I recently read an upsetting article on Twitter, telling the story of an elderly patient who died after falling from a patient hoist whilst being transported at her care home. This alone is upsetting but the real tragedy was that a subsequent investigation determined it could have been completely avoidable. A very quick search, alarmingly shows, more news stories reporting on care homes that have been prosecuted for negligence following similar falls, with the most recent being from only last month. The Health and Safety Authority reports that manual handling is one of the main accident triggers, although this includes patient moving and accidents involving healthcare professional moving inanimate objects, it corroborates the news reports.
From reading the articles it seems that the overriding causes seem to be poor assessment of the patient’s needs and insufficient information and training provided for the care givers, which lead me to delve a little bit deeper into the regulations surrounding patient handling and the proper procedures.
The regulations concerned are very broad and govern a wide range of lifting and lifting equipment, from industrial cranes to patient hoists and governs all lifting and lifting equipment that is used in any work place, the Lifting Operations and Lifting Equipment Regulations (LOLER) also govern lifting accessories for example slings and chains.
The regulations cover many points which would be part of a general risk assessment for any lift/transfer. Has the equipment been installed correctly? Is there ample space for the lift to take place safely and is the floor space clear of debris and obstructions? Also, is the equipment fit for purpose and strong enough for the load concerned? Weight limitations should be clearly marked and obvious to the user.
Other considerations, covered, and those that seem more pertinent to patient handling from reviewing the investigation reports, relate to supervision, safe guards and training. Hoists slings vary in size and appropriate application and here proper assessment of the patient is key for selection. How much support do they need, how does their condition, and medication, affect movement and strength? Are they vulnerable? Unable to understand or communicate? How willing are they to be moved? These risks need to be assessed for every step of the transfer.
Another important consideration would also be the staff on hand to assist. Are there enough people, are they adequately trained for use of the equipment and the procedure? Are they fully briefed on the patients notes and the recommendations for this type of transfer? One of the investigations highlighted that the injured patient’s notes were not transferred correctly when she moved care home, and despite the patient herself advising the care staff that they were using the incorrect sling for her, the staff proceeded and the patient fell. Also reports indicate that on more than one occasion, the proper safeguards i.e. safety pommels and restraints were not used correctly, if at all. This was attributed to improper or insufficient training on how the hoist should be used. It also seems that lifts/transfers are not being properly planned or supervised. One reported fall, which involved 2 staff members, occurred when one was positioned and behind the hoist and one stepped away to collect some of the patient’s personal possessions. This fall could have been prevented had the proper restraints been used or if a third staff member had assisted to remain in-front of the patient.
Undoubtedly the role of any healthcare professional is hard work, stressful and it seems understaffed. There may also be an issue of pressure to use equipment that they are not familiar with and have not been trained for, from peers and a culture of wanting to help the patient swiftly whilst causing them as little distress and with as much dignity as possible. None of the resulting investigations reported any malicious intent on the part of the care giver in any of the injuries or fatalities. It seems that in-depth training on conducting patient needs assessments and the capabilities and proper use of this lifting equipment would be the best place for time and money to be invested.
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Julie has written numerous interesting and well researched blogs on a wide range of topics related to Medical Devices and Human Factors. Please click here to read more of Julie's blogs and here to find out more about Julie.