How many times have you tried to move a large patient - from an OR table to a stretcher, from a stretcher to a recovery bed - and winced in pain? You might have woken up the next morning with tightness or pain and had to pop a couple aspirin to make it through another rough surgical day. Maybe you couldn't even make it to work, or you had to take a trip to the doctor.

Oh, and there's the kick-yourself factor: You could have prevented that injury by using the right patient-handling equipment.

Patient handling is the No. 1 cause of back injuries in healthcare settings, causing about 75 percent of them. Using preventive patient-handling devices is important, if only for your - and your nursing staff's - sake, not to mention your facility's bottom line.

The long-term impact of these on-the-job injuries: increased absenteeism, lost work time, burnout, decreased staff retention, high turnover and threatened recruitment, according to a 2003 position statement by the American Nurses Association.

The group estimates that up to 12 percent of nurses leave the workforce annually due to back injuries and over 50 percent complain of chronic back pain. This has been cited as a contributing factor to the nursing shortage and a perceived lowering of the social value of nursing as a profession. In addition, nurses lose roughly 750,000 working days a year because of back injuries, and costs for compensable back injuries ranged between $5,000 and $100,000 for each case.

A movement is afoot to require an absolute no-lift environment for healthcare workers. While some manual patient handling will always be required, it should be limited to assisting patients while using assistive patient-handling equipment. There is now a great selection of specialized assistive equipment to aide with patient handling tasks. To help you toward that end, we'll examine two groups of patient-handling equipment: patient transport devices (stretchers, hospital beds and wheelchairs) and transfer-assist devices (simple and complex solutions for scooting, sliding and lifting patients).

The single-surface approach
In many facilities, the stretcher (cart, gurney, trolley, cot) is used for more than mere patient transportation. Outpatient surgery centers are uniquely positioned to adopt a single-surface approach to patient handling for many procedures. The idea is that the patient starts and ends his surgical journey on the same surface. These specialized stretchers range from the plain, flat-top, tapered, head/eye surgery stretchers to complex OR table-stretcher hybrids.

The single-surface handling of surgical patients allows a no-lift/no-transfer work environment for the staff. The only staff transfer assistance is getting the patient onto the surgical stretcher (or chair) in pre-op and then assisting the patient to ambulation after recovery. This is also safer for the patient since it eliminates the risk of a fall-related injury while being transferred on and off the operating table from the stretcher. There are several features you might want to look for:

• high weight capacity and large patient surface;
• easy-to-maneuver articulation systems;
• standard-sized accessory rail that will accommodate most surgical table accessories;
• automated brakes; and
• user-intuitive controls in a convenient location.

Procedural stretchers have long been offered by the major stretcher manufacturers and have been used for decades in ophthalmology, fluoroscopic and gastrointestinal endoscopic procedures. They are designed with surgical procedures in mind, assuming short stays in pre and post-op. General-use stretchers are now available with extra wide litters (that is the part of the stretcher on top, under the mattress) and a variety of comfortable mattress options. These stretchers, which are larger than procedural stretchers, are offered to meet the needs of facilities that wish to provide a more comfortable outpatient experience and to meet the needs of the 23-hour-stay patient without the use of a full hospital bed.

Transfer devices
Effective use of patient-transfer devices depends of four key factors:

• The devices have to be available in sufficient quantity and convenience to encourage their use.
• The staff needs to be trained on their proper and safe use in accordance with the facility's ergonomic patient handling policy. (What? You don't have an ergonomic patient-handling policy?)
• Anyway, assuming you do have an ergonomic policy, sufficient space is needed to use the device properly and safely, avoiding obstacles such as walls and other equipment.
• And the devices need to be maintained and kept in good repair.

Each type of patient transfer is a task for specialized equipment. Using them significantly reduces the physical effort required from the caregiver, thereby significantly reducing the risk of musculoskeletal injury. These devices also make for a safer transfer for the patient since the caregiver may focus on the patient and the transfer, rather than on whether they will be able to bear the weight. Here's a look at the three kinds of patient-transfer devices.

• Full-body lifts. Sling-type full-body lifts can be either portable or part of a ceiling-mounted system. The portable devices are either manual or electric and lift by the action of either a hydraulic cylinder or electric motor. The patient is suspended in a sling device that can resemble a hammock or a harness that wraps around the patient's torso and legs, raising them in an upright sitting position. Full-body lifts are used to lift patients who are totally dependent, are very heavy or have other infirmities that keep them from assisting with their transfer. These devices are effective for transfers from stretcher to chair, stretcher to bed, and for lifting a patient from the floor after a fall.

Consider several factors when assessing a lift. Is the lift rated for the patient's weight? Are the appropriate-sized slings available for the patient's condition and anatomy? Does the lift provide adequate horizontal and vertical clearance for the stretcher or chair the patient is being transferred to or from? And most important, how many staff members are needed to correctly apply and use the particular lift (those ergonomic-policy and staff-training things again). Just because you have a lift does not mean you need only one staff member to safely lift and move a patient.

• Lateral-transfer devices. The most low-tech nursing device of all is a lateral-transfer device called the pull sheet. This humble linen has been used for all of recorded nursing history to drag the patient from one surface to the next, sometimes even being used as a lift sling. Not that this was always safe, but you always had sheets.

Lateral-transfer devices are used to move a supine patient from one horizontal surface to another horizontal surface. While the pull sheet is ubiquitous, newer devices are available to help with scooting patients. The most common is the patient roller, which is a row of steel tubes covered by a continuous roll of vinyl fabric that rolls over the tubes. A variety of sizes of this device - and wall brackets to keep them off the floor - are available. Such rollers are often used in surgery to get the patient onto the OR table and remove the pull sheet at the same time.

• Friction-reducing devices. This category of patient-transfer devices work by reducing friction between the patient and his resting place. These can be actual devices or special textiles, such as slippery sheets or low-friction mattress covers.

Most common of the friction-reducing devices is the transfer board. Made of a smooth resin, such as polyethylene, these sheets of plastic are used to provide a slick surface between the bed and stretcher, for instance, to allow the patient to be pulled with less force; different shapes, sizes and thicknesses for various applications are on the market.

The greatest advance in friction-reducing devices recently has been the introduction of air cushion patient-transfer devices. Powered by a blower (similar to a canister vacuum going full blast in reverse) these cushions are placed under a patient like a sheet and then inflated. As the cushion is inflated by the blower, it lifts the patient while exhausting out the bottom of the pad through perforated chambers. This provides a layer of air between the bottom of inflated cushion and the surface on which the patient is lying. The patient can then be moved almost effortlessly onto another horizontal surface. A big advantage of this type of system is its lifting capacity, which when coupled with the ease of movement, makes it great for use with the obese patient.

Sore subject
In addition to using the right patient transfer and transport devices, employees can reduce their risks by wearing appropriate slip-resistant footwear and clothing that allows free movement. Staff should also be mindful of loose jewelry that a patient could grab if he felt as though he were about to fall. (Not to mention that the stone mounts on some rings are sharp and can cut the patient's skin when you're reaching around a patient.)

Healthcare is not the occupation you first think of to top the Bureau of Labor Statistics musculoskeletal injury list. Yet nursing aides, orderlies and care attendants ranked first, and RNs sixth, on a list of at-risk occupations for strains and sprains. Other occupations making the top 10? Truck drivers, laborers, stock handlers and construction workers. With the tools available to you, healthcare workers don't have to be right up there.

References:
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