies on proper usage of patient-lifts. I also arranged a meeting with the laundry department’s manager to discuss how reusable slings would be laundered and redistributed to nuclear medicine. Infection control was involved to help in creating cleaning protocols for the recently purchased friction reduction sheets, which would be re-used between patients.
Though “proper body mechanics” are not preferred techniques taught by most safe patient handling consultants to prevent patient lifting and repositioning injuries, principles such as pushing vs. pulling, raising beds and examination tables to workable heights, and encouraging staff to use their leg muscles remain applicable injury prevention techniques in patient care settings. We were able to designate a convenient location to store and retrieve portable patient lifts. We worked on staff communication between the department and nursing units to ensure a patient’s mobility status was known before he or she arrived.
The long-term outcomes for this nuclear medicine department has been positive to date, yielding no patient handling injuries over the last 5 years. We effectively minimized normal daily risks created by patient care workloads through the incorporation of mechanical patient-lift equipment. Of all the lessons learned through this implementation, the one lesson that I continue to carry forth is that safe patient handling programs are as effective as the level of priority placed on it by its leadership. When the standard is set, staff will follow.
Roric P. Hawkins is the founder and president of The RP Hawkins Group (www.therphawkinsgroup.com) and is the safe patient handling coordinator at Michael E. DeBakey VAMC in Houston, TX. The views expressed here are his own.