Today’s PTs have more options than ever for safe patient transfers.

By Design, People are Simply not Easy to Move. Regardless, for Health Care Professionals Tasked With Handling Patients, There is no Choice but to Make it Happen. Though the Topic is Getting More Attention now Than Ever Before, the Very Nature of the Task has Always Presented Inherent Risks to the Caregiver.

“Patient handling has always presented a challenge, because people are not boxes. And even though some of us might think we have handles, we really do not have a firm place to grasp,” laughs Kathleen Rockefeller, PT, ScD, MPH, assistant professor at the School of Physical Therapy at the University of South Florida in Tampa. Rockefeller also currently serves as vice president of the Occupational Health Special Interest Group of the Orthopedics Section of the American Physical Therapy Association. “However, I think there has been an increase in the awareness of the implications to the health and safety of health care professionals.”

These challenges exist not just for PTs, but for all health care professionals—including nurses and occupational therapists—and Rockefeller credits much of the progress made regarding safe patient handling to the nursing community.

“There are more nurses in the country—from registered nurses to licensed practical nurses to nursing assistants—than there are therapists, so we do have very good, consistent data on injuries in nursing,” Rockefeller explains, noting that information pertaining to nursing collected by the Bureau of Labor Statistics (BLS) does not necessarily include data about PTs as well, because therapists are not an occupational category “captured” by the BLS; therapists are in the broad category of “other health professionals.” Improvements have started taking place, however. “For the past decade or so, the Patient Safety Center at the Tampa VA hospital, among others, have taken on the challenge of really doing research on issues related to patient handling by therapists.”

At the same time, and perhaps because of this increased focus, a push has been under way by manufacturers to create more and better products for patient handling.

The Best Intentions
In many health care facilities, making mechanical-lifting mechanisms available is not the challenge. However, getting them used is a different story.

“There’s always been some type of mechanical lift, but usually they were back in the storage room because they looked very intimidating, with chains and a hand pump,” Rockefeller says. “They were inconvenient for the health care professional and scary for the patients.”

Today’s systems incorporate state-of-the-art technology, making use of hydraulic lifting mechanisms and battery-operated controls. The resulting systems are far more appealing from an aesthetic perspective, while simultaneously performing in a smoother and more maneuverable manner.

More selection also translates to more choices for therapists. Rockefeller recommends PTs take advantage of the fact that more products are available for patient-handling interactions today than even 5 years ago.

“I’m not going to say it’s easy yet, but we’ve made great gains at being able to match a patient’s capabilities with a piece of equipment,” Rockefeller says. “And we certainly should take a look and she what might be applicable.”

Doing a Little Digging
Rockefeller encourages individual PTs to educate themselves and become more knowledgeable about the different types of equipment currently available. One great resource is the Internet. While she advises carefully evaluating any information collected online, she notes the wide variety of credible, free information.

“I encourage people not to re-create the wheel, because there is a lot of great information about this topic out there,” Rockefeller says. “Tampa VA’s Patient Safety Center site provides a list of products with links to vendor sites, as well as its whole ergonomics guide—over 120 pages—available for download.”

A myriad of sites provide free materials and contact information for equipment manufacturers, including links directly to their sites. In addition to being a great start for research, these types of “portals” make it easy for therapists to see what’s available, evaluate different models, and contact manufacturers directly for more information or to request on-site demonstrations.

Another option is product exhibitions at conferences and industry meetings, such as the 2006 Safe Patient Handling and Movement Conference held earlier this year in Clearwater Beach, Fla. Rockefeller served as part of the faculty, leading a session in the use of patient-handling technology to support therapeutic rehabilitation interventions.

Beyond getting hands-on access to the latest and greatest technologies, the greater the number of PTs attending these types of shows, the better the show becomes as a draw for vendors—creating a win-win scenario for everyone.

“It’s circular. Because of expense involved for a company to send people to show their products, the full range of products aren’t always displayed at physical-therapy conferences,” Rockefeller says, noting that the bigger the audience, the better the return on investment for vendors and the better the selection for attendees to experience.

There’s another benefit Rockefeller feels is just as important as access to information—access to the people responsible for creating the equipment. “The manufacturers want to hear our feedback, whether it’s about products that are not developed yet we think would serve a role in the patient-handling continuum, or if there are modifications to existing products that might make them more useful. The vendors really welcome to our ideas.”

Finding the Perfect Fit
Rockefeller emphasizes the difficulty in providing blanket recommendations for products or services because the needs of each facility vary greatly. Factors include a location’s unique patient population and its individual staffing patterns, and as best as possible, predictions about trends in the care provided. She gives the example of a brand-new medical center being built from the ground up.

“That is the ideal time to consider putting in the infrastructure for patient-handling equipment, particularly overhead or ceiling lifts,” Rockefeller says. “Whereas if you’re in a 50-year-old building that can’t accommodate ceiling lifts because there is asbestos, you’re going to have to choose a portable floor lift. Neither is necessarily better than the other; it’s about finding what works best for each facility.”

It’s also vital for institutions to understand that equipment is just the starting point. In order to make any safety program work, it requires effort from the entire health care facility.

According to Rockefeller, research and case studies on the topic make it abundantly clear that facilities must establish and implement policies and procedures that make equipment available when needed, and develop the staff and workflow to ensure it remains operable.

“You have to have the communication avenues in place so people know where the equipment is, how to get batteries charged, and where to get the slings,” Rockefeller says. Such things require coordinating with other departments, such as laundry facilities and the infection-control team. “You also need to have your training and education teams on board, because it’s essential for there to be mechanisms available for educating employees on the proper use of equipment.”

All Corners of the Triangle
In addition to equipment considerations, how safe a patient transfer is depends heavily on the participants involved.

Using the analogy of a triangle, Rockefeller points out the factors that need to be evaluated and accounted for in order to accomplish the job successfully. The first “corner” of the triangle is the patient.

“One of the challenges, especially in acute-care nursing homes, is that the patient’s condition changes constantly,” she explains. “Someone may be fully coherent in the morning and really tired in the evening; or their pain medications may differ; or other medications or treatments may change, so the patient is not static.”

Caregivers—the second corner—also need to constantly evaluate their own resources and condition on a daily basis. There is little argument that a brand-new therapist has a different tolerance level than one with 30 years’ experience, but even the most energetic PT has “off days”—all of which needs to be taken into consideration prior to handling patients.

The last component of the triangle is the actual environment where the care is taking place. Rockefeller believes it’s important for therapists to take into account everything going on in the room.

“This gets a little bit into the materials-handling and good principles of dealing with the environment that we all should do,” she says. “But it means considering if there are things in the way, knowing if the floor has just been waxed, noticing if the patient is distracted because the TV is on—that type of thing.”

In addition to relocating a patient from point A to point B, PTs have to also ponder how best to maximize available rehabilitation opportunities.

How exactly to do it all is a common topic at conferences and organization meetings, and Rockefeller is happy to see that it’s arching between nurses and PTs.

“At the [2006 Safe Patient Handling and Movement] conference in Florida, there was a group of therapists and rehabilitation nurses trying to look at the issues from the perspective of both of those disciplines,” says Rockefeller, who is encouraged by the recent partnership between the American Physical Therapy Association and the Association of Rehabilitation Nurses. “And the challenge we discussed was: How can we try to do it all? How can we protect the patient? How can we protect ourselves and facilitate the patient’s rehabilitation? And I think we are getting movement in that direction.”

Building Good Habits
Because of the diversity between health care facilities and the variances of patient populations, Rockefeller believes creating a master list of guidelines for safely moving patients is nearly impossible. Eventually, there is likely to be advice and recommendations specific to that patient population. However, she is a big believer in sticking with the basics.

“The things we were taught in physical-therapy school about patient assessment—weight-bearing, pain status, cognitive status, and that we need to stop and take 10 seconds to think about the situation—all of those things are still applicable; we just need to remember them,” she says, immediately acknowledging how challenging that can be in today’s hectic hospitals and care centers. “I know in a busy health care environment doing that is tough. So I’m not saying it is always easy, but it’s like any habit you have to get into.”

In order to enjoy a longevity of practice, it’s also important for therapists to be realistic about their own physical capabilities and avoid taking shortcuts to accomplish difficult tasks.

“A lot of us are survivors, so we learn tricks to get things done. But why put ourselves in a situation with the potential to jeopardize our own health?” she says. “That doesn’t do us any good, it doesn’t do our families any good, and it doesn’t do our patients any good.”

Teaming Up
In many facilities across the country, the question of proper patient handling is answered with the establishment of a designated lift team, something Rockefeller is not supportive of as a long-term measure because it essentially gives a small group of people all of the risk.

While the threat may be partially mitigated because, in the vast majority of cases, these teams tend to consist of the youngest and strongest staff members, the real problem goes unsolved.

“In some situations—a busy emergency room for example—lift teams might be one piece of the strategy,” Rockefeller says. In some cases, health care organizations have taken a traditional lift team and transformed it into subject-matter experts on using patient-moving systems. “In that case, they are really more of a transfer team, and they become the go-to people for demonstrating proper use of the equipment.”

Rockefeller still emphasizes the more-desirable option of making proper equipment and training available to caregivers, and she believes therapists can be a significant part of the solution.

“With our background, knowledge, and skills, therapists are well-situated to be on the ergonomics committees, safety committees, patient-handling committees, and equipment-selection committees. I want to see us at that table,” she says. “It’s important to communicate the message that therapists no longer have to feel their backs have to be a hoist. There are options available for improved safety; we just need to get word out.”

Dana Hinesly is a contributing writer for Physical Therapy Products.