One of the most common problems in safe patient handling programs is the inconsistent or incorrect selection of safe patient handling equipment by caregivers. Programs typically don’t have a consistent and standardized decision making process that is used and understood by all caregivers involved in the patient’s or resident’s care. This article will present the key reasons for “error” in the selection of safe patient handling equipment and recommend specific areas of assessment to minimize the risk of harm and injury to the patient or caregiver.
There are several reasons why there’s so much variation in how caregivers determine to use and select safe patient handling equipment. One of the primary reasons is the lack of a consistent patient assessment among caregivers. There are distinct differences in how nurses and therapists assess a patient’s mobility level. Therapists are trained to assess patients in a very standardized way, i.e. assess range of motion, strength and balance through specific measurement techniques. Nurses, on the other hand, might assess a patient’s mobility through a more informal process; typically by judging how a patient responds and moves when doing their daily patient assessment such as listening to their lungs, asking them questions to determine the level of alertness, skin inspection, etc. Differences can also be seen between nurses depending on their years of experience and what unit they work in.
Another common reason for error is the lack of or no standardized process to direct them once the caregiver has determined equipment should be used. Or, if there is a policy and process in place, the caregivers don’t consistently follow it as they do not perceive value in following it or it’s not functional for them to use at the bedside since it isn’t quick and easy for them to complete.
Other common reasons for error to occur in the selection of safe patient handling equipment include: Lack of assessing the space surrounding the patient, lack of common language that describes a patient’s mobility level, lack of standardized communication method between inter- and intra-departmental caregivers, “hand-off” communication that emphasize the number of people needed to move the patient instead of the equipment to use with the patient (i.e. patient is a moderate assist of 2), and lack of confidence and/or knowledge of the best equipment to use for the situation.
Since the decision of incorrectly choosing not to use equipment or selecting the wrong equipment can result in harm and injury to the patient and/or caregiver it’s critical that the safe patient handling program provide a consistent, standardized method of selecting safe patient handling equipment.
There are three components that are recommended to be a part of a standardized method:
- patient assessment;
- space (environment) assessment; and
- task assessment.
Let’s take a closer look at what should be included in each one.
Patient Assessment
The purpose of assessing the patient is to determine if the patient requires assistance, physical and/or verbal, by the caregiver. The caregiver should pay close attention to the cognitive level of the patient as well as how the patient moves, i.e. able to boost and turn themselves in bed, able to sit, stand and walk. The result of this assessment determines the patient’s mobility level.
Space (Environment) Assessment
The next assessment and the most commonly overlooked is the space surrounding the patient. It’s imperative that caregivers take into consideration the amount of clear space that surrounds the patient’s bed and path into the bathroom. This is as equally important for patients who require no assistance as it is for those who require safe patient handling equipment. Even if a patient is independent, there will be an increased fall/tripping risk if the room is crowded with equipment and furniture so that it impedes the clear space for a patient to walk around the room and into the bathroom. In the same manner, if there isn’t enough clearance at the side of the bed, a floor-based lift cannot be safely used.
Task Assessment
The final step after the caregiver assesses the patient and the space, and before the actual selection of the equipment, is to assess the task to be performed, which also takes into account the size of the patient. This must be factored into the decision making process in order to prevent the inappropriate selection of safe patient handling equipment.
Healthcare facilities will reap the many benefits to their safe patient handling program from incorporating a standardized safe patient handling equipment selection assessment process that addresses all three of the described components. One of the greatest benefits will be the reduced risk for patient and caregiver injury. It results in improved quality of patient care as well as patient and caregiver safety. It allows the nurse to consistently and accurately assess the need for safe patient handling equipment instead of solely relying on physical therapy assessments. The use of such a tool results in having another performance monitor for the safe patient handling program. The documentation will also serve as evidence that an accurate assessment was made in the case of a patient or caregiver injury. Perhaps the best reason for incorporating such a tool is the fact that it will result in supporting and reinforcing the safe patient handling culture.
Jill Kelby, PT, CEA is president of Ergo-PATH System, LLC. Ergo-PATH System leads and guides healthcare facilities to find cost effective and functional safe patient handling strategies and solutions. She can be reached 877.890.PATH (7284), jkelby@ergo-pathsystem.com or at www.ergo-pathsystem.com.