During a nursing in-service the following question was posed to the nurses: “How many of you go home with sore backs and need to take something to sleep at night because of it?” With most of the nurses raising their hands, we wanted to assure them they do not have to go home in pain and worry about if they will remain healthy until retirement.
Nursing is one of the most physically demanding professions. The average nurse lifts 1.8 tons each working day. As a result, 45% of all healthcare workers compensation claims dollars are spent on patient transfer related claims, and the average back surgery claim costs over $100,000. In addition, managing patient transfer risks protects the patient, as well as the caregiver. The average dropped patient claim cost over $15,000.
The following are some best practices for Patient Transfer to help manage these risks.
Best Practice #1 – Document Patient Transfer Requirements in the Chart
From admission to discharge, lifting requirements should be annotated in the chart. If there is no documentation of lifting requirements, then there is less accountability for failure to follow lifting protocols. The documentation should include the type(s) of equipment required for the transfer, the number of people required to safely move the patient, and any special considerations, such as:
- the ability of the patient to assist
- weight bearing status of patient
- upper extremity strength of patient
- ability of patient to cooperate/understand directions
- patient height/weight
- combative or mentally ill patients
- special circumstances, such as post-surgery, spinal injuries, presence of tubes, etc.
Most electronic medical records have the capability to include lifting requirements in the chart. Many hospitals also write the requirements on white boards in the room. However, if the requirements are on a white board or separate nurses notes, they need to also be documented in the chart. As a patient’s condition changes, the chart should also reflect changes in lift requirements, and should be a standard part of every patient hand-off.
Best Practice #2 – Education
Every employee who is involved with patient transfers should be provided handson training at orientation and at a minimum of once per year. The training should include a demonstration of proficiency on every type of patient transfer equipment and slings, gait belts, slip-sheets and team lifts. Each type of transfer should be individually demonstrated for proficiency and individually signed-off on. The instructors should be well trained; often, the best instructors are physical therapists.
Best Practice #3 – Team Lifting
When team lifts are mentioned, many think of “burly guys “to move every patient. Rather, it is the practice that nurses can call upon other caregivers to assist in patient transfers. Examples of appropriate team lifts include:
- Turning patients/repositioning/pulling patients up in bed
- Bed to wheelchair and back
- Wheelchair to commode and back
- Fallen patients
- Difficult or dependant admissions/discharges
- Helicopter and ambulance off-loads
- Morgue transfers
- Assistance in walking patients
In determining the number of people needed to transfer the patient, the most important factors are what is safest for the patient and the caregiver, as well as what will be most comfortable for the patient. Again, team lift requirements should be documented.
Best Practice #4 - Gait Belts and Patient Transfer Equipment
Gait belts are a “gate keeper” risk management tool. Generally, if a facility is using gait belts, then the caregivers are far more likely to use other appropriate equipment and call for team assistance. We recommend that either gait belts be placed in every room or that they become part of the caregiver’s uniform.
Patient transfer equipment can significantly reduce the likelihood of caregiver injuries. However, we often find that because of a lack of training or a lack of comfort level with the equipment, the equipment may remain in a closet unused. Lack of use can be a very expensive mistake. For this reason, we highly recommend the utilization of equipment with sufficient education and documentation.
The keys to best practices are communication and accountability. The aforementioned key indicators require clear communication to implement and
provide a solid basis for accountability. Yet, the over-riding purpose is to keep caregivers and patients safe, healthy and pain free.
ABOUT THE AUTHOR
Christopher M. Miller is the Director of the Healthcare Practice office located in Kansas City, Missouri. If you have questions about this or other risk you face, please contact your Gallagher Healthcare consultant.