Re: Zero Lift Policies

[Guest guest]

What you are describing appears similar to Dionne's Egress Test

for safe patient transfers. We have been using a similar " no lift "

policy at our facility with mixed success. I still find 2-3 nurses

" dragging " patients to the chair or commode. Since PT teaches patient

lifts during our Skills Fair for nursing every year, we emphasize the

role of the therapist in mobilizing patients by working on transfers,

not on using lift equipment. Most nurses understand our roles and

rarely question the reason we do not use lifts in many, not all,

instances. I think it may just be a matter of teaching staff on how

therapy works to help improve patient transfers so a lift will not be

necessary later.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

Co-Manager Rehabilitation Services

Providence Saint ph Hospital

500 E. Webster

P.O. Box 197

Chewelah, WA 99109

email: thomas.kaluzny@...

No trees were destroyed in the sending of this organic message. I do

concede, however, a significant number of electrons may have been

inconvenienced.

Therapy is about the power of possibility. So is Providence.

www.providenceiscalling.jobs/therapy

[Guest guest]

We made rehab the exception to this policy since we are working to improve

transfer status, this has not been problematic at our facility.

Sue Condon, PT

Director of Rehab

Divine Savior Healthcare

Portage, WI 53901

________________________________

From: PTManager on behalf of Mike Hampton

Sent: Tue 6/26/2012 6:29 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states

that there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep

patients safe, it has obvious implications from a rehab perspective. We continue

to have challenges with our occupational health department in regards to this

topic as we are perceived as " breaking " this policy when pefroming bed mobility,

transfer training, family training on appropriate dependent transfer techniques

etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Mike,

We formally had it written into the policy that therapy is exempt. That has

worked well. After all, our job is to put patients at risk. We couldn't rehab

our patients if we had to use lifts.

Deane

W. Deane

Rehabilitations Services

Finger Lakes Health

196 North St.

Geneva, New York, 14456

Tel:

Fax:

E-Mail: deane.butler@...

>>> Mike Hampton 6/26/2012 7:29 PM >>>

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Mike,

We formally had it written into the policy that therapy is exempt. That has

worked well. After all, our job is to put patients at risk. We couldn't rehab

our patients if we had to use lifts.

Deane

W. Deane

Rehabilitations Services

Finger Lakes Health

196 North St.

Geneva, New York, 14456

Tel:

Fax:

E-Mail: deane.butler@...

>>> Mike Hampton 6/26/2012 7:29 PM >>>

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Mike,

We formally had it written into the policy that therapy is exempt. That has

worked well. After all, our job is to put patients at risk. We couldn't rehab

our patients if we had to use lifts.

Deane

W. Deane

Rehabilitations Services

Finger Lakes Health

196 North St.

Geneva, New York, 14456

Tel:

Fax:

E-Mail: deane.butler@...

>>> Mike Hampton 6/26/2012 7:29 PM >>>

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

This is an area of practice begging less for evidence than for thoughtfulness

(although more research will be welcomed and even necessary to convince those

who don't trust their observational skills or intuition).

It's pretty well understood that handling dependent and semi-dependent patients

is physically challenging, and even damaging, to caregivers whether they are

nurses or aides with the goal of simply moving a patient from here to there, or

therapists with functional treatment goals. Either way, the injury rates from

handling patients are rather alarming. On the other hand, no-lift policies are

often implemented in the context of care patterns that are simply not ready for

them, e.g. hospital rooms are often too small for reasonable use of lift assist

equipment, equipment is often unavailable and/or there is no place to store it

handily in many hospitals, staffing levels are established that do not allow for

the increased time necessary to use lifting equipment, etc. That is why, I

think, you find nurses sometimes ignoring their no-lift policies and reverting

back to the old grunt and lift care pattern.

Here, by the way, is a pretty good research article that found patient

functional outcomes were as good or better after implementation of a Safe

Patient Handling policy than before implementation (I don't have anything but

the abstract, which does not say whether the policy was " zero-lift " or not):

http://www.ncbi.nlm.nih.gov/pubmed/21721394

And here is a good monograph (IMHO) addressing the issue from a number of

angles:

http://www.springerpub.com/samples/9780826163639_chapter.pdf

Those with responsibility for inpatient programs will definitely have an octopus

to wrestle if they decide to attack the problem.

Dave Milano, PT

Rehabilitation Director

Laurel Health System

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Mike Hampton

Sent: Tuesday, June 26, 2012 7:30 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states

that there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep

patients safe, it has obvious implications from a rehab perspective. We continue

to have challenges with our occupational health department in regards to this

topic as we are perceived as " breaking " this policy when pefroming bed mobility,

transfer training, family training on appropriate dependent transfer techniques

etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

This is an area of practice begging less for evidence than for thoughtfulness

(although more research will be welcomed and even necessary to convince those

who don't trust their observational skills or intuition).

It's pretty well understood that handling dependent and semi-dependent patients

is physically challenging, and even damaging, to caregivers whether they are

nurses or aides with the goal of simply moving a patient from here to there, or

therapists with functional treatment goals. Either way, the injury rates from

handling patients are rather alarming. On the other hand, no-lift policies are

often implemented in the context of care patterns that are simply not ready for

them, e.g. hospital rooms are often too small for reasonable use of lift assist

equipment, equipment is often unavailable and/or there is no place to store it

handily in many hospitals, staffing levels are established that do not allow for

the increased time necessary to use lifting equipment, etc. That is why, I

think, you find nurses sometimes ignoring their no-lift policies and reverting

back to the old grunt and lift care pattern.

Here, by the way, is a pretty good research article that found patient

functional outcomes were as good or better after implementation of a Safe

Patient Handling policy than before implementation (I don't have anything but

the abstract, which does not say whether the policy was " zero-lift " or not):

http://www.ncbi.nlm.nih.gov/pubmed/21721394

And here is a good monograph (IMHO) addressing the issue from a number of

angles:

http://www.springerpub.com/samples/9780826163639_chapter.pdf

Those with responsibility for inpatient programs will definitely have an octopus

to wrestle if they decide to attack the problem.

Dave Milano, PT

Rehabilitation Director

Laurel Health System

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Mike Hampton

Sent: Tuesday, June 26, 2012 7:30 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states

that there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep

patients safe, it has obvious implications from a rehab perspective. We continue

to have challenges with our occupational health department in regards to this

topic as we are perceived as " breaking " this policy when pefroming bed mobility,

transfer training, family training on appropriate dependent transfer techniques

etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

This is an area of practice begging less for evidence than for thoughtfulness

(although more research will be welcomed and even necessary to convince those

who don't trust their observational skills or intuition).

It's pretty well understood that handling dependent and semi-dependent patients

is physically challenging, and even damaging, to caregivers whether they are

nurses or aides with the goal of simply moving a patient from here to there, or

therapists with functional treatment goals. Either way, the injury rates from

handling patients are rather alarming. On the other hand, no-lift policies are

often implemented in the context of care patterns that are simply not ready for

them, e.g. hospital rooms are often too small for reasonable use of lift assist

equipment, equipment is often unavailable and/or there is no place to store it

handily in many hospitals, staffing levels are established that do not allow for

the increased time necessary to use lifting equipment, etc. That is why, I

think, you find nurses sometimes ignoring their no-lift policies and reverting

back to the old grunt and lift care pattern.

Here, by the way, is a pretty good research article that found patient

functional outcomes were as good or better after implementation of a Safe

Patient Handling policy than before implementation (I don't have anything but

the abstract, which does not say whether the policy was " zero-lift " or not):

http://www.ncbi.nlm.nih.gov/pubmed/21721394

And here is a good monograph (IMHO) addressing the issue from a number of

angles:

http://www.springerpub.com/samples/9780826163639_chapter.pdf

Those with responsibility for inpatient programs will definitely have an octopus

to wrestle if they decide to attack the problem.

Dave Milano, PT

Rehabilitation Director

Laurel Health System

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Mike Hampton

Sent: Tuesday, June 26, 2012 7:30 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states

that there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep

patients safe, it has obvious implications from a rehab perspective. We continue

to have challenges with our occupational health department in regards to this

topic as we are perceived as " breaking " this policy when pefroming bed mobility,

transfer training, family training on appropriate dependent transfer techniques

etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Sue's response below is the key as we as PTs are working on transfer TRAINING

versus simply moving the patient from one surface to another. As such, these

" zero lift " policies will present problems for us because the activity itself

involves lifting. Our goal, of course, is for the patient to be able to lift

him/herself during the transfer, during sit <==> stand, etc., but until that

time, we help and train them to do it, and we have to have our hands on the

patient to do it well.

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Zero Lift Policies

Posted by: " Sue Condon " scondon@... packerpals

Wed Jun 27, 2012 6:55 am (PDT)

We made rehab the exception to this policy since we are working to improve

transfer status, this has not been problematic at our facility.

Sue Condon, PT

Director of Rehab

Divine Savior Healthcare

Portage, WI 53901

________________________________

From: PTManager on behalf of Mike Hampton

Sent: Tue 6/26/2012 6:29 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Sue's response below is the key as we as PTs are working on transfer TRAINING

versus simply moving the patient from one surface to another. As such, these

" zero lift " policies will present problems for us because the activity itself

involves lifting. Our goal, of course, is for the patient to be able to lift

him/herself during the transfer, during sit <==> stand, etc., but until that

time, we help and train them to do it, and we have to have our hands on the

patient to do it well.

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Zero Lift Policies

Posted by: " Sue Condon " scondon@... packerpals

Wed Jun 27, 2012 6:55 am (PDT)

We made rehab the exception to this policy since we are working to improve

transfer status, this has not been problematic at our facility.

Sue Condon, PT

Director of Rehab

Divine Savior Healthcare

Portage, WI 53901

________________________________

From: PTManager on behalf of Mike Hampton

Sent: Tue 6/26/2012 6:29 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Sue's response below is the key as we as PTs are working on transfer TRAINING

versus simply moving the patient from one surface to another. As such, these

" zero lift " policies will present problems for us because the activity itself

involves lifting. Our goal, of course, is for the patient to be able to lift

him/herself during the transfer, during sit <==> stand, etc., but until that

time, we help and train them to do it, and we have to have our hands on the

patient to do it well.

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Zero Lift Policies

Posted by: " Sue Condon " scondon@... packerpals

Wed Jun 27, 2012 6:55 am (PDT)

We made rehab the exception to this policy since we are working to improve

transfer status, this has not been problematic at our facility.

Sue Condon, PT

Director of Rehab

Divine Savior Healthcare

Portage, WI 53901

________________________________

From: PTManager on behalf of Mike Hampton

Sent: Tue 6/26/2012 6:29 PM

To: ptmanager

Subject: Zero Lift Policies

Our medical center has a Safe Patient Handling policy wich basically states that

there is a " zero lift " policy for patient transfers. This means that if a

patient's mobility is impaired, one must use a lift or transfer device. In fact,

the job aid algorithm states that if the patient cannot perform 2-3 sit to stand

repititions at the edge of the bed, one must use a lift or other transfer device

(a tranfer device is NOT a gait belt).

While the intent of this policy is to reduce employee injuries and keep patients

safe, it has obvious implications from a rehab perspective. We continue to have

challenges with our occupational health department in regards to this topic as

we are perceived as " breaking " this policy when pefroming bed mobility, transfer

training, family training on appropriate dependent transfer techniques etc.

I would love to hear how other acute care and IRFs therapies are handing this

issue. Thanks.

Mike Hampton PT, MPT

Manager-Rehab Therapies

PeaceHealth St. ph Medical Center

Bellingham, WA

[Guest guest]

Zero lift policies are a little misleading. Even when using lifts correctly,

you still have to lift a bit. I use lifts in my treatments in acute care very

often. They HELP my treatments be more skilled and safe for both the patient,

me, my tech, and it is a good example for the nursing staff. Examples of

patient scenarios:

Very debilitated patient in ICU: hasn't walked or been out of bed in a week.

Dialysis, heart issues, etc: Unable to perform AROM BLE. Able to activate

muscles, but not able to complete even partial ROM unassisted. I used the

ceiling lift with a positioning sling (size of the bed with 5 loops on either

side) to assist rolling. I just hooked up one side of the sling. He could

initiate rolling, but needed help, so I had him initiate rolling, lifted him a

bit with the lift, and had him finish rolling. We did this for a few reps.

Completely wore him out. This is a much better option than me man handling him.

I was able to keep my hands free to facilitate and cue. Also, I didn't need a

tech. Had he been strong enough to sit on the edge of the bed, I would have

used the same lift to sit him (not 2 people total assist), then I could have

worked on sitting balance. (Could have also used a floor (hoyer type) lift to

so the same task.

Bariatric patient: couldn't lift legs due to mass of pannus. Did the same

rolling task with this patient. Able to clean him up with 1-2 staff members,

not 4-6. Patient was unable to bridge due his size and weight of his pannus. I

used the positioning sling loops under his bottom and lifted his rear off the

bed enough to get his feet on the bed in hooklying. From this position, he was

able to initiate a bridge, needed help from the lift to finish it, but without

the lift, he would not have been able to do this at all. Also, hooked up the

leg lifter sling to the lift with the sling under his pannus. Lifted the pannus

enough for the patient to actually perform AROM to his legs to about 80 degrees

flexion. He had not been able to bend them that far in supine due to his

pannus.

Some patients have a very hard time with supine to sit. That is sometimes the

hardest transfer during a treatment session. If your patient also needs to work

on sitting balance, scooting in the chair, sit to stand, etc., use the lift to

get them into the chair or the edge of the bed. Perform the other tasks that

need to be done, then work backwards from sitting to supine. Example: Work on

sitting to right elbow weight bearing and back up again. If the patient does

well, do that and add bringing one leg on the bed. This way, you can actually

work on training the components and not just doing it all for them because they

can't.

You can also use standing lifts in similar ways.

Lifts can be very helpful to our treatments. If your patients aren't able to

complete a task, we obviously want to address those tasks. There is a way to

incorporate the use of equipment into daily treatments. Creativity is the key.

www.safeliftingportal.com<http://www.safeliftingportal.com> has great

information and articles.

Robyn Holland, PT, GCS

Therapy Manager, Acute Care Therapy-South

Health

Robyn.Holland@...

Phone:

__________

Health - a Top 100 Integrated Health Care Network

COXHEALTH

[Guest guest]

It's exciting to see this topic being discussed here, as I've been involved

with safe patient handling and movement initiatives for over 10 years. I

agree that the term " zero lift " is unfortunate but it was the term used in

the " early days " and took on its own meaning. It's probably more accurate to

term these programs as low lift, minimal lift, safe patient handling, etc.

-- the common goal is to decrease exposure to the risk factors for

musculoskeletal disorders for caregivers by the appropriate use of available

technology to assist the tasks and activities of providing hands-on care. At

the same time we decrease the risk of injury for the patients, and may even

improve outcomes when integrated into rehabilitation care. The technology

just provides new tools for our use, and I definitely agree with Robyn that

" creativity is the key " -- my bias is that therapists are creative types so

here is another opportunity. It's also exciting to see therapists taking a

leadership role in these programs! Keep up the good work and share your

ideas and lessons learned.

There is a lot of good information out there on this topic. In addition to

the safe lifting portal site, the VA Safe Patient Handling and Movement site

is also full of information

http://www.visn8.va.gov/patientsafetycenter/safepthandling/

Kathleen Rockefeller, PT, ScD, MPH

Associate Professor & Research Coordinator

Hybrid Entry-Level DPT Program

Nova Southeastern University

Tampa FL

Krockefeller@...

Reply-To: <PTManager >

Date: Friday, June 29, 2012 11:26 AM

To: " PTManager " <PTManager >

Subject: Re: Zero Lift Policies

Zero lift policies are a little misleading. Even when using lifts

correctly, you still have to lift a bit. I use lifts in my treatments in

acute care very often. They HELP my treatments be more skilled and safe for

both the patient, me, my tech, and it is a good example for the nursing

staff. Examples of patient scenarios:

Very debilitated patient in ICU: hasn't walked or been out of bed in a

week. Dialysis, heart issues, etc: Unable to perform AROM BLE. Able to

activate muscles, but not able to complete even partial ROM unassisted. I

used the ceiling lift with a positioning sling (size of the bed with 5 loops

on either side) to assist rolling. I just hooked up one side of the sling.

He could initiate rolling, but needed help, so I had him initiate rolling,

lifted him a bit with the lift, and had him finish rolling. We did this for

a few reps. Completely wore him out. This is a much better option than me

man handling him. I was able to keep my hands free to facilitate and cue.

Also, I didn't need a tech. Had he been strong enough to sit on the edge of

the bed, I would have used the same lift to sit him (not 2 people total

assist), then I could have worked on sitting balance. (Could have also used

a floor (hoyer type) lift to so the same task.

Bariatric patient: couldn't lift legs due to mass of pannus. Did the same

rolling task with this patient. Able to clean him up with 1-2 staff

members, not 4-6. Patient was unable to bridge due his size and weight of

his pannus. I used the positioning sling loops under his bottom and lifted

his rear off the bed enough to get his feet on the bed in hooklying. From

this position, he was able to initiate a bridge, needed help from the lift

to finish it, but without the lift, he would not have been able to do this

at all. Also, hooked up the leg lifter sling to the lift with the sling

under his pannus. Lifted the pannus enough for the patient to actually

perform AROM to his legs to about 80 degrees flexion. He had not been able

to bend them that far in supine due to his pannus.

Some patients have a very hard time with supine to sit. That is sometimes

the hardest transfer during a treatment session. If your patient also needs

to work on sitting balance, scooting in the chair, sit to stand, etc., use

the lift to get them into the chair or the edge of the bed. Perform the

other tasks that need to be done, then work backwards from sitting to

supine. Example: Work on sitting to right elbow weight bearing and back up

again. If the patient does well, do that and add bringing one leg on the

bed. This way, you can actually work on training the components and not

just doing it all for them because they can't.

You can also use standing lifts in similar ways.

Lifts can be very helpful to our treatments. If your patients aren't able

to complete a task, we obviously want to address those tasks. There is a

way to incorporate the use of equipment into daily treatments. Creativity

is the key.

www.safeliftingportal.com<http://www.safeliftingportal.com> has great

information and articles.

Robyn Holland, PT, GCS

Therapy Manager, Acute Care Therapy-South

Health

Robyn.Holland@... <mailto:Robyn.Holland%40coxhealth.com>

Phone:

__________

Health - a Top 100 Integrated Health Care Network

COXHEALTH

[Guest guest]

It's exciting to see this topic being discussed here, as I've been involved

with safe patient handling and movement initiatives for over 10 years. I

agree that the term " zero lift " is unfortunate but it was the term used in

the " early days " and took on its own meaning. It's probably more accurate to

term these programs as low lift, minimal lift, safe patient handling, etc.

-- the common goal is to decrease exposure to the risk factors for

musculoskeletal disorders for caregivers by the appropriate use of available

technology to assist the tasks and activities of providing hands-on care. At

the same time we decrease the risk of injury for the patients, and may even

improve outcomes when integrated into rehabilitation care. The technology

just provides new tools for our use, and I definitely agree with Robyn that

" creativity is the key " -- my bias is that therapists are creative types so

here is another opportunity. It's also exciting to see therapists taking a

leadership role in these programs! Keep up the good work and share your

ideas and lessons learned.

There is a lot of good information out there on this topic. In addition to

the safe lifting portal site, the VA Safe Patient Handling and Movement site

is also full of information

http://www.visn8.va.gov/patientsafetycenter/safepthandling/

Kathleen Rockefeller, PT, ScD, MPH

Associate Professor & Research Coordinator

Hybrid Entry-Level DPT Program

Nova Southeastern University

Tampa FL

Krockefeller@...

Reply-To: <PTManager >

Date: Friday, June 29, 2012 11:26 AM

To: " PTManager " <PTManager >

Subject: Re: Zero Lift Policies

Zero lift policies are a little misleading. Even when using lifts

correctly, you still have to lift a bit. I use lifts in my treatments in

acute care very often. They HELP my treatments be more skilled and safe for

both the patient, me, my tech, and it is a good example for the nursing

staff. Examples of patient scenarios:

Very debilitated patient in ICU: hasn't walked or been out of bed in a

week. Dialysis, heart issues, etc: Unable to perform AROM BLE. Able to

activate muscles, but not able to complete even partial ROM unassisted. I

used the ceiling lift with a positioning sling (size of the bed with 5 loops

on either side) to assist rolling. I just hooked up one side of the sling.

He could initiate rolling, but needed help, so I had him initiate rolling,

lifted him a bit with the lift, and had him finish rolling. We did this for

a few reps. Completely wore him out. This is a much better option than me

man handling him. I was able to keep my hands free to facilitate and cue.

Also, I didn't need a tech. Had he been strong enough to sit on the edge of

the bed, I would have used the same lift to sit him (not 2 people total

assist), then I could have worked on sitting balance. (Could have also used

a floor (hoyer type) lift to so the same task.

Bariatric patient: couldn't lift legs due to mass of pannus. Did the same

rolling task with this patient. Able to clean him up with 1-2 staff

members, not 4-6. Patient was unable to bridge due his size and weight of

his pannus. I used the positioning sling loops under his bottom and lifted

his rear off the bed enough to get his feet on the bed in hooklying. From

this position, he was able to initiate a bridge, needed help from the lift

to finish it, but without the lift, he would not have been able to do this

at all. Also, hooked up the leg lifter sling to the lift with the sling

under his pannus. Lifted the pannus enough for the patient to actually

perform AROM to his legs to about 80 degrees flexion. He had not been able

to bend them that far in supine due to his pannus.

Some patients have a very hard time with supine to sit. That is sometimes

the hardest transfer during a treatment session. If your patient also needs

to work on sitting balance, scooting in the chair, sit to stand, etc., use

the lift to get them into the chair or the edge of the bed. Perform the

other tasks that need to be done, then work backwards from sitting to

supine. Example: Work on sitting to right elbow weight bearing and back up

again. If the patient does well, do that and add bringing one leg on the

bed. This way, you can actually work on training the components and not

just doing it all for them because they can't.

You can also use standing lifts in similar ways.

Lifts can be very helpful to our treatments. If your patients aren't able

to complete a task, we obviously want to address those tasks. There is a

way to incorporate the use of equipment into daily treatments. Creativity

is the key.

www.safeliftingportal.com<http://www.safeliftingportal.com> has great

information and articles.

Robyn Holland, PT, GCS

Therapy Manager, Acute Care Therapy-South

Health

Robyn.Holland@... <mailto:Robyn.Holland%40coxhealth.com>

Phone:

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