Safe lifting fits JCAHO fall prevention goal
Safe lifting fits JCAHO fall prevention goal
Assessment, safer lifts are part of program
If you're still trying to convince your hospital administration to invest in a safe patient handling program, here's a compelling reason: Lift equipment may help prevent patient falls. And the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has a special interest in fall prevention.
As a 2007 National Patient Safety Goal, JCAHO is requiring hospitals to implement a fall reduction program. Assessment of fall risk, medication use, and environmental measures such as bed alarms are key parts of fall prevention. So is ambulation, and lift equipment or the use of lift teams may help patients gain mobility. For example, a sit-to-stand lift can help patients who have some weight-bearing capabilities.
The Joint Commission doesn't specify that hospitals should purchase equipment. But that clearly is a component of patient transfers, says Carol Ptasinski, RN, MSN, MBA, senior associate director of standards interpretation.
"There should always be some equipment in place that would assist the staff in safe transfer of the patient," she says.
Assessing a patient's fall risk also involves an assessment of the patient's dependency and lift and transfer needs, she says. That assessment should be reevaluated when the patient changes medication, has surgery, or periodically during the patient's stay.
The VA Patient Safety Center of Inquiry at the James A. Haley Veterans Hospital in Tampa, FL, has developed algorithms that include an assessment of patient handling needs, which would be incorporated into a falls assessment.
Integrating safe patient handling with fall prevention also could help build support from nurses, says Audrey Nelson.
"Nurses have the idea that they always have to put the patient first," she says. "It's easier for them to buy into something where they think it would have an importance [to patients]."
Ceiling lifts provide support
At the Central Arkansas Veterans Healthcare System in Little Rock, patient safety practitioner Mary E. Watson, MSN, RN, APRN, BC, quickly saw the connection between fall prevention and safe patient handling.
The Joint Commission specifies the need to safely transfer patients, she notes. "If you are transferring the patient safely, then you are going to prevent injuries to staff that may occur if they were improperly transferred," she says.
Similarly, assessing and documenting a patient's transfer needs would include employee safety as well, she says. "It's a safe patient handling issue and not simply an exercise in assessment," she says.
Watson is integrating the assessment of fall risk with the patient transfer assessment, using the VA's algorithms. Her two-hospital system also is putting ceiling lifts in almost every patient room, which can be used for patient transfers and repositioning. Physical therapists can put the harness on patients and use the ceiling lift as a backup when the patients first begin to walk in their rooms, says Watson. "If they start to collapse, they're in a harness."
With lift equipment, nurses may provide more prompt and frequent transfers because they don't have to wait for co-workers to help, notes Nelson. In a retrospective study of 24 rehabilitation and long-term care units in Florida, she and her colleagues found patient outcomes improved with the implementation of a safe patient handling program, which incorporated both ceiling and floor lifts.
They compared residents in the units for the two years before and after the program was implemented. The residents had lower levels of depression and urinary incontinence, and improved in their activities of daily living. They were awake more hours during the day, and they had fewer falls.
The improvement was particularly noteworthy because resident functioning would be expected to decline during a four-year period, notes Nelson, whose study is not yet published.
"You're fighting an uphill battle to show an improvement," she says. "There were some variables that stayed the same, and we felt that was a good finding as well."
More research is needed on the link between fall prevention and safe patient handling, Nelson says. Beyond patient safety, research also reveals patient attitudes toward mechanical lift devices. In one survey, Nelson found that patients actually preferred the lift devices. "Nurses think if they don't touch the patient, that it's not good nursing care. Patients say there are good touches and touches that are not dignified. It's not a "caring touch" if multiple caregivers are struggling to lift a patient, she says.
If you're still trying to convince your hospital administration to invest in a safe patient handling program, here's a compelling reason: Lift equipment may help prevent patient falls.Subscribe Now for Access
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