section 7 · 2019-03-27 · Hoisting client from floor Ceiling hoist, mobile hoist, air jack...
Transcript of section 7 · 2019-03-27 · Hoisting client from floor Ceiling hoist, mobile hoist, air jack...
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section 7
Contents
• Usingequipmentformovingandhandlingpeople
• Typesofequipment
• Examplesofmovingandhandlingequipment
– Slidesheets
– Transferbelts
– Transferboards
– Air‑assistedtransferdevices
– Electricprofilingbeds
– Mobilehoists
– Standinghoists
– Ceilinghoists
– Gantryhoists
– Fixedwallhoists
– Slings
– Stretchers
– Wheelchairs
– Standingandpivotingaids(non‑electric)
– Showerandbathequipment
– Emergencyequipment
– Othertypesofequipmentandaids
• Referencesandresources.
Note:Allimagesandotherreferencestoequipmentshowninthissectionareprovidedforillustrativepurposesonly.Theyarenot,andshouldnotbetakenas,endorsementsofspecificequipmentorsuppliers.
Equipment for moving and handling people
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7.1 Using equipment for moving and handling peopleThissectiondescribesthemaintypesandfunctionsofequipmentformovingandhandlingpeople.Section8oftheGuidelines,‘Equipmentmanagement’,coversequipmentprocurementsystems,maintaininganequipmentregisterandequipmentstorage,maintenanceandreplacement.
Equipmentisacorecomponentineffectivemovingandhandlingprogrammes,togetherwithriskassessments,theuseofcorrecttechniques,stafftrainingandappropriatefacilitydesign.Thesupplyofequipmentbyitselfwillnotleadtoreducedratesofinjuryunlessequipmentuseispartofacomprehensivemovingandhandlingprogramme.Successfulprogrammesprovidebothequipmentandtraininginhowtousespecificitemsofequipmentforlifting,transferringandrepositioningclients.
Theproperuseofequipmentisessentialforthesafetyofbothclientsandcarersandimprovesthequalityofclientcare.Equipmentcanalsofacilitateclientrehabilitation,decreasemorbidityandpreservethedignityofclients.Comparedwithtechniquesthatinvolvemanualtransfersofclientswithoutequipment,theuseofequipmentlessenstheforcesrequiredformovingandhandlingclientsandcanreducetherisks.
Movingandhandlingequipmentalsoimprovesclientoutcomes,suchasreducingtheirlengthofstayandtheriskofcomplicationssuchasdeepveinthrombosis,chestinfections,urinarytractinfections,pressureulcers,skintearsandfalls.
Having‘fit‑for‑purpose’equipmentisoneofthemostimportantaspectsofmovingandhandlingprogrammes.Newmovingandhandlingequipmentisconstantlybeingdeveloped.Withtheincreasingcomplexityofequipmentandtechnologicaldevelopments,informationaboutspecificequipmentcanbecomeoutdated.Managersresponsibleforpurchasingequipment,andpeopleprovidingtraininginequipmentuse,needtokeepuptodatewithdevelopmentsinequipmentformovingandhandlingpeople.Theprimaryfocusofthissectionisondescriptionsofequipmentandspecificfeatures.Specificproceduresforusingequipment,suchasslidesheets,slingsandhoists,aredescribedinSection4Techniquesformovingandhandling people.
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Section 7: equipment for moving and handling people
7.2 Types of equipmentTable7.1showsthemaintypesofequipmentusedformovingpeople,andexamplesofcommonuses.Sometypesofequipmentareknownbyseveralnames,asshown.Detaileddescriptionsofeachtypeofequipmentareprovidedlaterinthissection.Forsomecategoriesofequipment,thereareseveralrelatedtypes,whichmayhavedifferentnames.
Table 7.1 Common types of equipment
Type of equipment(and alternative names) Description and common uses
Slide sheet(slidingsheet,slipperysam)
Asheetmadeoflow‑frictionmaterialandusedunderaclienttoalloweasyrepositioninginbed,slingattachmentandlateral transfers
Transfer belt(handlingbelt,gaitbelt,walking belt)
Abeltplacedaroundaclient’swaistduringseveraltypesoftransferandforassistedwalkingforrehabilitation.Therearemultipletypesofbelt
Transfer board(PATslide,slideboard,banana board)
Afull‑body‑lengthboardmadefromwoodorplastic,usedtobridgegapsforclienttransfersfromonesurfacetoanother,suchasfromastretcherorwheelchairtoabed.Smallertransferboardscanalsobeusedforlateral,seated‑to‑seatedtransfers
Air‑assisted transfer device Thereareseveraltypes:inflatablemattressesforlateral(bed‑to‑bed)transfersandair‑assistedliftingdevicesor ‘jacks’
Electric profiling bed(electricbed)
Anelectricallyoperatedbedthathasamattressplatformsplitintotwo,threeorfoursections,whichallowsadjustmentusingacontrolhandsetorpanel
Mobile hoist(floorhoist,floorlift,mechanicallift,portable hoist)
Ahoistwithwheelsthatcanbemovedalongthefloor–usedforliftingaclientinsideaslingoronastretcherdesignedforusewithhoists
Standing hoist(sittostandhoist,standinglift,stand‑aidhoist)
Aspecifictypeofmobilehoistdesignedtoassistpeoplebetweensittingandstandingpositions.Standinghoistsaredesignedtofitunderandaroundchairs
Ceiling hoist(overheadhoist,ceilinglift,mechanicallift,gantryhoist)
Ahoistattachedtopermanentlymountedceilingtrackthatmovesaclientinsideasling.Gantryhoistshaveoverheadtracksmountedonwheeledframes
Sling Afabricsupportusedforcarryingaclientwhilebeingmovedwithahoist–therearemultipletypesofsling
Stretcher Arigidframeusedtocarryaclientinalyingorsupineposition.Oftenmadeoflightweightmaterialandcommonlyusedinambulancesandbyemergencyservices.Wheeledstretchersareusedinhospitalsfortransportingclientsbetweenlocations,andshouldbeelectric
Wheelchair Amobilechairusedfortransportingaclientinasittingoruprightposition.Bariatricwheelchairsmustbepoweredormovedwithbedpushers
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Themaintypesofequipmentthatarecommonlyusedcanbesummarisedwithinthefourmaingroupsofclientmovingandhandlingtasks.Thesegroupsoftasksare:
• Sitting,standingandwalking
• Bedmobility
• Lateraltransfers
• Hoisting.
Table7.2providesasummaryofthecommontypesofequipmentusedforthesehandlingtasks.TherecommendedtechniquesforeachoftasksinthetablebelowaredescribedinSection5oftheGuidelines.
Table 7.2 Handling tasks for which equipment may be used
Type of taskExamples of specific movements
Examples of equipment that could be used
Sitting,standingandwalking
Sittingtostandingfroma chair
Transferbelt,standinghoist,mobilehoist,chair‑lifter
Standingtosittingona bed Transferbelt
Assistedwalking Transferbelt,walker,gutterframe,hoistwithwalkingharness
Bedmobility Turninginbed Slidesheets,electricbedwithturning function
Slidingclientupinbed Slidesheets,electricbed
Sittingpersonupontoedgeofbed
Slidesheets,electricbed,bed accessories
Lateraltransfers Lateraltransferfrombedto stretcher
Slidesheets,transferboard,airmattress,standinghoist
Transferringfromchairto commode
Ceilinghoist,mobilehoist,seatedtransferboard,standinghoist
Transferringtotoilet Ceilinghoist,mobilehoist
Hoisting Fittingaslingtoclientin bed Sling
Hoistingfrombedtochair Ceilinghoist,mobilehoist,standing hoist
Hoistingclientfromfloor Ceilinghoist,mobilehoist,airjack
Transferringtotoilet Ceilinghoist,mobilehoist,standing hoist
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Section 7: equipment for moving and handling people
7.3 Examples of moving and handling equipmentThenextpartofthissectionprovidesexamplesofthemorecommonlyusedtypesofequipmentforclienthandling.Furtherinformationaboutspecifictypesandfunctionsofequipmentcanbeobtainedfromthewebsitesshownattheendofthissection,andfromcompaniessupplyinghealthcareequipmentinNew ZealandandAustralia.Traininginproperuseisessentialforalltypesofequipment.
Slide sheets
Slidesheetsareoneofthemostcommonlyusedtypesofequipmentinhealthcareservices.Theyareusedtomoveclientshorizontallyonbeds,trolleysandchairswithoutlifting.Slidesheetsarerelativelylowcost,havemanyusesandarerelativelysimpletouse.Theyavoidtheneedtoliftclients,butdespitetheirsimplicitytheydorequiretrainingintheirproperuse.
Itisimportantthattheuseofslidesheetsisconsistentwithcurrentbestpractice,asdescribedinSection4Techniquesformovingandhandlingpeople.Trainingisnecessaryinthecorrectapplicationanduseofslidesheets.Incorrectusecancauseinjurytobothcarersandclients.Slidesheetsaremadefromlightweightfabricandhavelow‑frictionsurfacesthatbecomeveryslipperywhenplacedtogether.Theycomeindifferentconfigurations:thefabricmaybesewntogethertomakeadoublesheet,ortheymaycomeassinglesheetsthatthecarerfoldsovertoformadoublelayer.Twosheetscanalsobeusedtogether.Theymayormaynothavehandlesforhangingup.Twosinglesheetsarepreferableastheyaremultidirectionalandallowoptimalmovement.
Thereareseveralhandlingtechniquesthatuseslidesheets(seeSection4Techniquesformovingandhandlingpeople).Usingthemunderneathapersonallowsanindependentorassistedslidingmovementonabed.Theycanbeusedformanytasksinvolvinglateraltransfersandrepositioning,suchas:
• Movingaclientinbed
• Turningaclientontotheirsideinbed
• Transferringaclientfromabedtoabedwithatransferboard
• Foraclientwhohasfallenintoaconfinedspace;slidesheetscanbeusedtomovetheclientalongthefloortoalocationwhereahoistcanbeused
• Facilitatingindependentbedmobility.
Slidesheetscomeindifferentsizesandtheymaybepaddedorunpadded.Slidesheetswithloopscanbestoredonhooksbesideclients’beds.
Slide sheets
figure 7.1
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Points to note about slide sheets
• Alwaysconductariskassessmentpriortomovingaclient
• Mostslidesheettransfersrequiretwocarers
• Theriskassessmentshouldincludeskinintegrity,pressureareas,wounds,attachmentsandsensitivities
• Assesspainmanagement
• Encouragemobilitywherepossible
• Whenmovinglargeclients,ensurethereisasufficientnumberofcorrectlysizedslidesheetsandenoughstaffforthetransfer
• Infectioncontrolconsiderationsrequireslidesheetusewithoneclientonlybeforebeinglaundered
• Slidesheetsshouldbeaccessiblebesidethebedoftheclientforwhomtheyarerequired–asuitablestoragefacilityisneeded,suchasahook,containerorfabricholdingbag
• Whenaclientisdischargedormovedtoanotherlocation,orthesheetsbecomesoiled,theslidesheetsshouldbesentforlaundering
• Bed‑to‑bedtransfersshouldalwaysusebothslidesheetsandatransferboard
• Mosttypesofslidesheetaredesignedtobelaundered(seeSection8,Table 8.2).Theusualslidesheetlifespanisaround80washes,dependingonthequality
• Slidesheetsmustbeinspectedfortearsandotherdamagebeforeuse.
Slidesheetscanbeusedmultipletimesonthesameclientandrequirelaunderingwhensoiled,orbeforeusingwithadifferentclient.Organisationsneedtohaveasystemforlaunderingslidesheetsseparatelyfromregularlaundry,asahotwashdestroysthefabric,reducingthelifespanoftheslidesheet.Slidesheetcareshouldbeoutlinedintheorganisation’smovingandhandlingpolicy.Therearealsodisposableslidesheetsforsingleclientuseonly,whicharediscardedwhennolongerneededforthatclient.
Transfer belts
Transferbeltsarefastenedaroundclients’waistsortrunksduringtransfersandforassistedwalking.Theyareprimarilyforclientswhoaremobile.Themainfunctionoftransferbeltsistoassistalmostindependentclientsinmobilising.Theycanalso
Store slide sheets beside bed
figure 7.2
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Section 7: equipment for moving and handling people
assistwithclientswhomightbedifficulttohold,eitherbecauseofsize,ordiscomfort(malewalkingfemale)orbecausetheclientisuncomfortablewithbeingassisted.Thebeltscanprovideanextralayerbetweencarersandclients.Beltsdesignedspecificallytoassistclientswhenwalkingaresometimesreferredtoas‘gaitbelts’.
Transferbeltsareusedtoassistthedevelopmentofmobilityandrehabilitationforclientswhoareminimallydependent,haveweight‑bearingcapacityandarecooperative.Typesofuseincludebed‑to‑chair,chair‑to‑chairandchair‑to‑cartransfers,repositioningclientsinchairs,andsupportingclientswhilewalking.
Therearemultipletypesofbelt.Mostbeltsaremadeoffabricorcushionedmaterialandhavemultipleloopsorhandholds.
Thebeltsaresecuredaroundclients’waistsandadjusteduntiltheyarefirm,nottight.Transferbeltsshouldonlybewornbyclients,neverbycarers.
Points to note about transfer belts
Therearesomerisksforcarersassociatedwithusingtransferbelts.Forthisreason,somemovingandhandlingcoordinatorsrecommendthattransferbeltsnotbeusedforclienttransfers.Ifused,thecarershouldholdontothehandlesfromtheoutside,andneverputtheirthumbsinsideorthroughtheloops(incasetheclientfallsandthecarercannotdisengagetheirhands).Transferbeltsshouldneverbeusedtolift clients.
Transfer boards
Therearemultipletypesoftransferboardandrelatedassistivedevices.Full‑body‑lengthtransferboards(sometimeslabelledasPATslidesorTransglidesinNew Zealand)areusedtobridgegapsforclientswhoarelyingdownwhenslidingbetweentwoadjacentsurfacesatsimilarlevels,suchasfromabedtoastretcher.Theyareusuallymadeofplasticandshouldbeusedinconjunctionwithslidesheets.Smallertransferboardscanbeusedforseat‑to‑seattransfers,suchasbetweenacarseatandawheelchair.
Inthepast,rollerboardshavebeenusedaslying‑to‑lyingtransferdevices.Theseboardshavealoosevinylcoveringthatisdifficulttocleanandpotentiallyaninfection
Transfer belt
figure 7.3
Full‑length transfer board
figure 7.4
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controlrisk.Theseboardscreaterisksforcarerswhenreachingandrisksforclientswithskinshear.Itisrecommendedthatrollerboardsbereplacedwithfull‑lengthtransferboards.
Sitting‑to‑sitting transfers
Forsitting‑to‑sittinglateraltransfers,asmallertransferboardorslideboardcanbeusedtobridgegapsbetweenadjacentseats.Theseboardscanbestraightorcurvedlikeaboomerang(anexampleistheyellow‘bananaboard’).Smalltransferorslideboardscanbeusedforlateraltransferssuchasthosebetweena:
• Chairandwheelchair
• Bedandwheelchair
• Wheelchairandtoilet
• Wheelchairandcar.
Curvedtransferboardsmakeiteasiertotransferaroundfixedarmrests.Theboardsareusuallyprescribedbytherapists.Notethatclientsshouldhavesittingbalancetousetheseboardsandbothcarersandclientsrequiretrainingintheiruse.Iffeasible,arrangetohavethesurfacetowhichtheclientisbeingtransferredslightlylowerthanthesurfacefromwhichtheyarebeingtransferred.Thismakesiteasierfortheclientto move.
Air‑assisted transfer devices
Thereareanumberofair‑assistedtransferdevicesavailable.Therearetwogeneraltypes:inflatablemattressesforlateral(e.g.bedtobed)transfersandair‑assistedliftingdevices,or‘jacks’.Thesedevicesaregenerallyversatileandcosteffective,especiallyforsmallfacilities.
Inflatable mattresses
Forlateraltransferswhilelyingdown:theclientliesonthemattresswhiletheclientandmattressaretransferredbetweentwoadjacentsurfaces,andair‑assistedliftingdevices.Alateraltransferairmattresscanbeusedasanalternativetoatransferboardandslidesheets.Themattressesareeffectiveforreducingfriction,andthustheloadoncarersduringlateraltransfers.
Sitting transfer board
figure 7.5
Air‑assisted mattress
figure 7.6
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Section 7: equipment for moving and handling people
Air jacks
Air‑assistedliftingdevices,or‘jacks’,canbeusedtoraiseclientsfromthefloortobedorstretcherlevelbypumpingairintoanairmattresswithmultiplelayers,whichexpandverticallyasmoreairispumpedin.Thejackscanbeveryusefulforliftingfallenclientsfromthefloor.Figure7.7showsanexampleofanairjackthatliftsclientsinasittingposition.Figure7.8showsa‘Hoverjack’thatliftsclientsinalyingpositionfromthefloortobedheight.Alltypesofair‑assisteddevicerequirecarerstosteadytheclient,andanairpump.
figure 7.7
Air‑assisted jack
figure 7.8
Air‑assisted ‘Hoverjack’
Electric profiling beds
Anelectricprofilingbedhasamattressplatformcomprisingtwo,threeorfourseparatesections,eachofwhichcanbeadjustedusingacontrolhandsetorpanel.Heightadjustmentallowsthebedtoberaisedorloweredquicklyforclientmovementsandclinicalservices.
Someelectricbedshaveonemovablesectioninwhichonlytheheadorbackrestsectioncanberaised,allowingaclienttositupinbed.Withthesebeds,clientsaremorelikelytoslidedownthebedsandmayneedfrequenthelpfromcarers.
Example of an electric bed
figure 7.9
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Figure 7.10
Electric bed showing profile positions
Thegeneralbenefitsofelectricbedsare:
• Promotionofclientmobilityandindependence
• Reducedworkloadforstaff
• Reductioninmanualhandlingrisksandinjuriestostaff
• Reducedincidenceofpressuresoresinclients.
Withelectricbeds,staffcanadjusttheheightmoreaccuratelytosuitindividualclientandcarerneeds.Beingabletostandbackandobserveaclientwhileoperatingabedallowsstafftoobservetheclientmovingintodifferentpositions.Improvedclientcomfortismorelikelyasadjustmentsofthebedsareusuallysmootherthanwithbedsrequiringahydraulicpumpingaction.
Allclinicalareasandclientsbenefitfromthebedheightadjustmentthatallowslowbedheights.Electricbedsalsofacilitateclientsgettingoutofbedbyraisingthemclosertoastandingposition.Stafftimecanbesavedbythereducedneedformanualhandlingofclientsandtheremovalofhydraulicpumpingonnon‑electricbeds.
Points to note about electric beds
• Mattress compatibility:Someelectricbedsmayrequirespecialsectionedmattresses.Bedsrequiringspecialmattressesmaymeanreplacingbedsasa combinedbedandmattress procurement
• Size:Electricbedscanbelarge.Bedswithalonger‑than‑averagelengthmayleadtoreducedspaceinareassuchasmulti‑bedunits.Theycanbedifficult
Box 7.1
Compatibility of electric beds and mobile hoists
A common problem I have come across is the incompatibility of some cheaper electric beds with mobile hoists. The beds do not allow clear access underneath for the hoist legs to go under. Staff have to push and pull resulting in jerky movements for the resident. There was an incident where electric bed wires under the bed caused an accident when the hoist was pulled over the wires and the patient fell out of the sling. Manufacturers need to provide a way of hooking up the wires out of the way.
Source: Manual handling trainer
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Section 7: equipment for moving and handling people
tomanoeuvreintightcornersandnarrowcorridorsandthroughdoorwaysandhospitallifts
• Compatibility with other equipment:Mobilehoistsusuallyneedpositioningunderbeds.Canthesuppliedmobilehoistsfitunderthebedatitslowest setting?
• Weight and portability:Theportabilityofelectricbedsisaconsiderationforcommunityuseowingtotheneedtotransportthebedsandassembletheminclients’homesandotherresidentialsettings.Inhospitals,bedsmayneedtobemovedfromwardtoward.Beingabletomoveandsteerbedsmaybeaconsideration.Theheavyweightofmanyelectricbedsmaybeanissuewhenbedsareusedtotransportclientsthroughcarpetedareasorupslopingcorridors.Amechanicalbedpushercanbeusedtoassistwithmobilityofthe beds
• Installing new beds:Whenevernewequipmentispurchased,planforallrelevantcarerstobetrainedinitsuse.Bedsarebecomingmorecomplexandallpracticablestepsshouldbetakentoensuretheirsafeuse.
Specific features
Electricbedscomeinmanyshapesandsizes.Theycanincludemanyfeaturesthatarenotapparentonabriefinspection.Somepotentiallyusefulfeaturesaredescribedbelow.1Whenpurchasingelectricbeds,theassessmentandprocurementproceduresneedtotakeintoaccountthetypesofclientthatwillbeusingthebedsandthebedfeaturesthatwillmostoftenbeusedbycarers.
• Minimum height:Somemodelsofbedarequitehighwhenintheirlowestpositionsforsmallclients.Shortclientscanfinditdifficulttoplacetheirfeetonthefloorwhentransferringoffandontothebededge,reducingtheirindependence.Asimilarproblemcanoccurwiththeuseofpressure‑reducingoverlaymattresses,astheheightincreasecancausetransferdifficultiesforsomeclients.Someelectricbedsaredesignedtogodownclosetofloorlevel(sometimesreferredtoas‘floorline’beds)andcanbeusedinfallsmanagement
• Number of sections:Bedswithfoursectionsaremostversatileforpositioningclients.However,bedswithtwoorthreesectionsareavailable
1. SomeofthepointsinthissectionarefromthereportbyMHRA,2003.
Example of an electric bed that can lower close to floor level
figure 7.11
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• Bed‑to‑seat or bed‑to‑stand profiling:Somemodelsofelectricbedallowtheprofileofthebedtoconverttoaseatortoastandingpositionwhiletheclientisinthebed.Thisavoidstheneedforcarerstofitslingsonclientswhoarelyingdown,ormanuallyrepositioningclientsfromlyingtosittingandsittingtostanding
• Side rails:Railsatthesideofthebedthatcanberaisedorloweredpreventclientsrollingoutofbed.Theminimumheighttowhichbedscanbeloweredmaybecompromisedbytheuseofsiderails,particularlydrop‑downrailsandthosethatfoldunderneaththebed.Siderailsneedtobeadjustabletoallowtransfersbetweenbedandstretcher.Siderailsarearecognisedformofrestraint,andifbeingusedforrestraintneedtobenotedintherestraintregister,consistentwithorganisationpolicy.Splitrailsarepreferableandseenlessasa restraint
• Turning function:Somebedshaveturningfunctionsthatallowclientstobeturnedontheirsides.Dependingonthetypeofbed,turningcanbeactivatedbytheclientinbedorbyacarer,orthebedcanbeprogrammedtoturnatsetintervals.Cautionmustbeusedwithturningfunctionsasthereisthepotentialforlimbstobetrapped,particularlywithclientswhohavedecreasedsensationorcommunicationdifficulties.Mechanicalturningdoesnotreplacetheotherfunctionsofcarer‑providedturningofaclient,suchascheckingbreathingandskinandprovidinghumancontact
• Battery backup:Beingabletooperatebedsonbackupbatteriesmaybeneededwhereclientsaremovedbetweenlocationsinbed,orwhereaccesstoelectricalsocketsislimited
• Manual operation:Isthereprovisionformanualoperationincaseofbatteryorelectricalfailure?Themanualleversneedtobeidentifiedeasilybystaff
• Cleaning and infection control:Thecomponentareaoftheelectricbedframeandanyattachmentsshouldbeaccessibleforcleaning.Easeofcleaningisbestassessedwhentriallingabed
• Preventing client moving down the bed:Clientsoftenmovedowntheirbedswhenmovedfromlyingtosittingpositions.Onelectricbeds,thismayoccurasthebedsareprofiledtoliftupclients’heads.Thiscanbeavoidedifthebedsincludeafeaturecalled‘auto‑regression’ofthebackrestsinthebed specification
Side rails on a bed
figure 7.12
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Section 7: equipment for moving and handling people
• Lockout facility:Afacilitytolocktheadjustmentstopreventbedsbeingprofiledortiltedmaybeimportantinclinicalareaswhereitisnecessarytopreventkneeflexionorothermovementsinclientswhoneedtobenursedflat.Thelock‑outfeaturemayalsobeusefulduringvisitingtimestoavoidmishapsassociatedwithvisitors
• Wheel locks:Locksonbedwheelsareusedtopreventbedsbeingmoved.Theseareimportantforsometypesoftransfer,suchasbed‑to‑bedtransfersusingtransfer boards
• Handsets:Twofeaturesofthecontrolhandsetstoassessaretherobustnessofthehandsetsandcontrolpanels,andtheireaseof operation
• Other features:Thereareanumberofotherspecialistoperationsandfunctionsavailableonsomeelectricbeds.Theseincludeweighingscalesbuiltintothebeds,motorisedbedsthatassistmovementalongcorridors,andanti‑fallalarms.
Bed accessories
Therearemultipleaccessories,oradd‑ons,forbedsthatcanbeusefulforsometypesofclientandsetting,especiallyincommunitysettingswhereelectricbedsarenotavailable.Theseinclude:
• Bed ladders:Smallladdersorstepsplacedatthesidesorendsofbedsthatallowpartiallymobileclientstogetinandoutofbed
• Bed or hand blocks:Handblockshavewidebasesandhandholds.Theyareusedinpairsbyclientswhoaresittinginbed
• Bed levers:Abedleverisagrabrailthataclientcanusetohelpthemsituporturnoverinbed.Therearevarioustypesandtheycanbefixedtothewall,bedorfloor.Somemayobstructpartofthebedside,makingitdifficultfortheclienttogetinandoutofbed,whileothersareadjustableandcanbemovedawayfromthebed.Bed‑fixedleversmustbesecurelypositionedandfittedtobesafeforuse.Somebed‑fixedlevershaveplatformsorrailsthatgounderthemattresses,sotheyaresecuredinpositionbytheclients’bodyweight
• Rope ladders:Aropeladderhelpstheclienttopullthemselvesupinbedfromalyingpositiontoasittingposition.Ithasplasticorwoodenrungslinkedtogetherwithropetoformaladder.Theladderattachestothefootorbaseofthebed.Ropeladdersareunstabletopulluponandoftenneedpracticetomaster.Clientsneedtohavestrongupperlimbsandabdominalmuscles.Itis
Wheel locks on a bed
figure 7.13
204
essentialthattheropeladderissecurelyfixedtothebedandtheclientcanreachthefirstrungwhentheyarelyingonthebed.Ropeladderswithplasticrungsmaybeslipperytohold
• Overhead poles:Overheadorliftingpoles(sometimescalled‘monkeypoles’)areusedbyclientstomoveinbed,suchasupanddownthebedandinandoutofthebed.Theycanalsobeusedbyclientstoliftthemselvessothatbedpanscanbeplacedunderthem.Mostoverheadpolesusefloor‑orbed‑mountedcantilevergantries,withhandleshangingfromthemonheight‑adjustablestraps.Thegantryframesmustbesecuredtostopthemtipping.Allpolesshouldhavesafeworkingloads(SWLs)clearlymarkedon them
• Bed lifters:Theseareusedtoliftbedstosuitableworkingheightssothatcarersdonothavetostoop.Theyaresuitablefornon‑electricbeds,suchasinhomeswheretheyallowclientstocontinueusingtheirownbeds.Theydonotprovideprofilingactions,andtheyrequiresufficientspacetogetunderthe beds
• Bed movers:Thesebattery‑operateddevices(seeFigure7.15)attachunderthefootendsofbedsandallowoperatorstotransportbedsandclientstootherlocations.Theyhavecontrolsthatallowmanoeuvringinconfinedspacesandsteeringalongcorridors.Theirpositioningallowstheoperatorstoseetheclientsduringuse.Bedmoversreducestrainonstaffwhoregularlymovebedsduringtheirworkshifts.However,theyincreasetheoveralllengthofthebedsandmaynotfitinlifts.Bedmoversrequireadditionalstorageanditmaybedifficulttohavemoverskeptwhere needed.
Overhead pole
figure 7.14
Bed mover
figure 7.15
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Section 7: equipment for moving and handling people
Hoists
Therearethreegeneralcategoriesofhoist:mobilefloorhoists,standinghoistsandceilinghoists(sometimescalledoverheadhoists).Insomecountrieshoistsarecalledliftsormechanicallifts.Allhoistsuseslingstoholdclients,andsomehoistscanliftclientsinspeciallydesignedstretchers.AllhoistsshouldbecompliantwiththeStandardsNew ZealandrequirementsinAS/NZS3551:2004Technicalmanagementprogramsformedicaldevices.Thisstandardcoversprocurement,acceptanceprocess,safetyandperformancetestinganddisposal.
Thetypesofslingusedwithhoistsaredescribedlaterinthissection.Allhoists,slingsandceilingtrackingshouldbeclearlylabelledwiththeirSWLs.
Allcarersusinghoistsshouldbetrainedinfittingslingsandintheproperuseofhoistspriortousingthem.Carersalsoneedtobefamiliarwiththespecificfunctionsofparticulartypesormodelsofhoist.Likeothermovingandhandlingequipment,hoistdesignsandfeaturesarecontinuallyevolving.
Mobile hoists
Mobilehoists(sometimescalledmobilefloorhoists)areusedtotransferclientswhoarenotmobilebetweenlocations,suchasfromabedtoachairorabathroom.Theycanalsoassistwithambulation,gaittrainingandotherspecialisedfunctions.Theclientissupportedinahoistsling,whichshouldbesingle‑clientassignedforinfection control.
Mobilehoistscanbeverycosteffective,astheycanbemovedtodifferentlocationsinafacility.Onehoistcanbeusedforavarietyoftasks.Normallytwocarersarerequiredwhenhoistingaclientwithamobilehoist.2
2. ProceduresforusingmobilehoistsforspecificmovingandhandlingtasksaredescribedinSection4‘Techniquesformovingandhandling people’.
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Box 7.2
Parts of a mobile hoist
• Boom (goes up and down)
• Sling bar, spreader bar or yoke
• Legs (move in and out)
• Mast – upright part of hoist
• Handles – for manoeuvring the hoist
• Brakes – only to be used for storage. Do not use brakes when hoist is in use as the hoist needs to find its own centre of gravity, otherwise it may tip over
• Emergency stop button (if hoist is not working, check it is not pushed in)
• Emergency lower buttons (you may need extra pressure to come down on older hoists)
• Weight limit (SWL)
• Maintenance alert – do not use if out of date.
figure 7.16
Example of a mobile hoist
Mobilehoistscomeinmultipledesigns.Allhavecentralliftingframeswithboomsandslingbars(alsoknownasspreaderbarsoryokes)towhichtheslingsareattachedusingthehooksorclipsonthebars.Thebasesorlegshavewheelsthatallowthehoiststomovealongthefloor.Somehavebasesthatcanexpandorcontractinwidthtofitaroundorundercommodes,showerchairs,recliners,wheelchairsandbeds.Somehoistsarefoldableorcollapsible.Somemobilehoistshaveverticalliftmovementsandsomehavearcmovements.Verticalliftmovementsgenerallyprovideahigherliftandcanusuallybeusedforassistedwalkingwithwalkingslings.Nearlyallmobilehoistsarebatterypowered,soaroutinebattery‑chargingsystemis required.
Box 7.3
Using a mobile hoist without training
I was a nurse aide in this rest home. One day the manager wheeled in a hoist and told me to use it to lift the patient who was sitting on a commode and left me to it. So I hoisted a patient complete with commode and all. I didn’t have any training on how to use the hoist.
Source: Patient handling trainer
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Section 7: equipment for moving and handling people
Mobilehoistscanhavesomedisadvantages.Carersmayneedalotofstrengthtomovemobilehoists,inareaswithcarpet(especiallyifthehoistshavesmallwheels),throughdoorwaysandinslopingcorridors.Thereneedstobeenoughspaceintheroomtouseamobilehoistandsometimesfurniturecanrestrictmovement.Whenusingmobilehoistsoverbeds,somecannotlifthighenoughtoallowtheclientstoclearthebeds,especiallybedswithpressure‑caremattresses.Somebedsmaynothaveenoughspacebeneathtoallowthehoistbasetogetunderneath.
Points to note about mobile hoists
Whilemobilehoistscanbeversatile,usersshouldnotethefollowingspecificfeaturesandpotentiallimitations.
• Mobilehoistsneedadequatestoragespaceclosetolocationswheretheyareused.Theyrequiremorestoragespacethanceilinghoists
• Mostmobilehoistsarepoweredbybatteriesthatneedregularcharging.Theyneedasystemforroutinechargingofbatteries.Ifbatteriesaredetachable,itisdesirabletohavetwobatteriesforeachhoistsothatonebatteryisalwaysbeingcharged
• Allmobilehoistsshouldhaveastickerorcertificatewithdatesforroutinecheckingandservicing.Ahoistshouldnotbeusediftheexpirydateonthestickerhaspassed
• AllhoistsshouldbelabelledwithaSWL.Aspartofriskassessment,aclient’sweightshouldbecheckedtoensureitislessthantheSWLofthehoist,priorto lifting
• Wheelbrakesarefittedonmostmodelsofmobilehoist.Thebrakesshouldnotbeappliedwhilehoistingaclient.Mobilehoistsaredesignedtomovewhilehoistingclientssothattheslingbarisoverthecentreofgravityofthe load
• Itcanbeunsafetouseamobilehoistonaslopingfloororsurfacewherethereisariskthatthehoistcantipover
• Notallmobilehoistscanliftclientssafelyfromthefloor.Todothis,thefeetorbaseofthemobilehoistmustbedesignedtoallowafloorlift.Ifthisfeatureisneeded,checkthatthemodelbeingconsideredcandothissafely
Box 7.4
Lifting equipment reduces assaults on carers
Assaults by residents on caregivers in a residential care facility reduced after equipment to lift and transfer residents was introduced and carers were trained how to use the equipment. Residents felt caregivers could be trusted to move them comfortably and safely. Also, the physical separation between the caregiver and the resident through use of the lift, particularly patients with a known history of violence, is likely to have reduced assaults on caregivers when using lifts.
Source: Collins et al, 2004
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• Liftingheight–notallmobilehoistscanliftclientshighenoughtoclearbeds,especiallyifthebedshavepressuremattresses
• Somehoistsallowforinterchangeablespreaderbars;othersrequirethatonlythemanufacturers’spreaderbarscanbeused
• Somehoistsallowdifferenttypesofslingtobeused,whileothersrequirethatonlythemanufacturer’sslingforeachmodelofhoistcanbeused.Ifseveralmodelsofmobilehoistareusedinafacility,theinterchangeablyofspreaderbarsandslingsshouldbeconsidered.
Mobile hoist features and accessories
Thefollowingaccessoriesandfeaturesareavailableonsomehoists,orcanbepurchasedasoptionalaccessories.
• Ahand‑heldcontrolpaneltooperatethehoist–itneedstobeabletoclipontotheuprightframeofthehoist
• Awalkingslingallowsamobilehoisttobeusedformobilityandrehabilitation(seeFigure7.17)
• Scalestoweighclientsareavailableonsomehoists.Whenfittedasanadditionalattachmentabovetheslingbar,scalesmayreducethelifting height
• Allelectrichoistsmusthaveemergencystopbuttonsandmanualreleasemechanismstoallowclientsheldbythehoiststobeloweredwithoutbattery power
• Alow‑battery‑levelindicatororwarninglightisdesirable
• Thelengthoftheboomtowhichthespreaderbarisattachedneedstobeconsideredwhenhoistingatallorlargeclient.Alongerboomprovidesmorelegroombetweentheslingandtheuprightframe.However,withashorterboomtheclientcansitwithbothkneesononesideoftheframe,whichreducestheriskoftheirkneesknockingagainsttheframe
• Gaittrainingbarsassistwithmobility(Figure7.17)andareusefulforturning hoists
• Stretcherattachments(Figure7.18)enabletheimmobilisationofpotentialspinalcordinjuryclientsandareusefulinanytraumaorsuspectedinjuriesafterfalls.Theycanalsoenabletheweighingoftheseclientsiftheyhaveweighscale accessories.
Example of a mobile hoist with walking sling and gait training bars
figure 7.17
Example of a mobile hoist with a stretcher attachment
figure 7.18
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Section 7: equipment for moving and handling people
Standing hoists
Amobilestandinghoist(alsocalledasittostandhoistandstandinglifter)isaspecifictypeofmobilehoistusedtomoveaclientfromoneseatedsurfacetoanother,suchasfromachairtoatoilet.Thehoisthasaplatformorfootrestonwhichtheclientstands.Theclientissupportedbyaslingfittedaroundtheirtrunk(aspecialslingknownasa‘standaidsling’)andbyalegbraceorkneeblockthathasstrappingtoholdtheclient’slegsinplace.Standinghoistsaresuitableforclientswhoarepartiallyweightbearingandcansupportmostoftheirownweightwhilestanding.
Standinghoistsareusefulastheyallowmoreaccesstoclients’clothingthanslinghoists.Forthisreason,theyareusefulformovingclientsfromoneseatedpositiontoanotherandcanassistwithtoiletingpartiallymobileclients.Theyalsohaveatherapeuticbenefitforclientsinprovidinganopportunitytoincreaseweight‑bearingtolerance.Theyshouldonlybeusedfortransportingclientsforshortdistances,suchaswithinaroomortoanadjacentbathroom,notforlongerdistancessuchas corridors.
Points to note about standing hoists
• Itmaybeeasiertouseastandinghoistratherthanamobileoroverheadhoistfortoiletingaslongastheclienthassufficientweight‑bearingcapacity
• Extracareneedstobetakenwithclientswithspecificclinicalconditions,suchaslowmuscletone,osteoporosis,spinalmetastasisanddifficultystandingwiththeirfeetflat
• Standinghoistsshouldhaveadjustablelegstogounderandaroundchairsand toilets.
Example of standing hoist
figure 7.19
Example of standaid sling
figure 7.20
210
Ceiling hoists
Ceilinghoistsorceilingliftshavetrackingfastenedalongtheceilingandaregenerallyapermanentfeaturebuiltintoeitherasingleroomormultiplelocationsinaunitorfacility.Someversionsofceilingtrackingaredesignedtoberelativelyportable;thetrackingcanberemovedwhennolongerneeded.Gantryhoistshavethetrackingmountedonamobileframeandcanprovideahoistforasingleroomwhere,forexample,themainuseisfortransferstoandfroma bed.
Ceilinghoistshavefourmajoradvantagesoverothertypesofhoist:
• Theyrequirelessforcetomove
• Becauseoftheirimmediateavailability,thereisahigherlikelihoodofusewhen needed
• Floorcoveringsandunevensurfacesdonotaffectuse
• Theyhaveminimalstoragespacerequirements.
However,therearesomedisadvantages:theuseofceilinghoistsislimitedtoareaswithtrackinginstalled;andhoistswithfixedceilingtrackingmayinitiallybemoreexpensivetoinstallthanprovidinggantryhoistsormobilehoists.
Ceilingtrack(andgantryhoist)systemscanusuallyliftoveragreaterheightrangefromceilingtofloorthanmobilehoists.Ceilingtrackandgantryhoistsystemsrequirelessspacetooperatethanmobilehoistsandshouldbeconsideredifspaceis restricted.
Thehoistmayhaveaportablehoistunitormotorthatcanbeliftedoffthetrack,orafixedhoistunitthatispermanentlyattachedtothetrack.Table7.3outlinessomeoftheadvantagesanddisadvantagesoffixedandportableceilinghoistunits.Electricitytorunthehoistunitcanbesuppliedthroughthetrack,orbyabatteryfittedintothehoistunit.Someunitsareonlymotorisedforliftingclientsinslingsandnotformovingclientsalongthetrack.Theseunitsrequirecarerstopushclientsalongthetrack.Otherunitshavemotorfunctionsforbothliftingclientsandmovingclientsalongthetrack,operatedbyaremotecontrol.
Example of a ceiling hoist with a fixed unit
figure 7.21
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Section 7: equipment for moving and handling people
Table 7.3 Portable and fixed hoists for ceiling hoist systems
Portable hoist unit Fixed hoist unit
Chargingfacilityforhoistunitisusuallyoffthetrack;maybelessaccessible
Optionofwall‑mounteddockingunitoron‑track charging
Manualhandlingrequiredtoattachunitto track Nomanualhandlingofhoistunitrequired
Canbemovedtoothertrackswhenneededorstoredwhennotneeded
Canonlybeusedontrackwherefitted
Requiresadditionaltimeandefforttoattachthehoisttotracking.Thisislikelytobeadisincentiveforstaffusingthehoist
Staffmorelikelytousethehoistifitispermanentlyattachedtotracking
Ceiling track systems
Forceilinghoists,therearemultipletracksystemsavailable.Thetypeofceilingtracksystemselectedwilldependonthetypesofuseintended.Forsinglerooms,straighttrackingmaybetheeasiesttoinstall.However,itsmajorlimitationisthatitonlyallowstheliftingandmovingofclientsinastraightline.Addingcurvedsectionsoftrackingallowsincreasedcoverage,especiallyinbathrooms(seeFigure7.22).
Figure 7.22
Examples of ceiling tracking into a toilet
Themostversatiletrackingsystemisaparalleltrackingpatterncalledthe‘XY’system,whichprovidesfullroomcoverage.Withthissystemaclientcanbemovedanywhereintheroom.TheXYsystemhastwostraightsectionsoftrackoneachsideoftheroom,paralleltoeachother,withanothertrackjoiningthetwo.Thejoiningtrackcanslidealongthetwoparalleltracks.
Morecomplextracksystemsareavailableforhealthcarefacilitieswheretransfersbetweenrooms,suchasbedroomtotoilet,arerequired.Forexample,‘gates’(fortransitbetweentwoadjacenttracksystems)and‘turntables’(whichallowmovementfromonetracktoanotherattrackjunctions)canalsobefittedtoincreasetheversatilityofceilingtrackingsystems.MoreinformationabouttheinstallationofceilingtracksystemsisprovidedinSection9Facilitydesignandupgrading.
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Points to note about ceiling hoists
• Ceilinghoistsareusuallypermanentfixtures,sothebuildingstructuremustbesuitable.Somestructuralconsiderationscouldbewhetherceilingjoistsneedtobereinforced,andwhetherdoorwaysneedtobealteredtoaccommodatetracking
• Retrofittingispossibleformosttypesofstructureandceiling
• Ceilingtrackingcanbemostcosteffectivewhenincorporatedintoanewbuildingorinstalledduringplannedrenovations
• Allelectrichoistsmusthaveanemergencystopbuttonandmanualreleasemechanismtoallowclientsonthehoiststobeloweredwithoutbatterypower/electricitysupply
• Allceilinghoistunitsshouldhaveastickerorcertificatewithdatesforroutinecheckingandservicing.Hoistsshouldnotbeusedaftertheexpirydatesonthe stickers
• AllhoistsandceilingtrackingshouldbelabelledwiththeSWL.Aspartofriskassessmentpriortolifting,aclient’sweightmustbecheckedtoensureitislessthantheSWLofthehoistandtrack.
Ceiling hoist features and accessories
Thefollowingaccessoriesandfeaturesareavailableonsomeceilinghoistsorcanbepurchasedasoptionalaccessories:
• Scalestomeasureaclient’sweightareavailableonsomehoists
• Alow‑battery‑levelindicatororwarninglightisdesirable
• Awalkingslingallowsaceilinghoisttobeusedformobilityandrehabilitation.
Gantry hoists
Agantryhoistmaybeapreferredoptionwherefittingceilingtrackingistooexpensiveorwherealarge‑capacityhoistisonlyrequiredforalimitedtime.Thetransferrangeofgantryhoistsystemsislimitedbythelengthofthetrack.Someversionsofgantryhoistaresemi‑portableandcanbedisassembledandtransportedbyvehicle.
Gantry hoist
figure 7.23
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Section 7: equipment for moving and handling people
Fixed wall hoists
Afixedwallhoistisapermanentfixturebesideaclient’sbedorinabathroom(itissometimescalledabathinghoist),andswingstoallowtheclienttobemovedfromwheelchairtobath.Itcanonlybeusedforshorttransfers,forinstancefromabedtoabedsidecommodechair.Thebracketsfortheswinginghoistframecanbefixedinvariouslocationsinahospitalorfacilitysothattheportablehoistcanbeattachedwhenneeded.Fixedwallhoistscanbelocatedinsmallroomswherethereisnotenoughroomtousemobilehoists.Theyalsoprovideanalternativeifthebuildingstructuredoesnotallowoverheadtrackstobeinstalled.
Fixedwallhoistscanbeusefulinnursingandresidentialhomeswherehoistuseisvariable.Bracketscanbeinstalledinmultipleroomsandthehoistsmovedaroundasneeded.However,fixedhoistsdohavesomedisadvantages.Theyareusuallymoreexpensivethanmobilehoists.Asthebracketsarepermanentlymounted,positioningmustbecarefullyplannedtosuittheroomlayoutandtransferneeds.Oncethehoistbracketshavebeenfitted,theclient’sbedandothernearbyfurnitureusuallyneedtostayinthesamelocationinordertousethehoist.
Slings
Slingsareusedtosupportclientsbeingmovedwithhoists.Theslingisattachedtohooksorclipsonthehoistspreaderbaroryoketoprovidesupportfortheclientwhiletheyarebeingmoved.Thereareseveraltypesofslingavailablethataremadefromvariousmaterials.Becomingfamiliarwiththemultipletypesofslingisanessentialpartofusinghoists.Trainingprogrammestypicallyspendsometimeonteachingthecorrectuseofslings.Accidentsthatoccurduringtheuseofhoistsofteninvolveincorrectslinguse.Table7.4summarisessomeofthekeyfeaturesofslings.
Choosingtherightslingandfittingitcorrectlyimprovecomfort,dignityandsafetyfortheclient.Havingacomfortableandsecureexperiencecanhelptoovercomeareluctancetouseahoist,whichsomeclientshave.Generally,themorematerialaslinghasthegreaterthecomfortandsupportitprovides.
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Table 7.4 Sling features and functions
Sling feature Sling type Functions
Fabricormaterial Synthetic Mostcommontypeofslingforgeneralpurposeuse
Mesh Usedforbathing
Sheepskinorquilt lined
Forclientswithfragileskinorincreasedpainwhenbeinghoisted
Singleormultipleclient use
Disposable Forusewithoneclientonly.Usuallyhasa‘Donotuse’tagthatbecomesvisiblewhenwashed
Washable Canbeusedandlaunderedmultipletimes
Shapesandfunctions
Dividedlegsling Mostcommontypeforgenerallifting
Hammocksling Usedforliftingclientswhorequireadditionalsupport
Toiletingoraccess sling
Designedfortoiletuseortoallowaccesstoclothing;haslessfabricforsupport
Walkingsling Supportsaclientwhenwalking
Points to note about slings
• Compatibility of slings with hoists:Somehoistsaredesignedtobeusedwithonlyaspecifictypeofsling.Otherhoistscanusemultipletypesofsling.Thispointshouldbecheckedinthehoistinstructionmanualorwiththesupplier.Whenorderingnewslingsorhoistsitisimportanttoknowwhetherthenewversionswillbecompatibleorinterchangeablewithanyexistingslingsorhoists.Iftheyarenotcompatible,moreworkwillberequiredtomaintainandservicedifferentslingandhoistsystems.Itispossibletousemultiplebrandsofslingonsomehoists,butthisrequiresasuitablyqualifiedpersontodocumentcompatibility,preferablywithagreementfromthe suppliers.
• Reusable and disposable slings:Mostfacilitieshavereusableslingsthatarewashedbeforeusewithanotherclient.However,ifheavysoilingislikelyorinfectionriskishigh,disposableslingsmaybepreferred.Disposableslingsareforone‑clientuseonlyandshouldbedisposedofwhensoiledornolongerneededfortheclient.Theymustnotbewashedorcleanedthenreused.
• Laundry services:Thereareseveralwaystolaunderslingsandeachfacilityneedstohaveasysteminplace.Thesesystemsinclude:thefacilityownstheslingsandtheyarecleanedbyitsownlaundry;thefacilityownstheslingsanditslaundrycontractorcleansthemasanaddedservice;andthecontractlaundryserviceprovidestheslingsinagreement(e.g.types,numbers)withthe
Example of labels
figure 7.24
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Section 7: equipment for moving and handling people
facilityandcleansthem.Notethatsomeexternallaunderingservicesprovidespecificbrandsofslingonly.
• Standard labelling:Eachslingshouldbelabelledwiththefollowingdetails:
– Thenameoftheslingoritsmodelnumber
– Thenamesortypesofhoistforwhichtheslingisdesigned
– Thesizeofthesling
– TheSWLofthesling
– Anyspecialwashing,dryingandsterilisationinstructions
– Themanufacturer’snameorlogo,orregisteredtradename.
• Checking slings:Allslingsshouldbecheckedbeforetheyareused:
– Checkallloopsatconnectionpointsforsignsoffrayingandloose stitching
– Checkentireslingbodyforloosestitching,rips,holesandbleachstaining
– Checkforsignsoffabricweakening,suchasheatdamage,distortedfabricandstaining
– Checkallbuckles
– Size,shapeandfittingofslings.
Standard slings Fitting of sling so lower loops cross between client’s legs
figure 7.25 figure 7.26
Slingsareavailableinmultiplesizestosuittheweightsandbodysizesofclients.Slingsizescanrangefromverysmalltoextralarge.Theslingsizewillbeshownonalabelattachedtothesling.Mostslingsarenowcolourcoded;thesizeindicatedbyeachcolourshouldbeshownonastickerattachedtothehoistthatwillbeusedwiththesling.Notallmanufacturersusethesamecolourstoindicateslingsizes,sothisshouldbenotedifusingslingswithdifferenthoists.Slingsizesmayvarybetweenmanufacturers,socarersneedtomeasuretheslingforeachclienttoensurethecorrectsizeisused.Whenorderingslings,ensureeachslingislabelledwithitssizeandSWL,whichshouldbeinkilogramsforuseinNew Zealand.Iftheslingistoolarge,thereisariskoftheclientslippingoutofthesling.Aslingthatistoosmallcan
216
resultinthespreaderbarcomingtooclosetotheclient’sface,canbetightinthecrotchandcausediscomfort,ormaynotprovideenoughsupportfortheback.
Slingshaveloopsorstrapsthatareattachedtospreaderbarsonhoists.Sometimesthesestrapsareadjustableandcanbesetforaspecificclientbybeingmarkedwithapieceofwoolorapentoidentifythesettingfortheclient.Thismeanstheycanbehoistedinthesamepositionwithdifferentcarers.
Table7.5summarisesthemorecommontypesofslingandthesearedescribedinmoredetailbelow.Thereareothertypesofsling,suchasamputeeslings,thatrequirespecialistknowledgeforuse.Clientswithhipreplacements,morbidobesity,bilateralamputationsorothercomplicationsmayrequirespecialisedtransferassessmentsandspecialtyslings.
Table 7.5 Types of sling and purposes
Type of sling Purpose Limitations and comments
Standardordividedlegsling(universal sling)
AU‑shapedslingforgeneral lifting Notsuitablefortoiletingorclientswhocanonlybetransferredinalyingposition
Accessortoilet sling
(hygienesling)
Allowsmoreaccesstoclothingfor toileting
Clientneedssomeupperlimbandtruckcontrol
Hammocksling Arectangularslingthatsupportsthebodyoveralargearea
Moredifficulttoputonandtakeofftheclientthanastandardsling–noaccesstoclient’sbodyforwashing
Repositioningsling Afull‑bodyslingusedforturningorpositioninginbed
Aspecialisedslingforclientswhoneedturningregularly
Stretcher Allowsmovementofaclientinalyingposition
Thehoistmustbedesignedtobeusedwithastretcher
Walkingharnesssling Allowssupportforaclientwhile walking
Mainlyusedwithceilinghoistsormobilehoistswheretheboomcanberaisedhighenough
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Section 7: equipment for moving and handling people
Standard or divided leg sling
ThisisaU‑shapedslingandmayormaynothaveupperbackandheadsupport.Itsadvantagesarethat:
• Itiseasytoputonwhentheclientissittingorlying
• Itcoversalargesurfaceareaoftheclient’sbodyandismorecomfortablethanatoiletsling
• Whenthelegbandsarepositionedcorrectly,thereislesslikelihoodoftheclientslippingorfallingoutofthesling
• Thestandardslingcanbeusedtopickupaclientoffthefloor.
Somedisadvantagesarethatstandardslingsmaynotbeassuitableforbathingandtoiletingastheaccessortoiletsling.Thelegbandsorstrapscanbeuncomfortablefortheclientiftheyarenotpositionedcorrectlyoriftheclientisleftintheslingfortoo long.
Access or toilet sling (hygiene sling)
Toiletslingsprovidesplitlegsupportandupper‑mid‑backsupport.Someslingscomewithwaistsupportinsteadofupper‑mid‑backsupport.Theadvantagesofthisslingarethatitisusefulfortoiletingiftheclienthassomeupperlimbandtrunkcontrol,anditcanbeputonaclientinmostpositions.Itprovidesgoodaccessforwashingaswellastoileting.Someclientsmaybeabletoputthisslingonindependently.
Toiletslingshavedisadvantages.Theydonotprovideasmuchsupportasstandardslings,sotheyshouldonlybeusedforashorttime.Aclientwithreducedmuscletonehasanincreasedriskofslippingthroughthesling.Theclientmustbeabletocooperatefullyandnotraisetheirarmsovertheirhead.
Hammock sling
Thisisarectangularsling.Somehavecommodeopenings.Itiscomfortabletouseastheclient’sbodyissupportedoveralargerareathaninastandardsling.Thereislesslikelihoodofdiscomfortordamagetotheclient’sskin.Itissuitableforliftingtheclientoffthefloor.Somedisadvantagesarethatitcanbedifficulttoputonandtakeoffwhentheclientisseatedorlyinginbed,andthereisnoaccesstotheclient’sbodyforwashing,eveniftheslinghasacommodeopening.
Standard sling
figure 7.27
218
Repositioning sling
Thisisaspecialisedfull‑body‑lengthslingusedforturningorpositioninginbedclientswhoneedtobeturnedseveraltimesaday.Repositioningslingsareusuallyleftundertheclientintheirbed.Ifleavingaslingunderaclient,careshouldbetakentoremovewrinklesfromthematerialandtuckthestrapsunderthemattress.Flatbedsheets,soakerpadsandotheritemscanbeplacedontopofarepositioningslingtoabsorbmoistureandimprovecomfort.
Stretcher attachment
Astretcheror‘flatlifter’enablesthemovementofaclientinalyingposition.Thestretcherisabody‑lengthrigidscoopframe,oraseriesofflexiblebatonsthatarepositionedundertheclientandattachedtoaframethatisassembledaroundtheclient.
SomestretcherattachmentsaremadeofspecialmaterialdesignedforX‑rays.Stretcherattachmentsareusefulforspinalandpost‑operativeorthopaediccareastheclientscanbeimmobilisedduringtransfers.Somehoistsofferthree‑wayclientangleadjustmentsforthestretchersling:flat,headdown(Trendelenburg)andfeetdown.Notallhoistscanaccommodatestretcher attachments.
Walking harness sling
Walkingharnessslingsaredesignedtoprovidecompleteorpartialsupportforclientswhocanwalk.Theseslingscanbeusedwithceilinghoists,butarealsoavailablewithsomemobilehoistswheretheboomscanberaisedhighenoughforclientstostanddirectlyunderneaththeslingbars.
Stretchers
Stretchersareusedtotransportclientsinlyingpositionbetweenlocationswithinafacility.Theycomeinmanyshapesandsizes.Allhospitalstretchershavewheelsorcastorsandtheymaybeheightadjustable.Somestretchersarebatteryoperatedwithsimilarfunctionstoprofiling
Repositioning sling
figure 7.28
Example of a stretcher sling
figure 7.29
Mobile hoist with a walking harness sling
figure 7.30
219
Section 7: equipment for moving and handling people
beds.Stretchersareastandarditemofequipmentinallhospitalsandhealthcarefacilitiesandservices.Specialiststretchersincludethosedesignedspecificallyforambulanceuseandbariatricstretchersformorbidlyobeseclients.
Wheelchairs
Wheelchairsareanotherstandarditemforequipmentinhospitalsandhealthcarefacilities.Differentversionsareavailable.Somearedesignedtoprovideclientswithindependentmobilityandhavefeaturessuchasbeingfoldablefortransportincars.Othersaredesignedonlyforassistedmobilitywherecarersarerequired.Apointtonoteisthatdesignfeaturesthatareimportantforindividualuseinthecommunity,suchascollapsiblefootrestsandprotrudingparts,mayincreasethelikelihoodofinjury,especiallyifusedregularlybyclients.Forsuchclients,purpose‑builttransferandtransportchairsmaypresentfewercontacthazardsthanwheelchairsdesignedforindependentmobility.Bariatricchairsshouldhaveelectricmotors.
Standing and pivoting aids (non‑electric)
Thereareseveralnon‑electricstandingtransferaidsandtrolleysforclientswhocanstandbuthavedifficultywalking.Theseaidsorpivotingdevicescanbeusedwithclientswhocanstandbutwhoareunabletowalkwithoutassistance.
Standing transfer trolley
Astandingtransfertrolleyenablesacarertotransferaclientfromachairorawheelchairtoatoilet.Itisintendedforpeoplewhocanstandbuthavedifficultywalking.Theclientstandsonthefootrestandholdsthehandlebarforsupport.Somestandingtransfertrolleyshaveseatsthatcandropdownforclientstositonduringtransfers. Thetrolleysarethenmovedbycarerstothelocationsrequired.
Thestandingtrolleyisusefulforrehabilitation.Itiseasytouseandencouragessomemobility.Itprovidesanoptionbetweenmobilisingwithsomeassistanceandasittostandhoist.
Framed turning platform
Aframedturningplatformenablesaclienttostandduringamovefromseattoseat.Theframedturningplatformmayhavecushionedkneepadsfortheclienttobraceagainstduringthemove.Theclientputstheirfeetontheturntableandpullsthemselvesuptostandingusingthe
Wheelchair
figure 7.31
Framed turning platform
figure 7.32
220
handholds.Thecarerthenturnstheplatformandtheclientsitsdowninthenewposition.Theclient’sfeetmustbeplacedcentrallyontheturntableorframedturningplatformsothattherotationthroughthetransferissmooth.Careisneededastheseitemscanrotateunpredictablyifnotcontrolled.Theturningplatformshouldhaveafoot‑operatedbrakethatisengagedwhenthecarerstepsdownontheouteredgeoftheturntable.
Shower and bath equipment
Therearemultipletypesofequipmenttoassistclientstomoveinshowersandbaths.Twotypesofshowerequipmentaredescribedhere.
Wheeled shower chairs
Awheeledshowerchaircanbeusedtotransportaclienttoandfromashowerandcanbeusedintheshowerwhiletheclientremainsseated.Wheeledshowerchairsmayhavebackrests,armrestsandfootreststhatcanberemovedorshifted.Somealsohavetiltingfunctionstoalloweasiershowering.Wheeledshowerchairsareusuallymadefromperforatedplastictoallowwatertodrainfromtheseat.Poweredorbattery‑operatedshowerchairsarepreferred,astheyreducetheriskinpositioningclientsduringtheprocess.
Mobile shower trolleys
Mobileshowertrolleysarefull‑bodylengthsothataclientcanbeshoweredinalyingposition.Thistypeoftrolleycanalsobeusedasachangingtable.
Showertrolleystendtobeusedinopenshowerareasratherthaninshowercubicles,astheyareusuallytoolongtofitincubicles.Slidingequipmentcanbeusedtotransferaclientontoashowertrolley,ortheclientcanbehoisted.Manytrolleysareheightadjustablesothattheycanbepositionedatthecorrectworkingheightsforcarers.
Emergency equipment
Thereisarangeofequipmentavailableforemergencies.Withinfacilities,emergencyequipmentmaybeusedfortherapidevacuationofimmobileclientstoanoutsidelocation,suchasduringafireorearthquake.Ambulancesandotheremergencyservicevehiclesgenerallycarrymultipletypesofspecialistemergencyequipmentformovingpeople.
Mobile shower trolley
figure 7.33
221
Section 7: equipment for moving and handling people
Mostemergencyserviceshavestandard‘pickupandcarry’typesofstretcher.Thesecanbeusedinemergenciestomovepeoplequicklytootherlocations.Thesestretchersusuallyfoldintosmallpackagesforcompactstorage.Otherexamplesofemergencyequipmentaredescribedbelow.
Slide pads and sheets
Slidepadsandsheetsareanoptionforemergencyevacuationequipmentforimmobileclients.Slidepadsaresimilartosmallmattresses;theyhavestrapstosecureclientsandslipperysurfacesunderneathsotheycanbedraggedalongfloorsanddownstairswithclientslyingdown.Emergencyslidesheetsarefittedunderneathmattresses.Theyhavestrapsthatcanbefastenedovermattressestosecureclientstothemattresses,andslipperysurfacessothesheetswithclientsandmattressescanbedraggedalongthefloor.
Backboards or spine boards
Abackboardorspineboardisusedtoimmobiliseandtransportaclientwithasuspectedspinalinjuryinanemergency.Itisarigid,full‑body‑lengthboardtowhichtheclientisstrapped.Theseboardsmaybemadefromsheetaluminiumwithatubularaluminiumframe,woodwithaspecialwaterproofcoating,orcoatedplywood board.
Scoop stretchers
Ascoopstretcherisalightweight,concavestretcherthatseparatesintotwosectionsalongitslength(Figure7.35).Itcanbeplacedunderaclientfromeachsidewithouttheneedtorollorliftthem.Theconcavesurfacesupportstheclient,minimisinglateralmovementandreducingtheriskoffurtherinjury.Theclientcanthenbecarriedtoalocationwherefurthermedicaltreatmentcanbeadministered.
Thescoopstretchermayhaveanarrowfoot‑endframeforhandlinginconfinedareas.Itfoldsupforstorageandhaslockinglength‑adjustmentlatchesthatsnapintoplace.Somecompaniesarenowproducingcombinedboards(‘combiboards’)thatincludethefeaturesofbothspineboardsandscoopstretchers.
Slide pad
figure 7.34
Scoop stretcher
figure 7.35
222
Combination stretchers/chairs and evacuation chairs
Acombinationstretcherandcarrychairisanoptionfortransportingclientsinanemergency(Figure7.36).Itcanbeconfiguredforuseasawheeledchair,astairchairoraflatstretcher.
Anotheroptionisanemergencyevacuationchair,whichcanbeusedfortransportingclientsdownstairs(Figure7.37).
Other types of equipment and aids
Therearenumeroustypesofequipmentandmobilityaidotherthantheonesdescribedinearliersections.Ifaclientisabletobearsomeoftheirownweightforashortperiodoftime,therearevariousdevicesavailabletoassistintransfersbetweenbed,chairandtoilet.Someoftheseaidscanbeusedtohelpclientsmoveshortdistances,ortostandinasupportedmanner.Theyrangefromsimpletomoretechnical,suchaswalkers,transferbeltsandstandtositlifts.TheMinistryofHealthandtheAccident CompensationCorporation(ACC)bothpublishlistsofapprovedequipmentforpeoplewithdisabilitiesandlimitedmobility(seewww.accessable.co.nz).Notethattheselistscoveraverylimitedrangeofthemovingandhandlingequipmentthatisavailable.
Emergency evacuation chair
figure 7.37
Combination stretcher/chair
figure 7.36
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Section 7: equipment for moving and handling people
References and resourcesCollins,J.W.,Wolf,L.,Bell,J.,&Evanoff,B.(2004).Anevaluationofa‘bestpractices’
musculoskeletalinjurypreventionprograminnursinghomes.Injury Prevention,10(4),206‑211.
MHRA(MedicinesandHealthcareProductsRegulatoryAgency).(2003).Evaluation: Electrically powered profiling beds Part 1: Hospital beds(MHRA03038).London:MHRA.Retrieved9September2010fromwww.mhra.gov.uk.
Nelson,A.(2003).Patient Care Ergonomics Resource Guide: Safe patient handling and movement.Retrieved11August2010fromwww.anasafepatienthandling.org/Main‑Menu/SPH‑Background/SPH‑Solutions.aspx.
Nelson,A.,Collins,J.,Knibbe,H.,Cookson,K.,Castro,A.,&Whipple,K.(2007).Saferpatienthandling.Nursing Management,38(3),26‑33.
StandardsNew Zealand,AS/NZS3551:2004.Technical management programs for medical devices
Seewww.standards.co.nz/touchstone/Issue+16/Electrical/Electricity+Safety+Regulations+2010+Standards+for+hazardous+areas+and+electromedical+equipment.htm.
VISN8PatientSafetyCenterofInquiry.(2010).Technology Resource Guide.Retrieved29October2010fromwww.visn8.va.gov/patientsafetycenter.
WorkSafeBC.(2006).Transfer Assist Devices for Safer Handling of Patients: A guide for selection and safe use.Retrieved9September2010from
www.worksafebc.com/publications/health_and_safety/by_topic/health_care/default.asp.
Web resources: equipment3
BiomedicalServicesNZLtd
www.biomed.co.nz/medical‑device‑legislations.html
SafeLiftingPortal
www.safeliftingportal.com/patientlifts/index.html
WorkSafeBC:Workers’CompensationBoardofBritishColumbia,Canada
www.worksafebc.com/publications/health_and_safety/by_topic/health_care/default.asp
3. Note:IftheURLsshowndonotwork,doasearchontheorganisationtitle.Equipmentmanufacturersoftensponsororprovideequipmentwebsites.ACCandtheGuidelines’authorsdonotspecificallyendorseanymanufacturer.
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