Patient lifting and moving techniques are vitally important to both patient and health care staff in daily care and treatment. Although not directly related to a technical aspect of

hyperbaric medicine

, proper patient lifting is an essential component of daily patient care and when moving patients in and out of the

hyperbaric chamber.

Nursing has the highest rate of non-fatal occupational injuries among all professions according to data from the U.S. Bureau of Labor Statistics. In their average workday nurses, nursing assistants and other health care workers are exposed to serious and often career-threatening injuries as a result of manual lifting [1]. A Health Risk Appraisal survey from the American Nurses Association reported that 42% of nurses surveyed said their job duties include lifting or repositioning heavy objects (i.e., patients) [1].

The consequences of improper lifting techniques can have devastating effects not only for the patient but for the health care staff as well. The National Institute for Occupational Safety and Health reported that incident rates at hospitals are almost double the U.S. average across all industries, and nursing home rates show more than triple the average. NIOSH data from January 2020 shows that 75 lift-related injuries occur per 10,000 full-time hospital employees, and 107 injuries for every 10,000 people employed at nursing homes and residential care/skilled nursing [1]. Chances are good that these rates have increased since the advent of the 2020 pandemic, with more than 362,000 people alone hospitalized for COVID-19 [2].

The issue is compounded by an aging health care workforce. As the U.S. workforce ages, health care follows this curve. The average age of a registered nurse in the United States has climbed from 39 years old in 1990 to 51 years old currently, according to data from the National Nursing Workforce Study. An aging work force has greater risk for injury and often longer recovery times for injuries [1].

Patients need our help

Regardless of the type of hyperbaric chamber being utilized, patients who require HBO2 treatment often need assistance with proper placement and in attaining a comfortable position in a chamber environment. Some patients have weight-bearing restrictions on lower extremities which preclude them from ambulation and which can require strategic lifting and positioning. Often, critical care patients are completely incapable of providing assistance when transfers are necessary from the bed to stretchers, chairs or other types of support devices and conveyances. In these cases, it is up to the health care staff to move the patient. That’s when we need to exercise care for ourselves as well as our patients.

When presented with patient lifting situations health care workers often assemble and manually lift the patient. A newer concept endorsed by the CDC is to use mechanical lifting devices whenever possible to avoid injury. According to the CDC: “Ergonomics refers to the design of work tasks to best suit the capabilities of workers. In the case of patient handling, it involves the use of mechanical equipment and safety procedures to lift and move patients so that healthcare workers can avoid using manual exertions and thereby reduce their risk of injury” [3]. This must be accomplished in each case with care and caution tailored to each individual involved. In the link from reference #3 below the CDC describes in detail the consequences for health care staff when they employ improper patient lifting techniques.

We need to practice safeguards

Regardless of the occupancy or vocational classification, lifting injuries are common, especially when improper techniques are employed. Musculoskeletal injuries, especially of the lower back, can have devastating effects, are often career-threatening, and they can diminish the quality of life for the affected individual. To combat these negative consequences, insurance companies and specialty consultants have developed courses that instruct and advocate proper lifting techniques and the increased use of specially designed equipment to help eliminate or greatly reduce the manual effort necessary with patient lifting.

As individuals educated in hyperbaric medicine we are familiar with necessary safeguards associated with our use of pressure vessels. Calculating the load force of a surface area demonstrates how much total load is generated when even a small increase of pressure is attained. This is the exact concept that has been calculated – and proven – that when an individual lifts improperly, the effort places far more load on soft tissue and skeletal components than they are designed to handle. All too often the consequence is injury.

Injuries can have long-term consequences

As we noted, back-related injuries can be disastrous. Insurance companies providing workers compensation coverage classify these types of injuries as “long tail” liabilities meaning claims that are not settled until well beyond a policy’s expiration. Long-tail claims can negatively impact not only an individual but also the workers compensation coverage of a facility for many years. This is particularly true if payments are involved for extensive medical care and long-term disability. Eventually, this may affect the premium the facility must pay for workers compensation coverage, which management must consider as part of the total operating costs over many years, not just the year that the incident occurred.

Hyperbaric Unit Safety Directors should endorse proper patient lifting techniques and education into their safety programs. Management should be encouraged to participate by advocating and supporting programs that promote proper patient lifting. When necessary, management should provide capital funding for the acquisition of devices that minimize manual lifting and help improve safety for patients and staff alike. I encourage everyone to read the detailed information in the references, review your own practices and, where you feel it is needed, implement revised strategies based on these facts.

The truth is, we need to remain in our side of the examining table. To do this, we should exercise caution and advocate teamwork – for everyone’s well-being. There may be truth in the adage that medical workers don’t always make the best patients. Let’s be sure we don’t test that anytime soon.

References

  1. https://blog.allrisks.com/nsp-patient-lifting-injuries-remain-a-major-risk-for-healthcare-professionals
  2. https://gis.cdc.gov/grasp/covidnet/COVID19_5.html
  3. https://www.cdc.gov/niosh/topics/safepatient/default.html

Taken and updated from the ‘Safety Report: Patient Lifting,’ by Bill Gearhart, BS, CHT, DMT, EMT, CFPS, CRT, RCP, published in Pressure, the Membership Newsletter of the Undersea & Hyperbaric Medical Society in March/April 2014, revised May 2021 with Renée Duncan, UHMS Communications.