Patient Movement Factors for Consideration

Assessment of a patient’s ability to assist in own movement is a key component of a safe patient handling plan. The essential elements ought to be comprised in a bedside quick reference to the patient’s current movement capacity and the appropriate equipment solution.

If the patient is unable to weight bear, is not cooperative, has limited extremity strength, is in an awkward position and has limited or no ability to assist, mechanical assistance is a necessary solution. The type of equipment will depend on the size and weight of the patient and whether repositioning or movement is required.

Where a no lift policy is in force mechanical equipment will always be required. Obese and bariatric patients pose particular problems. The current level of disabling back injuries in healthcare workers is described as a crisis in America.

Various studies have been undertaken in the UK and America to address the issue of moving and handling injuries. These studies unanimously support the
use of mechanical equipment to reduce the incidence of back injury in healthcare staff. The introduction of mechanical equipment shows a rapid economic gain and a sustained reduction in the frequency of patient
handling injuries.

Intuitive responses from staff being trained in mechanical hoists suggest there is a perception that moving patients by fully mechanised hoists, floor and ceiling, is slow and inefficient process. In fact, the speed of movement of the patient in a bed to chair transfer is often quicker in floor-based hoists.

Floor-based, manually powered hoists

There is no doubt that the introduction of floor-based, manually powered hoists has reduced the extent of injury to staff involved in moving and handling
patients. The risk of musculoskeletal injuries from using the current range of manual floor-based hoists is relatively low at patient weights of up to around
318kg, depending on the size of the staff member and other factors.

The upper thoracic area exposure to injury from the forces required to move heavy patients in manual floor-based hoists has been the subject of recent studies that show the clear correlation between weight of patient and force required, and in many cases the force will exceed current health and safety guidance. There is a clear need to find a solution that addresses this risk of injury to allow compliance with the health and safety legislation that is in place in the UK and which unions are pressing for in America.

In the studies undertaken it is understandable that the focus is on the staff involved and limitation of risk to them. Very limited analysis has been undertaken on the views of patients. Anecdotal reports of patient reaction suggest that patients are comfortable and confident in full automatic overhead and floor-based systems even where the speed of transfer is slower.

In fact, most patients had little concern over the speed of the transfer when they were being moved in a stable, comfortable, smooth way. The main concerns reported were the proximity of hard lifting surfaces to face and body, discomfort from ill fitting slings and lack of confidence in equipment which ‘jerked’ and ‘twisted’ as it moved them. While this may be due to staff effectiveness in the operation of existing equipment it demonstrated a lack of confidence in the patient population.

Injuries caused by unsafe manual handling of patients are still a major source of ill health in health care workers, who have the highest musculoskeletal
disorder prevalence and incidence of any occupational/industry group.

Existing equipment has addressed some of the problems but there is still a long way to go before a satisfactory solution is found. Fully powered floor-based electrical hoists provide a solution by removing the manual handling risk, providing flexibility in movement, approach and function, addressing heavy and bariatric patient needs, and addressing the need for patient comfort,
safety and confidence.

The research shows there will be resistance to change depending on staff perception and social background but healthcare authorities and hospital managers, health and safety officers, and moving and handling policy makers have an obligation to overcome resistance in whatever form it takes to provide for a cultural change to the least risk method of patient movement.

Sources

Journal of occupational health psychology (1/05/06) (11/2);Applied
Ergonomics (1/04/05) (36/2); Journal of the International Society for Child and
Adolescent Injury Prevention (1/09/04) (10/4); A journal of environmental and
occupational health policy (1/02/08) (18/2);AAAOHN Journal (1/04/02) (50/3);
Applied Ergonomics (1/07/00) (31/3); Journal of long-term effects of medical
implants (1/02/05) (15/2).

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