May I suggest a document entitled Victorian Nurses back injury prevention project evaluation report. December 2004. It reviews the outcomes of the 1998 Victorian Nurse back injury prevention project (VNBIPP). A brief summary from the forward is a -24% reduction in the rate of standard back injury claims by nurses in public health services in Victoria -41% reduction in the rate of working days lost associated with the above -cost saving of est of $6.4 million (Mar-01 – jun-03) -reduction from 100 days per claim to 77 days per claim cost break even point is within 5 years plus many unmeasured benefits I am finding it hard to understand the people that support the view that allowing injury to your colleagues is acceptable. The lack of support for the use of equipment and improved environmental factors etc all impact on other staff that utilise transfer equipment. Cheers Glen
I just wanted to post a quick comment on this issue. I have worked as a PT for 14 years now, and am unfortunately a statistic of suffering a back injury while working w/a patient. I am fine now, but it led me to join a really dynamic group of people including another PT, OT’s,and members of an ergonomic division to develop ways to incorporate using lifts in treatment to not only benefit the patient and achieve functional goals but to also protect staff from injury. I have used a sit/stand type lift many times in inpatient rehab and now in acute care where I am practicing now. I use it to work on sitting balance, the components of sit to stand, standing tolerance, trunk control, weight shifting, posture, visual tracking. There is really a lot you can work on w/a patient using these devices as a tool in your treatment. I know many therapists feel if they aren’t touching and lifting the patient themselves, it isn’t PT. I was one of those people also until I really started to look at the lift as a device to help me achieve the functional goals of the patient. I along w/a colleague are hoping to present at the 2009 APTA conference in Baltimore on this very issue.
A recently updated document "A guide to designing workplaces for safer handling of people". I would strongly reccomend for anyone looking at suitable design to allow the use of transfer equipment with clients/patients.
I fully support the use of mechanical lifts during PT intervention. I am an acute care PT in a community
based hospital and intregate lifts into my treatment plans. I believe therapists approach the lifts
with different goals than RN staff would. RN staff simply use lifts to transfer patients, where thera-
pists can use the lifts to address the quality of movement, specifically with a sit<>stand lift. Tasks
can be segmented and impairments such as posture, balance, and BLE weight bearing can be
addressed. Given NIOSHs recent lifting recommendations of 35# for all healthcare workers, mechanical
lifts can assist us in following these guidelines. We are continually being asked to work with pts who
are more critically ill, older, and heavier than ever. Mechanical lifts assist in keeping therapists safe,
allow use to provide a safe environment for our patients, and can even help us meet our patient’s goals.
We can engage patients who would have otherwise been considered bedbound and who may have only
received bed exercises. As a PT community, I feel we need to shift focus from strictly preforming manual
transfers and consider other options such as mechanical lifts.
Thanks, Jennifer McIlvaine, MSPT
From my experience it probably depends which type of hospital etc as to the goal and outcomes. Nursing use of hoists etc in rehab hospitals is usually based around rehab plans with the distinct of reinforcing mobility plans developed by therapists, nursing staff and medicos etc. This can often mean that they are using hoist or not etc to increase mobility etc more frequently than physios and O/Ts etc within settings such as personal care showereing as they have much greater contact with the patient. I believe that all of these roles are complex and demand the best support available and a commitment to all roles that have patient care in this area and through managment support. It is about changing hte system for all.
The APTA/OSHA Reagion V Alliance continues to work on developing and promoting Safe Patient Handling and Moving(SPHM) through collaborative efforts. One subcommitte has recently (last week) compiled information for fact sheets that quantify the problem and provide direction to solving it by means of implementing use of mechanical assit devices and other no lift policies. Theses fact sheets are addressed to three distinct groups: PTs, care givers, and administrators. They are in the editing and formatting process now and will be available for distribution this year. The APTA at the state and national levels will distribute them at conventions, educational offerings, and on the web site. OSHA will distribute them when doing site visits at medical facilities and at conferences. We are also working on changing curriculums to start the new generation of PTs with the correct mind set.
I may be able to post the Fact Sheets here when they become available. Comments are greatly appreciated. Thanks.
That would be fantastic if I could see a copy. I am based in Victoria Australia which has very different expectations re:transfer equipment etc. The document I reccomended earlier is designed to integrate design and spatial requirements etc and put them in the one publication, if you have not had a look it may well be worth it. Also my understanding is that British Columbia has an excellent system re: hoist use, they may also be worth a look. As the entire system needs to support these endeaours for them to suceed. I would be great to see the documents you have porduced. Cheers Glen
We have reviewed the article as a group and find that it is very beneficial to look at facility design. We have included a reference in the fact sheet directed at the administrative/management population. It helps to think outside the box. Some of us PT types don’t have the whole picture and it help remind us that there are other perspectives that can make things safer for us and the patient as well as improved efficiency. This is an excellent forum to promote the best possible mouse trap. Thanks Glen. We appreciate your input. Godspeed, Ron
You may also want to consider they different types of overhead tracking available and the pros and cons. As a physio you "may" be looking at a single tracking to enhance walking/mobility. This would obvioulsy run in a single line, but if you use this sort of tracking to transfer (which it often is) it has the disadvatage that a patient may slide down the bed and need to be tranfered up the bed to be able to be transfered which is obviously self defeating. Full room coverage OHT will allow the hoist to be located directly over the patient reducing this problem and also allowing more flexibility of room use and bed etc as they do not need to be in a fixed location. This type of tracking is unfortunately much more expensive to purchase. There have been cost benfit studies done that support the use of OHT when compared to the injury costs. I think the BC has done one. Also available is
Efficency of overhead tracking lifts in reducing musculoskeletal injury among carers working in long term instituions May 2008 Alamgir, H et al
Effectiveness of overhead lifting devices in reducing the risk of injury to care staff in extended care facilities Feb 2005 Engst et al
The impact of new lifting technology in long term care A pilot study
AAOHN journalDec 1994 Holiday et al
David Mc Farlane who is a regular contributor has written an excellent article entitled
Mearurement of the forces neede to tranfer patiens from bed to hospital trolleys
I am also seeking out a study done by a major hospital here that did a cost benefit analysis
Cost/benefit is often a major driver in this area as the
Obviously the above articles are not directly related to PTs but my general understanding of the stats are that PTs have similar levels of musculoseletal disorder to the nursing staff if not higher.
If you want to send on the guidance that you mentioned previously my details are below
Hazard Management Division
222, Exhibition St
Ron the following document has some of the info on the process that this hospital went through. The relevant infromation starts on about page 126. They used full coverage tracking not the single line tracking and had significant cost benfits in reduced premium.
Ron here is a link to one of the studies that I mentioned. The cost benfits a clear. http://www.health.vic.gov.au/ohs/forum0508/index.htm
I would be interested in reviews of various sit-to-stand devices. We are trying to evaluate several for use in PT as well as nursing. Specific questions are: Is the removable footplate valuable? Are there brands or manufacturers to avoid? What features do PT’s find most useful?
One consideration I always had was for the cognitive level of your patients. E.g. patients with dementia etc can tend to lift their arms and drop tot the ground with standing machines. I was always a bit averse to using them in aged care for this reason as clientele could be variable during the course of the day and carer where often agency etc. Would you be better of with O/head tracking for the PT use as you probably are looking at ambulation etc? Does the removable foot plate capture the clients foot when it is not in place?
I understand the concern of patient’s raising their arms and falling to the ground. That is not just a problem for demented patients, but also those too weak to hold on with the sit-to-stand devices. The companies you want to look at for a sit-to-stand to a full lift (mobile or ceiling mounted) are the ones that have a vest or "lift pants" that do not permit the patient to fall. LIKO has a vest for the sit-to-stand that actually cinches around the patient if the start to fall and keeps them off the ground. It works…I tried to fall out and could not. They also have a walking vest that works the same way….cinches up to prevent the fall (yes, I tried to fall in it, too…couldn’t). This vest is used with a mobile lift or ceiling mounted. The straps attach tot he sling bar. This permits the patient to ambulate with as much weight as they can handle on their LE’s and provides the ability for progressive weight bearing, balance training, etc. LIKO also has a device called "walking pants" mainly for the very large patients that looks more like an hour glass design. It goes between the legs and the straps attach to the sling bar. The "pants" provide support from the hips/peri area. As far as sit-to-stands, some permit the foot pad to be removed for gait/ambulation adn some do not. You need to pay close attention to how the lift actually brings the patient to standing. Some of these lifts do not "stand" the patient in a position for walking, rather they tend to lean the patient posteriorly. You need to get into each device to see what it really does. If they say you can’t fall…..try. I have fallen out of other company’s slings and vests. I have not felt I could ambulate with some company’s sit-to stand devices.
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