Easing 'dead weight' lifts of anesthetized OR patients

New guidelines offer algorithms

The patient lies on a gurney in the operating room and needs to be transferred and positioned onto the table. As OR nurses and techs assess this situation, one thing is clear: The anesthetized patient isn't going to be able to help with the transfer.

The operating room presents unique challenges when it comes to patient handling, from patients who are essentially "dead weight" to the need to maintain the sterile field. Even lifting and holding an arm or a leg for extended periods can be a hazard.

New algorithms and guidelines from the Association of peri-Operative Registered Nurses (AORN) in Denver provide tailored direction on how to assess patients and implement the appropriate safe patient handling. The guidelines were developed by a task force and guided by the work of the VISN 8 Patient Safety Center of Inquiry at the James A. Haley VA Medical Center in Tampa, FL, which developed the initial algorithms for safe patient handling.

New strategies emerge

The new guidance reveals a maturing of the safe patient handling movement as new algorithms and guidelines emerge for areas with special needs and circumstances. Orthopedics and rehabilitation will be the focus of upcoming guidance documents, says Audrey Nelson, PhD, RN, FAAN, director of the Patient Safety Center and a member of the task force.

"When we started, we were just looking at the most generic high-risk tasks and trying to apply them across long-term care, community and acute care settings," she says. "That will only get you so far. To really get to the root cause of injuries, You need to go beyond the generic high-risk tasks."

Patient handling experts from the National Institute for Occupational Safety and Health (NIOSH) and the American Nurses Association also served on the task force.

Health care workers need to learn how to assess patient handling needs and need access to the appropriate equipment, says Nancy Hughes, MS, RN, director of the Center for Occupational and Environmental Health at the ANA in Silver Spring, MD.

"It is really important that each department look at their high-risk tasks and come up with solutions for the department," she says.

Seven high-risk tasks

For operating room nurses, safe patient handling means rethinking a variety of tasks. "Health care providers, particularly nurses, are going to take care of a patient at risk of their own health [if necessary]," says Carol Petersen, RN, MAOM, CNOR, perioperative nursing data set manager at AORN's Center for Nursing Practice. "If there are plans thought out ahead of time about how patients are moved and handled, including weight limits, we believe the nurses will be safer."

The task force listed the tasks in the operating room and prioritized them according to risk. They identified seven major high-risk activities: transferring patients, repositioning patients, lifting and holding patients' extremities, standing for a long period of time, holding retractors for a long period of time, lifting and moving equipment, and sustaining awkward positions.

The task force members then created a series of questions that could help guide health care workers toward the assistance they would need. The AORN guidelines make use of the new 35-pound manual lifting limit for health care developed by the NIOSH.

For example, if the nurse is holding a patient's leg, does it exceed the 35-pound limit? Is there equipment that could be used to support it? Does it need to be held during the entire surgical prep? Does the person holding the limb need to be scrubbed?

The use of patient handling equipment will require a change in the usual practice in the OR. The OR team, including physicians, need to be educated about the risks of manual lifting and the safe lifting methods and equipment.

"This is something that needs to be supported by the whole institution," says Petersen.

(Editor's note: The AORN safe patient handling guidelines are available for $39 from the AORN bookstore at www.aornbookstore.org/.)

(See Ergonomic Tool: Positioning/Repositioning the patient on the OR bed into and from the supine position.)