Patient lift

Example of a patient lift in aluminium

A patient lift (patient hoist, jack hoist, hydraulic lift) may be either a sling lift (or Hoyer Lift, a brand name) or sit-to-stand lift. This is an assistive device that allows patients in hospitals and nursing homes and those receiving home health care to be transferred between a bed and a chair or other similar resting places, using hydraulic power. Sling lifts are used for patients whose mobility is limited. They could be mobile (or floor) lifts or overhead lifts (suspended from ceiling-mounted or overhead tracks).^[1][2]

The sit-to-stand lift is designed to help patients with some mobility but who lack the strength or muscle control to rise to a standing position from a bed, wheelchair, chair, or commode. They use straps, vests, or belts (as opposed to slings) to make the transition possible.

Sling lift

The sling lift has several advantages. It allows heavy patients to be transferred while decreasing stress on caregivers while also reducing the number of nursing staff required to move patients. It also reduces the chance of orthopedic injury from lifting patients.^[3][4] Patients who have medical conditions that do not allow them to be bent and compressed by the sling as they are hoisted (i.e., cannot withstand "vertical transfer") will require specialised slings which can lift horizontally, or use other assistive devices for transfer. The other types of transfer device which allow for lateral or supine (supine position) transfer are stretcher chairs (also called transfer or convertible chairs) that allow patients to be slid or dragged from the bed onto a mobile stretcher that then converts to a mobile chair, and inflatable sliding mats which use air bearing technology to reduce friction during lateral transfer (see Lateral Patient Air Transfer). Other less expensive alternatives are disposable or washable sliding sheets and sliding boards.

A Hoyer lift

The term sling lift is also known as Hoyer Lift which refers to the oldest and most common brand name in the United States. The basic design for the sling lift was patented in 1955 by R.R. Stratton, and titled "Floor Crane with Adjustable Legs" (US 2706120 ). According to the patent, the lift's design was based on a similar device used in "automotive repair shops" which is described as a "floor crane available for lifting engines and other heavy parts". The adjustable "wide-spread legs" of the crane were needed to make the device maneuverable when the legs are parallel to each other but stable under heavy load when they are spread out at an angle. Modern floor lifts maintain the basic elements of the original 1950s design described in the patent.

Use of the a sling lift involves placing a special piece of fabric, called a sling, under the patient (usually made of woven nylon, cotton, or a similar material to a modern hammock), which can hold the weight of the patient while suspended in air. The fabric is attached to a series of hooks or clips.

Some variations of the sling involve the placement of a padded sling under the patient. When the patient is elevated, these pads hold the patient in place. Other kinds of specialized slings are toileting slings, amputee slings, quadriplegic slings (contain additional head support), showering slings and repositioning slings (for turning or sliding patients in bed), disposable slings (for enhanced infection control), and stretcher slings (for supine transfer). It is important that medical staff do an assessment of the patient's size, weight, and medical condition in order to select the proper sling to avoid injuring the patient during transfer. To reduce the risk of cross infection which is of critical importance in hospitals, the slings are often disposable or patient specific.

One limitation of common slings is that they bend and compress the patient during transfer which can be difficult for patients with painful medical conditions. Most patients must also be "log rolled" onto the sling prior to being hoisted which makes the transfer process a more complex activity. Nurses and Certified Nursing Assistants often receive specialized training in order to use the patient lift safely and effectively.

Another kind of sling lift, which is called a ceiling lift, can be permanently installed on the ceiling of a room in order to save space.^[5] Floor sling lifts usually have a wheeled base that requires additional space on the side of the patient's bed during transfer. The ceiling lift eliminates this space issue because the patient is supported by ceiling tracks instead of by the wheeled base. Ceiling lifts use the same sling technology as floor sling lifts. However, they usually have a "track system" attached to the ceiling for horizontal movement of the patient within the patient's room and often into an adjoining bathroom. Ceiling lifts also use an overhead electric motor (i.e., they are not hydraulic) controlled by a hand-held set of push buttons to raise and lower the patient. In most cases, the same overhead motor is used to move the patient horizontally, but such movement is limited by the placement of the overhead ceiling track system. Today, overhead or ceiling lifts, are becoming more common and are often installed when new hospitals, nursing homes, etc. are built.

There are many important benefits of ceiling lifts, both for the caregiver and for the patient, and for the facility. For the caregiver, the biggest benefit is reducing if not eliminating lower back injuries, many of which can be career ending. In the US, caregivers have the highest back injury rate of all professions. Also, since the average age of nurses in the US is climbing to the 50s, fewer and fewer can handle the physical demands required for caring for patients. So ceiling lifts promotes caregivers safety and job longevity. For the patient, the ability of a ceiling lift to reposition them and move them from bed to chair results in reduced incidence of pressure ulcers and pneumonia, less need for pain medication during such transfers, safer transfers and overall faster recovery. For the facility, their patients have better outcomes typically resulting in better economics (and fewer penalties resulting from "never events" like bed sores which ceiling lifts help eliminate), their staff have fewer injuries and since it takes one staff member versus 2-3 to move a patient from bed to chair even for a patient on a ventilator, the staff have significant productivity gains. So the return on investment for a functioning ceiling lift program is very strong which explains why the use of ceiling lifts are the standard of care in Canada, Europe and Australia.

Modular free-standing (or A-frame) overhead track systems are also available. These systems are less expensive than permanent ceiling track installations. The can also be quickly disassembled and moved from room to room as required. These systems are known as gantry hoists and are particularly useful for individuals who are travelling.

Sling lifts (both ceiling lifts and floor lifts) are available with an integrated patient scale which saves time since the patient can be weighed during transfer.

Sit-to-stand lift

Sit-to-stand lifts are designed to help patients who lack the strength or muscle control to rise to a standing position from a bed, wheelchair, chair, or commode. They use straps, vests, or belts (as opposed to slings) positioned around the patient's back usually fitting under their arms. They are therefore technically not "sling lifts" which are used for vertical patient transfer. Sit-to-stand lifts fix the patient legs in position exerting pressure on the patient's calves as the belt or strap is tightened by the lift mechanism. This tightening gradually moves the patient's body diagonally into a standing position. Standing is medically beneficial to reduce conditions such as osteoporosis which can occur when a disabled patient's bones weaken over time because they are no longer used support the patient's weight.

Sit-to-stand devices are designed to transfer a patient between two seating surfaces. These include surfaces such as a commode, shower or transfer bench, wheelchair, chair, and bedside or mattress. The physical demands required to transfer a patient using a sit-to-stand device are significantly less than manually performing a stand-and-pivot transfer thus decreasing the chances of caregiver back or shoulder overexertion injuries. Since sit-to-stand lifts typically have a smaller base than floor sling lifts, they can more easily fit and maneuver a patient into tight spaces such as bath and shower rooms.

The limitations of sit-to-stand lifts is that patients must be able to first sit up and second to physically support their own weight while in a standing position in order to use these devices.

The role of Safe Patient Handling programs

There has been considerable effort put forth by nursing advocacy groups (see the American Nursing Association's "Handle With Care" program at http://www.Nursingworld.org and http://www.anasafepatienthandling.org ) to encourage hospitals and nursing homes to adopt "zero-lift" or "no-lift" programs in order to prevent orthopedic injuries in healthcare workers. However such Safe Patient Handling and Movement (SPH&M) programs, which require the use of mechanical lifting aids, are sometimes difficult to implement. This is in part due to the time and effort required to safely use lift equipment. Transferring a patient with a lift takes between three and six minutes which is considerably longer than moving a patient manually. Lift manufacturers emphasize that the added time it takes to use lifts is worthwhile since mechanical lifting aids improve caregiver and patient safety and while also preventing patient falls.

One approach that has been used successfully is to create a facility "lift team" that is on call (usually 12 hours a day), and specializes in moving patients. This eliminates a number of issues mentioned above since the lift team brings the lift with them to the patient's room, maintains it in proper working order, is knowledgeable in the use of the lift, has special expertise in sling selection, and can move patients quickly and safely. The downside of the lift team is that the team(s) may be busy when needed, and patients who need to be mobilized quickly to meet schedules must wait for a team to become available. Most lift teams seek to guarantee that they will arrive in the patient's room and begin transfer in less than 20 minutes after the nurse makes a request for service.

Normally, much consideration is given to the patient’s comfort and wellbeing during the transfer process. For some patients, the use of a patient lift is more dignified than transferring a patient manually while some consider being hoisted in a sling less dignified. Lifts can enable families or caregivers to mobilize patients in the home setting rather than forcing patients to be relocated to an institutional setting. The inability to mobilize patients at home is one of the primary reasons that patients find it necessary to leave the home environment and enter a nursing home when they become temporarily or permanently disabled.

Safe patient handling is especially important in the area of bariatric care. Bariatric patients (patients who weigh more than 300 pounds) require additional staff training and specialized equipment for transfer, showering, toileting, etc.

Assessing the impact of prevention efforts, such as Safe Patient Handling programs, on occupational health and safety over time is important. Monitoring injury and illness trends is essential to identifying target interventions to improve occupational safety and health. The Occupational Health Safety Network (OHSN) is a secure electronic surveillance system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care personnel. Hospitals and other healthcare facilities can upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN enrollment is open to all healthcare facilities.

Legal issues

While patient lifts are often used by only one health care worker without assistance, most manufacturers require that two caregivers be present. However, the single caregiver approach makes the patient lift more usable in home care settings where there is often only one caregiver per patient. In either case, patient lifts require special care in their use, as any mistakes made may result in serious injury. Some injuries that have been caused by improper use or malfunction of Hoyer lifts have led to civil lawsuits.^[6][7]

In 1999, a lawsuit was filed after two women were injured in falls at a Massachusetts Sunrise Senior Living facility.^[8]

In January 2008, the family of an elderly Naples, Florida woman sued the nursing home where the woman was residing after she died from a fall off a Hoyer lift. The lawsuit alleges that the nursing home did not take X-rays following her fall.^[9]

In October 2006, Linda Ober, a resident of the Gateway nursing home in Oregon was dropped during transfer from a wheelchair to her bed while using a sling lift for transfer. The fall occurred because of an improperly positioned sling. The fall broke both of her legs. The nursing home failed to give her treatment following the fall for five days which resulted in the filing of criminal charges against two nursing employees and a 5.3 million dollar lawsuit ^[10] against the nursing home. Ms. Ober later died of medical complications resulting from the fall.

There are also legal issues for facilities who don't provide adequate mechanical lifting equipment to their staff. Approximately ten states have adopted legislation mandating that healthcare facilities provide lifting equipment for their staff and there is federal legislation pending. And in 2015, an investigative report for Public Radio did a series of articles on how poorly many hospitals are protecting their nurses from back injuries due to manual lifting vs using mechanical floor or ceiling lifts. Therefore there is a legal and regulatory movement underway to demand more action by employers of nurses to ensure they have the proper equipment and training to safely lift and transfer their patietns.

See also

• Casualty lifting

References