Presented By: Audrey Poei, OT Reg. (Ont.) and Dawn Wiggins, RPN Motion Specialties The Motion Group

Transcription

1 Presented By: Audrey Poei, OT Reg. (Ont.) and Dawn Wiggins, RPN Motion Specialties The Motion Group

2 Objectives Participants will be able to: Differentiate categories of lift and transfer equipment based on functional abilities i of its user. Identify the differences among slings available for lifts. List the steps involved for correct sling application i and use. List major safety factors involved in the operation of List major safety factors involved in the operation of lifting equipment.

3 Agenda Definition of a lift, transfer and reposition Goal of Safe Client Handling Assessment Holistic Perspective Algorithm from U.S. Department of Veterans Affairs Safe Client Handling Equipment Lifts Slings Transfer and Repositioning Aids

4 Definitions Lift Supporting the entire weight of the client while moving from one surface to another. Transfer A collaborative effort between caregiver and client while moving from one surface to another. Reposition Changing the position of the client on the same surface.

5 Goal of Safe Client Handling To utilize the safest method for both the caregiver and client, but also allow the client to be as independent d and participate ii as much as they are able.

6 Assessment Holistic Perspective (Canadian Model of Occupational Performance and Engagement) Person Cognitive, affective, physical and spiritual Occupation Slf Self care, leisure and productivity i Environment Physical, institutional, cultural l and social il (Polatajko, Townsend & Craik, 2007).

7 Assessment: One more thing Also consider Caregiver/Healthcare Provider Height, weight, strength, knowledge/training, etc.

8 Assessment Algorithms Assessment Criteria and Care Plan for Safe Patient Handling and Movement Developed by the US Department of Veterans Affairs VA Sunshine Healthcare Network / i / f andling/ Algorithms for various types of transfers and clients such as bariatric and orthopaedic conditions. (NIOSH, 2009; US Department of Veterans Affairs, 2011).

9 Assessment talgorithms Asks questions about The Client s: 1) Level of assistance (independent, partial, dependent) 2) Weight bearing status (none/partially/fully) 3) Cooperative/Comprehension (Yes/no) 4) Bilateral upper extremity strength (Yes/no) 5) Weight and height (BMI) (NIOSH, 2009; US Department of Veterans Affairs, 2011).

10 Assessment Algorithm Physical components of the client Check applicable conditions that may affect handling techniques used Hip/Knee/Shoulder Wounds affecting Severe Replacements transfer/positioning Osteoporosis/low bone density History of Falls Amputation Severe Pain/Discomfort Paralysis/Paresis Urinary/Fecal stoma Postural Hypotension Unstable Spine Contractures/Spasms Splints/Traction Severe Edema Tubes (IV, Chest, etc.) Respiratory/Cardiac Compromise Very Fragile Skin Fractures (NIOSH, 2009; US Department of Veterans Affairs, 2011).

11 Assessment Algorithms Algorithm 1: Transfer to and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair Algorithm 2: Lateral Transfer To and From: Bed to Stretcher, Trolley Algorithm 3: Transfer To and From: Chair to Stretcher or Chair to Exam Table Algorithm 4: Reposition in Bed: Side to Side, Up in Bed Algorithm 5: Reposition in Chair: Wheelchair and Dependency Chair Algorithm 6: Transfer a Patient Up From the Floor (NIOSH, 2009; US Department of Veterans Affairs, 2011).

12 Algorithm 1 Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair (U.S. Department of Veterans Affairs, 2011).

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14 Equipment toverview Lifts Total Passive Lifts Floor Ceiling (portable or fixed) Slings Hammock split leg Long seated/sit on Horseshoe Style (e.g. Quick Fit/Combi/Universal) Positioning Band/limb Walking/standing Transfer and Repositioning Aids Pivot Disc Handling Belt One way slide/glide Slide sheets Transfer board Repositioning Gloves Note: This is not an exhaustive list.

15 Total lpassive Lifts 1. Floor 2. Ceiling I. Portable II. Fixed

16 Total lpassive Lifts 1. Client 2. Caregiver 3. Types and how often transfers needed 4. Physical environment 5. Equipment options

17 Total Passive Lifts: Floor Lifts 1. Client Criteria i) Unable to bear weight, ii) Not co operative/unable to follow directions, iii) No upper extremity strength 2. Caregiver Typically done with 2 caregivers, but can be used with one caregiver. Refer to facility policies. 3. Types of transfers needed

18 TtlP Total Passive Lifts: Floor Lifts 4. Physical environment Transfer location from point A to point B Space underneath the bed: Can legs and castors fit under the bed? Height and size of the bed/wheelchair: Transfer point location (drop off and pick up location) Lifting height Base opening width Flooring 5. Equipment Check lift specifications Charging (i.e. Battery how often will it be used, would you need a second back up battery?) Slings and funding available Maintenance

19 Safe Use of Floor Lifts Perform a visual inspection of the lift and its component parts (e.g. slings) Rf Refer to manufacturer and facility specific instructionsi Keep in mind the concept of centre of mass over base of support to maintain stability.

20 Centre of Mass and Base of Support Physics 101

21 Centre of Mass and Base of Support Plan ahead and set up properly Lift used for transferring, not transportingti Open the legs to increase the base of support When using the lift, breaks on or breaks off? When turning the lift, move the lift around the client from the legs/base (e.g. pendulum)

22 Total Passive Lifts: Ceiling Lifts 1. Client Criteria i) Unable to bear weight, ii) Not co operative/unable operative/unable to follow directions, iii) No upper extremity strength* 2. Caregiver Can be done with one person. 3. Types of transfers needed 4. Physical Environment 5. Equipment Options Many options available, contact your dealer/vendor *Refer to sling criteria needed

23 Track kconfigurations i

24 Total Passive Lifts Portable Ceiling Lift Things to consider: How often and where are your transfer location(s)? Weight capacity Lift accessories (e.g. lanyard, reacher, weigh scale, carrybar) Cart/trolley Charging station Area for storage Slings Fixed Ceiling Lift Things to consider: How often and where are your transfer location(s)? Weight capacity Lift accessories Charging location Slings

25 Sit to Stand t St Lift Client tcriteria: i) Able to partially bear weight (at least 35 lbs) ii) Co operative (ie. Can follow directions) iii) Able to hold on using arms* *Refer to manufacturer specific instructions

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27 General Sling Overview Sling Options Various types Mesh, Canvas, Quilted, Padded Head support, no head support Waist bands (Velcro or buckle) Disposable and Re usable/washable etc.

28 Sling Types Hammock ( split leg ) Long seat ( full sling ) Horseshoe Style (e.g. Quick Fit/Combi/Universal) Hygiene/Toileting Positioning Roller bands/limb Standing/walking

29 Hammock ksling Client Criteria: i) Unable to weight bear ii) Uncooperative/co operative (recommend sling with hip/side straps) p) iii) No upper extremity strength 4 or 6 straps available 6 straps provide hip and lateral support Provides minimal hip rotation (picks up the client with hips in neutral thus reducing skin friction and shearing). Supportive for clients with uni or bilateral above knee amputations Caution use for clients with hip replacements

30 Long Seat Sling Client Criteria: Amputee (Single or bilateral and above the knee or below the knee ) Obese Tiny/frail especially ypalliative Contracted and Combative This sling goes on in bed and stays on. The mesh offers more breathability. No pressure points and no leg straps to unfold and bunch beside in chair so eliminates those pressure points. Great for log rolling in bed and raising upper body to assist in getting x ray films under people (especially in ICU's or trauma units) due to complications of rolling pt.'s with tubes. *positioning sling also works if supine lifting is required Caution use: Client with skin compromised skin integrity and therapeutic surface being used.

31 Horseshoe Sling Client Criteria: i) Unable to weight bear ii) Uncooperative/co operative iii) No upper extremity strength * Sling sizing is very important

32 Hygiene/Toileting il Sling Client Criteria: i) Unable to weight bear, but able to maintain i a seated position while being lifted ii) Co operative iii) Able to hold on with arms and keep arms placed outside of sling

33 General Sling Application Guidelines For seated slings: 1. Lean client forward and slide sling along back of chair behind the client (centre bottom of sling opening to client s tailbone and top of seat cushion). 2. Guide leg supports along outer thighs, h then bring sling up between the client s legs/thighs. 3. Cross leg straps through each other. 4. Attach sling straps to carry bar while holding onto carry bar. 5. Lift client up using the control unit. Before moving, check sling fit and strap safety (lower and correct if issues identified). 6. Complete transfer to new surface and lower client. 7. Unhook straps from carry bar. 8. Carefully guide leg straps under legs and away from thighs. 9. Lean client forward and carefully remove sling. * For general reference only. Does not supersede manufacturer or client specific instructions.

34 Application Procedure Refer to manufacturer specific instructions Options: 1. Open Leg 2. Divided Crossed Leg 3. Closed Leg

35 Positioning i i Sling Client Criteria: i) Unable to assist (dependent) OR ii) Able to partially assist it but greater than 200 lbs Used for lateral transfers, turning and boosting in bed Works well with a fixed ceiling lift and carry bar Consider compromised skin integrity, therapeutic ti surface being used.

36 Band Sling Client Criteria: i) Roller bands ii) Log rolling iii) Limb lifting Indications for use include: i) Bariatric use. (when getting a sling under is too manual) ii) Difficult to move resident s iii) Wound care iv) Assist with catherization v) Perineal care

37 Walking Sling Client Criteria: i) Ability to bear weight ii) Able to understand commands iii) Upper extremity strength required to push off arm rests or hold onto parallel bars

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39 Transfer and Positioning Aids Transfer Belt Pivot Disc One way slide/glide Slide sheets Transfer boards Seated Sliding Transfer Board Lateral Supine Transfer

40 Standing up from a seated position Breakdown: Position feet to allow for a proper base of support Place hands on arm rests Flex hip (nose over toes) Scoot to the edge of the chair Grasp firmly and push off arm rests using arms meat over feet

41 Transfer Belt Client Criteria: i) Partially weight bearing ii) Cooperative/able to follow commands iii) Upper extremity strength * Transfer to client s stronger side

42 Pivot Disc Could be used for: o: i) Car transfer ii) iii) Standing transfer Turning from edge of bed into lying position Client Criteria: i) Partially weight iht bearing ii) Cooperative iii) Able to follow directions

43 One Way Slide Assists with repositioning in a chair (correct sacral sitters) Not recommended to use for clients with compromised skin integrity (e.g. pressure ulcers), utilizing a therapeutic surface, etc. Use your clinical judgement

44 Slide Sheets Client tcriteria: i) Partially able to assist ii) Less than 200 lbs iii) 2 caregivers Cue client to assist with reposition Set up bed accordingly (pillows at head of bed and trendelenburg if possible)

45 Seated Sliding Transfer Board Client Criteria: i) Unable to bear weight ii) Cooperative/able to follow directions iii) Good upper extremity strength * Chair arms rests must be removable

46 Supine Lateral Transfer Board Client Criteria: i) Partially or unable to assist ii) < 200 lbs

47 Education Sessions Follow manufacturer s specific instructions Contact your vendor to set up training on equipment use Education topics include: Equipment specific in servicesi Train the trainer Half day or full day Safe Client Handling Seminars

48 Resources Contact your vendor Refer to manufacturer website Public Services Health and Safety Association, US Department of Veterans Affairs VA Sunshine Healthcare Network andling/

49 Speakers Contact Info Audrey Poei, OT Reg.(Ont.) Clinical Education Coordinator Motion Specialties Dawn Wiggins, RPN Clinical Educator Motion Specialties

50 Thank you!

51 References National Institute for Occupational Safety and Health [NIOSH]. (2009). Safe patient handling training for schools of nursing (DHHS Publication No ). Cincinnati, OH: US U.S. Government Printing Office. Polatajko, H.J., Townsend, E.A. & Craik, J. (2007). Canadian Model of Occupational Performance and Engagement (CMOP E). In E.A. Townsend and H.J. Polatajko, Enabling Occupation II: Advancing an Occupational Therapy Vision of Health, Well being and Justice through Occupation. P.23 Ottawa, ON: CAOT Publications ACE. U.S. Department of Veterans Affairs. (2011). Algorithms for safe patient handling and movement. Retrieved from p// /p / ing/