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Save Your Back, Save Your Budget

December 1, 2005
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Simple devices are available to help caregivers transfer residents-even those with bariatric issues-safely, confidently, and with dignity by Janet White
BY JANET WHITE Save your back, save your budget
Safe, simple, and cost-efficient transfer solutions are especially helpful in caring for bariatric residents
For many long-term care facilities, the challenge of patient handling has gotten tougher. Between shrinking reimbursement rates, bigger residents, and an increase in injuries to nursing staff and residents, nursing home operators are often in a bind to effectively care for their residents while keeping their operating costs down.

Although patient handling is a universal issue affecting residents of all sizes, it is particularly important when caring for bariatric residents because they usually require special equipment and more personnel for even routine handling procedures.

In its "Guidelines for Nursing Homes" at, OSHA identifies six common resident transfers requiring equipment:

1. Sit-to-Stand or Sit-to-Sit
2. Repositioning in Bed or Gerichair
3. Seated Lateral Transfers
4. Prone Lateral Transfers
5. Turning
6. Lifting Resident From the Floor

OSHA's guidelines recommend using powered patient-handling devices whenever possible to minimize caregiver injury. Although there are no substitutes for certain capital investments, such as overhead lift systems or convertible stretcher chairs, a ream of small, relatively inexpensive manual items are available to help with the vast majority of resident moves, including difficult bariatric positioning maneuvers-maneuvers such as lifting from the floor, turning, repositioning, and bed-to-wheelchair transfers.

The focus on injury prevention is especially important now that safe patient hand-ling is a matter of law-at least in Texas as of January 1, 2006. Texas SB 1525 requires hospitals and nursing homes to adopt a policy "to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient" (see The policy must include an "evaluation of alternative ways to reduce risks associated with patient handling, including evaluation of equipment and the environment" and "restriction, to the extent feasible with existing equipment and aids, of manual patient handling or movement of all or most of a patient's weight to emergency, life-threatening, or otherwise exceptional circumstances."

Most significantly, the law requires the plan to include "procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury." The law discourages, but does not prohibit, manual moving and lifting of residents. California, Massachusetts, Washington State, and New York all have similar bills pending, and it's clear that such laws will be on the books all across the country over the next few years.

But nursing home residents, especially larger ones, still need to be cared for, despite the risk of injury to nurses. So what's an administrator, DON, or therapist to do?

Many healthcare professionals are now turning to nonmechanical patient-handling products, most of which are small enough to put on a nurse's cart. These products are effectively reducing or eliminating the problems associated with the most common patient-handling issues in long-term care, particularly those with bariatric residents.

These problems may include physical injuries to staff and residents, as well as emotional and psychological injuries-for example, nursing staff may resent larger residents because of the extra care they require, and larger residents may feel humiliated in such an environment. The result is higher turnover of staff and residents.

This article suggests specific pieces of equipment to help reduce injuries among staff and residents, without doing damage to a facility's operating budget. These products make transfers and handling issues easier and less stressful for all involved, and they are especially useful in preserving the resident's comfort and dignity.
Figure 1.
Figure 2.
Sit-to-Stand or Sit-to-Sit
For partially dependent residents, the ideal piece of equipment is a powered stander, which can also be used as an ambulation aid. But in lieu of powered equipment, nurses or therapists are called on to get partially dependent residents to their feet, usually using a gait belt as a lifting aid.

Unfortunately, traditional gait belts were never meant to be used in lifting. They can chafe residents' skin and force caregivers to pull residents awkwardly upward with their arms and back, causing injury to themselves. And canvas gait belts should never be used with bariatric residents because they can literally "get lost" in the folds of a larger resident's skin, causing discomfort and possibly lacerations.

Instead, OSHA recommends using transfer belts with vertical handles to lift residents or to perform an assisted lift, when such a lift is possible. Strategically placed vertical grips (figure 1) allow a caregiver to raise a resident with a minimum of effort, using the long muscles in her thighs rather than her back muscles as leverage.