Safe Resident Handling Programs: Benefits and Strategies to Strengthen Practice
According to statistics from the Centers for Disease Control and Prevention (CDC), American men weighed an average of 190 lb and women an average of 160 lb in 2002.1 The CDC’s National Institute for Occupational Safety and Health (NIOSH) published the Revised NIOSH Lifting Equation in 1994, which set the maximum recommended weight limit for most patient-lifting tasks at 35 lb.2 The tremendous disparity between safe lifting requirements and the average weight of an American illustrates the need for implementing an effective safe resident handling program in long-term care (LTC) facilities, where mobility issues are common. This article outlines numerous benefits of safe resident handling programs and discusses training methods and strategies to optimize the efficacy of these programs once implemented.
Benefits to Caregivers and Institutions
An assessment by Prevent, Inc., found a significant drop in transferring injuries and resultant costs following implementation of a safe resident handling program at 105 LTC facilities.3 Twelve months prior to the program implementation, a total of 682 caregivers were injured while lifting, transferring, or repositioning residents who required partial or total assistance, incurring a total cost of $3,500,365.3 Twelve months after the safe resident handling program had been in place, 45 injuries to caregivers from lifting and transferring were reported, resulting in a total cost of $110,509.
Prevent, Inc., has surveyed more than 10,000 caregivers who have worked in a LTC facility with and without a safe resident handling program. The majority of those surveyed stated they would always choose to work in a nursing home with a safe resident handling program if they had that option. When nursing assistants do not have access to handling devices, they may lift more than 1.5 tons during an average 8-hour shift, increasing the risk of injury. Keeping manual demands of the job reasonable and safe may have a positive impact on recruitment of caregivers.
Benefits to Residents
The aging process slows down all body systems and increases the need for mobilization to sustain and promote good health. With the average American having a mean weight of approximately 175 lb, transfer and mobilization demands are high. When a safe resident handling program is not in place, the caregiver lacks the resources to safely move individuals who require partial or total assistance. Safe handling practices provide the appropriate tools and processes for safely increasing an LTC resident’s daily activity. This increase in movement improves the quality of life of residents by increasing socialization and reducing health risks associated with inactivity.4
The adage “use it or lose it” aptly reflects what prolonged bed rest can do to the human body. When muscles are not used, they atrophy and lose strength. Each week of bed rest results in an approximate 12% loss of muscle strength; thus, after 3 to 5 weeks of bed rest, almost half the normal strength of a muscle is lost.5 Inactivity also increases the risk of orthostatic hypotension, blood clots, pneumonia, and skin breakdown, all of which are major concerns in LTC facilities. Residents who require partial or full assistance with bed mobility are at especially high risk for skin breakdown, as nursing assistants frequently have to pull the resident up in bed. When a draw sheet under the resident is used to reposition him or her, shearing to the skin occurs, which can lead to stage 3 and 4 decubitus ulcers. Mandating the use of a handling sheet and lift to reposition residents eliminates the risk of shearing and physically enables caregivers to safely mobilize them in bed.
Training the Staff and Maintaining Program Efficacy
Mechanical lifts can be a weapon or a tool, depending on an operator’s expertise. Many facilities have received Immediate Jeopardy Tags due to tragic accidents when using such equipment to move residents. To reduce the risk of adverse events, adopting a training module should be considered in all LTC facilities. The training module would ideally include training, mentoring, and observing caregivers using the equipment upon hire, annually, and randomly.
While training caregivers on the use and function of equipment is critical, training alone cannot prepare them to lift and transfer residents competently. To develop and validate competency in equipment use, the best practice is to use expert-level safe handling nurses who train, mentor, and observe the caregiver’s skills during the provision of care. During an assessment of the efficacy of Prevent, Inc.’s, safe resident handling program, safe handling nurses at more than 600 facilities reported that caregivers who demonstrated competency in using the equipment were more likely to be compliant with the safe resident handling protocols. Assessing and documenting caregivers’ competency in using the handling equipment increases their understanding of the dangers when mechanical lifts are not used correctly; provides an opportunity to assess the resident’s response to the transfer and adjust the equipment used, if needed; and mentors best practices for using the handling equipment.
Another strategy to reduce the risk of injury with a lift is to implement a mandatory “time out” after the sling is hooked and the lift frame is raised. This time-out period is taken before moving the resident from the surface, allowing the operator to verify that the sling hooks are securely fastened and the sling is supporting the resident. This practice should be monitored during observations of the caregivers to ensure that it becomes an established part of the lifting procedure.
Sustaining an effective safe resident handling program requires consistent monitoring and reinforcement of caregivers’ use of handling equipment and emphasis on the need for caregivers to report any changes in a resident’s functional ability, as this may require a change in safe handling needs. Caregivers’ observations regarding residents’ safe handling needs should be reviewed as part of the established review of residents’ care plans. Another opportunity that strengthens and sustains the safe handling practice is to integrate the use of the handling equipment as an intervention to reduce residents’ risk of falls and skin breakdown. The directives within the care plan become part of the treatment, thereby increasing caregivers’ awareness that safe resident handling programs also have considerable therapeutic benefits.
Auditing the support practices on a routine basis helps maintain the integrity of the program. Some areas to routinely audit are the preventive maintenance checks on the equipment, including the integrity of the cloth slings and accessories; the accuracy of the safe resident handling assessments; caregivers’ communication of residents’ safe handling needs; and the overall training module, including documentation of equipment use. Achieving benefits from a safe resident handling program requires permanently integrating triggers mandating the use of equipment into the plan of care, developing caregivers’ confidence and competence in using the equipment, and implementing processes to sustain the integrity of the safe handling practices.
Take-Home Message
Without an ongoing commitment to safety, tragic accidents can occur with the use of handling equipment. A successful safe resident handling program can provide numerous benefits, including dramatic financial savings from a reduction of injuries to caregivers, improved recruitment and retention of staff, enhanced clinical outcomes and quality of life among residents, and a positive impact on risk management. To implement your safe resident handling program and ensure it is successful, consult with an expert-level safe handling nurse to provide the support needed.
The author is president of Prevent, Inc., a registered nurse-led safe handling development service that provides healthcare organizations with the resources, support, training, and mentoring needed to integrate the use of handling devices to lift, transfer, and reposition their clients safely.
Ms. Bogue is president, Prevent, Inc., Hickory, NC. She is also a clinical advisor for the American Association for Long Term Care Nursing.
References
1. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height and body mass index, United States 1960-2002. Advance Data from Vital and Health Statistics. 2004;347:1-2. www.cdc.gov/nchs/data/ad/ad347.pdf. Accessed May 28, 2011.
2. Waters T. When is it safe to manually lift a patient? Am J Nursing. 2007;101(8):53-58.
3. Prevent, Inc. Safe Patient Handling Program Impact: Long Term Care Program. Accessed May 28, 2011.
4. Peterson B, Bogue B. Patient Mobilization. Patient Safety & Quality Healthcare. Accessed May 28, 2011.
5. Nursing Times.net. Effects of bedrest 3: musculoskeletal and immune systems, skin and self-perception. www.nursingtimes.net/effects-of-bedrest-3-musculoskeletal-and-immune-systems-skin-and-self-perception/5003298.article. Accessed May 28, 2011.
