Full Lifting Mobile Hoists: Are we missing opportunities to avoid manual handling?

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Hoisted beyond safety

Beyond Safety

1 Risk Managed Pty Ltd

FULL LIFTING MOBILE HOISTSAre we missing opportunities to avoid manual handling?

Aideen Gallagher Risk Managed

1BEYOND SAFETYIf and when to prescribe a full lifting hoist2Using and choosing full lifting hoists3Using and choosing ceiling track hoistsHoistED programme

This presentation today if part of a workshop series I have developed called HoistED, which essentially means hoist education. The workshop has three levels and is run over three days. The first level addresses if and when to prescribe a full lifting hoist. Level two addresses using and choosing full lifting hoists and level three addresses ceiling track hoists.

The programme applies the most up to date research on injury prevention, manual handling and hoist use from a physical, social and emotional level. My vision is that every therapist prescribing a hoist uses a simple system to ensure they end up with a solution that in safe, efficient and takes very opportunity to avoid any exposure to manual handling. The second vision I have for this workshop is that is provides a pathway to bring the most innovative equipment in this space to the prescribers by providing an avenue for meaningful engagement with quality equipment through the problem solving activities participants go on. My aim is to introduce some best practice guidelines to the area and the study yesterday is an example of that.3 Risk Managed Pty Ltd

BEYOND SAFETY2Using and choosing full lifting hoistsHoistED programme

Today we are going to complete on of the activities from level 2 of the programme in using and choosing full lifting hoists4 Risk Managed Pty Ltd

BackgroundTheoryPracticePRESENTATION OUTLINEBEYOND SAFETY

Selecting a hoist system the Hoisted programme

A hoist system has three main parts, a hoist, a yoke and a sling. Under the Hoisted programme, it is recommended a hoist is selected, then yoke and finally the sling


Person Environment Occupation (PEO) Model (Law et al, 1996)

This diagram illustrates the PEO model of occupational performance, which we all learn in university. It basically says that the person interacts with the environment, through the tasks they do and the way they do it. 6 Risk Managed Pty Ltd

Person Environment Occupation (PEO) Model (Law et al, 1996)

If you look at this diagram it essentially includes everything you have to consider when addressing a manual handling issue and some of these factors are indeed more important than others. The tasks are manual handling transfers, the performance becomes how we do them and the aim in the middle is a safe and efficient transfer. This concept of efficiency is a key point I want to come back to later. This diagram assumes that one person interacts with the environment through the task however in manual handling there is always at least two people and in bariatric care, sometimes more. What was a simple diagram now gets complicated and we feel somewhat surprised when manual handling is complicated.


Nurses 21.9/100FTECare aids 37/100FTE (Alamgir et al, 2007)

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The health care sector has been recognized as a hazardous industry with higher rates of musculoskeletal disorders (MSD) compared with the national average (HSE, 2014). Within the sector, whilst nurses in acute care were found to have an injury rate of 21.9 per 100 full time staff, nursing home staff recorded the highest annual injury rates with 37.0 injuries per 100 full time staff (Alamgir et al, 2007). Campo et al, (2008) found a further likelihood of MSD with increased exposure to manual handling tasks.


There are many reasons in the literature about why a support worker can get injured. Lower rights, low education but also the fact they are working in the family home. No matter what anyone says about WHS right, it is still the clients home and that in itself leaves the care giver vulnerable.

The care giver needs to get an outcome. You need to get the client on the bed, you need to get the client into the chair. You cant essentially say no, as Chris said yesterday some days you have to do it. So if there is a gap, the care giver has the fill it. I believe if we prescribe hoists correctly, there should be no gaps or unnecessary manual handling and my workshops teaching therapists the skills of working this out.

What is the gap?Healthcare activities involve a variety of these manual handling tasks, essential to patient care. Manual handling is defined as any activity that requires the use of force to lift, lower, push, pull, carry or otherwise move, hold or restrain a person, animal or thing (Occupational Safety and Health Regulation, 1996). Retsas and Pinikahana (2000) confirmed that potentially hazardous manual handling is not confined to lifting tasks alone but can arise from less strenuous manual handling tasks. Such tasks include positioning or moving equipment.


AIM OF A HOIST

SAFE TRANSFER

EFFICIENT TRANSFER

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The world health organisation talks about health being much more than the absence of disease, it is a state of wellbeing.

Similarly, I think the use of a hoist should aspire for much more than the aim of safety, it should aspire for efficiency and this is what we will look at today in terms of hoist prescription

Aim of a Hoist System

A full lifting hoist is used by non-weight bearing individuals. As well as transferring a client comfortably and safely, the traditional aim of a hoist system is to eliminate lifting from the transfer for the care giver. Although hoists reduce lifting, there can be a high level of manual handling required within a hoist transfer, exposing a care giver to musculo-skeletal injury (MSI). The Hoisted programme involves systematically identifying areas where this exposure to manual handling is taking place and implementing strategies to control it. The aim is therefore an efficient and effective hoist transfer that aspires beyond the safety aim.


HOIST PRESCRIPTION STAGES

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THE HOIST

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The hoist is the foundation to whether a full system will meet the pick up and drop down points. The hoist interacts with equipment that creates a footprint. The hoist must fit around this footprint to meet these pick up and drop down points. If the equipment does not facilitate the client be moved to and from these pick up points, the care giver will be required to fill the gaps leading to unnecessary manual handling.


ACTIVITY ANALYSIS

IDENTIFY DROP DOWN AND PICK UP POINTS

TEST IF THE HOIST MEETS DROP DOWN AND PICK UP POINTS123

HOIST PRESCRIPTION PROCESSBEYOND SAFETY




Origin of a transfer

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Destination of a transfer

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SAFE WORKING LOAD

Firstly it is based on weight and the safe working load. If someone is large in terms of weight, we choose a large hoist and if small you use a small hoist. This is correct for weight16 Risk Managed Pty Ltd

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ANTHROPOMETRICS

Secondly based on size of the person in terms of antro-metrics. Taller person, larger hoist, smaller person smaller hoist. This is also correct and this is there is another reason when you might choose a larger hoist17 Risk Managed Pty Ltd

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This humble wheelchair is the key to hoist prescription in determining the hoist, yoke and sling.

Chris Coliviti talked about your client giving you clues as to the way they do things if you look. This wheelchair will give you lots of clues as to what hoist, yoke and sling to select for a client.

We are not just looking about safety here, we are aspiring for as much efficiency as possible.18 Risk Managed Pty Ltd

EQUIPMENT FOOTPRINTSBEYOND SAFETY

If we are looking to ensure an efficient hoist transfer, we need to look at equipment footprints19 Risk Managed Pty Ltd

ORIGINDESTINATIONBedShower commode chair Shower commode chair BedBed Wheelchair

ACTIVITY ANALYSIS1BEYOND SAFETY





POSITIONING INTO THE WHEELCHAIR Where should the drop down point be?BEYOND SAFETY

OriginPick up pointDestinationDrop down pointBed900mm from top of bed 450mm inShower commode chair Client back touching backrest when 5cm from seat of chair Shower commode chair Yoke at sternum of clientBed900mm from top of bed 450mm inBed 900mm from top of bed 450mm inWheelchair Client back touching backrest when 5cm from seat of chair

IDENTIFY DROP DOWN AND PICK UP POINTS2





Testing a hoist meets pick up and drop down points

When the care receiver is moved to 5cm over the seat of the chair, do they reach the drop down point with their back touching the backrest of the chair?Station 1Station 2Station 3Station 4HoistSmall HoistSmall HoistLarge HoistLarge HoistChair Small chairLarge chairSmall chair Large chair Positive ObservationsNegativeObservations





REFERENCES

Alamgir, H., Civtkovich, Y., Yu, S., Yassi, A. (2007). Work-related injury among Direct Care occupations in British Columbia, Canada. Occupational Environmental Medicine, published online May 23, 2007 Campo, M., Weiser, S, Koenig, K. L., & Nordin, M. (2008). Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Physical Therapy, 88, 608619.

Health Service Executive (2014). Musculoskeletal Disorders in Great Britain 2014. www.hse.gov.uk/statistics/Kay, K., Glass, N. & Evans, A. (2014). Its not about the hoist: A narrative literature review of manual handling in healthcare. Journal of Research in Nusring, 19(3), 226-245.Martin PJ, Harvey JT, Culvenor JF, Payne WR. Effect of a nurse back injury prevention intervention on the rate of injury compensation claims. J Safety Res. 2009;40(1):139. http:// dx.doi.org/10.1016/j.jsr.2008.10.013.Marras, W.S., Knapik, G. G., Ferguson, S. (2009). Lumber spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices. Ergonomics, 52 (3), 384-397.

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References:Alamgir, H., Civtkovich, Y., Yu, S., Yassi, A. (2007). Work-related injury among Direct Care occupations in British Columbia, Canada. Occupational Environmental Medicine, published online May 23, 2007 Campo, M., Weiser, S, Koenig, K. L., & Nordin, M. (2008). Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Physical Therapy, 88, 608619.

Health Service Executive (2014). Musculoskeletal Disorders in Great Britain 2014. www.hse.gov.uk/statistics/Kay, K., Glass, N. & Evans, A. (2014). Its not about the hoist: A narrative literature review of manual handling in healthcare. Journal of Research in Nusring, 19(3), 226-245.Martin PJ, Harvey JT, Culvenor JF, Payne WR. Effect of a nurse back injury prevention intervention on the rate of injury compensation claims. J Safety Res. 2009;40(1):139. http:// dx.doi.org/10.1016/j.jsr.2008.10.013.Marras, W.S., Knapik, G. G., Ferguson, S. (2009). Lumber spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices. Ergonomics, 52 (3), 384-397.Retsas, A., & Pinikahana, J. (2000). Manual handling activities and injuries among nurses: an Australian hospital study. Journal of Advanced Nursing, 31(4), 875-883.Schoenfisch AL, Lipscomb HJ, Pompeii LA, Myers DJ, Dement JM. Musculoskeletal injuries among hospital patient care staff before and after implementation of patient lift and transfer equipment. Scand J Work Environ Health. 2013 Jan;39 (1):2736. http://dx.doi.org/10.5271/sjweh.3288.Occupational Safety and Health Regulation (1996) Part 3, Division 1, s3.4Prism Medical UK, (2015). http://prismmedical.co.uk/about/enabling-single-handed-care/Rush A.(2004). Assessing clients for correct hoist or sling: a practical guide. International Journal of Therapy and Rehabilitation. 11 (4), 179- 182.Bakewell, J. (2007). Which hoist and why? A product guide. International Journal of Therapy and Rehabilitation. 14(9): 424-429.


REFERENCES

Retsas, A., & Pinikahana, J. (2000). Manual handling activities and injuries among nurses: an Australian hospital study. Journal of Advanced Nursing, 31(4), 875-883.Schoenfisch AL, Lipscomb HJ, Pompeii LA, Myers DJ, Dement JM. Musculoskeletal injuries among hospital patient care staff before and after implementation of patient lift and transfer equipment. Scand J Work Environ Health. 2013 Jan;39 (1):2736. http://dx.doi.org/10.5271/sjweh.3288.Occupational Safety and Health Regulation (1996) Part 3, Division 1, s3.4

Prism Medical UK, (2015). http://prismmedical.co.uk/about/enabling-single-handed-care/

Rush A.(2004). Assessing clients for correct hoist or sling: a practical guide. International Journal of Therapy and Rehabilitation. 11 (4), 179- 182.

Bakewell, J. (2007). Which hoist and why? A product guide. International Journal of Therapy and Rehabilitation. 14(9): 424-429.Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L (1996) The Person-Environment-Occupation Model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23. - Diagram reproduced with permission from CAOT

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MEDIACare giver with client in hoist istock used with permissionMan in hoist shutterstock used with permissionCare giver with client istock used with permissionGap by Kevan is licenced under Flick CC -https://creativecommons.org/licenses/by/2.0/ Hoist Allegro Concepts Image used with permissionBathroom Scale-001 by Mason Masteka https://creativecommons.org/licenses/by-sa/2.0/ DGJ_4705 - Russian Matryoshka by Dennis Jarvis https://creativecommons.org/licenses/by-sa/2.0/ My daughter in her wheelchair by Glenn Beltz https://creativecommons.org/licenses/by/2.0/ Footprints in the snow by Christian Guthier https://creativecommons.org/licenses/by/2.0/ Positioning into wheelchair Risk Managed

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