Getting a Lift to Safety
Date: April 15, 2013
Too weak to stand on her own, the patient had slunk to the floor, where she remained while a nurse sought help to lift her into a hospital bed. Happening by chance upon the scene, Quentin Simeone, clinical coordinator for patient transit services at Suburban Hospital, suggested they use the mechanical lift device that was available for that purpose.
“The patient probably weighed over 350 pounds, and there was no way we could have safely lifted her back into bed. And someone on the care team could have injured themselves,” Simeone says.
In 2007, the Maryland legislature passed a law requiring hospitals to create safe patient handling policies and protocols for using mechanical devices to lift, transfer and reposition patients who weigh 35 pounds or more. The legislation chiefly targeted the high incidence of back, shoulder and other injuries experienced by nurses and other frontline staff.
But as Simeone and co-workers developed a compliance plan, they soon realized that a safe environment for employees is a safe environment for patients as well.
Whether in ambulatory or inpatient settings, unsafe handling procedures that place patients as well as workers at risk have caught the attention of caregivers throughout the Johns Hopkins Health System and across the nation. “Few activities in health care link patient and worker safety more directly than lifting, transferring, repositioning and ambulating patients,” the Joint Commission asserts in a recent monograph.
The uncertainty experienced by patients during a makeshift transfer hinders trust in caregivers, says Terry Nelson, assistant director of nursing in the Department of Medicine at The Johns Hopkins Hospital. “A lot of patients look at us inquisitively, as if to ask, ‘How strong are you?’ and you’re 5 feet, 2 inches and don’t have the best back,” Nelson says. “Even when patients are being moved from a stretcher to a bed or chair, they feel better when there’s a device underneath them.”
With guidance from Hopkins Hospital’s safe patient handling committee, Nelson, along with Melinda Sawyer, then the department’s safety officer, spearheaded a department-wide initiative to reduce lift-related injuries. New devices were placed on every unit, an ongoing training program launched and a cadre of nurse super-users assigned to promote unit-based safe handling practices.
“We need to change the culture: that’s the most difficult thing,” Nelson says. “Every single day, managers and lift champions have to make the equipment visible and advocate its use, help nurses and other frontline workers use the devices more quickly, and more efficiently.”
Reinforcing the Message
This year, Hopkins Hospital’s safe patient handling committee has made it a priority to educate staff on the availability of lift devices and protocols for their use. In January, the committee invited a safe patient handling expert to reinforce the correct use of lifts in various clinical settings. Slowly but surely, constant encouragement from Nelson and scores of other managers and lift champions in the Department of Medicine have led to acceptance of new handling policies and practices, she says. “As they care for a sicker and heavier population, medicine staff members on all floors are reporting regular use of mobile lifting devices,” Nelson says. Correct handling methods and devices are essential in outpatient settings as well. Until recently, some frail or disabled patients arriving at the Johns Hopkins Outpatient Center didn’t anticipate the level of support they would need to get out of their vehicle, even with assistance. “We would do what we could, but recognized that there has to be a safer way for the patient and staff,” says Julie Kubiak, the outpatient center’s assistant director of nursing.
After careful research, Kubiak’s department purchased a portable lift and partnered with security personnel to develop a protocol for assessing patients’ need for lift assistance. Before the lift device went into service, however, it got a workout from Kubiak and her team. “We brought our cars around and pretended to be patients to see what it would feel like, located the flattest part of the curb and how the process differed, depending on the vehicle.”
Portable lifts are now stationed outside the adult emergency department in the Sheikh Zayed Tower, the Meyer building and the Jefferson Street entrance to the Weinberg building. “Some people may question the need for a lift that is used perhaps four or five times a year. But every time it’s used, it’s very important,” Kubiak says. “Otherwise, that patient wouldn’t be able to see their provider.”