section 7 · 2019-03-27 · Hoisting client from floor Ceiling hoist, mobile hoist, air jack...

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section 7

Contents

• Usingequipmentformovingandhandlingpeople

• Typesofequipment

• Examplesofmovingandhandlingequipment

– Slidesheets

– Transferbelts

– Transferboards

– Air‑assistedtransferdevices

– Electricprofilingbeds

– Mobilehoists

– Standinghoists

– Ceilinghoists

– Gantryhoists

– Fixedwallhoists

– Slings

– Stretchers

– Wheelchairs

– Standingandpivotingaids(non‑electric)

– Showerandbathequipment

– Emergencyequipment

– Othertypesofequipmentandaids

• Referencesandresources.

Note:Allimagesandotherreferencestoequipmentshowninthissectionareprovidedforillustrativepurposesonly.Theyarenot,andshouldnotbetakenas,endorsementsofspecificequipmentorsuppliers.

Equipment for moving and handling people

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7.1 Using equipment for moving and handling peopleThissectiondescribesthemaintypesandfunctionsofequipmentformovingandhandlingpeople.Section8oftheGuidelines,‘Equipmentmanagement’,coversequipmentprocurementsystems,maintaininganequipmentregisterandequipmentstorage,maintenanceandreplacement.

Equipmentisacorecomponentineffectivemovingandhandlingprogrammes,togetherwithriskassessments,theuseofcorrecttechniques,stafftrainingandappropriatefacilitydesign.Thesupplyofequipmentbyitselfwillnotleadtoreducedratesofinjuryunlessequipmentuseispartofacomprehensivemovingandhandlingprogramme.Successfulprogrammesprovidebothequipmentandtraininginhowtousespecificitemsofequipmentforlifting,transferringandrepositioningclients.

Theproperuseofequipmentisessentialforthesafetyofbothclientsandcarersandimprovesthequalityofclientcare.Equipmentcanalsofacilitateclientrehabilitation,decreasemorbidityandpreservethedignityofclients.Comparedwithtechniquesthatinvolvemanualtransfersofclientswithoutequipment,theuseofequipmentlessenstheforcesrequiredformovingandhandlingclientsandcanreducetherisks.

Movingandhandlingequipmentalsoimprovesclientoutcomes,suchasreducingtheirlengthofstayandtheriskofcomplicationssuchasdeepveinthrombosis,chestinfections,urinarytractinfections,pressureulcers,skintearsandfalls.

Having‘fit‑for‑purpose’equipmentisoneofthemostimportantaspectsofmovingandhandlingprogrammes.Newmovingandhandlingequipmentisconstantlybeingdeveloped.Withtheincreasingcomplexityofequipmentandtechnologicaldevelopments,informationaboutspecificequipmentcanbecomeoutdated.Managersresponsibleforpurchasingequipment,andpeopleprovidingtraininginequipmentuse,needtokeepuptodatewithdevelopmentsinequipmentformovingandhandlingpeople.Theprimaryfocusofthissectionisondescriptionsofequipmentandspecificfeatures.Specificproceduresforusingequipment,suchasslidesheets,slingsandhoists,aredescribedinSection4Techniquesformovingandhandling people.

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Section 7: equipment for moving and handling people

7.2 Types of equipmentTable7.1showsthemaintypesofequipmentusedformovingpeople,andexamplesofcommonuses.Sometypesofequipmentareknownbyseveralnames,asshown.Detaileddescriptionsofeachtypeofequipmentareprovidedlaterinthissection.Forsomecategoriesofequipment,thereareseveralrelatedtypes,whichmayhavedifferentnames.

Table 7.1 Common types of equipment

Type of equipment(and alternative names) Description and common uses

Slide sheet(slidingsheet,slipperysam)

Asheetmadeoflow‑frictionmaterialandusedunderaclienttoalloweasyrepositioninginbed,slingattachmentandlateral transfers

Transfer belt(handlingbelt,gaitbelt,walking belt)

Abeltplacedaroundaclient’swaistduringseveraltypesoftransferandforassistedwalkingforrehabilitation.Therearemultipletypesofbelt

Transfer board(PATslide,slideboard,banana board)

Afull‑body‑lengthboardmadefromwoodorplastic,usedtobridgegapsforclienttransfersfromonesurfacetoanother,suchasfromastretcherorwheelchairtoabed.Smallertransferboardscanalsobeusedforlateral,seated‑to‑seatedtransfers

Air‑assisted transfer device Thereareseveraltypes:inflatablemattressesforlateral(bed‑to‑bed)transfersandair‑assistedliftingdevicesor ‘jacks’

Electric profiling bed(electricbed)

Anelectricallyoperatedbedthathasamattressplatformsplitintotwo,threeorfoursections,whichallowsadjustmentusingacontrolhandsetorpanel

Mobile hoist(floorhoist,floorlift,mechanicallift,portable hoist)

Ahoistwithwheelsthatcanbemovedalongthefloor–usedforliftingaclientinsideaslingoronastretcherdesignedforusewithhoists

Standing hoist(sittostandhoist,standinglift,stand‑aidhoist)

Aspecifictypeofmobilehoistdesignedtoassistpeoplebetweensittingandstandingpositions.Standinghoistsaredesignedtofitunderandaroundchairs

Ceiling hoist(overheadhoist,ceilinglift,mechanicallift,gantryhoist)

Ahoistattachedtopermanentlymountedceilingtrackthatmovesaclientinsideasling.Gantryhoistshaveoverheadtracksmountedonwheeledframes

Sling Afabricsupportusedforcarryingaclientwhilebeingmovedwithahoist–therearemultipletypesofsling

Stretcher Arigidframeusedtocarryaclientinalyingorsupineposition.Oftenmadeoflightweightmaterialandcommonlyusedinambulancesandbyemergencyservices.Wheeledstretchersareusedinhospitalsfortransportingclientsbetweenlocations,andshouldbeelectric

Wheelchair Amobilechairusedfortransportingaclientinasittingoruprightposition.Bariatricwheelchairsmustbepoweredormovedwithbedpushers

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Themaintypesofequipmentthatarecommonlyusedcanbesummarisedwithinthefourmaingroupsofclientmovingandhandlingtasks.Thesegroupsoftasksare:

• Sitting,standingandwalking

• Bedmobility

• Lateraltransfers

• Hoisting.

Table7.2providesasummaryofthecommontypesofequipmentusedforthesehandlingtasks.TherecommendedtechniquesforeachoftasksinthetablebelowaredescribedinSection5oftheGuidelines.

Table 7.2 Handling tasks for which equipment may be used

Type of taskExamples of specific movements

Examples of equipment that could be used

Sitting,standingandwalking

Sittingtostandingfroma chair

Transferbelt,standinghoist,mobilehoist,chair‑lifter

Standingtosittingona bed Transferbelt

Assistedwalking Transferbelt,walker,gutterframe,hoistwithwalkingharness

Bedmobility Turninginbed Slidesheets,electricbedwithturning function

Slidingclientupinbed Slidesheets,electricbed

Sittingpersonupontoedgeofbed

Slidesheets,electricbed,bed accessories

Lateraltransfers Lateraltransferfrombedto stretcher

Slidesheets,transferboard,airmattress,standinghoist

Transferringfromchairto commode

Ceilinghoist,mobilehoist,seatedtransferboard,standinghoist

Transferringtotoilet Ceilinghoist,mobilehoist

Hoisting Fittingaslingtoclientin bed Sling

Hoistingfrombedtochair Ceilinghoist,mobilehoist,standing hoist

Hoistingclientfromfloor Ceilinghoist,mobilehoist,airjack

Transferringtotoilet Ceilinghoist,mobilehoist,standing hoist

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7.3 Examples of moving and handling equipmentThenextpartofthissectionprovidesexamplesofthemorecommonlyusedtypesofequipmentforclienthandling.Furtherinformationaboutspecifictypesandfunctionsofequipmentcanbeobtainedfromthewebsitesshownattheendofthissection,andfromcompaniessupplyinghealthcareequipmentinNew ZealandandAustralia.Traininginproperuseisessentialforalltypesofequipment.

Slide sheets

Slidesheetsareoneofthemostcommonlyusedtypesofequipmentinhealthcareservices.Theyareusedtomoveclientshorizontallyonbeds,trolleysandchairswithoutlifting.Slidesheetsarerelativelylowcost,havemanyusesandarerelativelysimpletouse.Theyavoidtheneedtoliftclients,butdespitetheirsimplicitytheydorequiretrainingintheirproperuse.

Itisimportantthattheuseofslidesheetsisconsistentwithcurrentbestpractice,asdescribedinSection4Techniquesformovingandhandlingpeople.Trainingisnecessaryinthecorrectapplicationanduseofslidesheets.Incorrectusecancauseinjurytobothcarersandclients.Slidesheetsaremadefromlightweightfabricandhavelow‑frictionsurfacesthatbecomeveryslipperywhenplacedtogether.Theycomeindifferentconfigurations:thefabricmaybesewntogethertomakeadoublesheet,ortheymaycomeassinglesheetsthatthecarerfoldsovertoformadoublelayer.Twosheetscanalsobeusedtogether.Theymayormaynothavehandlesforhangingup.Twosinglesheetsarepreferableastheyaremultidirectionalandallowoptimalmovement.

Thereareseveralhandlingtechniquesthatuseslidesheets(seeSection4Techniquesformovingandhandlingpeople).Usingthemunderneathapersonallowsanindependentorassistedslidingmovementonabed.Theycanbeusedformanytasksinvolvinglateraltransfersandrepositioning,suchas:

• Movingaclientinbed

• Turningaclientontotheirsideinbed

• Transferringaclientfromabedtoabedwithatransferboard

• Foraclientwhohasfallenintoaconfinedspace;slidesheetscanbeusedtomovetheclientalongthefloortoalocationwhereahoistcanbeused

• Facilitatingindependentbedmobility.

Slidesheetscomeindifferentsizesandtheymaybepaddedorunpadded.Slidesheetswithloopscanbestoredonhooksbesideclients’beds.

Slide sheets

figure 7.1

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Points to note about slide sheets

• Alwaysconductariskassessmentpriortomovingaclient

• Mostslidesheettransfersrequiretwocarers

• Theriskassessmentshouldincludeskinintegrity,pressureareas,wounds,attachmentsandsensitivities

• Assesspainmanagement

• Encouragemobilitywherepossible

• Whenmovinglargeclients,ensurethereisasufficientnumberofcorrectlysizedslidesheetsandenoughstaffforthetransfer

• Infectioncontrolconsiderationsrequireslidesheetusewithoneclientonlybeforebeinglaundered

• Slidesheetsshouldbeaccessiblebesidethebedoftheclientforwhomtheyarerequired–asuitablestoragefacilityisneeded,suchasahook,containerorfabricholdingbag

• Whenaclientisdischargedormovedtoanotherlocation,orthesheetsbecomesoiled,theslidesheetsshouldbesentforlaundering

• Bed‑to‑bedtransfersshouldalwaysusebothslidesheetsandatransferboard

• Mosttypesofslidesheetaredesignedtobelaundered(seeSection8,Table 8.2).Theusualslidesheetlifespanisaround80washes,dependingonthequality

• Slidesheetsmustbeinspectedfortearsandotherdamagebeforeuse.

Slidesheetscanbeusedmultipletimesonthesameclientandrequirelaunderingwhensoiled,orbeforeusingwithadifferentclient.Organisationsneedtohaveasystemforlaunderingslidesheetsseparatelyfromregularlaundry,asahotwashdestroysthefabric,reducingthelifespanoftheslidesheet.Slidesheetcareshouldbeoutlinedintheorganisation’smovingandhandlingpolicy.Therearealsodisposableslidesheetsforsingleclientuseonly,whicharediscardedwhennolongerneededforthatclient.

Transfer belts

Transferbeltsarefastenedaroundclients’waistsortrunksduringtransfersandforassistedwalking.Theyareprimarilyforclientswhoaremobile.Themainfunctionoftransferbeltsistoassistalmostindependentclientsinmobilising.Theycanalso

Store slide sheets beside bed

figure 7.2

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assistwithclientswhomightbedifficulttohold,eitherbecauseofsize,ordiscomfort(malewalkingfemale)orbecausetheclientisuncomfortablewithbeingassisted.Thebeltscanprovideanextralayerbetweencarersandclients.Beltsdesignedspecificallytoassistclientswhenwalkingaresometimesreferredtoas‘gaitbelts’.

Transferbeltsareusedtoassistthedevelopmentofmobilityandrehabilitationforclientswhoareminimallydependent,haveweight‑bearingcapacityandarecooperative.Typesofuseincludebed‑to‑chair,chair‑to‑chairandchair‑to‑cartransfers,repositioningclientsinchairs,andsupportingclientswhilewalking.

Therearemultipletypesofbelt.Mostbeltsaremadeoffabricorcushionedmaterialandhavemultipleloopsorhandholds.

Thebeltsaresecuredaroundclients’waistsandadjusteduntiltheyarefirm,nottight.Transferbeltsshouldonlybewornbyclients,neverbycarers.

Points to note about transfer belts

Therearesomerisksforcarersassociatedwithusingtransferbelts.Forthisreason,somemovingandhandlingcoordinatorsrecommendthattransferbeltsnotbeusedforclienttransfers.Ifused,thecarershouldholdontothehandlesfromtheoutside,andneverputtheirthumbsinsideorthroughtheloops(incasetheclientfallsandthecarercannotdisengagetheirhands).Transferbeltsshouldneverbeusedtolift clients.

Transfer boards

Therearemultipletypesoftransferboardandrelatedassistivedevices.Full‑body‑lengthtransferboards(sometimeslabelledasPATslidesorTransglidesinNew Zealand)areusedtobridgegapsforclientswhoarelyingdownwhenslidingbetweentwoadjacentsurfacesatsimilarlevels,suchasfromabedtoastretcher.Theyareusuallymadeofplasticandshouldbeusedinconjunctionwithslidesheets.Smallertransferboardscanbeusedforseat‑to‑seattransfers,suchasbetweenacarseatandawheelchair.

Inthepast,rollerboardshavebeenusedaslying‑to‑lyingtransferdevices.Theseboardshavealoosevinylcoveringthatisdifficulttocleanandpotentiallyaninfection

Transfer belt

figure 7.3

Full‑length transfer board

figure 7.4

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controlrisk.Theseboardscreaterisksforcarerswhenreachingandrisksforclientswithskinshear.Itisrecommendedthatrollerboardsbereplacedwithfull‑lengthtransferboards.

Sitting‑to‑sitting transfers

Forsitting‑to‑sittinglateraltransfers,asmallertransferboardorslideboardcanbeusedtobridgegapsbetweenadjacentseats.Theseboardscanbestraightorcurvedlikeaboomerang(anexampleistheyellow‘bananaboard’).Smalltransferorslideboardscanbeusedforlateraltransferssuchasthosebetweena:

• Chairandwheelchair

• Bedandwheelchair

• Wheelchairandtoilet

• Wheelchairandcar.

Curvedtransferboardsmakeiteasiertotransferaroundfixedarmrests.Theboardsareusuallyprescribedbytherapists.Notethatclientsshouldhavesittingbalancetousetheseboardsandbothcarersandclientsrequiretrainingintheiruse.Iffeasible,arrangetohavethesurfacetowhichtheclientisbeingtransferredslightlylowerthanthesurfacefromwhichtheyarebeingtransferred.Thismakesiteasierfortheclientto move.

Air‑assisted transfer devices

Thereareanumberofair‑assistedtransferdevicesavailable.Therearetwogeneraltypes:inflatablemattressesforlateral(e.g.bedtobed)transfersandair‑assistedliftingdevices,or‘jacks’.Thesedevicesaregenerallyversatileandcosteffective,especiallyforsmallfacilities.

Inflatable mattresses

Forlateraltransferswhilelyingdown:theclientliesonthemattresswhiletheclientandmattressaretransferredbetweentwoadjacentsurfaces,andair‑assistedliftingdevices.Alateraltransferairmattresscanbeusedasanalternativetoatransferboardandslidesheets.Themattressesareeffectiveforreducingfriction,andthustheloadoncarersduringlateraltransfers.

Sitting transfer board

figure 7.5

Air‑assisted mattress

figure 7.6

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Air jacks

Air‑assistedliftingdevices,or‘jacks’,canbeusedtoraiseclientsfromthefloortobedorstretcherlevelbypumpingairintoanairmattresswithmultiplelayers,whichexpandverticallyasmoreairispumpedin.Thejackscanbeveryusefulforliftingfallenclientsfromthefloor.Figure7.7showsanexampleofanairjackthatliftsclientsinasittingposition.Figure7.8showsa‘Hoverjack’thatliftsclientsinalyingpositionfromthefloortobedheight.Alltypesofair‑assisteddevicerequirecarerstosteadytheclient,andanairpump.

figure 7.7

Air‑assisted jack

figure 7.8

Air‑assisted ‘Hoverjack’

Electric profiling beds

Anelectricprofilingbedhasamattressplatformcomprisingtwo,threeorfourseparatesections,eachofwhichcanbeadjustedusingacontrolhandsetorpanel.Heightadjustmentallowsthebedtoberaisedorloweredquicklyforclientmovementsandclinicalservices.

Someelectricbedshaveonemovablesectioninwhichonlytheheadorbackrestsectioncanberaised,allowingaclienttositupinbed.Withthesebeds,clientsaremorelikelytoslidedownthebedsandmayneedfrequenthelpfromcarers.

Example of an electric bed

figure 7.9

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Figure 7.10

Electric bed showing profile positions

Thegeneralbenefitsofelectricbedsare:

• Promotionofclientmobilityandindependence

• Reducedworkloadforstaff

• Reductioninmanualhandlingrisksandinjuriestostaff

• Reducedincidenceofpressuresoresinclients.

Withelectricbeds,staffcanadjusttheheightmoreaccuratelytosuitindividualclientandcarerneeds.Beingabletostandbackandobserveaclientwhileoperatingabedallowsstafftoobservetheclientmovingintodifferentpositions.Improvedclientcomfortismorelikelyasadjustmentsofthebedsareusuallysmootherthanwithbedsrequiringahydraulicpumpingaction.

Allclinicalareasandclientsbenefitfromthebedheightadjustmentthatallowslowbedheights.Electricbedsalsofacilitateclientsgettingoutofbedbyraisingthemclosertoastandingposition.Stafftimecanbesavedbythereducedneedformanualhandlingofclientsandtheremovalofhydraulicpumpingonnon‑electricbeds.

Points to note about electric beds

• Mattress compatibility:Someelectricbedsmayrequirespecialsectionedmattresses.Bedsrequiringspecialmattressesmaymeanreplacingbedsasa combinedbedandmattress procurement

• Size:Electricbedscanbelarge.Bedswithalonger‑than‑averagelengthmayleadtoreducedspaceinareassuchasmulti‑bedunits.Theycanbedifficult

Box 7.1

Compatibility of electric beds and mobile hoists

A common problem I have come across is the incompatibility of some cheaper electric beds with mobile hoists. The beds do not allow clear access underneath for the hoist legs to go under. Staff have to push and pull resulting in jerky movements for the resident. There was an incident where electric bed wires under the bed caused an accident when the hoist was pulled over the wires and the patient fell out of the sling. Manufacturers need to provide a way of hooking up the wires out of the way.

Source: Manual handling trainer

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tomanoeuvreintightcornersandnarrowcorridorsandthroughdoorwaysandhospitallifts

• Compatibility with other equipment:Mobilehoistsusuallyneedpositioningunderbeds.Canthesuppliedmobilehoistsfitunderthebedatitslowest setting?

• Weight and portability:Theportabilityofelectricbedsisaconsiderationforcommunityuseowingtotheneedtotransportthebedsandassembletheminclients’homesandotherresidentialsettings.Inhospitals,bedsmayneedtobemovedfromwardtoward.Beingabletomoveandsteerbedsmaybeaconsideration.Theheavyweightofmanyelectricbedsmaybeanissuewhenbedsareusedtotransportclientsthroughcarpetedareasorupslopingcorridors.Amechanicalbedpushercanbeusedtoassistwithmobilityofthe beds

• Installing new beds:Whenevernewequipmentispurchased,planforallrelevantcarerstobetrainedinitsuse.Bedsarebecomingmorecomplexandallpracticablestepsshouldbetakentoensuretheirsafeuse.

Specific features

Electricbedscomeinmanyshapesandsizes.Theycanincludemanyfeaturesthatarenotapparentonabriefinspection.Somepotentiallyusefulfeaturesaredescribedbelow.1Whenpurchasingelectricbeds,theassessmentandprocurementproceduresneedtotakeintoaccountthetypesofclientthatwillbeusingthebedsandthebedfeaturesthatwillmostoftenbeusedbycarers.

• Minimum height:Somemodelsofbedarequitehighwhenintheirlowestpositionsforsmallclients.Shortclientscanfinditdifficulttoplacetheirfeetonthefloorwhentransferringoffandontothebededge,reducingtheirindependence.Asimilarproblemcanoccurwiththeuseofpressure‑reducingoverlaymattresses,astheheightincreasecancausetransferdifficultiesforsomeclients.Someelectricbedsaredesignedtogodownclosetofloorlevel(sometimesreferredtoas‘floorline’beds)andcanbeusedinfallsmanagement

• Number of sections:Bedswithfoursectionsaremostversatileforpositioningclients.However,bedswithtwoorthreesectionsareavailable

1. SomeofthepointsinthissectionarefromthereportbyMHRA,2003.

Example of an electric bed that can lower close to floor level

figure 7.11

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• Bed‑to‑seat or bed‑to‑stand profiling:Somemodelsofelectricbedallowtheprofileofthebedtoconverttoaseatortoastandingpositionwhiletheclientisinthebed.Thisavoidstheneedforcarerstofitslingsonclientswhoarelyingdown,ormanuallyrepositioningclientsfromlyingtosittingandsittingtostanding

• Side rails:Railsatthesideofthebedthatcanberaisedorloweredpreventclientsrollingoutofbed.Theminimumheighttowhichbedscanbeloweredmaybecompromisedbytheuseofsiderails,particularlydrop‑downrailsandthosethatfoldunderneaththebed.Siderailsneedtobeadjustabletoallowtransfersbetweenbedandstretcher.Siderailsarearecognisedformofrestraint,andifbeingusedforrestraintneedtobenotedintherestraintregister,consistentwithorganisationpolicy.Splitrailsarepreferableandseenlessasa restraint

• Turning function:Somebedshaveturningfunctionsthatallowclientstobeturnedontheirsides.Dependingonthetypeofbed,turningcanbeactivatedbytheclientinbedorbyacarer,orthebedcanbeprogrammedtoturnatsetintervals.Cautionmustbeusedwithturningfunctionsasthereisthepotentialforlimbstobetrapped,particularlywithclientswhohavedecreasedsensationorcommunicationdifficulties.Mechanicalturningdoesnotreplacetheotherfunctionsofcarer‑providedturningofaclient,suchascheckingbreathingandskinandprovidinghumancontact

• Battery backup:Beingabletooperatebedsonbackupbatteriesmaybeneededwhereclientsaremovedbetweenlocationsinbed,orwhereaccesstoelectricalsocketsislimited

• Manual operation:Isthereprovisionformanualoperationincaseofbatteryorelectricalfailure?Themanualleversneedtobeidentifiedeasilybystaff

• Cleaning and infection control:Thecomponentareaoftheelectricbedframeandanyattachmentsshouldbeaccessibleforcleaning.Easeofcleaningisbestassessedwhentriallingabed

• Preventing client moving down the bed:Clientsoftenmovedowntheirbedswhenmovedfromlyingtosittingpositions.Onelectricbeds,thismayoccurasthebedsareprofiledtoliftupclients’heads.Thiscanbeavoidedifthebedsincludeafeaturecalled‘auto‑regression’ofthebackrestsinthebed specification

Side rails on a bed

figure 7.12

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• Lockout facility:Afacilitytolocktheadjustmentstopreventbedsbeingprofiledortiltedmaybeimportantinclinicalareaswhereitisnecessarytopreventkneeflexionorothermovementsinclientswhoneedtobenursedflat.Thelock‑outfeaturemayalsobeusefulduringvisitingtimestoavoidmishapsassociatedwithvisitors

• Wheel locks:Locksonbedwheelsareusedtopreventbedsbeingmoved.Theseareimportantforsometypesoftransfer,suchasbed‑to‑bedtransfersusingtransfer boards

• Handsets:Twofeaturesofthecontrolhandsetstoassessaretherobustnessofthehandsetsandcontrolpanels,andtheireaseof operation

• Other features:Thereareanumberofotherspecialistoperationsandfunctionsavailableonsomeelectricbeds.Theseincludeweighingscalesbuiltintothebeds,motorisedbedsthatassistmovementalongcorridors,andanti‑fallalarms.

Bed accessories

Therearemultipleaccessories,oradd‑ons,forbedsthatcanbeusefulforsometypesofclientandsetting,especiallyincommunitysettingswhereelectricbedsarenotavailable.Theseinclude:

• Bed ladders:Smallladdersorstepsplacedatthesidesorendsofbedsthatallowpartiallymobileclientstogetinandoutofbed

• Bed or hand blocks:Handblockshavewidebasesandhandholds.Theyareusedinpairsbyclientswhoaresittinginbed

• Bed levers:Abedleverisagrabrailthataclientcanusetohelpthemsituporturnoverinbed.Therearevarioustypesandtheycanbefixedtothewall,bedorfloor.Somemayobstructpartofthebedside,makingitdifficultfortheclienttogetinandoutofbed,whileothersareadjustableandcanbemovedawayfromthebed.Bed‑fixedleversmustbesecurelypositionedandfittedtobesafeforuse.Somebed‑fixedlevershaveplatformsorrailsthatgounderthemattresses,sotheyaresecuredinpositionbytheclients’bodyweight

• Rope ladders:Aropeladderhelpstheclienttopullthemselvesupinbedfromalyingpositiontoasittingposition.Ithasplasticorwoodenrungslinkedtogetherwithropetoformaladder.Theladderattachestothefootorbaseofthebed.Ropeladdersareunstabletopulluponandoftenneedpracticetomaster.Clientsneedtohavestrongupperlimbsandabdominalmuscles.Itis

Wheel locks on a bed

figure 7.13

204

essentialthattheropeladderissecurelyfixedtothebedandtheclientcanreachthefirstrungwhentheyarelyingonthebed.Ropeladderswithplasticrungsmaybeslipperytohold

• Overhead poles:Overheadorliftingpoles(sometimescalled‘monkeypoles’)areusedbyclientstomoveinbed,suchasupanddownthebedandinandoutofthebed.Theycanalsobeusedbyclientstoliftthemselvessothatbedpanscanbeplacedunderthem.Mostoverheadpolesusefloor‑orbed‑mountedcantilevergantries,withhandleshangingfromthemonheight‑adjustablestraps.Thegantryframesmustbesecuredtostopthemtipping.Allpolesshouldhavesafeworkingloads(SWLs)clearlymarkedon them

• Bed lifters:Theseareusedtoliftbedstosuitableworkingheightssothatcarersdonothavetostoop.Theyaresuitablefornon‑electricbeds,suchasinhomeswheretheyallowclientstocontinueusingtheirownbeds.Theydonotprovideprofilingactions,andtheyrequiresufficientspacetogetunderthe beds

• Bed movers:Thesebattery‑operateddevices(seeFigure7.15)attachunderthefootendsofbedsandallowoperatorstotransportbedsandclientstootherlocations.Theyhavecontrolsthatallowmanoeuvringinconfinedspacesandsteeringalongcorridors.Theirpositioningallowstheoperatorstoseetheclientsduringuse.Bedmoversreducestrainonstaffwhoregularlymovebedsduringtheirworkshifts.However,theyincreasetheoveralllengthofthebedsandmaynotfitinlifts.Bedmoversrequireadditionalstorageanditmaybedifficulttohavemoverskeptwhere needed.

Overhead pole

figure 7.14

Bed mover

figure 7.15

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Hoists

Therearethreegeneralcategoriesofhoist:mobilefloorhoists,standinghoistsandceilinghoists(sometimescalledoverheadhoists).Insomecountrieshoistsarecalledliftsormechanicallifts.Allhoistsuseslingstoholdclients,andsomehoistscanliftclientsinspeciallydesignedstretchers.AllhoistsshouldbecompliantwiththeStandardsNew ZealandrequirementsinAS/NZS3551:2004Technicalmanagementprogramsformedicaldevices.Thisstandardcoversprocurement,acceptanceprocess,safetyandperformancetestinganddisposal.

Thetypesofslingusedwithhoistsaredescribedlaterinthissection.Allhoists,slingsandceilingtrackingshouldbeclearlylabelledwiththeirSWLs.

Allcarersusinghoistsshouldbetrainedinfittingslingsandintheproperuseofhoistspriortousingthem.Carersalsoneedtobefamiliarwiththespecificfunctionsofparticulartypesormodelsofhoist.Likeothermovingandhandlingequipment,hoistdesignsandfeaturesarecontinuallyevolving.

Mobile hoists

Mobilehoists(sometimescalledmobilefloorhoists)areusedtotransferclientswhoarenotmobilebetweenlocations,suchasfromabedtoachairorabathroom.Theycanalsoassistwithambulation,gaittrainingandotherspecialisedfunctions.Theclientissupportedinahoistsling,whichshouldbesingle‑clientassignedforinfection control.

Mobilehoistscanbeverycosteffective,astheycanbemovedtodifferentlocationsinafacility.Onehoistcanbeusedforavarietyoftasks.Normallytwocarersarerequiredwhenhoistingaclientwithamobilehoist.2

2. ProceduresforusingmobilehoistsforspecificmovingandhandlingtasksaredescribedinSection4‘Techniquesformovingandhandling people’.

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Box 7.2

Parts of a mobile hoist

• Boom (goes up and down)

• Sling bar, spreader bar or yoke

• Legs (move in and out)

• Mast – upright part of hoist

• Handles – for manoeuvring the hoist

• Brakes – only to be used for storage. Do not use brakes when hoist is in use as the hoist needs to find its own centre of gravity, otherwise it may tip over

• Emergency stop button (if hoist is not working, check it is not pushed in)

• Emergency lower buttons (you may need extra pressure to come down on older hoists)

• Weight limit (SWL)

• Maintenance alert – do not use if out of date.

figure 7.16

Example of a mobile hoist

Mobilehoistscomeinmultipledesigns.Allhavecentralliftingframeswithboomsandslingbars(alsoknownasspreaderbarsoryokes)towhichtheslingsareattachedusingthehooksorclipsonthebars.Thebasesorlegshavewheelsthatallowthehoiststomovealongthefloor.Somehavebasesthatcanexpandorcontractinwidthtofitaroundorundercommodes,showerchairs,recliners,wheelchairsandbeds.Somehoistsarefoldableorcollapsible.Somemobilehoistshaveverticalliftmovementsandsomehavearcmovements.Verticalliftmovementsgenerallyprovideahigherliftandcanusuallybeusedforassistedwalkingwithwalkingslings.Nearlyallmobilehoistsarebatterypowered,soaroutinebattery‑chargingsystemis required.

Box 7.3

Using a mobile hoist without training

I was a nurse aide in this rest home. One day the manager wheeled in a hoist and told me to use it to lift the patient who was sitting on a commode and left me to it. So I hoisted a patient complete with commode and all. I didn’t have any training on how to use the hoist.

Source: Patient handling trainer

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Mobilehoistscanhavesomedisadvantages.Carersmayneedalotofstrengthtomovemobilehoists,inareaswithcarpet(especiallyifthehoistshavesmallwheels),throughdoorwaysandinslopingcorridors.Thereneedstobeenoughspaceintheroomtouseamobilehoistandsometimesfurniturecanrestrictmovement.Whenusingmobilehoistsoverbeds,somecannotlifthighenoughtoallowtheclientstoclearthebeds,especiallybedswithpressure‑caremattresses.Somebedsmaynothaveenoughspacebeneathtoallowthehoistbasetogetunderneath.

Points to note about mobile hoists

Whilemobilehoistscanbeversatile,usersshouldnotethefollowingspecificfeaturesandpotentiallimitations.

• Mobilehoistsneedadequatestoragespaceclosetolocationswheretheyareused.Theyrequiremorestoragespacethanceilinghoists

• Mostmobilehoistsarepoweredbybatteriesthatneedregularcharging.Theyneedasystemforroutinechargingofbatteries.Ifbatteriesaredetachable,itisdesirabletohavetwobatteriesforeachhoistsothatonebatteryisalwaysbeingcharged

• Allmobilehoistsshouldhaveastickerorcertificatewithdatesforroutinecheckingandservicing.Ahoistshouldnotbeusediftheexpirydateonthestickerhaspassed

• AllhoistsshouldbelabelledwithaSWL.Aspartofriskassessment,aclient’sweightshouldbecheckedtoensureitislessthantheSWLofthehoist,priorto lifting

• Wheelbrakesarefittedonmostmodelsofmobilehoist.Thebrakesshouldnotbeappliedwhilehoistingaclient.Mobilehoistsaredesignedtomovewhilehoistingclientssothattheslingbarisoverthecentreofgravityofthe load

• Itcanbeunsafetouseamobilehoistonaslopingfloororsurfacewherethereisariskthatthehoistcantipover

• Notallmobilehoistscanliftclientssafelyfromthefloor.Todothis,thefeetorbaseofthemobilehoistmustbedesignedtoallowafloorlift.Ifthisfeatureisneeded,checkthatthemodelbeingconsideredcandothissafely

Box 7.4

Lifting equipment reduces assaults on carers

Assaults by residents on caregivers in a residential care facility reduced after equipment to lift and transfer residents was introduced and carers were trained how to use the equipment. Residents felt caregivers could be trusted to move them comfortably and safely. Also, the physical separation between the caregiver and the resident through use of the lift, particularly patients with a known history of violence, is likely to have reduced assaults on caregivers when using lifts.

Source: Collins et al, 2004

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• Liftingheight–notallmobilehoistscanliftclientshighenoughtoclearbeds,especiallyifthebedshavepressuremattresses

• Somehoistsallowforinterchangeablespreaderbars;othersrequirethatonlythemanufacturers’spreaderbarscanbeused

• Somehoistsallowdifferenttypesofslingtobeused,whileothersrequirethatonlythemanufacturer’sslingforeachmodelofhoistcanbeused.Ifseveralmodelsofmobilehoistareusedinafacility,theinterchangeablyofspreaderbarsandslingsshouldbeconsidered.

Mobile hoist features and accessories

Thefollowingaccessoriesandfeaturesareavailableonsomehoists,orcanbepurchasedasoptionalaccessories.

• Ahand‑heldcontrolpaneltooperatethehoist–itneedstobeabletoclipontotheuprightframeofthehoist

• Awalkingslingallowsamobilehoisttobeusedformobilityandrehabilitation(seeFigure7.17)

• Scalestoweighclientsareavailableonsomehoists.Whenfittedasanadditionalattachmentabovetheslingbar,scalesmayreducethelifting height

• Allelectrichoistsmusthaveemergencystopbuttonsandmanualreleasemechanismstoallowclientsheldbythehoiststobeloweredwithoutbattery power

• Alow‑battery‑levelindicatororwarninglightisdesirable

• Thelengthoftheboomtowhichthespreaderbarisattachedneedstobeconsideredwhenhoistingatallorlargeclient.Alongerboomprovidesmorelegroombetweentheslingandtheuprightframe.However,withashorterboomtheclientcansitwithbothkneesononesideoftheframe,whichreducestheriskoftheirkneesknockingagainsttheframe

• Gaittrainingbarsassistwithmobility(Figure7.17)andareusefulforturning hoists

• Stretcherattachments(Figure7.18)enabletheimmobilisationofpotentialspinalcordinjuryclientsandareusefulinanytraumaorsuspectedinjuriesafterfalls.Theycanalsoenabletheweighingoftheseclientsiftheyhaveweighscale accessories.

Example of a mobile hoist with walking sling and gait training bars

figure 7.17

Example of a mobile hoist with a stretcher attachment

figure 7.18

209


Standing hoists

Amobilestandinghoist(alsocalledasittostandhoistandstandinglifter)isaspecifictypeofmobilehoistusedtomoveaclientfromoneseatedsurfacetoanother,suchasfromachairtoatoilet.Thehoisthasaplatformorfootrestonwhichtheclientstands.Theclientissupportedbyaslingfittedaroundtheirtrunk(aspecialslingknownasa‘standaidsling’)andbyalegbraceorkneeblockthathasstrappingtoholdtheclient’slegsinplace.Standinghoistsaresuitableforclientswhoarepartiallyweightbearingandcansupportmostoftheirownweightwhilestanding.

Standinghoistsareusefulastheyallowmoreaccesstoclients’clothingthanslinghoists.Forthisreason,theyareusefulformovingclientsfromoneseatedpositiontoanotherandcanassistwithtoiletingpartiallymobileclients.Theyalsohaveatherapeuticbenefitforclientsinprovidinganopportunitytoincreaseweight‑bearingtolerance.Theyshouldonlybeusedfortransportingclientsforshortdistances,suchaswithinaroomortoanadjacentbathroom,notforlongerdistancessuchas corridors.

Points to note about standing hoists

• Itmaybeeasiertouseastandinghoistratherthanamobileoroverheadhoistfortoiletingaslongastheclienthassufficientweight‑bearingcapacity

• Extracareneedstobetakenwithclientswithspecificclinicalconditions,suchaslowmuscletone,osteoporosis,spinalmetastasisanddifficultystandingwiththeirfeetflat

• Standinghoistsshouldhaveadjustablelegstogounderandaroundchairsand toilets.

Example of standing hoist

figure 7.19

Example of standaid sling

figure 7.20

210

Ceiling hoists

Ceilinghoistsorceilingliftshavetrackingfastenedalongtheceilingandaregenerallyapermanentfeaturebuiltintoeitherasingleroomormultiplelocationsinaunitorfacility.Someversionsofceilingtrackingaredesignedtoberelativelyportable;thetrackingcanberemovedwhennolongerneeded.Gantryhoistshavethetrackingmountedonamobileframeandcanprovideahoistforasingleroomwhere,forexample,themainuseisfortransferstoandfroma bed.

Ceilinghoistshavefourmajoradvantagesoverothertypesofhoist:

• Theyrequirelessforcetomove

• Becauseoftheirimmediateavailability,thereisahigherlikelihoodofusewhen needed

• Floorcoveringsandunevensurfacesdonotaffectuse

• Theyhaveminimalstoragespacerequirements.

However,therearesomedisadvantages:theuseofceilinghoistsislimitedtoareaswithtrackinginstalled;andhoistswithfixedceilingtrackingmayinitiallybemoreexpensivetoinstallthanprovidinggantryhoistsormobilehoists.

Ceilingtrack(andgantryhoist)systemscanusuallyliftoveragreaterheightrangefromceilingtofloorthanmobilehoists.Ceilingtrackandgantryhoistsystemsrequirelessspacetooperatethanmobilehoistsandshouldbeconsideredifspaceis restricted.

Thehoistmayhaveaportablehoistunitormotorthatcanbeliftedoffthetrack,orafixedhoistunitthatispermanentlyattachedtothetrack.Table7.3outlinessomeoftheadvantagesanddisadvantagesoffixedandportableceilinghoistunits.Electricitytorunthehoistunitcanbesuppliedthroughthetrack,orbyabatteryfittedintothehoistunit.Someunitsareonlymotorisedforliftingclientsinslingsandnotformovingclientsalongthetrack.Theseunitsrequirecarerstopushclientsalongthetrack.Otherunitshavemotorfunctionsforbothliftingclientsandmovingclientsalongthetrack,operatedbyaremotecontrol.

Example of a ceiling hoist with a fixed unit

figure 7.21

211


Table 7.3 Portable and fixed hoists for ceiling hoist systems

Portable hoist unit Fixed hoist unit

Chargingfacilityforhoistunitisusuallyoffthetrack;maybelessaccessible

Optionofwall‑mounteddockingunitoron‑track charging

Manualhandlingrequiredtoattachunitto track Nomanualhandlingofhoistunitrequired

Canbemovedtoothertrackswhenneededorstoredwhennotneeded

Canonlybeusedontrackwherefitted

Requiresadditionaltimeandefforttoattachthehoisttotracking.Thisislikelytobeadisincentiveforstaffusingthehoist

Staffmorelikelytousethehoistifitispermanentlyattachedtotracking

Ceiling track systems

Forceilinghoists,therearemultipletracksystemsavailable.Thetypeofceilingtracksystemselectedwilldependonthetypesofuseintended.Forsinglerooms,straighttrackingmaybetheeasiesttoinstall.However,itsmajorlimitationisthatitonlyallowstheliftingandmovingofclientsinastraightline.Addingcurvedsectionsoftrackingallowsincreasedcoverage,especiallyinbathrooms(seeFigure7.22).

Figure 7.22

Examples of ceiling tracking into a toilet

Themostversatiletrackingsystemisaparalleltrackingpatterncalledthe‘XY’system,whichprovidesfullroomcoverage.Withthissystemaclientcanbemovedanywhereintheroom.TheXYsystemhastwostraightsectionsoftrackoneachsideoftheroom,paralleltoeachother,withanothertrackjoiningthetwo.Thejoiningtrackcanslidealongthetwoparalleltracks.

Morecomplextracksystemsareavailableforhealthcarefacilitieswheretransfersbetweenrooms,suchasbedroomtotoilet,arerequired.Forexample,‘gates’(fortransitbetweentwoadjacenttracksystems)and‘turntables’(whichallowmovementfromonetracktoanotherattrackjunctions)canalsobefittedtoincreasetheversatilityofceilingtrackingsystems.MoreinformationabouttheinstallationofceilingtracksystemsisprovidedinSection9Facilitydesignandupgrading.

212

Points to note about ceiling hoists

• Ceilinghoistsareusuallypermanentfixtures,sothebuildingstructuremustbesuitable.Somestructuralconsiderationscouldbewhetherceilingjoistsneedtobereinforced,andwhetherdoorwaysneedtobealteredtoaccommodatetracking

• Retrofittingispossibleformosttypesofstructureandceiling

• Ceilingtrackingcanbemostcosteffectivewhenincorporatedintoanewbuildingorinstalledduringplannedrenovations

• Allelectrichoistsmusthaveanemergencystopbuttonandmanualreleasemechanismtoallowclientsonthehoiststobeloweredwithoutbatterypower/electricitysupply

• Allceilinghoistunitsshouldhaveastickerorcertificatewithdatesforroutinecheckingandservicing.Hoistsshouldnotbeusedaftertheexpirydatesonthe stickers

• AllhoistsandceilingtrackingshouldbelabelledwiththeSWL.Aspartofriskassessmentpriortolifting,aclient’sweightmustbecheckedtoensureitislessthantheSWLofthehoistandtrack.

Ceiling hoist features and accessories

Thefollowingaccessoriesandfeaturesareavailableonsomeceilinghoistsorcanbepurchasedasoptionalaccessories:

• Scalestomeasureaclient’sweightareavailableonsomehoists

• Alow‑battery‑levelindicatororwarninglightisdesirable

• Awalkingslingallowsaceilinghoisttobeusedformobilityandrehabilitation.

Gantry hoists

Agantryhoistmaybeapreferredoptionwherefittingceilingtrackingistooexpensiveorwherealarge‑capacityhoistisonlyrequiredforalimitedtime.Thetransferrangeofgantryhoistsystemsislimitedbythelengthofthetrack.Someversionsofgantryhoistaresemi‑portableandcanbedisassembledandtransportedbyvehicle.

Gantry hoist

figure 7.23

213


Fixed wall hoists

Afixedwallhoistisapermanentfixturebesideaclient’sbedorinabathroom(itissometimescalledabathinghoist),andswingstoallowtheclienttobemovedfromwheelchairtobath.Itcanonlybeusedforshorttransfers,forinstancefromabedtoabedsidecommodechair.Thebracketsfortheswinginghoistframecanbefixedinvariouslocationsinahospitalorfacilitysothattheportablehoistcanbeattachedwhenneeded.Fixedwallhoistscanbelocatedinsmallroomswherethereisnotenoughroomtousemobilehoists.Theyalsoprovideanalternativeifthebuildingstructuredoesnotallowoverheadtrackstobeinstalled.

Fixedwallhoistscanbeusefulinnursingandresidentialhomeswherehoistuseisvariable.Bracketscanbeinstalledinmultipleroomsandthehoistsmovedaroundasneeded.However,fixedhoistsdohavesomedisadvantages.Theyareusuallymoreexpensivethanmobilehoists.Asthebracketsarepermanentlymounted,positioningmustbecarefullyplannedtosuittheroomlayoutandtransferneeds.Oncethehoistbracketshavebeenfitted,theclient’sbedandothernearbyfurnitureusuallyneedtostayinthesamelocationinordertousethehoist.

Slings

Slingsareusedtosupportclientsbeingmovedwithhoists.Theslingisattachedtohooksorclipsonthehoistspreaderbaroryoketoprovidesupportfortheclientwhiletheyarebeingmoved.Thereareseveraltypesofslingavailablethataremadefromvariousmaterials.Becomingfamiliarwiththemultipletypesofslingisanessentialpartofusinghoists.Trainingprogrammestypicallyspendsometimeonteachingthecorrectuseofslings.Accidentsthatoccurduringtheuseofhoistsofteninvolveincorrectslinguse.Table7.4summarisessomeofthekeyfeaturesofslings.

Choosingtherightslingandfittingitcorrectlyimprovecomfort,dignityandsafetyfortheclient.Havingacomfortableandsecureexperiencecanhelptoovercomeareluctancetouseahoist,whichsomeclientshave.Generally,themorematerialaslinghasthegreaterthecomfortandsupportitprovides.

214

Table 7.4 Sling features and functions

Sling feature Sling type Functions

Fabricormaterial Synthetic Mostcommontypeofslingforgeneralpurposeuse

Mesh Usedforbathing

Sheepskinorquilt lined

Forclientswithfragileskinorincreasedpainwhenbeinghoisted

Singleormultipleclient use

Disposable Forusewithoneclientonly.Usuallyhasa‘Donotuse’tagthatbecomesvisiblewhenwashed

Washable Canbeusedandlaunderedmultipletimes

Shapesandfunctions

Dividedlegsling Mostcommontypeforgenerallifting

Hammocksling Usedforliftingclientswhorequireadditionalsupport

Toiletingoraccess sling

Designedfortoiletuseortoallowaccesstoclothing;haslessfabricforsupport

Walkingsling Supportsaclientwhenwalking

Points to note about slings

• Compatibility of slings with hoists:Somehoistsaredesignedtobeusedwithonlyaspecifictypeofsling.Otherhoistscanusemultipletypesofsling.Thispointshouldbecheckedinthehoistinstructionmanualorwiththesupplier.Whenorderingnewslingsorhoistsitisimportanttoknowwhetherthenewversionswillbecompatibleorinterchangeablewithanyexistingslingsorhoists.Iftheyarenotcompatible,moreworkwillberequiredtomaintainandservicedifferentslingandhoistsystems.Itispossibletousemultiplebrandsofslingonsomehoists,butthisrequiresasuitablyqualifiedpersontodocumentcompatibility,preferablywithagreementfromthe suppliers.

• Reusable and disposable slings:Mostfacilitieshavereusableslingsthatarewashedbeforeusewithanotherclient.However,ifheavysoilingislikelyorinfectionriskishigh,disposableslingsmaybepreferred.Disposableslingsareforone‑clientuseonlyandshouldbedisposedofwhensoiledornolongerneededfortheclient.Theymustnotbewashedorcleanedthenreused.

• Laundry services:Thereareseveralwaystolaunderslingsandeachfacilityneedstohaveasysteminplace.Thesesystemsinclude:thefacilityownstheslingsandtheyarecleanedbyitsownlaundry;thefacilityownstheslingsanditslaundrycontractorcleansthemasanaddedservice;andthecontractlaundryserviceprovidestheslingsinagreement(e.g.types,numbers)withthe

Example of labels

figure 7.24

215


facilityandcleansthem.Notethatsomeexternallaunderingservicesprovidespecificbrandsofslingonly.

• Standard labelling:Eachslingshouldbelabelledwiththefollowingdetails:

– Thenameoftheslingoritsmodelnumber

– Thenamesortypesofhoistforwhichtheslingisdesigned

– Thesizeofthesling

– TheSWLofthesling

– Anyspecialwashing,dryingandsterilisationinstructions

– Themanufacturer’snameorlogo,orregisteredtradename.

• Checking slings:Allslingsshouldbecheckedbeforetheyareused:

– Checkallloopsatconnectionpointsforsignsoffrayingandloose stitching

– Checkentireslingbodyforloosestitching,rips,holesandbleachstaining

– Checkforsignsoffabricweakening,suchasheatdamage,distortedfabricandstaining

– Checkallbuckles

– Size,shapeandfittingofslings.

Standard slings Fitting of sling so lower loops cross between client’s legs

figure 7.25 figure 7.26

Slingsareavailableinmultiplesizestosuittheweightsandbodysizesofclients.Slingsizescanrangefromverysmalltoextralarge.Theslingsizewillbeshownonalabelattachedtothesling.Mostslingsarenowcolourcoded;thesizeindicatedbyeachcolourshouldbeshownonastickerattachedtothehoistthatwillbeusedwiththesling.Notallmanufacturersusethesamecolourstoindicateslingsizes,sothisshouldbenotedifusingslingswithdifferenthoists.Slingsizesmayvarybetweenmanufacturers,socarersneedtomeasuretheslingforeachclienttoensurethecorrectsizeisused.Whenorderingslings,ensureeachslingislabelledwithitssizeandSWL,whichshouldbeinkilogramsforuseinNew Zealand.Iftheslingistoolarge,thereisariskoftheclientslippingoutofthesling.Aslingthatistoosmallcan

216

resultinthespreaderbarcomingtooclosetotheclient’sface,canbetightinthecrotchandcausediscomfort,ormaynotprovideenoughsupportfortheback.

Slingshaveloopsorstrapsthatareattachedtospreaderbarsonhoists.Sometimesthesestrapsareadjustableandcanbesetforaspecificclientbybeingmarkedwithapieceofwoolorapentoidentifythesettingfortheclient.Thismeanstheycanbehoistedinthesamepositionwithdifferentcarers.

Table7.5summarisesthemorecommontypesofslingandthesearedescribedinmoredetailbelow.Thereareothertypesofsling,suchasamputeeslings,thatrequirespecialistknowledgeforuse.Clientswithhipreplacements,morbidobesity,bilateralamputationsorothercomplicationsmayrequirespecialisedtransferassessmentsandspecialtyslings.

Table 7.5 Types of sling and purposes

Type of sling Purpose Limitations and comments

Standardordividedlegsling(universal sling)

AU‑shapedslingforgeneral lifting Notsuitablefortoiletingorclientswhocanonlybetransferredinalyingposition

Accessortoilet sling

(hygienesling)

Allowsmoreaccesstoclothingfor toileting

Clientneedssomeupperlimbandtruckcontrol

Hammocksling Arectangularslingthatsupportsthebodyoveralargearea

Moredifficulttoputonandtakeofftheclientthanastandardsling–noaccesstoclient’sbodyforwashing

Repositioningsling Afull‑bodyslingusedforturningorpositioninginbed

Aspecialisedslingforclientswhoneedturningregularly

Stretcher Allowsmovementofaclientinalyingposition

Thehoistmustbedesignedtobeusedwithastretcher

Walkingharnesssling Allowssupportforaclientwhile walking

Mainlyusedwithceilinghoistsormobilehoistswheretheboomcanberaisedhighenough

217


Standard or divided leg sling

ThisisaU‑shapedslingandmayormaynothaveupperbackandheadsupport.Itsadvantagesarethat:

• Itiseasytoputonwhentheclientissittingorlying

• Itcoversalargesurfaceareaoftheclient’sbodyandismorecomfortablethanatoiletsling

• Whenthelegbandsarepositionedcorrectly,thereislesslikelihoodoftheclientslippingorfallingoutofthesling

• Thestandardslingcanbeusedtopickupaclientoffthefloor.

Somedisadvantagesarethatstandardslingsmaynotbeassuitableforbathingandtoiletingastheaccessortoiletsling.Thelegbandsorstrapscanbeuncomfortablefortheclientiftheyarenotpositionedcorrectlyoriftheclientisleftintheslingfortoo long.

Access or toilet sling (hygiene sling)

Toiletslingsprovidesplitlegsupportandupper‑mid‑backsupport.Someslingscomewithwaistsupportinsteadofupper‑mid‑backsupport.Theadvantagesofthisslingarethatitisusefulfortoiletingiftheclienthassomeupperlimbandtrunkcontrol,anditcanbeputonaclientinmostpositions.Itprovidesgoodaccessforwashingaswellastoileting.Someclientsmaybeabletoputthisslingonindependently.

Toiletslingshavedisadvantages.Theydonotprovideasmuchsupportasstandardslings,sotheyshouldonlybeusedforashorttime.Aclientwithreducedmuscletonehasanincreasedriskofslippingthroughthesling.Theclientmustbeabletocooperatefullyandnotraisetheirarmsovertheirhead.

Hammock sling

Thisisarectangularsling.Somehavecommodeopenings.Itiscomfortabletouseastheclient’sbodyissupportedoveralargerareathaninastandardsling.Thereislesslikelihoodofdiscomfortordamagetotheclient’sskin.Itissuitableforliftingtheclientoffthefloor.Somedisadvantagesarethatitcanbedifficulttoputonandtakeoffwhentheclientisseatedorlyinginbed,andthereisnoaccesstotheclient’sbodyforwashing,eveniftheslinghasacommodeopening.

Standard sling

figure 7.27

218

Repositioning sling

Thisisaspecialisedfull‑body‑lengthslingusedforturningorpositioninginbedclientswhoneedtobeturnedseveraltimesaday.Repositioningslingsareusuallyleftundertheclientintheirbed.Ifleavingaslingunderaclient,careshouldbetakentoremovewrinklesfromthematerialandtuckthestrapsunderthemattress.Flatbedsheets,soakerpadsandotheritemscanbeplacedontopofarepositioningslingtoabsorbmoistureandimprovecomfort.

Stretcher attachment

Astretcheror‘flatlifter’enablesthemovementofaclientinalyingposition.Thestretcherisabody‑lengthrigidscoopframe,oraseriesofflexiblebatonsthatarepositionedundertheclientandattachedtoaframethatisassembledaroundtheclient.

SomestretcherattachmentsaremadeofspecialmaterialdesignedforX‑rays.Stretcherattachmentsareusefulforspinalandpost‑operativeorthopaediccareastheclientscanbeimmobilisedduringtransfers.Somehoistsofferthree‑wayclientangleadjustmentsforthestretchersling:flat,headdown(Trendelenburg)andfeetdown.Notallhoistscanaccommodatestretcher attachments.

Walking harness sling

Walkingharnessslingsaredesignedtoprovidecompleteorpartialsupportforclientswhocanwalk.Theseslingscanbeusedwithceilinghoists,butarealsoavailablewithsomemobilehoistswheretheboomscanberaisedhighenoughforclientstostanddirectlyunderneaththeslingbars.

Stretchers

Stretchersareusedtotransportclientsinlyingpositionbetweenlocationswithinafacility.Theycomeinmanyshapesandsizes.Allhospitalstretchershavewheelsorcastorsandtheymaybeheightadjustable.Somestretchersarebatteryoperatedwithsimilarfunctionstoprofiling

Repositioning sling

figure 7.28

Example of a stretcher sling

figure 7.29

Mobile hoist with a walking harness sling

figure 7.30

219


beds.Stretchersareastandarditemofequipmentinallhospitalsandhealthcarefacilitiesandservices.Specialiststretchersincludethosedesignedspecificallyforambulanceuseandbariatricstretchersformorbidlyobeseclients.

Wheelchairs

Wheelchairsareanotherstandarditemforequipmentinhospitalsandhealthcarefacilities.Differentversionsareavailable.Somearedesignedtoprovideclientswithindependentmobilityandhavefeaturessuchasbeingfoldablefortransportincars.Othersaredesignedonlyforassistedmobilitywherecarersarerequired.Apointtonoteisthatdesignfeaturesthatareimportantforindividualuseinthecommunity,suchascollapsiblefootrestsandprotrudingparts,mayincreasethelikelihoodofinjury,especiallyifusedregularlybyclients.Forsuchclients,purpose‑builttransferandtransportchairsmaypresentfewercontacthazardsthanwheelchairsdesignedforindependentmobility.Bariatricchairsshouldhaveelectricmotors.

Standing and pivoting aids (non‑electric)

Thereareseveralnon‑electricstandingtransferaidsandtrolleysforclientswhocanstandbuthavedifficultywalking.Theseaidsorpivotingdevicescanbeusedwithclientswhocanstandbutwhoareunabletowalkwithoutassistance.

Standing transfer trolley

Astandingtransfertrolleyenablesacarertotransferaclientfromachairorawheelchairtoatoilet.Itisintendedforpeoplewhocanstandbuthavedifficultywalking.Theclientstandsonthefootrestandholdsthehandlebarforsupport.Somestandingtransfertrolleyshaveseatsthatcandropdownforclientstositonduringtransfers. Thetrolleysarethenmovedbycarerstothelocationsrequired.

Thestandingtrolleyisusefulforrehabilitation.Itiseasytouseandencouragessomemobility.Itprovidesanoptionbetweenmobilisingwithsomeassistanceandasittostandhoist.

Framed turning platform

Aframedturningplatformenablesaclienttostandduringamovefromseattoseat.Theframedturningplatformmayhavecushionedkneepadsfortheclienttobraceagainstduringthemove.Theclientputstheirfeetontheturntableandpullsthemselvesuptostandingusingthe

Wheelchair

figure 7.31

Framed turning platform

figure 7.32

220

handholds.Thecarerthenturnstheplatformandtheclientsitsdowninthenewposition.Theclient’sfeetmustbeplacedcentrallyontheturntableorframedturningplatformsothattherotationthroughthetransferissmooth.Careisneededastheseitemscanrotateunpredictablyifnotcontrolled.Theturningplatformshouldhaveafoot‑operatedbrakethatisengagedwhenthecarerstepsdownontheouteredgeoftheturntable.

Shower and bath equipment

Therearemultipletypesofequipmenttoassistclientstomoveinshowersandbaths.Twotypesofshowerequipmentaredescribedhere.

Wheeled shower chairs

Awheeledshowerchaircanbeusedtotransportaclienttoandfromashowerandcanbeusedintheshowerwhiletheclientremainsseated.Wheeledshowerchairsmayhavebackrests,armrestsandfootreststhatcanberemovedorshifted.Somealsohavetiltingfunctionstoalloweasiershowering.Wheeledshowerchairsareusuallymadefromperforatedplastictoallowwatertodrainfromtheseat.Poweredorbattery‑operatedshowerchairsarepreferred,astheyreducetheriskinpositioningclientsduringtheprocess.

Mobile shower trolleys

Mobileshowertrolleysarefull‑bodylengthsothataclientcanbeshoweredinalyingposition.Thistypeoftrolleycanalsobeusedasachangingtable.

Showertrolleystendtobeusedinopenshowerareasratherthaninshowercubicles,astheyareusuallytoolongtofitincubicles.Slidingequipmentcanbeusedtotransferaclientontoashowertrolley,ortheclientcanbehoisted.Manytrolleysareheightadjustablesothattheycanbepositionedatthecorrectworkingheightsforcarers.

Emergency equipment

Thereisarangeofequipmentavailableforemergencies.Withinfacilities,emergencyequipmentmaybeusedfortherapidevacuationofimmobileclientstoanoutsidelocation,suchasduringafireorearthquake.Ambulancesandotheremergencyservicevehiclesgenerallycarrymultipletypesofspecialistemergencyequipmentformovingpeople.

Mobile shower trolley

figure 7.33

221


Mostemergencyserviceshavestandard‘pickupandcarry’typesofstretcher.Thesecanbeusedinemergenciestomovepeoplequicklytootherlocations.Thesestretchersusuallyfoldintosmallpackagesforcompactstorage.Otherexamplesofemergencyequipmentaredescribedbelow.

Slide pads and sheets

Slidepadsandsheetsareanoptionforemergencyevacuationequipmentforimmobileclients.Slidepadsaresimilartosmallmattresses;theyhavestrapstosecureclientsandslipperysurfacesunderneathsotheycanbedraggedalongfloorsanddownstairswithclientslyingdown.Emergencyslidesheetsarefittedunderneathmattresses.Theyhavestrapsthatcanbefastenedovermattressestosecureclientstothemattresses,andslipperysurfacessothesheetswithclientsandmattressescanbedraggedalongthefloor.

Backboards or spine boards

Abackboardorspineboardisusedtoimmobiliseandtransportaclientwithasuspectedspinalinjuryinanemergency.Itisarigid,full‑body‑lengthboardtowhichtheclientisstrapped.Theseboardsmaybemadefromsheetaluminiumwithatubularaluminiumframe,woodwithaspecialwaterproofcoating,orcoatedplywood board.

Scoop stretchers

Ascoopstretcherisalightweight,concavestretcherthatseparatesintotwosectionsalongitslength(Figure7.35).Itcanbeplacedunderaclientfromeachsidewithouttheneedtorollorliftthem.Theconcavesurfacesupportstheclient,minimisinglateralmovementandreducingtheriskoffurtherinjury.Theclientcanthenbecarriedtoalocationwherefurthermedicaltreatmentcanbeadministered.

Thescoopstretchermayhaveanarrowfoot‑endframeforhandlinginconfinedareas.Itfoldsupforstorageandhaslockinglength‑adjustmentlatchesthatsnapintoplace.Somecompaniesarenowproducingcombinedboards(‘combiboards’)thatincludethefeaturesofbothspineboardsandscoopstretchers.

Slide pad

figure 7.34

Scoop stretcher

figure 7.35

222

Combination stretchers/chairs and evacuation chairs

Acombinationstretcherandcarrychairisanoptionfortransportingclientsinanemergency(Figure7.36).Itcanbeconfiguredforuseasawheeledchair,astairchairoraflatstretcher.

Anotheroptionisanemergencyevacuationchair,whichcanbeusedfortransportingclientsdownstairs(Figure7.37).

Other types of equipment and aids

Therearenumeroustypesofequipmentandmobilityaidotherthantheonesdescribedinearliersections.Ifaclientisabletobearsomeoftheirownweightforashortperiodoftime,therearevariousdevicesavailabletoassistintransfersbetweenbed,chairandtoilet.Someoftheseaidscanbeusedtohelpclientsmoveshortdistances,ortostandinasupportedmanner.Theyrangefromsimpletomoretechnical,suchaswalkers,transferbeltsandstandtositlifts.TheMinistryofHealthandtheAccident CompensationCorporation(ACC)bothpublishlistsofapprovedequipmentforpeoplewithdisabilitiesandlimitedmobility(seewww.accessable.co.nz).Notethattheselistscoveraverylimitedrangeofthemovingandhandlingequipmentthatisavailable.

Emergency evacuation chair

figure 7.37

Combination stretcher/chair

figure 7.36

223


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musculoskeletalinjurypreventionprograminnursinghomes.Injury Prevention,10(4),206‑211.

MHRA(MedicinesandHealthcareProductsRegulatoryAgency).(2003).Evaluation: Electrically powered profiling beds Part 1: Hospital beds(MHRA03038).London:MHRA.Retrieved9September2010fromwww.mhra.gov.uk.

Nelson,A.(2003).Patient Care Ergonomics Resource Guide: Safe patient handling and movement.Retrieved11August2010fromwww.anasafepatienthandling.org/Main‑Menu/SPH‑Background/SPH‑Solutions.aspx.

Nelson,A.,Collins,J.,Knibbe,H.,Cookson,K.,Castro,A.,&Whipple,K.(2007).Saferpatienthandling.Nursing Management,38(3),26‑33.

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Seewww.standards.co.nz/touchstone/Issue+16/Electrical/Electricity+Safety+Regulations+2010+Standards+for+hazardous+areas+and+electromedical+equipment.htm.

VISN8PatientSafetyCenterofInquiry.(2010).Technology Resource Guide.Retrieved29October2010fromwww.visn8.va.gov/patientsafetycenter.

WorkSafeBC.(2006).Transfer Assist Devices for Safer Handling of Patients: A guide for selection and safe use.Retrieved9September2010from

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Web resources: equipment3

BiomedicalServicesNZLtd

www.biomed.co.nz/medical‑device‑legislations.html

SafeLiftingPortal

www.safeliftingportal.com/patientlifts/index.html

WorkSafeBC:Workers’CompensationBoardofBritishColumbia,Canada

www.worksafebc.com/publications/health_and_safety/by_topic/health_care/default.asp

3. Note:IftheURLsshowndonotwork,doasearchontheorganisationtitle.Equipmentmanufacturersoftensponsororprovideequipmentwebsites.ACCandtheGuidelines’authorsdonotspecificallyendorseanymanufacturer.

section 7 · 2019-03-27 · Hoisting client from floor Ceiling hoist, mobile hoist, air jack...

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