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Safe lifting: The assessment imperative


Nurses are trained to perform rapid, efficient clinical assessments. Patient handling is no exception. To be effective, a safe patient-handling program should emphasize the importance of routinely assessing ergo­nomic hazards and the patient’s functional ability, level of assistance, and mental status.

The goal is to turn assessment into a habit caregivers perform automatically before starting any handling task. This will help them cope with virtually any handling situation that might arise—and perhaps avoid a disabling or career-ending injury. On most nursing units, routine competency reviews are a part of training; this periodic in-service will remind staff of the importance of assessing the patient’s handling needs.

This article reviews general guidelines for safe patient handling. Depending on your duties, you can use it as a teaching tool for staff or the patient’s family members or as your own refresher course.

Getting started
Learning objectives for a safe handling training program include:

  • assessing the patient’s functional ability to participate in the handling task
  • identifying potential ergonomic hazards
  • selecting and applying slings properly
  • performing specific handling tasks safely and efficiently.

For maximal effectiveness, participants should get the chance to practice lifts and transfers using a wide range of equipment and devices under varied circumstances before performing them on patients.

Assess the patient’s functional ability
Evaluate the patient and the situation to determine proper selection of the lift, sling, accessories, and specific handling procedure. Assess the patient’s functional ability using at least these four criteria:

  • Physical capabilities. Determine the patient’s height and weight and gauge her basic physical capabilities. For instance, can she sit on the side of the bed or logroll unassisted? Does she have physical limitations, such as an amputated limb?
  • Clinical condition. Does the patient have a clinical or medical condition that could influence equipment selection or handling technique? For example, is she receiving drugs that cause weakness or impair balance? Has she undergone recent joint surgery? Does she have a chronic disease that might cause spasm or contractures? Is she attached to medical equipment you’ll have to work around, such as an I.V. line or ventilator?
  • Ability to assist and bear weight. Evaluate how much physical assistance the patient can provide during the lift. Can she bear her full weight without assistance, or is she partially or totally dependent on assistance? Can she maintain her balance? Assess her strength and stability. How much effort will she need to exert for the lift to proceed safely and efficiently? If she starts to lose weight-bearing ability in the middle of the lift or transfer, could you support her unassisted?
  • Mental status. Assess the patient’s mental status and cooperativeness. Ask if she has questions about the procedure; as she responds, gauge her mental status and cognitive ability. Can she follow directions? To test this, ask her to shake your hand.

If your evaluation reveals problems that reduce the patient’s functional ability, be sure to obtain adequate assistance for the handling task.

Identify ergonomic hazards
Caregivers need to be able to recognize handling maneuvers that increase their risk of injury.

Select and apply slings
By now, you’ve determined which type of lift or other transfer device to use and whether to obtain assistance from one or more colleagues. Next, plan the sequence of steps needed for executing the handling task safely and efficiently.

  • Choose the right sling, lift sheet, repositioning sheet, or other accessory. All lifts require use of a lift accessory, such as a sling, lift sheet, or repositioning sheet. Slings come in various sizes, designs, construction, fabric, and infection-control properties. Basic decision trees are available to aid selection of the most appropriate sling for the patient’s size and clinical condition. Evaluation criteria include the specific task to be performed, amount of support needed (for instance, lumbar spine support to complete head support), clinical limitations (as for a postoperative patient), patient’s ability to assist with a specific maneuver (such as bathing or toileting), and whether the sling will be left under her for a prolonged period. Also determine whether the task requires other accessories.
  • Place the sling in the proper position. If the patient is supine, logroll her so you can apply the sling under her in a centered position. If she’s seated, place the sling behind her and slide it down until its lower edge reaches her tailbone. Then position the upper portion of the sling behind her.
  • Position the leg supports. Next, slide the leg supports under the patient’s thighs, making sure the sling fabric lies flat and reaches completely around her thighs. Verify that the sling fits snugly around her buttocks, and remove any slack from behind to eliminate the risk of skin shear.
  • Connect the straps to the stretcher or sling bar. Hook the upper sling straps onto the sling bar first, then hook the lower sling straps onto it. Lift the patient slowly, checking to make sure all sling elements are positioned properly.
  • Complete the maneuver. Guide the patient using gentle hands-on pressure on one or more of the sling straps or guide handles. Lift her only as high as necessary to complete the transfer. Never keep her suspended in the sling longer than necessary. Tell her what will happen next.

Nurturing the “assess first, lift later” mentality
If you’re responsible for training staff members, you can put your mind at ease if you help them develop the “assess first” habit. Once they’ve acquired the assessment habit, you’ll be able to stand aside and trust them to perform the patient-handling task safely on their own.

Selected references
For a complete list of selected references, see June 2007 references.

Jan DuBose, RN, is Director of Education at Liko Inc., a global patient lift manufacturer with North American headquarters in Franklin, Mass.

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