Additional Client Handling Considerations and Resources
Client Mobility Assessments
All caregivers must be able to evaluate all factors that impact a client's mobility. The goal is to maximize the client’s participation in the move and ensure that the move is done without jeopardizing the client or the caregiver’s safety.
The purpose of the assessment is to determine the type of procedure that should be used and how much assistance from the staff is required to safely move a client. The assessment considers issues such as:
- How much physical help can the client give, and can they weight-bear
- How much can the client co-operate
- Does the client have perceptual problems or sensory deficits
- Is the appropriate equipment available
- Are there environmental factors that can interfere with the transfer
- Are there risk factors associated with the caregiver
Three types of client mobility assessments:
1. Initial client mobility assessment
The organization has developed a process to assess a client’s mobility within 24 hours of admission.
2. Ongoing client mobility assessments
The organization has developed a formal process to reassess a client’s mobility on an ongoing basis.
The ongoing client mobility assessment mirrors the components of the initial client assessment. A trained staff member should complete the ongoing mobility assessments. Organizations should incorporate a continuous client mobility assessment into the existing review of their client’s service and care plans.
When assessing a client’s mobility status, four major factors should be considered.
- Communication, cognition, behavioural and emotional status, medical and physical status
- Skills, knowledge, experience, height, size relative to client, wellness, fitness, strength, time of day, time pressure, shift work, fatigue, frequency of lifting, number of caregivers.
- Space, lighting, temperature, obstacles, noise, floors, layout and colours
- Inadequate training in the use of equipment
- Improper use of equipment
- Use of faulty equipment
- Lack of an equipment preventive maintenance program
- Non-compliant equipment (e.g., not meeting CSA standards)
- Non-adjustable equipment (e.g., bed heights)
- Fixed arm and leg rests on wheelchairs and geriatric chairs
- Poorly designed equipment features that require excessive force to operate (e.g., bed cranks, bed rails, brake)
- Fit of the equipment with respect to the client and environment
- Ease of use of the equipment
- Availability of the equipment
- Storage of equipment
3. Client mini-assessment
The organization has developed and implemented a methodology to briefly assess any changes in client’s medical status or abilities prior to any client handling activity.
This mini-client assessment (based on communication, ability, resistance and equipment/environment) must occur before any planned client-handling activity to ensure that the previously chosen procedure is still appropriate. A mini assessment reminds a caregiver to look for changes in a client’s:
- medical condition
- cognitive status
- behaviour, strength
- range of motion
- changes in the environment or issues with the caregivers
Communication of Client Assessment Plan
The organization has developed a client assessment plan to communicate and document the client mobility assessment findings.
Upon completing the client assessment, a mobility plan must be communicated and documented in the client’s chart or service delivery notes. In addition, a client mobility plan outlines a variety of potential repositioning, transfer and lift techniques and equipment.
A logo system consisting of pictograms of the organization’s accepted client handling procedures effectively augments communication of the chosen procedure. Logos can be reduced in size and inserted into the client’s chart.
Client Handling Procedures
The organization has established standard safety procedures for client handling tasks (transfers, lifts, repositioning).
Key categories related to client handling include:
- Transfers- Procedures used to assist a weight bearing client from one surface to another.
- Lifts- Procedures used to support or carry the entire weight of a person from one surface to another. A lift is used to move a client who may be physically unable to weight-bear through his/her arms or legs and/or is cognitively unable to co-operate in the procedure.
- Repositioning- A procedure used to move a client to a new position on the same surface.
Transferring or repositioning clients can be as hazardous to caregivers as manual lifts. Using assistive devices and proper techniques can reduce excessive forces. Organizations need to support the use of appropriate transfer and repositioning procedures and devices to reduce the risk of injury to clients and caregivers.
The goals of the transfer or repositioning procedure are to:
- Ensure the safest and most comfortable procedure for the client and the caregiver
- Allow the client to feel as independent as possible by allowing them to participate
- Reduce the risk of injury to both the client and the caregiver
- Provide good control and ensure that the client feels secure
- Reduce the intensity of biomechanical stresses and physical demands for the caregiver, such as awkward postures, high forces associated with lifting/lowering and/or pushing or pulling
- Permit the caregiver to assume a position with good leverage
Employers should ensure:
- Information is provided to workers on preparing for a transfer or repositioning procedure
- Provide step-by-step instructions for safely turning, repositioning, and transferring clients with and without assistive devices such as transfer boards, belts, and discs as well as handling slings, slide boards and slider sheets
Transfer categories which would require the development of standard procedures may include:
- Independent unsupervised transfer
- Independent supervised transfer
- Minimal assistance transfer
- One-person transfer
- Two-person transfer
Transfers may include assistive aids (such as a transfer board, transfer belt, slides) and may be unique to a specific location, e.g., automobiles.
The proper choice and use of equipment to transfer clients can reduce physical demands on caregiver’s by improving postures and reducing excessive forces related to lifting, lower pushing, pulling, carrying, and gripping. Familiarity with equipment and devices and their uses helps the organization make appropriate purchases.
The use of client handling devices should:
- Ensure a secure and safe client transfer
- Reduce the intensity of biomechanical stresses
- Reduce the physical demands of the task, such as pushing or pulling
- Permit the caregiver to assume a position with better leverage and optimal postures
- Allow the client to participate as much as possible
Connect with your rehabilitation provider for assistance with providing/developing/training on specific manual client handling safe work procedures.
Client Lifts (including mechanical devices) and Slings
The organization has developed a process for the safe lifting of clients, including a standard mechanical lift procedure based on manufacturer guidelines. The organization should also establish a standard procedure for laterally sliding a client from one horizontal service to another.
Preparing for a lift begins with the caregiver confirming that the prescribed procedure and equipment is the most appropriate or the client, determined by an assessment and should be conducted each time a caregiver prepares to carry out the procedure. Risk factor consideration should include the:
Lifts are done for clients who are physically unable to bear weight or cognitively unable to assist with the manoeuvre. A lift may be done manually or with an assistive device to move the entire body weight. Manual lifting is strongly discouraged and is often prohibited unless there is a life-threatening emergency.
Mechanical and ceiling lifting devices are engineering controls that decrease the risk of injury by eliminating the forceful exertion, awkward postures and repetitive motions associated with manual client lifting. Mechanical lifts must comply with CSA standards.
The purpose of a lifting device is to:
- Ensure that the client is secure and safe during the lift
- Reduce the physical demands of handling patients by eliminating or reducing the need to perform manual lifts
- Reduce the risk factors for MSDs
- Assist clients and move them from one surface to another when the client is:
- Not physically able to move themself
- Not mentally able to help with lifts
- Unable to bear weight using one or two legs or both arms
- May be unpredictable in physical support performance
The lifting devices come in a variety of designs and may be categorized as:
- Ceiling lifts
- Portable lifts – active and passive
- Stationary or fixed lifts
- Total-body lifts (passive lifts) also including ceiling lifts
- Ambulation lifts (active lifts)
- Bathtub and shower lifts
Mechanical lifts or ceiling lifts should be used to move non-weight-bearing clients:
- To and from a bed
- To and from a seated surface (wheelchair, geriatric chair, commode)
- Off the floor
- In and out of tubs/showers
Sling selection, use, care, and maintenance are essential to the safety and comfort of patients. Most sling manufacturers offer many options. The condition and size of the client(s) being lifted in the slings must be considered to ensure a proper fit. Slings should not be left in position under the client (unless designed/manufactured to do so and documented in the client assessment). Most heavy equipment suppliers have published comprehensive guides that can assist with the use and care of the slings. Only slings designed for that specific equipment must be used. Slings should be inspected thoroughly before every use.
Examples of sling types may include but is not limited to:
- Hygiene split leg
- Repositioning sling
Sliding, Repositioning and Transfer Aids
Slider / repositioning sheets: A low-friction product/sheet that reduces the force required to pull or push a client during a lateral slide procedure or movement on the same surface to assist with repositioning.
Anti-slip repositioning sheets: Small sheets placed on the chair’s seat and help prevent the client from sliding forward due to the unidirectional anti-slip properties of the sheet.
Repositioning slings: Some mechanical ceiling lift manufacturers have developed repositioning slings and procedures to reposition and/or turn clients,
Transfer/walking belt: Ambulation belts assist with guiding balance during activities such as standing, walking, or transferring a weight bearing client.
Transfer/slider board: This is used to assist with transferring a sitting client from one surface to another (by sliding on the surface of the board) at the same height.
Transfer disc: A floor aid used for clients with difficulty moving or pivoting their feet during a transfer.
Equipment Planning, Purchasing and Maintenance
The organization has developed equipment planning, purchasing and maintenance processes to optimize client handling procedures and accommodate client handling equipment.
Equipment that lacks engineering controls may expose the caregiver to awkward postures and excessive forces, especially of the shoulders, neck and back. Therefore, ergonomic features and engineering controls must be considered when selecting equipment to ensure that the most appropriate and safest products are purchased.
The organization should develop a process to plan for the selection and evaluation of client handling equipment that ensures the equipment meets its needs. A collaborative team approach that includes the purchasing department, management, health, and safety, JHSC, front-line users, infection control, housekeeping, maintenance, and other stakeholders is recommended.
The team should determine:
- The equipment required based on the initial needs assessment – i.e., injury statistics, client mobility assessment needs, environmental assessment, equipment assessment and cultural assessment
- A list of equipment required by location
Equipment must always be in good working order so a preventive maintenance program must be in place. Regular inspections of all parts of wheeled equipment, such as beds, chairs, transfer or lift devices and their attachments, must be carried out according to manufacturer’s instructions. Most equipment comes with a required maintenance schedule.
A regularly scheduled maintenance program ensures sufficient safe and effective mechanical lifting devices and associated equipment . All portable and ceiling mechanical lifts are required to follow the preventive maintenance schedule set by the manufacturer. Slings should also be laundered and used according to the manufacturer’s guidelines. Inappropriate cleaning may affect the integrity of the material and may result in tearing.
In addition to the standard preventive maintenance on the equipment, the organization should ensure there is a:
- Process to take malfunctioning and defective equipment out of regular use.
- Tracking system for prompt turnaround times.
- Process to maintain equipment instruction manuals.
- Documentation system for defective equipment.
A well-documented and communicated defective equipment policy and procedure must be in place. This includes reporting a breakdown, removing the equipment from service, and repairing it.
Maintenance of the environment is also important to ensure the safety of the caregiver and client, and to ensure the easy and safe movement of equipment. This includes ensuring that:
- Doors open and close easily
- Floors are maintained (clean, dry, free from slip and trip hazards)
- Hallways and emergency exits are unobstructed
- Equipment storage areas are available and accessible
- Safety devices (hold-open devices, grab bars, railings, etc.) are in good working order
The organization has developed an environmental design and planning process to optimize client handling procedures and accommodate client handling equipment and activities.
Environmental design involves physical changes to the workstations, equipment, tools, and the work environment. Considering the impact of the environmental design is important to:
- Ensure a secure and controlled client transfer/lift
- Reduce the intensity of biomechanical stresses on the caregiver
- Eliminate or reduce physical demands of the task
- Permit the caregiver to assume postures and positions with better leverage
Work environment considerations should include:
- Appropriate flooring type, a review of joints
- Colour contracts
- Extreme temperatures
- Appropriate lighting
- Work / workstation and client activity layouts and space requirement to safely perform the procedure
- Equipment, furniture, and tools