Give Your Nurses a Lift

Gastroenterology

By: , Cathy Krueger, Ron Zimmerman

Published: 10/10/2007

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Our hospital's patient-handling program saves backs, bumps and bucks.


If you're concerned about nurses wrenching their backs and patients losing their footing, you can implement a program, just as we did at our hospital, that minimizes manual lifting.

We call our program Healthy Moves, and outfitted our day surgery unit with gait belts of various sizes, one total lift machine and several friction reducing transfer sheets. The department also has access to a forced-air hover mat.

How do staff know which piece of equipment to use on which patient? That's all covered in an extensive training program and outlined on a reference card that attaches to staff ID badges (see "Handy Reference" on page 44). The double-sided plastic card is extremely effective. It contains a basic algorithm of safe patient transfer protocol. When questions or concerns arise for proper care, a quick glance at the card provides a step-by-step formula to match the patient with the correct piece of lifting equipment. Starting at the top of the card, a nurse works down through the list of questions until she answers "yes." When she does, the proper equipment is pictured to the right. Let's say a patient in PACU needs to use a restroom. According to the reference card, the attending nurse determines if the patient can stand, pivot or walk without assistance and with no risk of falling. If so, the patient stands without aid of a lifting device. If not, the nurse should consider using the Stedy, a transfer device resembling a walker used by the elderly.

All the right moves
When facing a situation beyond the scope of the reference card, staff can approach our unit safety leaders, a group comprised of RNs, certified nurse assistants, LPNs, physical therapists and escort staff who received specialized training in patient transfer. The safety leaders serve as advocates of our lifting program and accessible resources when challenging lifting questions arise.

Here's how a scaled-down version of the unit safety leaders concept would work for surgery centers and hospital outpatient departments. Assign a safe patient lift leader, someone to serve as an expert on the lifting equipment you employ and the lift policies you create. Schedule quarterly meetings with the safety leader to provide updates on lift policies and to perform case studies on specific patient populations, notably bariatric patients.

Patient lift leaders should assist in your facility's staff education program, with a particular emphasis on employee orientation. At our hospital, new hires receive two hours of equipment training and body lift demonstrations, conducted by the nurse educator and a safety unit leader from one of the hospital's departments. The education includes a rundown of hospital personnel to contact when lifting issues or questions arise. We also empower each employee to refuse, without penalty, aiding in a patient lift if proper equipment is not used.

Another invaluable aspect of our orientation program involves hands-on training with each lifting device. Employees alternate between the roles of patient and mover, allowing for an appreciation of both perspectives. The experience gives staff a voice of authority when dealing with patients who refuse the use of a lifting device. Nothing allays patients' fears better than nurses who give detailed descriptions of how the equipment will feel, and can attest to its safety by saying, "I should know, I've been transferred in it." Putting staff into the lifting devices also mimics actual clinical practice, giving users a feel for how the equipment will work and move in real-life situations.

Handy Reference

Safe Patient Transfer Protocol

If patient can stand, pivot and walk with no physical assistance from staff with no risk of falling - No lift needed!

Otherwise, consider Stedy

Patient is able to pull himself into a standing position? Patient weighs less than 265 pounds?

Otherwise, consider Chorus

  • Patient can bear weight on at least one leg?
  • Patient is able to follow simple instructions?
  • Patient is able to grip with at least one hand?
  • Patient can sustain moderate pressure on lower back?
  • Patient weighs less than 420 pounds?

Otherwise, use Tempo/Opera

  • Patient can undergo a semi-reclined position?
  • Patient unable to bear weight?
  • Patient weighs less than 440 pounds?
  • Patient needs to be lifted from the floor (after assessment)?

If patient cannot move self in bed, use Maxislide. If questions, consult with TMC.

  • Patient requires assistance moving up in bed or turning?
  • Patient requires assistance with lateral transfers?
  • Other circumstances resulting in difficult move within the bed?

* This is only a guide and cannot address all circumstances & medical conditions. Only a team approach with Nursing & Therapy or qualified medical personnel involvement will create the safest situation for the patient and staff, while meeting the goal of increasing mobility and improving patient health.

All rights reserved. Copyright 2003, ARJO Inc. USA 12/08/03

Reinforce the Positives

Improving your patient lifting program should consist of positive reinforcement, including on-the-spot recognition of a lifting job well done. Our safety leaders make frequent rounds with a watchful eye on staff techniques. When a flawless transfer is observed, the safety leader issues a coupon to the deserving employee. Half the coupon is good for free food from the hospital's cafe to be used during employee breaks; the other portion is entered in a quartely drawing for a $75 voucher redeemable at numerous local restaurants and shops.

We also use communication bulletins to dole out praise, as well as updates and trends in patient moving news. Our program's newsletter circulates the hospital three times annually, covering the latest in patient ergonomics, lifting techniques and transfer equipment. Throughout the year, our staff receives e-mail updates about new nurse orientations, meetings of patient leadership groups and developments in patient handling legislation.

- Ron Zimmerman, PE, CHSP, CSP

If we could do it over again
Despite our patient lift program's success, we've since realized many improvements we could have made during the rollout.

  • The lift program's policy and procedures manual should define the roles of all involved staff members, including the patient handling staff and the non-clinical staff (housekeeping, engineering and infection control, for example).
  • Staff should complete a formal patient assessment tool for all patients admitted into the facility. We now have a computer assessment program that requires nurses to complete patient assessments on a daily basis.
  • We wish we had designed a proper accident/incident investigation tool earlier on. This includes an incident investigation team that would evaluate adverse events and near-misses to determine the incidents' root causes and necessary corrective actions. The team documents the findings and action taken and investigates near-miss incidents immediately to implement retraining.
  • Equipment accessibility can make or break a lifting program. Proper storage and ease of access are key elements to the success of the program. Using staff buy-in and assistance to design or locate a proper storage area would allow for greater compliance.
  • Having an adequate number and location of electrical outlets in central locations helps to maintain the equipment.
  • Regular monitoring of the location and upkeep of patient handling equipment helps provide greater accessibility and compliance of use. Ideally, you should assign monitoring to a group of key employees.
  • Create a regular communication and training program for unit or facility safety leaders to review the barriers to lifting success they've experienced or witnessed, including case scenarios, equipment use and locations.
  • The new-hire orientation process should include the review and hands-on demonstration of the patient handling program and equipment. The unit or facility safety leaders should be an active part of this process.
  • Training should extend beyond the classroom knowledge to real-life situations. It's ideal when this can occur when the equipment is actually needed on a patient. Staff members who are unfamiliar with the equipment can assist and learn while completing the desired task.

Blueprint for success
Between the 2001 launch of the program and 2003, our patient handling incident rates dropped 41 percent and workers' compensation costs fell 85 percent, resulting in a $222,000 savings for the hospital. The Healthy Moves program demonstrates a clear facilitywide commitment to the safety of staff and patients. What started as loose recommendations and suggested guidelines today serves as a blueprint for success in healthcare facilities nationwide. We've aligned with the American Nurses Association's "Handle With Care" campaign and continue to present best-practice recommendations at OSHA conferences. But we won't rest on past laurels. A truly effective ergonomic program requires constant training and retraining. From where we sit, our work has only just begun.

When Lifts Go Wrong

Create an atmosphere of accountability when investigating lifting mishaps. Your staff needs to know that their actions have consequences and lifting policies will be strictly enforced.

When a lifting mistake or injury occurs, ask the employees present to submit an incident report that includes the date of the event, where the incident occurred, the staff involved and the equipment used or not used. As is the case with most adverse events, discovering the cause requires timely reporting and response. Train staff to notify clinical managers immediately after a lifting incident, no matter how minor they perceive it to be. The importance of a quick response is magnified in the outpatient setting as patients typically leave the center hours after surgery, requiring a follow-up phone call or chart review to learn the facts of the incident. Facts become distorted as hours pass.

It's a good idea to have the lead investigator act as employee advocate. Make the face-to-face questioning more of a casual conversation than an interrogation. Avoid asking the "what happened?" question. Instead, take the employee to a private location and inquire about her well-being. Ask, "Do you have the tools you need to feel safe?" and, "How are you feeling?" Ask about barriers the nurse experienced, real or perceived, to performing the lift safely.

After meeting with the parties involved, gather the clinical manager and patient lift leader to review the facts of the case. Was the injury the result of a blatant disregard for the facility's lifting policy? Does the event call for disciplinary action or should the employee be retrained? Did other factors beyond the control of the staff lead to the lifting mishap?

If disciplinary action is required, the message should come from someone other than the facility's lifting advocate. Punishment handed down by the same person who encourages proper lifting techniques will drive reporting underground and raise the guards of employees instead of encouraging the level of communication that would foster improvements.

Adequate discipline depends on your own management style, but here's what we do. When one of our lift experts or safety leaders observes a violation of our lifting policy, even in passing, an on-the-spot retraining takes place. That first-time offense occurs without penalty. A second incident results in a verbal warning documented in the employee's file. The third strike calls for a written warning and a fourth offense may result in a forced leave of absence or even termination.

Whichever behavior modification program you enact, remember that gentle pressure relentlessly applied will improve staff performance. Coming down hard on offenders will turn off the frontline employees, the exact population you need to reach.

- Cathy Krueger, PT

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