Amber Perez, LPN, BS, MHA, felt a sharp pain descending from her shoulder as she tried to move a patient in a bed, a task she had performed routinely in six years as a bedside nurse.

“I inhaled sharply as a stab stopped me in my tracks and took over my body,” she recalled. “ I shifted my weight while moving my 160-pound patient by myself. The patient woke up and he resisted movement. I realized I was seriously injured. After my patient handling injury, all aspects of my life were really impacted in a way that I couldn’t imagine at the time.”

Perez told her story at a webinar hosted by the Association of Occupational Health Professionals in Healthcare.1 She left the bedside and began pursuing education on Safe Patient Handling and Mobility (SPHM), becoming an expert and consultant. At one point, she returned to the patient bedside part time to get a real-world view on the challenges and barriers to implementing this equipment and ensuring access. She found a lack of emphasis on SPHM, and equipment often was stored away or disorganized.

“Safe patient handling and mobility is possible,” Perez said. “Here are some of my lessons learned. First of all, we must be proactive and not reactive.”

It is essential to conduct a mobility assessment with a tool such as the Bedside Mobility Assessment Tool, which assesses patients in sitting, standing, and walking ability and lists equipment like sliders, lifts, slings, and air hover mats according to the patient’s mobility.2

“What I’ve learned with working with multiple organizations is that if they don’t have a formal nursing mobility assessment, you can simply start by associating nursing assessment terminology with the terminology they have,” Perez explained.

For example, the commonly used numerical Braden Scale to assess skin damage and risk of pressure ulcers can be modified to rank patient mobility and risk of falls.

“You also hear one-plus and two-plus assist,” she said. “This refers to how many people should be involved in the transfer. What you can do is just translate that into [safe handling] equipment. Standby assist would likely fall on the scale of mobility assessment levels, but also it can just simply equal non-powered standing [and] safety walkers. Anything that would be similar to that minimal standby.”

If moving the patient by traditional methods calls for one more person, you may choose a non-powered stand aid, a sit to stand, or a safety lock.

“If you need two people, now we’re talking about needing a mobile lift, a ceiling lift, and a slide sheet for assisted lateral transfers,” Perez said. “That’s a really simple way that a facility that does not have a formal mobility assessment can just start changing the language and making translations from the terms that they’re using into equipment-friendly terms.”

She also suggested making a chart of equipment categorized as “good, better, best” for specific SPHM situations.

Is Lift Equipment Accessible?

The equipment must be accessible to the healthcare workers or switching from more bodies to safe machines is not going to work.

“All the equipment needs to be accessible, available, and practical,” Perez said. “There are a lot of organizations that have anti-slide sheet, anti-low-tech philosophy. I’ve heard the safe patient handling manager say, ‘Listen, if I give them the choice to use a slide sheet, they’ll never use the ceiling lift.’ That just bothers me to my core because we need to have options.”

There are times when the patient needs to be moved quickly; for example, to a toilet in a situation Perez described from personal experience. She solved the problem with a slide sheet, although a ceiling lift would have been the generally preferred option given the patient’s limited mobility.

“Even if I had a ceiling lift, it might have been better to use a slide sheet because that might have been my only option to transfer that gentleman in an emergency,” she recalled. “I couldn’t get a ceiling lift with a sling under the patient in time. I really am a strong believer in offering options.”

Options — and accessibility. “If you have a lift and it’s shared between floors, it’s not accessible,” Perez said. “It just cannot be considered accessible. Think about my story and that situation — the gentleman needs to use the bathroom right now. I can’t go upstairs and get the lift, so that’s not accessible. Slide sheets are low-cost, accessible, easy to carry around, and low-tech.”

Many facilities end up designating a storage room for the varieties of patient safety equipment, but they cannot just be pushed in the room helter skelter.

“Think about how you’re going to make them accessible,” Perez says. “There’s a box of gloves in every room, right? Many of these manufacturers make holders, clips, dispensers — lots of different options of putting them in the room. If it’s in the room, they’re going to grab it, they’re going to use it.”

Slings should be labeled and boxed to easily find the right size. “With lifts, the same thing,” she added. “They can’t be buried behind commodes and walkers in storage closets. If somebody’s on the floor, I need to be able to grab the mobile lift. I can’t be pulling things out of the way in order to get it.”

It is a good idea to use “fall cart” with critical supplies that can be transported to the patient. Perez recalled such a cart at a hospital that used an air-assisted hover lift, a seated sling, slide sheets, and a checklist of all the things nurses should remember in handling a patient fall.

‘Benefit the Nurse’

While Perez certainly is an SPHM expert and enthusiast, she has learned through experience how to present the equipment to nurses and nursing administration.

“You need to present your change in a way that will benefit the nurse,” she explains. “If you have a lot of resistance and you’re not getting a lot of participation in your safe patient handling, I would regroup and not frame it around a safety initiative. [For example], safety lockers are amazing. The ones that have slings or seats so that you can mobilize your patient, especially when physical therapy’s not around. These kinds of solutions are going to be better accepted because they’re solving a problem for the nurse. From there, you build on that.”

In perhaps the most revelatory aspect of her presentation, Perez found patient safe mobility and equipment was critical when the pandemic hit, which happened during her return stint to the bedside.

“Supplies were limited, we couldn’t even get regular contact gowns, and we couldn’t afford to waste anything,” Perez recalled. “It was just a very desperate situation. But slide sheets, non-powered stand aids, and ceiling lifts absolutely saved my back, my health, and my life — and protected patients.”

Safe patient handling and mobility also made transfers and mobility possible to single caregivers, a critical factor during the pandemic.

“Mid-pandemic, we started learning about the benefit of proning patients as a first line of defense for those with respiratory distress syndrome caused by COVID,” Perez said. This practice of placing patients face down on their stomachs enhances oxygen exchange.

“Slide sheets and repositioning sheets were amazing at helping us prone those patients safely and quickly,” Perez said. “I had to move this patient by myself, or [maybe] with one other person. I had no choice but to use safe patient handling. It was something that was absolutely necessary.”

SPHM should be a part of emergency preparedness plan, and in many facilities it is probably not, she said.

“How will you move bodies when there’s a mass casualty?” Perez asked. “I was working for a medical device company and working bedside. We were getting desperate calls from New York around April and May of 2020, asking how many slide sheets we had left because all the suppliers were running out. They needed them to transfer the bodies onto these refrigerated [morgue] trucks that were parked behind the building. It just blew my mind that this was an issue.”

REFERENCES

  1. Association of Occupational Health Professionals in Healthcare. Enhancing patient safety and outcomes: The safe patient handling connection. Aug. 11, 2021.
  2. Duke MOVES. Adult Bedside Mobility Assessment Tool (BMAT) for nurses. Updated October 2018.