October 13, 2017

By: Roric P. Hawkins, MBA, BSN, RN

Working within the parameters

Safe patient handling (SPH) is a much-needed solution to address widespread injuries occurring among nurses performing patient care. Injuries that result from manually lifting human beings often happen because of many factors, but nevertheless remain an existing problem in need of a committed focus. Though there are a variety of injury prevention programs in patient-care settings intended to address the safety of those who function within these spaces, it has become ever-more important to remember that the foundation, processes, and incorporation of patient-lift technology were developed to target specifically the safety of healthcare workers.

In defining SPH as a program, it’s important to ensure that the intent remains committed to minimizing injuries in healthcare staff related to manually lifting and moving patients first. Combining these programs with other hospital injury prevention initiatives run the risk of assuming SPH to be an “extension” or an “addition to” resource, opposed to an evidenced-based program created to address a specific objective.

 Safe patient handling is assistance

When considering an injury prevention program such as SPH, it’s reasonable to attribute some positive patient care outcomes to processes that include use of patient-lift technology. For instance, equipment used to assist patients to stand are contributors to patients being out of bed sooner, an overhead ceiling lift used to turn-and-reposition patients with limited mobility assists in preventing hospital acquired pressure injuries, and equipment used to assist patients with toileting may prevent a patient from falling. Whereas these scenarios are certainly positive contributors to the overall quality that we as clinicians strive to achieve, re-directing the focus from the SPH program’s primary aim runs the risk of diluting its intended purpose especially should we sensationalize the program’s ability to assist. Taking SPH while in its infancy and promoting it as the answer to addressing core hospital quality indicators runs the potential of distracting us from creating the employee safety outcomes for which SPH was primarily intended.

 Let’s consider

To put into context the risks of promoting SPH as something other than an employee injury prevention program, let’s consider my first example of using equipment to assist patients out of bed. Physicians often prescribe physical activity for patients centered on realistic mobility goals depending on the patient for therapeutic purposes. As a nurse seeks to satisfy such orders, not only is the therapeutic impact at the forefront of the nurse’s consideration, but also the nurse considers his or her ability from a manual/physical standpoint to carry out the prescribed mobility tasks. Because the decision to complete this order is ultimately decided based upon the caregiver’s physical abilities or available assistance, patient-lift technology typically does not factor in as a therapeutic option unless the technology is already embedded into the clinical culture as the standard for patient lifting. Advertising SPH and related equipment as an early patient mobility program typically does little to influence the caregiver’s initial consideration for whether to use equipment, especially if patient-lift technology has not been integrated into everyday patient-care operations. This isn’t to say that SPH doesn’t have a necessary stake in early mobility aspirations; it’s simply to suggest that promoting early mobility through SPH does not necessarily influence caregivers to consider using patient-lift technology.

In considering SPH as a fall prevention program, it’s important to guard against creating a “conflict in patient care” when making a safety versus professional therapy determination. Patient-falls in hospital organizations create many challenges to caregivers working at the bedside. It’s not enough at times for nurses to exercise prudent nursing judgement related to falls when generally speaking, most if not all patient falls are unplanned events. Implementing the use of fall assessment tools placing mechanical lifts as the highlighted feature runs the risk of conflicting with professional physical/occupational therapy’s scope of practice.

Initial nursing patient assessment on hospital admissions adequately addresses the patient’s mobility status for the purposes of determining whether the use of a patient-lift device is necessary. From this initial assessment, the nurse can reasonably conclude whether a total-assist lift, moderate-assist lift, or a lateral transfer device is suitable, barring any unexpected changes to the patient’s physical status. Should the bedside nurse require more technical patient mobility information, physical therapy should be appropriately consulted as opposed to nursing professionals attempting to make a patient mobility determination in accordance with some mobility algorithm assessment tool. The inclusion of patient-lift technology applied to patient care should not disrupt services provided by professionals specifically trained to address patient mobility capabilities.

 Keeping on target

When implementing new SPH programs, it’s important not to allow too many competing influences to deter end-users from the ultimate injury prevention objective of using patient-lift equipment in place of manual patient lifting. Too often in our efforts to become more sophisticated in our approach to patient care, we not only miss the mark on our intended objectives, but we sometimes discourage our own processes. The methods in which new innovations are delivered are as equally important as the innovation itself. Cluttering new implementations with important but misplaced details is sometimes enough to end new practice processes before ever starting. Should we remember to work within the parameters for which SPH programs were created, the program will eventually at its own pace allow us to expand its focus into other quality care initiatives.

 

Roric P. Hawkins is the founder and president of The RP Hawkins Group (www.therphawkinsgroup.com) and is the safe patient handling coordinator at Michael E. DeBakey VAMC in Houston, TX. The views expressed here are his own.

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