Evidence Based Practice

Safe Patient Handling Evidence-Based Practice

March 27, 2012 by Elena Noble, MPT

A therapist practices safe patient lifting by transferring a woman from a treatment table using the Rifton TRAMSafe patient handling is big. Some states have already passed legislation supporting this trend in healthcare and many hospitals and institutions are implementing “no lift” or “zero lift” programs with much success. In these instances success is described in terms of decreased staff injuries, decreased workers’ compensation monies, and improved patient experience. There is a wealth of information available about best practices for safe patient lifting and transfer, but here are some studies and papers I found worthwhile.

Nurse Safety

Long-term Effectiveness of “Zero-Lift Program” In Seven Nursing Homes and One Hospital

This article is the landmark 1999 research study by Arun Garg. Research data was collected on staff injuries and workers’ compensation costs resulting from manual lifting and transferring of patients, prior to and following the implementation of a zero-lift program.

Handle with Care

This article describes the American Nurses Association’s (ANA) Handle with Care patient safety campaign with its main points:

  1. Manual patient handling is unsafe and directly responsible for musculoskeletal disorders among nurses.
  2. Patient handling can be performed safely with the use of assistive equipment and devices.
  3. There exists a simultaneous reduction of risk for injury among nursing staff and improvement in quality of care for patients.

A Comprehensive Analysis of Low-Back Disorder Risk and Spinal Loading during the Transferring and Repositioning of Patients using Different Techniques

Here is the full text of the research study done at the Biodynamics Laboratory in Ohio State University pointing to the necessity of using mechanical lifts for patient transfers to prevent caregiver injury.

Safe Lifting and Movement of Nursing Home Residents

This guide is invaluable for any administrators, nursing home owners or other professionals interested in implementing a safe lifting program at their facility. “Research conducted by the National Institute for Occupational Safety and Health (NIOSH), the Veterans’ Health Administration (VHA), and the University of Wisconsin-Milwaukee has shown that safe resident lifting programs that incorporate mechanical lifting equipment can protect workers from injury, reduce workers’ compensation costs, and improve the quality of care delivered to residents. This guide also presents a business case to show that the investment in lifting equipment and training can be recovered through reduced workers’ compensation expenses and costs associated with lost and restricted work days.”

Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders

This comprehensive booklet outlines problems and solutions for resident lifting, and other activities that pose risk for caregiver injury. Read this document on-line (OSHA website)

An Evaluation of a “Best Practices” Musculoskeletal Injury Prevention Program in Nursing Homes

Data was collected from January 1995 through December 2000, at six nursing homes, showing a significant reduction in injury incidence, workers’ compensation costs, and lost workday injuries, after implementing a “Best Practices” program.

Evidence Based Practice for Safe Patient Handling and Movement

Solutions are offered in this article for effectively addressing caregiver safety during lifting tasks. These solutions are organized into three groups: engineering based, administrative and behavioral.

Department of Veterans Affairs

Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement

This guidebook was developed by the Patient Safety Center of Inquiry, Veterans Health Administration. It provides extensive coverage of the topic including the development of the No-Lift policy.

Cost Effectiveness of a Multifaceted Program for Safe Patient Handling

This 18-month observational study measured the incidence and severity of injury to caregivers before and after the Safe Patient Handling and Movement project, introduced by The Patient Safety Center in the Veterans Health Administration (VHA).

OT/PT Safety

Employment Relations and Union Services: Health and Safety – Work-related Strain Injuries (Musculoskeletal Disorders)

This website from American Physical Therapy Association (APTA) provides comprehensive safe lifting recommendations and resources for physical therapists.

Safe-Patient-Handling Equipment in Therapy Practice: Implications for Rehabilitation

Published in the American Journal of Occupational Therapy, this study discusses the use of safe patient handling equipment and the implications for patients, therapists and rehabilitation outcomes.

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Deborah Markle | March 24, 2012
I need safe, effective, low cost lifting for child in 5th grade. She is 48 inches tall and weighs 65 pounds. Space is limited.
Elena Noble, MPT | March 24, 2012
Hi Deborah, Nothing to offer yet, but stay tuned to this space for a major product announcement next month we’re going to be introducing a fabulous transfer and mobility device that will be small, compact, lightweight, and affordable. Elena
Carla Wilhite | March 28, 2012
OT’s and PT’s probably cannot go with a total “no lift” policy for some patient’s who are in rehab re-learning how to sit up, stand, and transition. I think we need some guidance about which patients should be zero or reduced lift, and those who need the dynamic challenge to the neuro system in re-organizing patterns of movement. Is there such guidance?
Elena Noble, MPT | September 23, 2013
Hi Carla, You have a good point. I know that in 2008, the APTA collaborated with OSHA to set out some standards and guidelines for safe patient handling for PTs working in rehabilitation. So far I have only found these guidelines presented in a “pay-for” course on the APTA website. I am sure OT guidelines would be similar. As OTs and PTs we are trained to do the manual transfers encouraging the patient to participate as much as possible during the transfer for motor-relearning, muscle strengthening etc. However, at least for the sit-stand transfers, I know there is equipment available that allows for the patient to be actively invovled in the transfer while still being supported by the lift and therefore minimizing the risk of injury to the PT. Bed mobility is a lot more challenging though! But OTs and PTs certainly do need to be thinking about applying safe patient handling in their area of practice as it is a growing concern across the board.
donna | December 16, 2014
I work with elderly residents who are in middle to late stage dementia; many can no longer support themselves to stand or even to turn in bed. I believe that all transfers and repositioning of these residents should be done by at least two aides, as much for the comfort of the resident as for the safety of the aides. I can't find authorities to support this position to go to my manager about this. Can you offer suggestions? Thanks.
Elena | February 23, 2015
Hi Donna, 

Unfortunately even lifting or repositioning a patient with 2 aides is risky and can result in injury. That is why the Safe Patient Handling Movement guidelines recommend using a lift/transfer device for all patient mobility and transfer routines. This is the only way to keep both the patient and caregivers safe.

Mary Ann Kinney | August 29, 2016
Do you have a percent for staff who do not use the Air Pal equipment properly? Most specifically I am interested in the Air Pal for our heavy patients and using connections for inflating properly or not making sure the exact number of nurses or support staff are guiding the Air Pal on the extreme weight challenged patient. Thanks, Mary Ann Kinney, DNP,RN
Elena | August 29, 2016
Hi Mary Ann, I am not aware of any literature pertaining to the Air Pal. Perhaps one of our readers can answer this question or has experience/literature on the Air Pal?