Transcript of Moving and handling 2015 spire
- 1. PATIENTS SAFETY TRANSFERS AND LIFTING
- 2. Taking the pain out of Patient handling The healthcare
industry is getting serious about avoiding caregiver/nurses
injuries caused by patient lifts and transfers. FOR DECADES, nurses
and other healthcare providers have suffered debilitating
musculoskeletal injuries when lifting, transferring, and
repositioning patients manually.Today, the healthcare industry
acknowledges that manual patient handling isnt safe. Were so
devoted to protecting our patients that we dont focus enough on
protecting ourselves .
- 3. Never allow the client to grasp you around the neck as this
could result in injury. The client should be transported the
shortest possible distance by the lifting device. Agree on the
timing of the transfer with the client and other caregiver(s) and
count together. Assure that the path of the transfer or lift is
clear from obstructions and that furniture and aids that the client
is being transferred to are properly placed and secure.
- 4. If the weight of the person is more than one-fourth of your
body weight, you should get someone to help you. Also, get
assistance if lifting the person is awkward. If assistance is
needed, find out the person's strengths and weaknesses. Often one
side of the body is stronger. The stronger side should be
transferred first. Do not attempt to transfer anyone if you feel
unable to lift their full weight. Never leave a person unattended
on a bedside commode
- 5. Proper Body Mechanics Safety Precautions Using specific
methods to lift large weights without injury Safety Precautions Use
legs, not back to lift Largest bone/muscle group Keep weight close
to body Shifts center of gravity to patient More leverage
- 6. Body Mechanics Condiserations Guidelines for
lifting/carrying Consider pt weight Know your limitations Lift
without twisting Position feet one in front of the other
Communicate with partner Keep back locked and dont twist Flex at
hips (not at waist) Bend at knees Keep elbows bent with arms close
to sides Dont hyperextend your back Avoid reaching more than 15-20
in front of your body Push rather than pull Keep line of pull
through midline
- 7. Proper lifting technique
- 8. Avoid reaching more than 15-20" in front of your body. Avoid
reaching and strenuous activity for more than 1 minute. Keep your
back in locked-in position. Avoid stretching or overreaching when
reaching overhead.
- 9. Transfers - Safety Safety is a major concern when
transferring. Falls are a common hazard. If a patient starts to
fall do not try to stop the fall, instead assist the patient to the
floor while protecting the head from injury. This will reduce the
risk of patient as well as staff injury. Complete a thorough
nursing assessment before you move the patient to determine if
she/he has suffered any injuries. Prevention of injury is the key,
be aware of the clients motor deficit, ability to support their
body weight and use effective body mechanics & lifting
techniques. When in doubt regarding the patients ability -GET
ASSISTANCE
- 10. GENERAL MOVING AND/OR LIFTING PATIENT RECOMMENDATIONS i.
Ensure the patient's privacy is maintained ii. If a patient arrives
on a trolley or wheelchair, ascertain how ambulant they are by
asking the doctor or nurse, in this instance, do not depend on the
patient's comments as they may be confused or too helpful etc. It
is best that when in doubt, then lift the patients so as to avoid
accidents. iii. Remove jewellery from your hands and wrists as this
may cause skin damage to the patient. iv. Support/splint areas as
needed e.g. fractured limbs, cervical spine etc v. Ensure the
patient's arms and legs are in a suitable position.
- 11. vi. Ensure there is nothing restrictive to the patient's
movement e.g.. bedclothes vii. Ensure that tubes are free moving
e.g. urinary catheters, IV drips, NG tubes, drains etc viii. Do not
rush the patient. If you do you will find that the patient won't be
helping and you will have to support the whole weight. ix. Whenever
possible have an assistant, preferably of the same frame and height
as yourself. Use a count down to effectively work as a team. When
holding onto an assistant, grab his/her wrist in preference to the
hand, so if one looses his/her grip then that support is still
retained by the other. x. Lift, don't drag the patient otherwise
you may cause skin tearing. xi. If one person is aiding the patient
then be on the patient's weaker side so that they may assist you
with their better side.
- 12. Patient safety: Patients who are at risk for falling must
receive diligent care to prevent falls. Always return the bed to
the height that is safe for the patient, which is usually the
lowest position. Always ensure bedrails are up when the patient is
in bed, if required. Never leave a patient unattended on the edge
of a bed, unless she can fully support herself and is able to walk.
Gather all needed supplies ahead of time, prior to beginning care,
so the patient is not left unattended. Better to be safeusing a
lift and having the help of a colleague than sorry. If you are
helping a patient to walk or stand and he starts to fall, do not
attempt to stop him from falling. Instead, guide and support his
fall and protect his head.
- 13. As you go about your daily work, remember to push, pull or
roll heavy objects rather than lifting themwhenever possible. Dont
ever lift or transfer a client if you feel dizzy or lightheaded.
You could both be in for a spill! Encourage your clients to
practice good posture, too. They may experience fewer aches and
pains...and have a better quality of life! Ask your supervisor to
review safe transfer procedures with you anytime you feel the
need.
- 14. Exercise regularly to keepyour back and abdominalmuscles
strong. Rememberthat thesemuscles actlike a naturalgirdle toprotect
yourback. Exercise regularly to keep your back and abdominal
muscles strong. Remember that these muscles act like a natural
"girdle to protect your back. If youve felt pain or discomfort
while moving a particular client , then DONT DO IT AGAIN IN
THESAMEWAY! Change your technique or get help when its time to move
that client again. Dont ever lift or transfer a client if you feel
dizzy or lightheaded. You could both be in for a spill! Just
because a client is small doesn't mean that she will be easy to
transfer. Be sure to think about the clients flexibility, range of
motion and overall strength. All these things together affect how
easy a client is to transfer
- 15. V.WHEELCHAIRS:
A.Makesurethechairislockedwhenremovingorseatingtheperson.
B.Pullthewheelchairbackwardsupstepsorcurbs.
C.Adjusttheheightofthefootpedalssothepersonissittingata90degreeangleatthe
hipandknee.
D.Whenremovingorseatingtheperson,thefollowingprocedureissuggestedaseasy
foryouandmostcomfortablefortheperson:
VI.LIFTINGANDMOVING(frombedtowheelchair):
A.Alwaysbegintheliftingprocedurebymovingthepersontotheedgeofthebed.
First,movetheuppertrunk,thenthelegsoneatatime.Repeatthisuntilthepersonis
neartheedgeofthebed.Repeatedmovementofthetrunkandlegsiseasierthanlifting
thepersonasawholeallatonce.
B.Remember,bendfromyourknees,notfromyourwaist.Ifyoumustbendfromthe
waist,tightenyourstomachmuscleswhilebendingandlifting.Thisreducespullonthe
backmuscles.Keepyourbackstraightatalltimes.Thefollowingarestep-by-step
procedureswhichwillmakeliftingandtransferringsaferandeasier.
- 16. OtherTips For Safe Lifting &Transferring Try to stretch
and loosen your muscles every day before work. Even five minutes of
stretching can help save your back! Just because a client is small
doesn't mean that she will be easy to transfer. Be sure to think
about the client's flexibility, range of motion and overall
strength. All these things together affect how easy a client is to
transfer. If appropriate, use an assistive device to move a client.
This may include a transfer belt, sliding board or draw sheet A
back injury can change your life. It can keep you from being able
to do your job...and from doing the things you love. A back injury
can also give you a lifetime of chronic pain
- 17. Guidelines for Reaching Avoid twisting. Keep your back
straight when leaning over patients. Lean from the hips. Use
shoulder muscles with log rolls. Guidelines for Pushing and Pulling
Push whenever possible rather than pull. Keep your back locked-in.
Keep elbows bent with arms close to sides. Keep the line of pull
through the center of your body by bending your knees. Keep weight
close to body. Push at a level between your waist and shoulders.
Use kneeling position if weight is below waist level. Avoid pushing
and pulling from overhead position.
- 18. VII.THE ONE-PATIENTTRANSFER: A. Prepare for the lift. 1.
Place a belt around the person's waist. 2. Place wheelchair at a
slight angle to the side of the person's bed. 3. Lock both brakes
on the wheelchair. 4. Remove the armrest of the wheelchair on the
side next to bed, if possible.This helps prevent bumping the
person's hips or buttocks and allows for lifting without lifting
too high. 5. Swing away the legrests of the chair. If legrests will
not swing away, lift the pedals to avoid interference during the
transfer. 6. If the person has a catheter, be sure the bag is lower
than the bladder and that both bag and tubing are out of the way.
(This applies equally to transfers from a wheelchair to a surface
and from a surface to a wheelchair.) 7. Stabilize the bed, so it
will not move
- 19. B. Steps in the one-person transfer. 1. Place the person's
legs over the side of the bed with the knees near the bed's edge.
2. Place the person's hands in his or her lap. 3. Place your arms
under the person's armpits and around the back. 4. Raise the person
to a sitting position on the side of the bed. Do not let go unless
the person can sit alone without support. 5. Gradually slide the
person forward until the person's feet are flat on the floor. Place
your feet in a "v" on both sides of the person's feet for support.
Have your feet far enough apart to give you a good base of
support.Your knees should be on each side of the person's knees. 6.
Have the person lean forward. If possible, place the person's arms
around your shoulders. Allow the person to reach with an outside
arm for the far wheelchair arm. 7. Bend your hips and knees while
keeping your back straight. Place your arms around the person's
waist. Grip the person's belt on both sides toward the back with
your hands. (If the person is not wearing a belt, a safety belt may
be put on during the preparation stage.) 8. Keep the person's knees
stabilized. Count 1-2-3, then pull forward on the belt to lift the
person. 9. When the person is high enough to clear the armrest or
chair surface, turn by taking small steps. Be sure to keep the
person's knees blocked with your own knees. 10.When turned, bend
your hips to squat and lower the person to the chair's seat. 11.
Replace the footrests, then the armrest. 12. Remove the belt, if
necessary.
- 20. C. Alternate lifts: use only to lift a very small person.
1. Prepare for the lift by following the same procedure as outlined
in steps 1-6 in the one- person transfer. 2. If the individual is
totally incapable of assisting you and you are alone without
another's assistance, follow the procedure listed below. (If the
person is more than one-fourth of your body weight, try not to lift
the person by yourself.) a. Move the person to the side of the bed
in a lying pohition. b. Fold the person's arms across his or her
chest. c. Place your feet far enough apart to give you a good base
of support. d. Bend your knees slightly. e. Place one of your arms
under the person's neck. f. Place the other arm under the person's
knees. g. Using the strength in your legs, draw the person close to
your body and lift up while keeping your back straight. h. Take
small steps to the wheelchair. Remember to keep your knees bent.
Carefully place the person in the seat of the chair. i. Check on
the person's sitting position and adjust the wheelchair seat belt.
j. Fasten the seat belt. k. Repeat the procedure to lift an
individual from a wheelchair to another area (e.g., to a bed or
couch).
- 21. VIII.THETWO-PERSONTRANSFER: A. Prepare for the transfer. 1.
Know where you are going to move the person. 2. Prepare the
wheelchair, tub, or bed prior to starting to lift the person. 3. Be
sure the wheelchair brakes are locked. 4. Remove the wheelchair's
armrest which is closest to the destination point. 5. Swing away or
remove the legrests or lift pedals, if possible. 6. If the person
has a catheter, be sure the bag is lower than the bladder and that
both bag and tubing are out of the way. (This applies equally to
transfers from a wheelchair to a surface and from a surface to a
wheelchair.) 7. Stabilize the surface from which you are lifting
the person.
- 22. B. Steps in a two-person transfer. 1.The taller lifter
should stand at the back of the person. 2. The shorter person
should stand on one side of the person. 3.The lifter at the back
should put his or her arms under the person's shoulders and around
the person's chest with arms folded across the person's chest. 4.
The taller lifter at the back should then widen the base of support
by spreading feet apart and bending slightly at the hips and knees.
(Remember to not bend the back, but to use the strength in the hips
and knees.) 5. The shorter lifter at the side places both arms
under the person's thighs in order to support the buttocks and
lower legs. Clasp one hand to wrist for firm grip. 6.The shorter
lifter should also widen the base of support by spreading feet
apart. 7. Bend knees and hips slightly before lifting. 8. Be sure
the person being lifted keeps elbows next to the body or place arms
and elbows in that position, if necessary. 9. The taller lifter
counts to three after which both lifters should straighten their
hips and knees to lift the person in unison. Both lifters step to
the transfer surface and place the person there. If the individual
is being put in bed, repositioning for comfort may be
necessary.
- 23. BACK CARE 101 LIFTING MECHANICS AND SAFETY Lifting
mechanics: Keep your back in balance and maintain good posture.
Maintain the three natural curves of your spine. Always lift with
your quads.These are long and strong. If you bend at your waist and
extend your upper body to lift an object, you upset your backs
alignment and your center of balance.You also force your spine to
support the weight of your body and the weight of the object you're
lifting.Your lower back lifts 7-10 times the weight of an object.
For example, if you bend over to pick up a 10 lb. box, your back is
lifting 70-100 lbs., plus the weight of your upper body.This
situation is called "overload".You can avoid overloading your back
by using good lifting techniques. Maintain a wide base of support
by keeping your feet apart.
- 24. Avoid twisting your back.Twisting can overload your spine
and lead to serious injury. Make sure your feet, knees, shoulders
and hips are pointed in the same direction when lifting or
transferring. Do not lift heavy objects above shoulder level. Avoid
reaching. Tuck your pelvis. By tightening your stomach you can tuck
your pelvis which will help your back stay in balance while you
lift. Bend at your knees instead of at your waist.This helps you
keep your centre of balance and lets the strong muscles in your
legs do the lifting. Lift with your legs. Hold the patient or
object close to you and in line with your centre of gravity. If
necessary, hop onto a patients bed if you need to be closer to him
for a move. Never work over a bedrail. Always lower it prior to
providing any patient care. Always raise the bed to a good working
level. Make sure you lower it once you are done so your patient can
safely get out of bed, or so if she falls, she will not fall as
far. Whenever possible, utilize gravity instead of fighting against
it. For example, if transferring a patient from a bed to a chair,
make sure the bed is slightly higher than the chair. Pushing is
easier than pulling, as the body weight can be used to help move
the object or person.When pushing, get close to the object/person,
push with your legs, arms should be lock in a bent position, the
back should be straight, and push horizontally. When pulling, keep
the back and arms straight, and use your legs and body weight to
pull.
- 25. Steps for transferring from Bed to Wheelchair Remove
clutter from area, including all scatter rugs Discuss with the
transferee, the process before and during the transfer The amount
of room available for transfer will dictate which side of the bed
you will be transferring from. Determine if the transferee has a
stronger side, as he/she will be better able to scoot to the edge
of the bed on that side prior to transfer. Position wheelchair on
the transferees strongest side (for example if the right side is
strongest, you will be transferring from the right side of the
bed.) Assist person to be transferred to edge of bed and to sitting
position first with feet dangling and then with feet on floor For
ease of transfer, position the wheelchair next to the knee on
his/her strongest side Pull wheelchair within a foot of the persons
knee and lock the wheelchair brakes Explain the sequence of lifting
and pivoting into the wheelchair (example: on the count of 3, I am
going to help you stand up and turn to your strong side; eg right
side as in above example; and sit in the wheelchair) Using the bear
hug technique, ask the person to place his/her arms on your
shoulders as you place your arms around his/her trunk Bracket their
feet with your feet to prevent slipping Using your leg muscles,
stand up and bring the person upward in a slow steady rising motion
If transferee is capable, have him/her reach for the furthest
wheelchair armrest Pivot towards wheelchair seat, and lower slowly
Attach or swing foot rests of wheelchair into place Place persons
feet onto foot rests of wheelchair
- 26. Steps for transferring from Wheelchair to Bed Have the bed
at the lowest level. Park the wheelchair with the persons strongest
side next to the bed. Lock the wheelchair brakes and remove feet
from foot rests. Swing or remove foot rests from wheelchair.
Explain the sequence of lifting and pivoting into the wheelchair
(example: on the count of 3, I am going to help you stand up and
turn to your strong side; eg right side as in above example; and
sit in the wheelchair). Using the bear hug technique, ask the
person to place his/her arms on your shoulders as you place your
arms around his/her trunk. Bracket their feet with your feet to
prevent slipping. Using your leg muscles, stand up and bring the
person upward in a slow steady rising motion. Seat the person on
the bed Assist in bring the persons legs up onto the bed. Position
for comfort.
- 27. Patient Positioning Unresponsive pt (non traumatic) Rolled
into recovery position (Left side) Pt with dyspnea or chest pain
Position of comfort As long as hypotension doesnt occur Suspected
spine injury Immobilized to long backboard Pregnant Pt Left lateral
recumbent Supine= Fetus on vena cava Shock Elevated legs 8-12
Nausea/Vomiting Position of comfort EMT in position to control
airway
- 28. Bed to Standing Position the wheelchair close to the side
of the bed, and lock the wheels. It should be on the side that the
patient feels the strongest. Ideally, the bed should be slightly
higher than the wheelchair. Assist the patient to a sitting
position by gently grasping under the legs and swinging them over
the edge of the bed. Use the electric bed to assist the patient to
sitting or assist the patient to sitting by grasping her hands.
Secure a gait belt around the patient's waist.The nurse should keep
her feet shoulder width apart, her back straight and her knees
bent. Place the patient's hands on the bed or on the arms of the
wheelchair. Hold the patient close, and lift with the knees until
the patient is in a standing position. Standing to Sitting Pivot
the patient toward the wheelchair. Be sure that the patient reaches
back to feel for the chair and does not fall into the chair as this
can be dangerous. Slowly bend at the knees and lower the patient
into the chair while keeping the back straight. Read more: Proper
LiftingTechniques for Nurses | eHow.com
http://www.ehow.com/info_8221747_proper-lifting-techniques-nurses.html#ixzz1o04Dw600
- 29. Position in Bed Many times, a patient will need to be
repositioned in bed.This requires assistance from another person.
Be sure there is a draw sheet under the patient for lifting and
turning.The bed should also be locked with the rails up and the
height at waist level to avoid stooping. Ask the patient to help,
if possible, by bending his legs and pushing or by pulling on the
side rails. Everyone involved in the lift should work in unison,
usually on a count of three. With a straight back and bent knees,
get as close to the patient as possible, and slide him up in the
bed to reposition him. Shift weight from one foot to another
instead of twisting with the back. GeneralTechniques In general, it
is best to lift with the knees and avoid twisting the back.
Although it is sometimes impossible to avoid lifting, it helps to
get as many people as possible to help with the bigger lifts that
sometimes are necessary. Keeping the neck and back in alignment
with the feet shoulder width apart is a good general rule to follow
when attempting to lift patients. Never lift at the waist, and
always try to get the weight as close to the body as possible to
make carrying it easier on the back.
- 30. Lifting & Moving Patients BACK Thousands of patients
are lifted and moved by EMTs and many EMTs are injured because they
attempt to lift or move a patient improperly. A wide variety of
patient conditions as well as circumstances affect how the patient
is "packaged" for transport. The expression "Lift with your legs
and not your back." is a very important part of proper body
mechanics. Always get as close to the patient as you can when
lifting. Keep your arms and patient as close to your body as you
can to help create leverage and maintain balance. Bend at the knees
while keeping your back as straight as possible. Recognize your
limitations and call for back-up when needed to lift patient.
- 31. Guidelines for Carrying Patients and Equipment Whenever
possible, move patients on devices that can be rolled. Minimize the
distance needed to carry patients Know the weight to be carried.
Work in a coordinated manner with your partner. Keep the weight as
close to your body as possible. Keep your back in a locked-in
position and refrain from twisting. Flex at the hips, NOT the
waist, and bend at the knees. Do not hyperextend your back (do not
lean back from the waist). Try to lift with a partner that has
similar height and strength. Guidelines for Safe Carrying on Stairs
One of the most difficult carries an EMT must do is carry a patient
backwards up a stairway.Try to carry heavy patients up a stairway
with two people at the top, shoulder to shoulder, and two at the
bottom of the stretcher. Always carry patients head first up the
stairs and feet first down the stairs. Try to use a stair chair if
the patient's condition allows it. If a stair chair is not
available, use a light but sturdy kitchen chair. If neither are
available, use the extremity lift. Keep you back in the locked-in
position. Flex at the hips, NOT the waist, and bend at the knees.
Keep the weight and your arms as close to your body as
possible.
- 32. Clothing Drag 1.Tie the patient's wrists together if you
have something quickly available. If nothing is available, tuck the
hands into the waist band to prevent them from being pulled
upwards. 2. Clutch the patient's clothing on both sides of the neck
to provide a support for the head. 3. Pull the patient towards you
as you back up, watching the patient at all times.The pulling force
should be concentrated under the armpits and NOT the neck. Sheet
Drag 1. Fold or twist a sheet or large towel lengthwise. 2. Place
the narrowed sheet across the chest at the level of the armpits.
3.Tuck the sheet ends under the armpits and behind the patient's
head. 4. Grasp the two ends behind the head to form a support and a
means for pulling. 5. Pull the patient toward you while observing
the patient at all times. Blanket Drag 1. Lay a blanket lengthwise
beside the patient. 2. Kneel on the opposite side of the patient
and roll the patient toward you. 3. As the patient lies on their
side while resting against you, reach across and grab the blanket.
4.Tightly tuck half of the blanket lengthwise under the patient and
leave the other half lying flat. 5. Gently roll the patient onto
their back. 6. Pull the tucked portion of the blanket out from
under the patient and wrap it around the body. 7. Grasp the blanket
under the patient's head to form a support and means for pulling.
8. Pull while backing up and while observing the patient at all
times. Bent Arm Drag