EP30f, Safe Patient Handling.pdf

University of California Irvine HealthCare

Policy and Procedure Manual

SAFE PATIENT HANDLING

PATIENT CARE RELATED Date Written: 08/07 Date Reviewed/Revised: 04/08 Page No. 1 of 5

I.

PURPOSE To provide an environment of safe patient handling which promotes the well-being of our patients by decreasing risk for skin breakdown, risk of falls, and complications of immobility, while maintaining a safe work environment for the patient care provider. .

II.

BACKGROUND Immobility can be caused by illness or injury which may result in a number of complications and prolong hospitalization or result in further medical complications and debilitation. Progressive mobility incorporates a plan to mobilize a patient, starting at repositioning and regular turning schedules for bedrest patients, up to independent ambulation. These activities are essential to the total well-being of the patient. However, in the implementation of progressive mobility activities the possibility of unintentional harm to the patient or healthcare provider exists. These risks may be minimized through the use of safe patient handling techniques and tools. The Medical Center’s goal is to create a culture of safety for all patient care staff, through the services of a Lift Team and appropriate utilization of lift and transfer equipment, thereby creating a safer environment for the patient.

III.

POLICY Safe patient handling techniques will be utilized for all patient lifts, transfers, and repositioning. Nursing care staff (RN/SHA) are responsible for implementing routine Q2 hour turning and repositioning of all patients who are unable to perform these tasks independently. MaxiSlides (non-friction surface sheets) will be utilized by nursing staff for all repositioning and turning of patients who require assistance to prevent skin breakdown due to shearing forces, to promote patient comfort, and to decrease risk of injury to the care provider. Drawsheets will not be used for the transfer and repositioning of patients. Transfer tubes or MaxiSlides will be used by all nursing staff in the transfer of patients who require assistance between bed surfaces (guerney, OR tables, bed). Patient care staff will utilize mechanical lift equipment and transfer devices for all transfers or lifts requiring any assistance, except in the event of an emergency. (Please see “Service Plan for Safe Patient Handling and Movement”, to determine most appropriate equipment to use). 1

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The Acute Rehabilitation Unit and Physical Medicine & Rehabilitation staff will utilize lift and transfer equipment as appropriate to their patients’ individual needs as the goal of this service is to promote the return of the patient to a community level of care, which may not include the use of assistive devices. The Lift Team shall be called for the transfer or lift of the non-complex patient whenever the safety of the patient or healthcare provider is at risk should their assistance not be utilized The Lift Team shall be called whenever possible for the transfer and lift of all complex patients, i.e. multiple lines, traction, ventilators, or bariatric patients. The Lift Team utilizes the SBAR hand-off (see “SBAR Lift Team Report”) with the oncoming shift to promote continuity of service to patients identified as requiring lift services. The Lift Team shall make routine rounds on each patient care unit at least twice a shift, for updates on specific patient needs for assistance. The Lift Team is available for staff education and training in the appropriate use of lift equipment and transfer devices.. IV.

PROCEDURES A.

B.

C.

D.

E.

Upon admission, and with each change in status, the RN will assess patient for level of assistance necessary for patient handling during lifts, turns, and repositioning. Re- assessment should be completed by the RN prior to each lift, turn, or repositioning task if the patient has varying levels of ability to assist due to medical reasons, fatigue, medications, etc. When in doubt, the nurse will assume the patient cannot assist with the patient movement and requires full assistance. Nurse communicates with the Lift Team members during routine rounds to identify patients requiring left team assistance for scheduled or planned transfers or patient movement. Nurse calls the Lift Team for urgent or unplanned patient transfers or lifts, via the group paging system for assistance with patients requiring full assistance or complex lifts.. The Lift Team determines the lift/transfer needs for the patient in conjunction with nursing staff to determine the safest mode of transfer (See “Service Plan for Safe Patient Handling and Movement”). The Lift Team members will always utilize assistive devices or lift equipment for patient handling, except in the case of an emergency.

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F.

G.

H.

I.

V.

The unit nursing staff (Registered Nurse or Hospital Assistant) shall remain with the lift team until completion of the patient movement task to provide patient specific information pertinent to patient handling. Lift Team members perform hand hygiene and appropriate infection control practices prior to, during, and after all patient contact, including equipment disinfection. Lift Team, in collaboration with the patient care provider, shall perform lift or patient movement utilizing safe patient handling practices and good body mechanics. Lift Team activity is documented and maintained in the Lift Call binder, stored in the Lift Team office.

REFERENCES American Nurses Association (2003). Position statement on Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders. http://www.nursingworld.org/readroom/position/workplac/pathand.pdf Standards of Care: Progressive Mobility Protocol

Author:

Terri Donly, RN Carlos Torres, LVN Jennifer Bailey, PT

Approvals:

Nursing Standards Committee Nursing Leadership Policy Review Committee Performance Improvement Committee Med Exec Committee Governing Body

04/2008 07/2008 08/19/2008 October 8, 2008 October 20, 2008 October 20, 2008

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UC Irvine Medical Center Lift Team Service Plan for Safe Patient Handling and Movement

Date/Time:__________________ Nursing Unit/Room No:________ RN:_______________ Assessed by:_______________ I. Diagnosis:_________________________ Isolation: No_____ Yes_____ Type:__________________ II. Weight:___________

Height:____________

III. Weight Bearing Capability: Full_______ Partial_______ No_______ IV. Upper Extremity Strength: Yes______ No______ V. Patient’s Level of Comprehension and Cooperation: _____Cooperative (able to follow simple commands) _____Unpredictable (frequent behavior changes, restraints) VI. Conditions that may affect transfer / repositioning (Check all that apply) _____Respiratory compromise _____History of falls _____Postural hypotension _____Severe Osteoporosis _____Severe edema _____Fractures _____Paralysis/paresis _____Urinary / fecal stoma _____Amputation _____Severe pain _____Splints / traction _____Tubes (IV, chest, gastric, etc.) _____Contractures/spasm _____Incontinence _____Unstable spine _____Wounds affecting transfer / repositioning _____Hip / knee replacement _____Fragile skin / decubitus ulcer VII. Service Plan (Circle all that apply) Patient Profile Patient requires assistance to move up in bed or turning or lateral transfers or pt with decubitus ulcer. Patient requires assistance to move up in bed or turning or lateral transfers or pt with decubitus ulcer (Heavy weight-over 300 lbs). Patient weighs less than 265 lbs & able to pull self into standing position. Patient able to bear weight on at least one leg, & able to follow simple instructions, & able to grip with at least one hand or a 2nd staff member able to assist, and able to undergo moderate pressure to the mid or lower back. Patient can undergo a semi-inclined position

Patient ABCs normal, not able to bear weight or pull self into sitting position.

Task Transfer to & from: Bed to bed or bed to gurney, cardiac chair, exam table. Transfer to & from: Bed to bed or bed to gurney, cardiac chair, exam table. Transfer to & from: Bed to chair, wheelchair, toilet or shower. Transfer to & from: Bed to chair, wheelchair or toilet.

Transfer to & from: Bed to wheelchair, gurney, cardiac chair, exam table. Transfer up from floor to bed, chair, wheelchair, gurney.

Lift Device/Equipment Maxi Slides/tubes

Hover Matt

Stedy

Sara Plus (pt wt less than 420 lbs) Sara 3000 (pt wt less than 440 lbs) Maxi Move (pt wt less than 500 lbs) Tenor (pt wt 501 - 704 lbs) Maxi Move (pt wt less than 500 lbs)

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SBAR Lift Team Report Report Shift: Report Shift:

S B

A

R

given by: __________________ Date: ______________Time: ______________ ____________ received by: _________________ ____________

Situation: Patient Nursing Unit/Room No: ______________________ Male Female Gender: Diagnosis: _______________________________________ Nurse: ________________________________________ Yes No Infection Control/ Isolation: Contact Droplet Airborne Isolation Types: Background: None Latex Other Allergies: Full DNR Code status: Language:____________________________ Developmental issues:___________________________ Assessment: Yes No Type: Restraints: ___________________________ Mental Status: Alert and oriented x4 Cooperative Unpredictable Cardiopulmonary Status: IV Oxygen Pulse Ox Telemetry SCD Trache GI/GU Status: NG GT JT Tubes: Foley Fecal stoma Drains: Musculoskeletal status: ______________________________ Arm & leg strength Motor & function coordination Activity: Recommendation: Equipment needs: Hover Matt Maxi Move Maxi Slide/transfer tubes Sara Plus/Encore Sara 3000 Stedy Tenor Trixie Service plan for continuing safe patient handling and movement ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

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