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6/2/2017

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PhysicalTherapistsandSafePatientHandlingandMobility:OptimumOutcomesandSafetyforEveryone

ChrisWilsonPT,DPT,DScPT

BoardCertifiedGeriatricClinicalSpecialist

PhysicalTherapy.comSeminar

June2,2017

LearningObjectives• Uponcompletionofthissession,theparticipantwillbeableto:

– ListatleastthreeoftheconceptsofRC29-12APTAPositionregardingtheRoleofPhysicalTherapyinSafePatientHandling.

– Describeatleasttwooftherolesandatleasttwooftheresponsibilitiesofvarioushealthprofessionalsasitrelatestosafepatienthandlingconcepts.

– Describetheroleandatleasttwooftheresponsibilitiesofthephysicaltherapistandphysicaltherapistassistantasitrelatestosafepatienthandling.

– Listatleastthreecommoninterventionsemployedbyphysicaltherapyprofessionalsinsafepatienthandling.

– Identifyatleastthreeoftheconceptsofsafepatienthandlingwithinthecontextofclinicaleducationandacademicentry-leveltrainingofthephysicaltherapistandphysicaltherapistassistant.

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HousekeepingInfo• Allpresentedmaterialsareexamplesandshouldnotsupersedemedical

decisionmakinginthebestinterestofindividualizedpatientsafetyandcare

• Allpatientsinthevideoshavesignedareleaseforuseoftheirimagesforeducationalpurposes;theiridentitiesarestillobscuredforanonymity

• Allpatientmobilityequipmentfromdifferentmanufacturersareuniquewithspecificfeatures,instructions,proceduresandsafetytechniques.

• Thispresentationisonlyanintroductiontodifferenttypes ofsafepatienthandlingequipmentandISNOTINTENDEDTOREPLACEORSUPPLIMENTTHEMANUFACTURERSINSTRUCTIONSORPROCEDURES.

• Allequipmentshouldbeinspectedbeforeinitialuseandonaregularbasisasindicatedbyyourfacility’sequipmentmaintenancepolicy.

• Althoughcertainexamplesaredepictedhere;thespeakerdoesnotendorseanyparticularbrandormodelofequipmentandhasstrivedtorepresentavarietyofcompaniesandequipment

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Whatdoourpatientsneed/expect?

• Safetyfirstthenclinicalcompetency

• First,donoharm…

• Consistency…ALWAYSprovidingthesamelevelofcare

• Explaininghowwearebeingsafeandcompassionate

• Wearenotjudgedonthequalityofourtechnicalmedicalcare,butonthecompassionandsafety

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EffectsofProlongedInactivityandBedRestonBodySystems

BodySystemAffected EffectsCardiac • Decreasedplasmavolume

• Cardiacatrophy• Orthostaticintolerance

Respiratory • Dorsalatelectasis• Slowedrespiratoryrate• Decreasedmovementof

secretions• Decreasedchestcompliance• Decreasedtidalvolume

Musculoskeletal • Muscleatrophy• Decreasedmusclemass• Decreasedcontractibility• Jointandmuscle

contractures• Bonedemineralization

BodySystemAffected EffectsMetabolic • Increasedinsulin

resistance• Alteredtriglycerides

Gastrointestinal • Decreasedperistalsisandfecalimpaction

• Increasedriskofrenalcalculi

• Increasedhypercalciuria

Psychological • Depressionandanxiety• Decreasedmotivation• Decreased

participationinactivities

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CurrentClimateofHealthcare

• Medicarewillnolongerpayforcareforpreventableiatrogenicconditions

• Iatrogenic- astateofillhealthoradverseeffectorcomplicationcausedbyorresultingfrommedicaltreatment.– BloodClots

– PressureUlcers

– Injuriesfromfallsinhospital

– UrinaryTractInfections

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OSHAExamplesofCostSavings

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https://www.osha.gov/dsg/hospitals/documents/3.5_SPH_effectiveness_508.pdf

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Source: U.S. Department of Labor, BLS, 2006 1

0

50

100

150

200

250

300

350

Inci

denc

e Ra

te/1

0,00

0 w

orke

rs

Occupation

Incidence Rate by Selected Occupations with Musculoskeletal

InjuriesNA

Laborers and Freight

Truck Drivers:heavy

Construction

Truck Drivers:light

Janitors

Healthcare Workers

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Work-RelatedMusculoskeletalDisorders(WMSDs)

• Gloveretal.(2005)reported32%ofphysicaltherapists(n=3,661)withWMSDslostworktime– Careerprevalenceofinjurywas68%

– Lowbackwasmostcommonlyaffected(44%)

– Nearlyone-third(32%)ofinjuredrespondentsfirstexperiencedtheirworstinjurywithin5yearsofgraduation

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Work-RelatedMusculoskeletalDisorders(WMSDs)

• Molumphyetal.(1985)reportedthat18%ofphysicaltherapists(n=344)withWMSDsofthelowbackchangedtheirworksettingand12%reducedtheirpatientcarehours

• Cromieetal.(2000)reportedthat1in6(n=821)changedsettingsorlefttheprofessionduetoWMSDs

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RiskFactorsforWSMDs

• Awkwardpositions• Confinedworkspace• Unpredictablepatientbehavior• Patient’sweight• Transferdistance

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SafePatientHandlingLegislationandRehabilitationProfessionals

• Legislationmayaffectoralterthecareweprovide– Dutyasautonomousprofessionalstohaveinputintothe

process

• Notconsistentlysolicitedforinputwhennewlegislation,policies,orprogramsregardingsafepatienthandlingarebeingdevelopedorenacted

• Uniquelyplacedtolendinsightsintothedevelopment,implementation,evaluationoftechnologyandeducationofSafePatientHandlingtechniques.

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WhyTherapistsareSPHMExperts

• Neuromusculoskeletalexperts• Rehabilitation• Fallprevention• Wellness• Injuryprevention• Technologyuseinpatienthandling• Theknowledgeandbackgroundofergonomics• Integrallyinvolvedwiththecareofthemostphysicallychallenging

patients

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AmericanPhysicalTherapyAssociationendorsesthefollowingconcepts:

• 1.InvolvementandLeaders

• 2.RoleModeling

• 3.Teachingothers

• 4.Promoteflexibilityinpolicies

• 5.Accesstoequipment

• 6.OrientationandTraining

• 7.Entryleveleducation

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RoleofInterdisciplinaryTeaminMobility

• Nursing– Daytodaycareinvolvingmovementofthepatientforpreventionandmaintenance.

• OftenpurposefulmovementforthepatienttoachieveADL’s(bathing,toileting,dressing,grooming,maintainingskinintegrity,preventionofdeconditioning)

• TotakewhatisgainedinPTandOTandusedailyforthepatientshealthbenefit

• Chancetotalkeachotherupandshowcollaborationandcoordinationofcare– patientswanttoknowthatwearetalkingtoeachotherastohowtobestcareforthem

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EffectofaSafePatientHandlingProgramonRehabilitation

– MarcCampo,PT,PhD,aMariyaP.Shiyko,PhD,bHeatherMargulis,PT,MS,cAmyR.Darragh,OTR/L,PhDd.ArchivesofPhysicalMedicineandRehabilitation2013;94:17-22

• Abstract– Participants:Consecutivepatients(N=1291)overa1-yearperiodwithoutanSPHprogram

inplace(n=507)andconsecutivepatientsovera1-yearperiodwithanSPHprograminplace(n=784).

– Interventions:TheSPHprogramconsistedofadministrativepoliciesandpatienthandlingtechnologies.Thepolicieslimitedmanualpatienthandling.Equipmentincludedceiling- andfloor-baseddependentlifts,sit-to-standassists,ambulationaides,friction-reducingdevices,motorizedhospitalbedsandshowerchairs,andmultihandledgaitbelts.

– Results:PatientsrehabilitatedinthegroupwithSPHachievedsimilaroutcomestopatientsrehabilitatedinthegroupwithoutSPH.AsignificantdifferencebetweengroupswasnotedforpatientswithinitialmobilityFIMscoresof15.1andhigheraftercontrollingforinitialmobilityFIMscore,age,lengthofstay,anddiagnosis.ThosepatientsperformedbetterwithSPH.

– Conclusions:SPHprogramsdonotappeartoinhibitrecovery.Fearsamongtherapiststhattheuseofequipmentmayleadtodependencemaybeunfounded.

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SafePatientHandlingBasics

Protectyourpatientandyourself

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– Manualliftingofpatientsbeminimizedinallcasesandeliminatedwhenfeasible

– Employersshouldputaneffectiveergonomicsprocessinplacethatprovidesmanagement

• KeyTenets:• Programinvolvesemployees

• Identifiesproblems

• Implementssolutions

• Addressesinjuryreports

• Providestraining

• Evaluatesergonomicefforts

23https://www.osha.gov/dep/enforcement/inpatient_insp_06252015.html

PrinciplesofSafePatientHandling2

• Injurycanhavemultiplecauseswithcontributingfactorsfromthecaregiver,patientandtheenvironment

• Moving,transferring,andrepositioningpatientsrepetitivelycanleadtofatigue,pain,andinjury

• Safepatienthandlingprogramscanmodifytheriskfactorsofthepatient,caregiver,andtheenvironmentwhenappliedproperly

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• Laboratoryandclinicalresearch:– SPHMprogramscangreatlyreduceriskofinjuryto

caregivers

– regardlessoftheirage,lengthofemployment,orjobduties

• DonotunderestimateorlosefocusofthefactthatSPHMprogramscanprotectpatientsbyreducingtheirriskofinjury,skintears,bruising,pressureulcers,andbeingdropped

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• ASPHMprogramismultifaceted

• Itconsistsof:– Mechanicalequipmenttoliftandrepositionpatients– Asafeliftingpolicy– Employeetrainingonliftdeviceusage– Patientcareassessmentprotocolsandalgorithms

– Department-basedsafetyleaders– Administrativesupport

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LocationsthatSPHMareAppropriateFor

• Inpatientrehabunit• Acutecaresetting• Intensivecareunit• Surgicaldepartment

– PreOp/Postop

• Spinalcordinjuryunit• BrainInjuryunit

• Nursinghome– Subacuterehab

– ExtendedCarefacility

• Homecare• Outpatientclinic

– Generallyneurobasedclinic

• Pediatricclinic• Schoolsystem

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PrinciplesofSafePatientHandling

• Appropriatescreeningsforinjury/fatiguetostaffandpromptmedicalfollowup

• AdministrativesupportanddepartmentbasedsafetyleadersarerequiredtocoordinatetheresourcesandactivitiesnecessaryforaneffectiveSPHMprogram

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ParadigmShiftinThinking

• AlthoughentrylevelPT/OTprogramsstillteachmanualpatienthandlingmethods,SPHMshouldbeincorporatedintotheprofessiontomoveawayfrommanualpatientliftingandtheover-relianceonbody-mechanicstomultifacetedSPHMPrograms

• Bodymechanicsisnotenough…

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BarrierstoRehabProfessionalsAdoptionofSPHM

• “Itswhatwehavealwaysdone”

• “Stoppingtogettheequipmentisahassle”

• “Theequipmentneverworksandisbroken”

• “Theequipmentdoesalltheworkforthepatientanddoesn’tallowthemtorehabilitate”

• “Theequipmentdoesn’tallowmetocueorinstructmypatientcorrectly”

• “Notenoughroomtouseequipment”

• Internalguiltorexternalpeerpressureaboutdemonstratinghowhardyouareworking

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WORKSMARTERNOTHARDER

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FalseParadigm

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BalancingAct

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Safe and Effective Patient Care

Opt

imal

Out

com

es

OffBalance!

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ScopeoftheProblem

• Hospitals,nursinghomesandpersonalcarefacilitieshadoneofthehighestratesofinjuryandillnessamongindustriesforwhichlostworkdayinjuryandillness1

• Rehabspecialistsworkwiththemostdebilitated,weakest,“unsafest”ofallofthepatientpopulation

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Myth:Educationandtrainingareeffectiveinreducinginjuries3

• Facts:– trainingaloneisnoteffective,includingthefollowing:

• 1)Bodymechanicstrainingisbasedonresearchthatisnotlikelygeneralizabletopractice.

• 2)Itisdifficulttotranslateclassroomcontenttodirectpatientcare.• 3)Noconsensusonwhatproperbodymechanicsare• 4)Manualpatientliftingtasksareunsafeastheyarebeyondthecapabilitiesofthe

averageclinician• 5)Mostlabresearchisdoneonyounghealthymales,notreflectiveofourhealthcare

workforce

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Myth:Backbracesareeffectiveinreducingriskstocaregivers3

• Facts:– Backbeltswerewidelyusedinthe1990’sasastrategytoprevent

job-relatedinjuries– Thereisnoevidencethesebeltsareeffective

– Commontherapythoughtprocessoncorestrengthandbackbracesmaycausedisuseatrophy

– Otherbodypartsvulnerabletoinjurytoo!

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“Myth:Mechanicalliftsarenotaffordable3

• Facts:• Thelong-termbenefitsofproperequipmentfaroutweigh

costsrelatedtowork-relatedinjuries.– Theincidenceofinjuriesdecreasedfrom60– 95%

– Workers’compensationcostsdecreasedby95%

– Insurancepremiumsdropped50%

– Medicalandindemnitycostsdecreasedby92%

– Lostworkdaysdecreasedby84%– 100%– Absenteeismduetoliftingandhandlingwasreducedby98%”

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“Myth:Useofmechanicalliftseliminatesalltheriskofmanual

lifting3

• Facts:– Whileliftingdevicesminimizerisk,unfortunatelytheriskcannotbe

eliminatedaltogether.

– Evenwhenusingliftingequipment,thepatientmustfirstberolledinordertoinsertthesling.

– Humaneffortisstillneededtomove,steady,andpositionthepatient.

– Sincemostinjuriesinmobilityarecumulative,anystepstominimizerisksinkeytaskswilloffersubstantialbenefits.”

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“Myth:Liftingapatientistheonlyhighrisktaskwedo3

• 1)Gaittrainingwithpatientswithunstablegait

• 2)Helpingtomakeanoccupiedbed

• 3)Assistingwithdressingapatientinbed

• 4)Transferringapatientfrombedtostretcher

• 5)Transferringfrombedtowheelchairorachair

• 6)Pushingheavyequipment

• 7)Repositioningapatientinachairorbed

• 8)AssistingapatientwithbathroomADLs

• 9)Assistingwithlowerbodydressing”

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Facts: High risk tasks include patient care activities outside of lifting such as:

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“Myth:Ifyoubuyequipmentanddevicesforsafepatienthandlingandmovement,therapistswillusethem3

• Severalreasonswhypatient-handlingequipmenthasfailedinthepast• Staffwon’tuseequipmentthatis:

– neitherpatient- noruser-friendly

– isunstable

– hardtooperate

– difficulttostore

– noteasilyaccessibleoravailable

– poorlymaintained”

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BodyMechanics

• Mentallyandphysicallyplanfortheactivitybeforeattemptingit

• Positionyourselfclosetothepersonanduseshortleverarms• Widebaseofsupportandnotwisting

• Holdthegaitbeltinsteadofthepatient’slimbs• Don’tletthemgrabaroundyourneck– forearmsareokay• Don’tdoitforthepatient– letthemdoasmuchastheycan

andyoudotherest• Gethelp!• Makesurethepatientisprepared

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BackInjuriesduringPatientHandling

• Almostallbackinjuriesduringroutinepatienttransferscanbepreventedbyplanningandproperpreparation.

• Rushingintoasituationincreasestheriskofbackinjuriesandinjurytothepatient

• Mostinjuriesoccurduringliftingandperformingatwistingmotionatthesametime

• Recruityourstomachmusclesandgetintoa“NeutralSpine”positionwithsome“lordosis”(backwardcurve)

• Ifpossibleshouldbestandinginfrontofthesubjecttoavoidtorqueingyourspine

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KnowingyourPatientandRequiredAssistiveEquipment

• Priorfunctionallevel?

• Whatareyourgoalsforthatsession?– Evaluatecurrentstatus

• Maybelessequipmentbased

• Patientsize

• Musclestrengthnotalwaysindicativeoffunctionalcapacity

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2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

(*BMI ³30, or about 30 lbs... overweight for 5’4” person)

2010

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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ObesityFactsfromtheCDC

• Obesityiscommon,seriousandcostly– Morethanone-thirdofU.S.adults(35.7%)areobese.[Readdatabrief [PDF-528Kb]]– Obesity-relatedconditionsincludeheartdisease,stroke,type2diabetesandcertain

typesofcancer,someoftheleadingcausesofpreventabledeath.[Readguidelines]– In2008,medicalcostsassociatedwithobesitywereestimatedat$147billion;the

medicalcostsforpeoplewhoareobesewere$1,429higherthanthoseofnormalweight.[Readsummary]

• Obesityaffectssomegroupsmorethanothers– Non-Hispanicblackshavethehighestage-adjustedratesofobesity(49.5%)

comparedwithMexicanAmericans(40.4%),allHispanics(39.1%)andnon-Hispanicwhites(34.3%)[SeeJAMA.2012;307(5):491-497.doi:10.1001/jama.2012.39].

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DifferenceswithPatientofSize

• Healthcareworkerperceptions

• Slowerhealing

• Slowerprogression

• Samephysicalcapabilityvsdisabilities

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BestPracticeswithPatientsofSize(Barr2001)

• Administrativesupportandbacking

• Carefulreviewofphysicalenvironmentandpatientcareequipment

• Knowweightcapacityofequipmentandfurniture

• Sensitivecare

• Adaptablephysicalassessmentequipment

• Assuringsafetyiftraditionalphysicalassessmentnotachievable

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PatientofSizeMobilityBarriers

• Furtherimpactedby:– Staffingshortages– Unclearprocesses– Unfamiliaritywithequipment– Unavailabilityofequipment– MedicalComorbidities

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HealthcareWorkerInjuries

• 8.8/100fulltimehospitalworkers,and13.5/100workersinnursingandpersonalcarefacilitiesinjured

• Highratesofmusculoskeletaldisordersamonghealthcareworkers,mostcommonlybackinjuries/pain

• Musculoskeletalinjuriesareoftentheresultofthefrequentpatientliftingandtransferringrequiredofhealthcareworkers

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PatientofSizeCommittee

• Hospitalgroupdesignedtoevaluateentirespectrumofaspectsofhavingpatients/clients/visitorsofsize

• Supportedbyhospitaladministrationandmedicaladministration

• IncludedbothIPandOPstaff• Largefocuswith4differentsubgroups

• Examinedentirescopeofcarefromentrytodischargefromvariouspointsofservice

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PersonsofSizePatientCareAspects

• Logofweightcapacities/boresizesofallimaging/surgicalequipment

• Increasedawareness

• Unifiedprocessforcleaningequipment/lifts/slings

• ConsultationprocessforPT/OT/CWOCN/Dietary/etc.

• Bariatrickit• Sensitivitytraining• Backcaretraining• Support/proliferationof

SPHMtrainingcourse• Physicianeducation• Bedmanagement

procedures

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DignityandSensitivity

• Onlinetrainingmoduleforobesitysensitivity

• Obesitybiasisreal

• Potentialtoaffect:– ClinicaljudgmentsofHCW

– Maydeterindividualswithobesityfromseekinghealthcare

– Disclosinghealthchoices

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HCWandObesity(Maiman1979)

– 88%- obesitywasaformofcompensationforlackofloveorattention

– 70%- attributedthecausetoemotionalproblems

• PercentofHCWbelievedthefollowingaboutpersonswithobesity:– 87%- areindulgent– 74%- havefamilyproblems– 32%-theylackwillpower

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HealthProfessionalsAttitudes

• HoppeandOgden(1997)

– FoundthatHCWbelievedthat:• Obesitymorerelatedtolifestylethanbiologicalfactors• Viewedobesityaspreventableortreatable• Viewedfailureofweightlossasacomplianceissue• Confidentintheirskillsinadvisinginweightloss• Notconfidentinoutcomesoftheiradvice

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AttitudestowardObesePatients

• ZuseloandSeminara(2006)

– Surveyed119RNs

– Commonthemes:• Expressingsympathyorastounded

• Veryconcernedtoprovideequaltreatmentandrespectfulcare

• Alsoconcernedaboutavoidinginjuringthemselves

• Overwhelmedbyincreasedtimerequiredforpatientcareactivities

• Rehabnursesconcernedabouttransfersandphysicalcareneeds

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AdministrativeControlsCont.

• Patientliftteams:– “Twophysicallyfitpeople,competentinlifting

techniques,whoworktogethertoperformhigh-riskpatienttransfers”

– Selectedbasedonlackofinjuryhistory,strength,training

– Effectiveindecreasingthelostdays,restrictedworkdays,andcompensableinjurycosts

• “CodeHeavy”

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AdministrativeControlsCont.

• Patientcareergonomicassessmentprotocols:– Patienthandlingtasksvarywidelyfromoneinstitutionto

anotherandisoftendependentuponavailableliftingaids– Duetolackofequipment,caregiverssometimesusethese

aidsinappropriatelyandfailtomatchspecificpatientcharacteristicstotheequipment

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RoleofAlgorithms

• VABariatricMobilityAlgorithms– http://www.visn8.va.gov/visn8/patientsafetycenter/safePtHandling/toolkitBa

riatrics.asp

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NIOSHWebBasedTraining

• http://www.cdc.gov/niosh/docs/2009-127/safe.html

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Gait/TransferBelts

• Asolid,securebeltorotherdeviceclosesttothepatient’scenterofgravitytocontroltheirweight

• Preventtheneedtograbatlimbsorclothes• Rollsofgaitbeltmaterialisavailableonhospital

floor– contactyournursemanagerifyouarenotsurewhereitis

• Twistupasheetasagaitbeltandtieit• Howmightitlooktoafamilymemberifagait

beltwasavailableandwasn’tusedandapatientfell?

• Explainingwhyweusethegaitbelts– weALWAYSusegaitbeltstomakesurethatyouaresafe- likeaseatbeltinthecar

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Canyoutellthedifference?

• WhichofthefollowingequipmentisforaPatientofSize?

• AorB

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AB

67

AB

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AB

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ColorcodingofBariatricEquipment

• Recommendacolorcodinghospitalwideforequipment

• Debateonplacingweightcapacitiesonequipment

• Sensitivityvssafety

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BariatricKit

• UponAdmission

• Nurseorderinitiated– BPcuff

– Gown

– Socks

– Pamphletondiet

– Listofavailableequipment

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DailyReportofPatientsofSize

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Bari-RehabPlatform2™

• “Comesstandardwithpressureredistributionmattress

• Retractabledeck

• WISEGUARD™

• HeadAngleIndicator(V.A.P.)

• Scaleincluded

• Powerdriveavailable

• FullFrameTrapezeavailable

• 1,000lb.capacity”

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TotalCare®Bariatric

• MadebyHill-ROM

• Pressureredistributionairmattress

• Temperaturecontroltorelieveheatproduction

• 200-550lbs...

• Width- 40inches

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TotalCare®P500Mattresssurface

• AlsofromHill-ROM

• Moreusefulforlessmobilebariatricpatients

• Betterforpreventionofpressuresores

• Turnassistusingbedinflationmode

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BurkeTriFlex• 1000lbs..capacity

• Extrawidthcapabilityfrom37"to48"to54".

• "Fold&Roll"designfor1persondeliverysystemandeasystorage

• FullyelectricwithHi-Lo,Tredelenberg/ReverseTrendelenbergandCardioChair

• FullHeadandKneeGatchAdjustment.

• CPRRelease&BatteryBackUp

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RentingorOwningEquipment

• 2010– Costtohospitalforrentingbedswas$33,273forBeaumont

HospitalTroy.• 400bedhospitalinmetroDetroit

– 97instancesofrental

– Averagecostpercase=$343justforbariatricbeds

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DecisiontoBuyorRentBariatricEquipment(VA2012)

• Factorsconsideredwhenpurchasingorrentingbariatricequipment:– Numberandfrequencyofbariatricadmissions

– Equipmentpurchasecost

– Rentalcost

– Spacedemands:includingfitthroughdoorways/hallways,etc.

– Patientcareneeds:bedroom,bathroom

– Equipmentstorageneeds

– Lengthofstay

– Equipmentcleaningandmaintenanceneeds

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FrontEgressExamples

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UtilizingUEStrength

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Whohasseen?Whohasused?

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BedMobility:TheLateralTransfer

• Highrisktask:– Horizontallyreachacrosstothepatient’sbedtoholdthedraw

sheetpriortopullingthepatient– Postureadoptedduringtask

– Weightofpatient– Lackofhandles-poorcoupling

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FrictionReducingDevices

• CommonBrands:1. Maxislide2. LateraltransferAid3. Flatsheetset4. Hovermatt5. Airpal

• Thereare3types:1. AirAssisted2. Lateralslidingaids3. Bedassistedtransfers

1. I.E.fullyinflatingbed

2. Trendelenburgposition

3. Assistedpositioningbedtorollsidetoside

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PatientAssistEquipmentforBedMobility

• LateralTransferdevices

• Generallydesignedtoreducefrictionwhengoingfromsurfacetosurface • Assistswithbedtostretcher

typetransfers-transferboardsorfabric

• NotoftenusedinOT/PTbecauseof“lackoffunctionalcarryover”

• Positionedunderthepatientprovidingasmoothsurfacetoslidethepatient

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AirAssistedLateralSlidingAids

• Aflexiblemattressplacedunderpatient;inflatesbyportableairsupply.

• Patientismovedonacushionedfilmofair

• Thisreductioninfrictionmakesthelateraltransfermucheasierforthecaregiver

• Cost:$1200-$1600

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Airassistedlateralslidingaid• Awaterproof,anti-

bacterialanti-stain,nylonmattressthatallowsforlateraltransfers.

• Noweightlimit• Maxinflatethehospital

bed

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Don’tforgetaboutLiftswhendoingBedMobility

• Overheadliftandtracksystemsarenotjustformovingapatientfromsurfacetosurface

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If you can’t move the

track, move the bed

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MechanicalLiftSystems

Lettechnologydotheliftingforyou.

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GeneralPrinciplesofMechanicalLifts

• Needappropriatespaceinroom• Moveasmuchfurnitureoutofway• Needclearanceonbottomofbed• Electricalandcordlessbetterthanmanualelevation• LiftsinOT/PTshouldbeameanstoanendinmostcases

– Positioningfortreatment

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RehabilitatingtheDebilitatedPatient

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This is where

rehab works

ExamplesofPurposesofLifts

• PositioningforADLs

• Assistingapatientfromthefloor

• Positioningforwheelchairactivities

• Assistingwithuprighttolerancetraining

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CriteriaforSelectionofLiftingandTransferringDevices5

• Thedevicesshouldbeappropriateforthetaskthatistobeaccomplished.

• Thedevicemustbesafeforboththepatientandthecaregiver.Itmustbestable,strongenoughtosecureandholdthepatient,andpermitthecaregivertousegoodbodymechanics.

• Thedevicemustbecomfortableforthepatient.Itshouldnotproduceorintensifypain,contributetobruisingoftheskin,orteartheskin.

• Thedeviceshouldbeunderstoodandmanagedwithrelativeease.

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CriteriaforSelectionofLiftingandTransferringDevices5

• Thedevicemustbeefficientintheuseoftime.

• Needformaintenanceshouldbeminimal.

• Storagerequirementsshouldbereasonable.

• Thedevicemustbemaneuverableinaconfinedworkspace.

• Thedeviceshouldbeversatile.

• Thedevicemustbeabletobekeptcleaneasily.

• Thedevicemustbeadequateinnumbersothatitisaccessible.

• Cost.

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TypesofLiftSystems• OverheadTracksystem

– CommonModelscapacityareeither600#or1000#

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MechanicalLiftSystems

• Regularandbariatricmodels• Canbeusedto:

– Transferapatienttoandfromachair/WC

– TransferapatienttoandfromaBSC

– Transferapatienttoandfromthefloor

– 750or1000#

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www.liko.com

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MechanicalLiftSystems• Gettheappropriateslingsizeforthe

patient• 2optionsforplacingslingon:

– Layingdown– Sitting

• WhenliftinggenerallydoNOTlockbrakes,thiswillallowthelifttoadjustunderthepatientforbalance

• Dependsonmanufacturersspecifications

• BariatricLiftsdonotalwaysallowforslingplacementinsitting,onlylaying

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www.liko.com

Portableoverheadlift

• MaybeapplicableinICUsorlongertermresidents

• Bedclearanceissues

• Needmorespace

• Varietyofslingsavailable

• Scaleavailable

• 750or1,000lb.capacity

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• Bari-Lift & Transfer™

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LimitationswithEquipmentUse

• Patientaversion

• Unstableequipment/operationallydifficulttouse

• Storageissues/inconvenience

• Poormaintenanceandcleaning

• Timeconstraints

• Inadequatenumberofavailablelifts

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LimitationswithEquipmentUse

• Notrainingondeviceonfloorswithhighturnoverlevels

• Spacerestrictionstocontrolequipment

• Incompatibleequipmentpurchased

• Weightlimitations

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AWORDABOUTTHETHERAPEUTIC USEOFPATIENT

HANDLINGEQUIPMENT2

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Mechanicalassistance2

• Usingmechanicaladvantagetoreplaceorassistpatient-initiatedmovementorcaregiverinitiatedmovement

• Mayhavetohave2mobilityprocessesforonepatient:1. ToaccomplishnursingcareorcurrentADLlevel

RoleofRehab:ConsultanttodemonstrateandprescribemobilityrecommendationsandequipmentusefornursingduringADLs

2.Treatmentinterventionforrehabilitativeprocess

Dynamicandchangingbasedonpatientprogressionorregression

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TherapistsafetyANDrehabpotential2

• Shouldnot bemutuallyexclusive

• Equipmentcanbeusedasassistivedevicesduringrehab

• Increasespatientfamiliaritywithliftingequipmentduringnursing-assistedADLs

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TherapistSafetyANDRehabPotential2

• Policiesshouldhavethefollowingobjectives:– ALLstaffshouldknowhowtouseALLequipment

– Whenable,developalgorithmsorpresentcasestudiesonuniqueusesofequipment

– Encouragepatientparticipationwhenusingmachinery(ex,usestandingframesaswalkingaidesaswell)

– CollaboratewithPT,PM&R,nursing,SLPforoptimaloutcomesandutilizationofequipment

– ProvideconsistencyinuseofequipmentforOT/PT/Nursing

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ClinicalApplicationsofNon-MechanicalStandingAid

• Contraindications:– RestrictedWBUEsorLEs– Poor/notrunkcontrol– Dizzinessandhypotension

• Indications:– Intractablebackpain– Lowerextremity

weakness/partialparalysiswithgoodtrunkstrengthandsittingbalance

– PatientswhocanpivottransferwithhelpandusingUEs

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MechanicalStandingAid• Canbeusedasamechanical

liftaidfortransfersandprogresstowalking

• CanworkonstandinglevelADLsinconjunctionwithstandingbalanceandstrength/gaitwithPT

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Sara Plus from Arjo-HuntleighWeight Capacity 450 lbs

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WALKINGAIDS

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StandingPlatformsasGaitTrainingDevices

• Notjustfortransfers

• Removefootplate

• Walkingsling

• Dependingonriskofbucklingofknees,maywanttoleaveshinplatein.

• Weightcapacity420#

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LiteGait

• LitegaitoftenusedinPTforadvancedgaitretraining

• HasapplicabilitytoOTusesoutsideoftreadmillwithunweightingduringADLtaskperformance

• StandinglevelADLswherebalanceorfatiguewouldbeanissue

• FreesOTshandstocue,assist,remediateADLtask

• Weightcapacityupto500#

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Gaittrainingtopreventovershootingoffootplacement

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AtaxiaafterBcerebellarinfarctandexcision

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FacilitatingaLHemipareticleg

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Summary

• Mobilityisanessentialcareportionofanypatient’scare– justasimportantasbathing,grooming,toiletingandeating.

• Safetyfirstandpracticemakesperfect

• Knowyourequipmentanddon’tbeafraidtoexperimentinacontrolledfashionforthebestinterestofthepatient’srehabandsafety

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References

1. OccupationalSafetyandHealthAdministration.NursingHomesandPersonalCareFacilitiesWebsite.http://www.osha.gov/SLTC/nursinghome/index.html.AccessedApril23,2012.

2. NelsonAL.SafePatientHandlingandMovement.NewYork,NY:Springer;2006.3. MichiganHealthandHospitalAssociation.PatientLift/AssistEquipmentGuide.

Lansing,MI;MichiganHealthandHospitalAssociationServiceCorporation;2003.

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References

4. UnitedKingdomNationalArchives.TheManualHandlingOperationsRegulations1992.http://www.legislation.gov.uk/uksi/1992/2793/introduction/made.AccessedMay24,2012

5. VeteransHealthAdministrationandDepartmentofDefense.PatientCareErgonomicsResourceGuide:SafePatientHandlingandMovement.Tampa,FL;PatientSafetyCenterofInquiry:2005(rev).

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References• AmericanNursesAssociation.SafePatientHandlingandMobility:

InterprofessionalNationalStandards.SilverSprings,MD:AmericanNursesAssociation;2013.

• OccupationalSafetyandHealthAdministration.Safepatienthandlingprogramseffectivenessandcostsavings.https://www.osha.gov/dsg/hospitals/docu-ments/3.5_SPH_effectiveness_508.pdf.PublishedSeptember2013.AccessedMay12,2015.

• WilsonTP,DavisKG,KotowskiSE,DaraisehN.Quantificationofpatientandequipmenthandlingfornursesthroughdirectobservationandsubjectiveperceptions.AdvancesinNursing.2015.http://dx.doi.org/10.1155/2015/928538.

• CollinsJW,WolfL,BellJ,EvanoffB.Anevaluationofa“bestpractices”musculoskeletalinjurypreventionprograminnursinghomes.InjPrev.2004;10(4):206-211.http://dx.doi.org/10.1136/ip.2004.005595.

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References

• OccupationalSafetyandHealthAdministration.NursingHomesandPersonalCareFacilitiesWebsite.http://www.osha.gov/SLTC/nursinghome/index.html.AccessedApril23,2012.

• NelsonAL.SafePatientHandlingandMovement.NewYork,NY:Springer;2006.• MichiganHealthandHospitalAssociation.PatientLift/AssistEquipmentGuide.

Lansing,MI;MichiganHealthandHospitalAssociationServiceCorporation;2003.

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References

• UnitedKingdomNationalArchives.TheManualHandlingOperationsRegulations1992.http://www.legislation.gov.uk/uksi/1992/2793/introduction/made.AccessedMay24,2012

• VeteransHealthAdministrationandDepartmentofDefense.PatientCareErgonomicsResourceGuide:SafePatientHandlingandMovement.Tampa,FL;PatientSafetyCenterofInquiry:2005(rev).

• ZuzeloPR,SeminaraP.InfluenceofRegisteredNurses’AttitudesTowardBariatricPatientsonEducationalProgrammingEffectiveness.JContinuingEducationNurs.2006;37:65-73.

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References

• BarrJ,CunneenJ.UnderstandingtheBariatricClientandProvidingaSafeHospitalEnvironment.ClinNursSpec.2001;5:219-223.

• MuirM,GerlachS.ReducingRisksinBariatricPatientHandling.CanadianNurse.2003;8:29-33.

• MarrasWS,DavisKG,Kirking,BC,Bertsche,PK.Acomprehensiveanalysisoflowbackdisorderriskandspinalloadingduringthetransferringandrepositioningofpatientsusingdifferenttechniques.Ergonomics.1999;42:904-926.

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References

• PuhlR,BrownellKD.Bias,discrimination,andobesity.ObesRes.2001;9:788–805.

• MaimanLA,WangVL,BeckerMH,FinlayJ,SimonsonM.Attitudestowardobesityandtheobeseamongprofessionals.JAmDieteticAssoc;1979;74:331–336.

• GloverW,McGregorA,SullivanC,HagueJ.Work-relatedmusculoskeletaldisordersaffectingmembersofthecharteredsocietyofphysiotherapy.Physiotherapy;2005;91(3):138-147.

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InjuryandBackPainReferences

• MolumphyM,UngerB,JensenGM,LopopoloRB.Incidenceofwork-relatedlowbackpaininphysicaltherapists.PhysTher.1985;65:482–486.

• CromieJE,RobertsonVJ,BestMO.Work-relatedmusculoskeletaldisordersinphysicaltherapists:prevalence,severity,risks,andresponses.PhysTher.2000;80:336–351.

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SafePatientHandlingReferences

• NelsonA,BaptisteAS.Evidence-basedpracticesforsafepatienthandlingandmovement.OnlineJIssuesNurs.2004;9(3).AccessedDecember13,2012.

• CollinsJW,WolfL,BellJ,EvanoffB.Anevaluationofa“bestpractices”musculoskeletalinjurypreventionprograminnursinghomes.InjPrev.2004;10:206-211.

• Buchwald,H.,Avidor,Y.,Braunwald,E.,Jensen,M.D.,Pories,W.,Fahrbach,K.,&Schoelles,K.Bariatricsurgery:asystematicreviewandmeta-analysis.JAMA.2004;292:1724-37.

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