Investigating Patient Lift Injuries Expert Article

In this article, health care expert and physical therapist, Christian Mongrain discusses medical patient lift investigations. His discussion includes a description of why medical lifts are used, relevant industry standards, and some examples of how injuries occur.

Overexertion Injuries Among Health Care Workers – the Reason for Patient Lift Usage

The prolific use of patient lifts has come about as the result of the high rate of injuries among health care workers. According to the United States Department of Labor, the health care industry has one of the highest rates of work related injuries and illnesses.¹

Almost half of the occupational injuries sustained in health care are from overexertion or bodily reaction including manual lifting, bending, or reaching, which are motions often related to manual patient handling. ² In 2010, among all occupations, nursing aides, orderlies, and attendants, had the highest rates of musculoskeletal disorder at 249 per 10,000 workers. ³

Studies have proven that injury to health care providers can be significantly reduced through safe patient and resident handling programs. ^4,5,6 One focus in these safe patient handling programs is reducing physical stress of health care workers by utilizing mechanical equipment to lift and reposition patients/residents.

The reduction of musculoskeletal injuries to health care workers associated with the use of mechanical lifts has been offset somewhat by injuries to patients and health care workers associated with user error, improper lift usage, and equipment failures. Adequate safety and patient lifting programs are an important component for health care workers and patients alike.

Safe Resident and Patient Lifting Programs

One of the key components of a safe patient lifting program includes the requirement for a health care provider to perform an assessment before attempting to reposition or transfer a patient/resident. Included in this assessment are:

1. Patient functional ability (cooperation, strength, coordination, recent completion of task)
2. Precautions (weight bearing, exertion, positioning, bracing, medical stability)
3. Patient height and weight
4. Assistance available (people and/or equipment)
5. Patient goals

A health care provider also considers environmental adjustments that can make the transfer easier and safer for the patient/resident/caregiver. Considerations include removing or organizing obstacles (furniture, medical linens such as IVs/telemetry/catheters, or hospital equipment) and adjusting seating surfaces to reduce the strain on the provider and patient/resident (such as raised toilet seats, chair cushions, or raising the bed height). When a patient or resident is identified as requiring more assistance than one person can safely provide, additional manual assistance should be obtained, either by other people or by mechanical equipment (including patient lifts).

Mechanical Patient Lifts

There are several types of mechanical patient lifts designed to address different patient needs. Mechanical lifts can be used to transfer a patient from one surface to another; such as a bed to a chair, or they can be used to reposition a patient; such as from supine to sidelying. Some patient lifts are designed to assist a patient from sit to stand, using a sling that supports the patient around his/her torso. The more common lift accomplishes complete suspension of a patient in a sling, and is known as a Hoyer lift.

Choosing the Medical Lift & Sling

Patient lifts vary in size, capacity, features, and portability. The two main components of patient lifts are the mechanical lift (pictured above) and the sling (commonly made of strong fabric to support the person being lifted). After determining that a lift should be used to move a patient, the provider must carefully select the most appropriate lift and sling taking into consideration the patient’s height, weight, medical condition, precautions, and the purpose of the transfer. Patient ability to assist and support himself must be considered by the care provided when choosing between a sit-to-stand mechanical lift or a dependent (Hoyer) lift.

Slings vary in size and shape and are designed to accomplish specific patient needs. Some slings accomplish positioning on a toilet or bedside commode without requiring removal of the sling from beneath the patient, while others allow a provider to place the sling under the patient while they are already seated in a chair in order to safely complete a dependent transfer when a patient is unable to stand. Our health care experts can determine if both the mechanical lift and sling were appropriately chosen for the unique circumstances of the individuals involved.

Mechanical Lift Safety

Before providing patient care using a mechanical lift, the user should receive training and demonstrate competence in operating the medical device. Users should be aware of manufacturer guidelines and facility policy and procedures to ensure that the adequate amount of assistance is provided, and both lift and sling capacities are not exceeded.

Portable lifts typically have adjustable bases that, when a lift is being performed, should be expanded to increase the base of support, thereby reducing the risk of tipping.

Lifts require regular maintenance and inspection to confirm safety and function. Slings are often assigned to an individual patient or resident, but require laundering when soiled or before use with other patients to reduce risk of hospital acquired infections. Risk assessment for pressure injury is crucial for providers in determining the necessity to remove the sling from beneath the patient after each transfer. [link to: Bed Sore Article]

Slings require inspection prior to each use and should not be used if there is visible compromise including loose stitching, holes or tears in the fabric. Laundering by manufacturer specific guidelines is important to maintain the strength and integrity of the fabric and prevent failure under load. Some manufacturers make slings that are ‘single patient use’ eliminating the need for laundering, and are to be discarded when compromised, soiled, or upon patient discharge.

Investigating Incidents Involving Mechanical Lifts

While mechanical lifts are intended to reduce injury to staff and patients, improper maintenance or use can lead to incidents resulting in injury or death.

When slings are not appropriately sized or positioned, the fabric can restrict a patient/resident’s blood flow or breathing. Performing a mechanical lift using the wrong size sling (too large or too small) can result in a patient fall due to slipping out of the sling or failure of the material. Poor maintenance, improper laundering, inadequate training, and inadequate inspection can result in equipment failure creating a dangerous condition for both the user and the patient/resident. Overloading, lack of adequate assistance, or improper use can cause the lift to tip over or fail and result in a patient fall.

The health care experts at Robson Forensic can analyze the cause of mishaps involving medical lifts and the relevant standards of care.

For more information submit an inquiry or contact the author of this article.

Sources

1. Occupational Safety and Health Administration, Worker Safety in Your Hospital. 
2. Bureau of Labor Statistics. 2013. “Facts About Hospital Worker Safety” 
3. Occupational Safety and Health Administration. 
4. Evanoff, B., Wolf, L., Aton, E., Canos, J. and Collins, J. (2003), Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. Am. J. Ind. Med., 44: 451–457. doi:10.1002/ajim.10294
5. Li J, Wolf L, Evanoff B. Use of mechanical patient lifts decreased musculoskeletal symptoms and injuries among health care workers. Injury Prevention. 2004;10(4):212-216. doi:10.1136/ip.2003.004978.
6. Veterans Health Administration and Department of Defense, October 2001. Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, developed by Patient Safety Center of Inquiry, Tampa, FL.

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Christian H. Mongrain, PT, DPT, HEM

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Joseph Muniak, MS, OTD, OTR/L

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