From: Advance Magazine On-Line for Providers of Post-Acute Care, Sept. '05

Reducing Risk Facilitating safe and dignified transfers is a major challenge for post-acute care providers. A new alternative can make it safer.

By Cynthia Price Cohen, JD, PhD

Three procedures cause widespread injuries to health care providers and patients: manual transfers, repositioning and ambulation. These often result in patient skin tears and bruises, shoulder dislocations, rib fractures and contusions, and, in the case of falls, serious fractures. Resulting staff injuries, especially back injuries, can be extremely costly and lead to staff turnover, substitute hiring and increased workers' compensation claims. The time and funds it takes to file patient injury reports and respond to lawsuits can become overwhelming. These injuries occur because the human torso is simply not designed to be lifted, hauled or supported. Overwork and understaffing exacerbate the problem.

MANUAL TRANSFERS
Whether a caregiver is transferring a resident from a chair, a bed or a commode, both people are at risk. If the caregiver loses her grip, one or both people could fall. Lifting someone under the arms is not the most ideal solution because it can be painful for patients and can cause shoulder dislocations and bruising.

Until recently, the only manual device available for caregivers to use in transferring partial weight bearing patients has been the "gait belt" - a wide canvas belt fastened tightly around the waist of the patient, giving the caregiver something to hold onto when lifting or stabilizing a patient. However, it necessitates close physical intimacy between the caregiver and the patient. Typically, caregivers must crouch down in front of the patient and wrap their arms around the patient - grabbing the gait belt in back; then, with the patient's face on the caregiver's mid-section, they lift - relying solely on the strength of their legs.

Now a new generation of transfer garments is beginning to replace the gait belt as an alternative transfer device. These vest-like garments fill the need for a comfortable, dignified, easy-to-use method of transferring patients without the risk of injury to the caregiver or the patient. With an attached webbing harness at the chest and waist (front and back), supplying a convenient secure grip for the caregiver during transfers, the transfer garment spreads the pressure over the whole torso.

Elaine Rosen, PT, DHSc, OCS, FAAOMPT, Associate Professor from the Hunter College, City University of New York, Physical Therapy Graduate School, remarked, "I see the (transfer garment) as a wonderful aid for patients and caregivers in both long term care facilities and home care settings where injuries from transfers are a serious problem."

RE-POSITIONING
This procedure causes the most injuries to staff and patients. It is difficult and biomechanically dangerous for caregivers. The most common technique is for two care providers to straighten the patient and then push him back into the chair. This method may harm patients since caregivers have a tendency to grab the patients' arms or armpits.

The transfer garment's webbing harness makes repositioning safe and injury free. The aid stands on the side of the patient, grasps the webbing in front with one hand and with the other hand the webbing in back. Then with bent knees and straight back lifts up to easily repositioning the patient.

AMBULATION
The gait belt has been the standard for aiding in walking. It works very well as long as it is not so tight that it bruises the ribs of the patient or so loose that it slips up the body. Its disadvantage is that if the patient stumbles and starts to fall the gait belt only controls the lower torso so that past a certain point the upper torso can overweight the body and pull both the patient and staff to the ground.

Caregivers may also help patients walk by holding onto a body part or piece of clothing. This is the most common--and most dangerous--method. If the patient loses his balance, he could fall. Or, if the caregiver doesn't let go when the patient starts falling, the patient could experience dislocations, sprains, bruises or tears.

Reporting on his experiences with the transfer garments, Todd Boyles, who oversees educational and safety programs at the Martha Lloyd Community Services facility, located in Troy, Pennsylvania, explains, "They (transfer garments) enable direct support professionals to escort individuals, while allowing them to ambulate as independently as possible. They eliminate the need for gait belts and allow direct support professionals to avoid injury to themselves and their clients while routinely transferring and safely repositioning individuals throughout the day. The (transfer garment) wearers are able to gain confidence, and an increased sense of independence and dignity."

LIFTING
There are a variety of techniques to help protect staff and residents. The foundation is good biomechanics (using the body in a safer way). If employees must manually lift a resident, limit the number of combined movements that can lead to injury, says Mark Sanna, DC, a consultant to the American Chiropractic Association. Specifically, lifting and twisting, or even worse, lifting and twisting with a forward bend, increase pressure on the lumbar discs and can lead to back injury. Instead of rotating or twisting from the waist, pivot at the feet, he advises.

Depending on the weight of a patient, by using a transfer garment, a single caregiver can pick a patient up off the floor or a two-person lift can be employed to carry a patient.

Cynthia Price Cohen is chief executive officer of LiftVest USA and the executive director of the ChildRights International Research Institute. She is also an adjunct professor at the University of Tulsa College of Law.