I am a nurse and am confused as to how much patient weight I am allowed to lift without hurting my back. My job description states 50lb. What is the real limit?

In 1994, the National Institute for Occupational Safety and Health (NIOSH) released a lifting equation that was designed to assist organizations and healthcare workers with determining safe lifting limits during lifting/handling tasks; unfortunately, it didn't specifically address patient handling limits. In 2007, Tom Waters of NIOSH wrote an article that appeared in the American Journal of Nursing titled œWhen is it safe to manually lift a patientĀ. In this article, Tom states. In general, the revised equation yields a recommended 35-lb. maximum weight limit for use in patient-handling tasks. When weight to be lifted exceeds this limit, assistive devices should be used (Pg. 53). However 35 lbs. is a guideline for patients who are co-operative and when the outcome of the lift is totally predictable, which is difficult when patients are unwell. It may be best to work on the assumption that there is no safe way to manually lift a patient and use the lifting equipment available to you.

By the way 51 lbs. is the recommended lifting for materials handling, not patients.

Reference: Waters, T. (2007, August). When is it safe to manually lift a patient? American Journal of Nursing; 107(8):53-8.

I am a wound care nurse and am often asked to review patient's dressings on their heels and apply a wound vac. to them. Do you have something that can hold the patients leg while I treat it instead of having to ask one of the nurses to hold it?

The best tool to use for this is a limb holding sling. It can be attached to a ceiling or floor lift and lifts the extremity and holds it while you complete wound care. Please make sure, if the process is going to take more than a few minutes, that you lower the leg and rest it during the procedure to maximize blood flow to the area and to prevent discomfort to the patient.

I am a physical therapist and hurt my back a few years ago when an obese patient I was assigned to for ambulation therapy fell and I was trying to use proper body mechanics and a gait belt to help her to the ground. I came off of light duty and I am afraid of getting hurt again, this time permanently. I don't want to quit my profession because I love what I do, but I am afraid that this will happen again. Is there another way to get my patients walking without getting hurt again?

There is a variety of equipment that can be used to ambulate a patient, and which does not prevent them regaining their confidence and gait when recovering from illness or surgery. Some facilities install a single ceiling track in the corridors of the unit or the rehabilitation center. The patient can then ambulate wearing a special sling. There are also some floor lifts that can be used for this purpose. Both options provide for support of the patient during ambulation and the great part is that should a patient become weak and need to rest or become unsteady during the therapy session, the lift catches them, not the therapist. This provides for a more secure therapy session and may reduce patient falls and staff injuries during this important rehabilitation therapy. Another benefit of these options is that you will be able to ensure that prescribed weight bearing is actually weight bearing, eliminating the need to estimate the patient's actual weight bearing during ambulation.

I have to turn patients every 2 hours and we are short staffed, so I usually turn the patients by myself and go home sore. I don't have time to wait for another nurse to come and help me and even when someone can help me, I still go home sore. Do you have something I can use to turn patients without waiting for help?

There are a variety of different types of equipment that you can use to turn your patient, and as I am sure you realize human strength is not one of them. If you have a ceiling lift installed this can assist with this activity as can a floor-based lift. With both of these pieces of equipment you still need to get the patient on to the sling and that in itself can place you at risk of injury if you are unsure of the correct technique to apply a sling with bariatric patients. VanderClips are a great tool that can assist with turning patients every 2 hours. VanderClips hook to your existing lift , whether it is a ceiling or floor lift. They clip to the patient's sheet so there is no trying to get the sling in place. When you elevate the lift, the clips lift the sheet which turns the patient for you. The great thing with the VanderClips is that you can do this yourself and don't need to wait for your colleagues to help you. Just make sure that the bedrails are raised at the side of the bed the patient will be facing.

I take care of my dad at home, so that he doesn't have to go into a nursing home. He has some upper body strength, but is not able to move without assistance, so my husband, son and I have to move and lift him. My husband and I are hurting our backs and have to take medicine now. We can't afford the costs of having lifts that go in the ceiling installed, are there ways to do the moving and lifting without spending a lot of money?

There are many tools available that assist loved ones with repositioning in a home environment. Floor lifts can offer a nice option in providing a wide range of assistance to caregivers without the costs of installation to consider. Floor lifts also offer the flexibility of providing for care needs in any room of the house. Repositioning slings are a nice accessory to purchase to meet the needs you have described. They are placed under the loved one and then attached to the lift, so that the lift handles the weight of the task. You might also want to consider purchasing a slide sheet, which can be used to reposition your father when he is in bed.

I take care of my husband in our double-wide mobile home. The hospital gave us a hospital bed and a floor lift and a couple of the slings as well as assisted us with putting a ramp in and helped with getting the doors widened, but it is really hard to push the lift on my carpeted floors. Is there a floor lift that is easier to push on the carpet or is there a better way to get my husband in and out of the bed and chair?

This is a common problem with carpeted environments. Generally speaking, the smaller the wheels on the floor lift, the more difficult it is to push the lift over the carpeting. It is usually recommended to remove carpeting altogether, but if that is not possible, then don't be afraid to ask the equipment vendor if they will switch the wheel casters on the lift to meet the needs of your home environment. Keep in mind you will need the wheels to easily glide under the bed, so you will need to provide the vendor with the height you will need to get the lift under.

You might also wish to consider purchasing some of the plastic covering that you can buy to put over carpets to protect them from wear and tear. That way the wheels of the floor lift will move easier and you can still see the carpet design.

I use lifts at work and our slings come in different sizes, but they all have the capacity to carry the same weight limits. How do I know what size is right for my patient?

This is a question that many healthcare workers ask. Since slings come in all shapes and sizes, here are a few tips on sizing:

Universal slings, such as VANCARE's Uni-Fit SLINGS, should be long enough to fit from the bottom of the patient's coccyx to the top of, or a few inches above, the patient's head and wide enough for sling fabric to extend at least two inches in front of the patient's anterior shoulder.

Sitting slings, such as the VERA-LIFT„ sitting sling, should be long enough to extend from the bottom of the patient's coccyx to two to three inches below the lower edge of the patient's shoulder blades.

The amputee sling should be long enough to fit from behind the knees (if the amputation(s) are below the knee), or from the bottom of the longest stump (if amputations are above the knee), to the top of the patient's head.

And Ambulation Slings take into account actual chest and thigh measurements.

Resource Link: UNI-FIT Sling

We were told that we have to create a Safe Patient Handling program and that I am supposed to lead the program. I have never even heard of Safe Patient Handling. Do you have programs that help someone like me get a program started?

You might want to consider attending a national or state conference on safe patient handling, or attending a workshop to help you get started. You may also want to consider contracting a SPH consultant to assist you with the program planning and initial risk assessment. VANCARE/Visioning HealthCare offer a number of programs and services geared toward helping an organization implement and sustain a SPH program every step of the way and provide consulting, ANCC accredited SPHM workshops and comprehensive risk assessments to their clients.

We bought a bunch of equipment, but staff isn't using it. Now the facility is upset because they spent so much money, but the injury outcomes are the same. What am I doing wrong? How do I make staff use the equipment?

While purchasing SPH equipment is an important aspect of implementing a program, it is not the only factor in creating staff buy-in and success for the program. There are several factors that may be causing this problem:

  • Staff not receiving enough training in the use of the equipment.
  • No written policy to articulate the organization's expectations of them.
  • Not enough equipment or of the wrong kind.

It is important to find out the cause of the problem. Sometimes that means going right back to the beginning and conducting a full risk assessment of the whole facility and determining whether the resistance is equipment or staff related. One thing that is for sure, telling the staff that they have to do it does not work.

My hospital has approved funding for equipment purchases, but I don't know what I need. I don't want to make a mistake that will waste the funds. How do I know what to buy and how much to buy?

The simple answer is to conduct a comprehensive SPHM risk hazard assessment of the whole facility, but this can be challenging, if like you, you have little experience in this area. This is the perfect time to seek the assistance of a Consultant that will provide a thorough, un-biased assessment of the facilities™ equipment and educational needs. Many facilities feel that they do not want to spend any of their money on a Consultant because it takes away the funding for equipment. However, a good consultant will be able to save you many thousands of dollars on equipment so they pay for themselves very quickly. All assessments are not created equal so don't be afraid to ask to see a sample assessment to determine if it will give your facility the information needed to move forward.

I work with a patient population that is dependent and develops pressure ulcers easily. I was told it is OK to leave repositioning slings under the patient, but I am afraid they will cause sores. What should I do?

Prevention of pressure ulcers is high on most healthcare workers™ minds these days as Medicaid/Medicare no longer reimburses costs associated with hospital-acquired ulcers. The first point to prevention of pressure ulcers is to turn patients 30 degrees every two hours, unless contraindicated. We must remember that the primary cause for pressure ulcers is not relieving pressure on the skin in a specific area. Second, wrinkles must be removed from under patients, so that the patient is laying on a smooth surface as wrinkles can cause pressure ulcers. Third, don't be afraid to ask for evidence that supports leaving repositioning slings under patients while they receive care at your facility. Generally speaking, these types of slings do not cause pressure ulcers; lack of repositioning causes pressure ulcers. If the sling is in place, it is easier for healthcare workers to reposition the patient without having to wait for a coworker to become available and it is more likely that you will be willing to reposition the patient more often.

I want to use the ceiling lift with my patients, but they refuse to allow me to. I tell them I have to use it, but they just ask another nurse to do the move without equipment and the nurse does it. I want to respect a patient's right to refuse, but I should have a right to not get hurt while caring for the patient. What am I supposed to do?

There is nothing quite as frustrating as wanting to use the equipment, but then the patient refuses to have it used on them. Add to that the frustration of having a coworker come behind you and complete the movement without equipment leading to the patient continuing to request manual handling. A few things to consider are: 1) educate the patient upon admission to the expectation that staff will utilize the equipment to provide the safest care possible for them. Some facilities show videos or give brochures that show the equipment in use. These allow the patients to see the equipment in action and it sets the precedence that equipment will be used to protect both the patient and the staff. 2) Determine the patient's reason for refusal. Often times it is fear of the unknown and taking the time to educate the patient and answer questions may resolve the refusal point. 3) Finally, make sure that all staff is onboard with utilizing equipment. If they are not and you are uncomfortable with speaking to them, allow the manager to determine how to best handle the situation. While no one wants to bring this type of situation to the manager, it is important to safeguard the health of coworkers and to prevent patient injuries. Safe Patient Handling and Movement is about process improvement and cultural change, which unfortunately does not happen overnight, so continue to model the appropriate use of the equipment.