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Even children pose hazard of lift injury
Ped hospitals set weight limits for lifts
With the youngest and tiniest patients, pediatrics hardly seems like a hot zone for patient handling injuries. Yet that assumption of safety is itself a hazard. Pediatric caregivers treating children, adolescents, and young adults may be at significant risk of injury.
"We do have injuries back injuries and shoulder injuries," says Lyn Sapp, RN, MN, CRRN, clinical nurse specialist and clinical practice manager of the inpatient rehab unit at Seattle Children's. "They are the same injuries as with adults, just probably not as frequent."
"If you use the 35-pound mark as a maximum lifting weight [of patients, as recommended by the National Institute for Occupational Safety and Health], you can have a toddler 18 months of age in the 90th percentile who would weigh 35 pounds," she says. "It's kind of silly to think that just because they're kids, they aren't heavy."
"[Nurses] think, 'Well, they're just kids. I lift my kids at home.' But it's not the same and there still is potential for injury there," adds Diane Anderson, RN, MN, MPH, COHN-S, supervisor of Occupational Health Services at Seattle Children's.
In a survey of pediatric clinicians about their perception about safe patient handling, Sapp found that most reported a low to moderate level of daily pain or discomfort. "They attributed it to daily movement of patients," she says, which is evidence of the need for a safe patient handling program in pediatrics.
Constant lifting and repositioning also creates the problem of cumulative trauma, notes Kristi Haglund, MEHS, safety specialist at Children's Hospitals and Clinics of Minnesota in Minneapolis and St. Paul.
A safe patient handling program reduced injuries by 69% in 2006 and 2007 at the Minnesota children's hospitals. "Even if you're lifting what has been traditionally considered light in health care, you're still going to be hurting yourself over the long run," she says.
Use tools designed for adult care
Pediatric programs should use the same tools as in adult health care to prevent patient handling injuries, says Kathleen Motacki, MSN, RN, BC, lecturer at the Henry P. Becton School of Nursing and Allied Health at Fairleigh Dickinson University in Teaneck, NJ.
"Although patient assessment criteria and algorithms exist for patients in medical, surgical, and orthopedics, there are no specific algorithms for pediatric patients," she says. "Those health care workers working in the pediatric setting must rely on the established evidence-based approaches to safe patient handling. The generic algorithms and patient assessment tool should be utilized when the child is greater than 35 lbs."
Algorithms for safe patient handling are available from the VISN 8 Patient Safety Center at the James A. Haley VA Medical Center in Tampa, FL (www.visn8.med.va.gov/patientsafetycenter/safePtHandling/SPHMAlgorithms.pdf). Motacki was scheduled to speak on pediatric patient handling at the Safe Patient Handling & Movement Conference in Tampa in March. She also is a co-editor, along with ergonomics experts Audrey Nelson and Nancy Menzel, of An Illustrated Guide to Safe Patient Handling and Movement (Springer Publishing; 2009).
Ceiling lifts are the preferred tool to reduce injuries because they're convenient and easy to use, says Haglund. As Children's Hospitals and Clinics expands and remodels, it is adding more ceiling lifts.
"The nurses who have used the ceiling lifts in the actual patient rooms have really liked them and found them easier to use [than other lifts]," she says.
"We would [need] the same basic lift equipment as an adult hospital would. We have patients who are up to 300 pounds," she says. "You have to have a wide range of equipment in the pediatric population."
Seattle Children's also installed ceiling lifts, starting in the rehab unit. "I have seen personally the decrease in injuries to staff in my tenure here," says Sapp. "Those who are injured keep doing things without equipment to support them."
It's important to establish a clear policy. "If [the patients] are not able to help with at least 50% of their body weight or if that weight is more than the recommended limit of 35 pounds, they use a lift," says Anderson.
The Minnesota hospitals set the limit at 30 pounds based on recommendations of Liberty Mutual Insurance Co. The policy was set by a safe patient handling task force, which included frontline nurses. "If [the patients weigh] 30 pounds and they can't move, transfer, or ambulate on their own, then we're going to be using safe patient handling equipment," says Haglund.
Children's Hospitals and Clinics of Minnesota also requires nurses to take a competency test on safe patient handling equipment every year and provides "ergo coaches" on units to help co-workers with the equipment.
Still, there are special issues that arise in the pediatric setting that must be addressed by the safe patient handling program.
Some children may have disabilities that cause contractures or stiff muscles, and other children may be squirmy. Caregivers need the assistance of co-workers, even when they're using lift equipment, says Motacki. "We have a less helpful population in some respects. Kids are more likely to move in unpredictable ways and not be participatory in transfers and lifts," says Anderson.
Nurses working with infants may not be performing heavy lifts, but the stretching and reaching and bending over incubators create a strain that should be addressed, she says.
Of course, pediatric units and hospitals need a range of slings. The extra small sling can accommodate a patient who weighs just 20 pounds.
Nurses may worry that their young patients will be fearful of the mechanical lifts. But there's plenty of opportunity for hands-on care while placing the child in the sling and even while moving them, says Haglund.
Some children love it. "They think it's like a ride," she says. "There are definitely some who have been afraid of it as well. That's where the caregiver comes in, they have to walk the patient through it and make them feel comfortable."
"They can focus more closely on the child rather than just on the lift itself. They can keep that eye contact with the patient, and they can still touch the patient," she says.
Meanwhile, with fewer injuries, Haglund hopes to retain nurses at the bedside. "Hopefully, we'll see our nurses are staying at Children's because they're not leaving the program after having a back injury," she says.
(Editor's note: The 10th Annual Safe Patient Handling & Movement Conference is being held in Lake Buena Vista, FL, March 31-April 2, 2009. More information is available at www.cme.hsc.usf.edu/sphm/.)