A Look at Patient Handling Equipment

Written by Kelsey McCoskey and Col. Myrna Callison

MMT 2012 Volume: 16 Issue: 1 (February)

Over the past several years, the U.S. Army Public Health Command has been developing and implementing a Safe Patient Handling Program for the Army Medical Command. The goal of this comprehensive program implementation plan is to decrease caregiver injuries, improve patient outcomes and provide the highest levels of comfort possible for patients and health care providers.

Manually moving and handling patients—an activity undertaken many times each day by health care staff—carries a high risk for musculoskeletal injury. Few patients weigh 35 pounds, the maximum allowable weight for a one-person manual patient movement according to the National Institute for Occupational Safety and Health. For the caregiver, musculoskeletal injuries associated with patient movement not only cause pain and discomfort, but can result in lifelong disability. The Department of Labor recognizes nursing as having among the highest injury rates of any occupation in the United States. According to the Bureau of Labor Statistics (BLS), the nursing profession is consistently near the top of occupations with non-fatal injuries and illnesses involving musculoskeletal disorders with days away from work. In 2010, nursing aides, orderlies and attendants had the highest incidence rate and highest case count of all occupations. Incidence rate for musculoskeletal disorder cases with days away from work for nursing aides, orderlies and attendants increased 10 percent from 2009 to a rate of 249 cases per 10,000 full-time workers. These occupations also had a 7 percent increase in the number of work-related musculoskeletal disorders cases. These injury rates can be compared to the incidence rate for laborers and freight, stock and material movers, which increased 6 percent to 155 cases per 10,000 workers. The BLS also reported the median lost work days were six days for nursing aides, seven days for registered nurses and eight days for licensed practical nurses. There is a high rate of underreporting associated with nursing injuries. In a survey of hospital workers published in 2005, it was found that although 39 percent had experienced a work-related injury in the previous year, only 61 percent of cases were actually reported, even though two-thirds of these injuries required medical care and 44 percent resulted in lost time from work.

One of the goals of a comprehensive safe patient handling program is to minimize or eliminate work-related musculoskeletal disorders among patient care providers. Implementation of a comprehensive program includes seven essential elements. These elements are: ergonomic site assessment, facility champions, unit peer leaders, multidisciplinary facility SPH committee, minimal lift policy, comprehensive training and finally, equipment.

Research has found that in their postintervention assessment, patient handling equipment was the highest cost item and was the most effective factor of the SPH program as reported by nurses. There are many different types of equipment that can be included in a SPH program. It’s important to ensure that a detailed ergonomic site assessment is completed prior to equipment purchasing decisions. This site assessment should include a comprehensive assessment of patient rooms, patient bathrooms (both private and communal), storage rooms, bathing/tub rooms and hallways. This assessment will help to compile a list of equipment needs to begin the cost estimation process. In addition to an ergonomic site assessment, holding an equipment fair for staff and patients to field test the different pieces of equipment and different manufacturers will help identify what works best in their facility and will also help gain support from staff and patients. Once this has been completed, a facility can make decisions about what types of equipment will best suit its needs and budget. One of the primary factors that contributes to staff use of equipment is accessibility and ease of use.

The gold standard of lifts is also one of the most common and versatile types of equipment. Ceiling lifts consist of rails that are either mounted into the ceiling via the underlying ceiling structure or provided via unobtrusive wall-mounted supports. These fixed rails can be installed in several different configurations. For example, the ceiling lift may consist of one straight rail over a bed. This configuration limits the use of the motor, sling and lift to the area directly below the straight rail. A second configuration is a traverse rail. This system is sometimes referred to as an H-track or XY track. This commonly consists of two stationary rails positioned parallel to each other and a third rail that slides back and forth on the two stationary rails. This allows the ceiling lift to be used anywhere within the space between the two fixed rails. The use of a traverse system results in increased use and flexibility in areas where the lift is used.

The motor of a ceiling lift typically sits inside a box that slides on the rail. This motor is what lifts and lowers a patient suspended in a sling. Motors come with different lifting capacities depending on the manufacturer. There are standard motors which lift approximately 500 pounds and bariatric motors which can lift in excess of 1,000 pounds. Different manufacturers have found different ways of utilizing the motors for this additional weight allowance. The motor is typically controlled by a handheld device that the health care provider uses to raise and lower the patient in their sling. Another aspect to consider when evaluating the ceiling lift system is charging of the motor and the handheld device. For example, some manufacturers have a home base system where the motor and handheld device is either moved manually or moved automatically to one spot where it recharges. Other systems include rails that are constantly charged so that the motor remains charged no matter where it is located in the system.

The third important aspect of a ceiling lift is the sling. The selection of slings can be overwhelming but there is a sling for nearly any diagnosis and condition. Slings can be designed to be laundered or to be one-use disposable slings. Sometimes a facility might use primarily laundered slings but have disposable slings available for specific settings, such as an operating room. There are several basic slings in a variety of sizes usable in many cases such as seated slings, hygiene slings and repositioning sheets. However, depending on patient populations, there may be a need for specialized slings such as supine slings, amputee slings, pediatric slings, ambulation slings, limb support slings, bathing slings and so on. Continuous and effective training on the many types and uses for slings will assist health care providers with becoming more comfortable with the use of slings, but also more adept in the different ways slings can be used to assist with a wide variety of patient care and movement tasks beyond the fairly straight forward traditional bed-to-chair or chair-to-chair or bed-to-bed transfers.

Additionally, ceiling lifts can be designed with extension rails in place to allow the patient to be moved into a bathroom area. Because many bathrooms are relatively small spaces and there is the potential for wet surfaces, bathrooms can present unique challenges for staff to assist patients and for eliminating patient falls. For dependent patients, a ceiling lift into a bathroom provides a safe transfer to and from the commode and shower and improves the ease with which a health care provider assists with toileting and hygiene. For less dependent patients, a ceiling lift and ambulation sling in a bathroom can provide greater independence to stand at a sink and perform basic activity of daily living tasks without the fear of fatigue and falls. Additional areas that can be considered for ceiling lifts are ambulance bays, family waiting and rest areas, and outdoor patient seating areas.

In 2010, the Facility Guidelines Institute (FGI) included the addition of a Patient Handling and Movement Assessment (PHAMA) into the text of the 2010 Guidelines for Design and Construction of Health Care Facilities. This introduced a requirement for project applicants to conduct a PHAMA as part of the sequence of pre-design functional and space programming processes for new construction and renovation projects. Further, the 2010 Guidelines require applicants to revise that PHAMA as new information becomes available throughout project design, construction, and commissioning. An accompanying white paper on safe patient handling outlines the rationale, design, implementation and development of a business case for safe patient handling programs. This white paper provides users of the Guidelines with background information on the new PHAMA requirement, provides readers with information and resources to help prepare a PHAMA, and provides recommended coverage levels for each clinical area within a hospital.

The ceiling lift coverage recommendations by clinical area/unit are based on the research and experience of the Veterans Health Administration and their patient populations, so there may be room for modification of the recommendations based on individual facility needs and different patient populations. In general, the traverse track configuration is preferred for nearly all clinical areas. This configuration presents the opportunity to use the ceiling lift for a much greater range of transfers and activities than a single rail track could provide. The exception to this is in an area where the only activity needed would be moving a patient from one surface to another where each surface could be easily positioned underneath the fixed rail. One example of how this practice could be effective is in a Magnetic Resonance Imaging (MRI) waiting area where there is ample space and the only transfer needed would be moving patients from a wheelchair or stretcher to a non-ferrous MRI stretcher.

The number and type of ceiling lifts needed varies by clinical area but also by patient population and room configuration. More physically dependent patient populations require more recommended ceiling lift coverage. For example, according to the guidelines outlined in the white paper, ICU beds should be covered at 100 percent with medical/surgical units potentially requiring anywhere from 50 to 100 percent bed coverage depending on the patient population and facility. In facilities with multi-bed rooms, it may be more cost-effective to get maximum bed coverage through installation of one lift in the multi-bed rooms versus many lifts in multiple single rooms. Something to consider in a multiple bed room is how the ceiling lift will interact with the existing privacy curtains. Typically there will need to be a modification to the curtain systems to accommodate a ceiling lift traversing the overhead space. Additionally, facilities with a high bariatric patient census will need to take this into consideration when purchasing ceiling lifts and the associated slings.

It is of the utmost importance that health care providers are trained on the use of the equipment and the many different slings and their uses. A staff training room with a ceiling lift is ideal so that new employees can become comfortable with the skills needed to use ceiling lifts to their maximum potential. A training room can also help existing staff with refresher training, advanced use of the lifts, and alternative ways to use slings to assist patients in gaining more independence in addition to protecting health care providers from injury.

Ceiling lifts are not just for fully dependent patients. With the proper sling and user training, lifts can be used to assist with gait training and weight-bearing progression. For example, straight rails tracked down an inpatient unit hallway or over parallel bars and treatment mats can be used for physical therapy staff to work on gait training or traverse rail systems in an activities of daily living room can be used to assist occupational therapists in allowing patients to gain more independence and perform more advanced tasks than they might have been able to do without the support and security of the sling and lift.

Ceiling lifts are not the only types of equipment available. There are also floor-based sling lifts that assist in performing many of the tasks that ceiling lifts perform. Concerns associated with floor-based lifts include the space requirements to accommodate the wheeled base, especially in small or crowded rooms, storage, accessibility and maneuverability. For example, in a 2009 study the spine forces resulting from ceilingmounted lift systems were considered safe, while floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling maneuvers. Additional ancillary safe patient handling equipment includes powered and manual sit to stand lifts, air-assisted lateral transfer devices, friction reducing devices, slide boards/roll boards, adjustable beds, stretchers and gurneys, standing aids, shower chairs and other devices to assist transport. A comprehensive ergonomic site assessment and safe patient handling program would identify which types of equipment would be most appropriate to support the success of the program.

Safe patient handling equipment is an essential part of any safe patient handling program and is also the highest cost portion of a program. However, a site assessment of a facility prior to purchasing equipment, an educated understanding of the facility’s specific needs, and a review of the different types of equipment available can help ensure a solid foundation for a safe patient handling program. ♦

This is a general discussion of safe patient handling equipment and is not intended to be prescriptive or to endorse any equipment type or manufacturer. For more detailed technical information, please contact safe patient handling equipment manufacturers. For more detailed information on site assessments please reference the FGI PHAMA Whitepaper or contact the authors of this article: Kelsey McCoskey holds a Master of Science degree in occupational therapy and is a certified professional ergonomist. Colonel Myrna Callison holds a Bachelor of Science degree in occupational therapy and a Ph.D. in industrial engineering with a human factors engineering emphasis. For more information please contact McCoskey or Callison at the USAPHC Ergonomics Program: 410-436-3928, This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or
This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Ms. Kelsey L. McCoskey, MS, OTR/L Ergonomist, CPE Army Institute of Public Health and Col. Myrna Callison, Ergonomics Program Manager, Army Institute of Public Health.

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