In the last year, Texas and Washington State have passed legislation mandating the implementation of safe patient handling policies in hospitals and other health care institutions. Several other states have introduced similar legislation, and a federal mandate may eventually follow. The goal of these laws is to decrease the high rate of often debilitating musculoskeletal injuries suffered by nurses as a result of the manual lifting, handling, and transfer of patients, as well as to prevent injuries to patients from such processes. While the Washington law establishes clear requirements for the purchase and implementation of mechanical lifting devices, the Texas act restricts manual patient handling to "emergency" or "life-threatening" circumstances and strongly encourages policies designed to lead to the use of mechanical devices.
Mechanical lifts can and do prevent injuries to nurses. The danger of manual lifting for nurses is well documented. What we don't quite know is how safe mechanical lifts are for patients. The reporting of occupational injuries is mandated by the U.S. Department of Labor, but the U.S. Food and Drug Administration (FDA) allows voluntary reporting of patient injuries that involve lifting equipment.
Just because we don't have reliable statistics doesn't mean that mechanical lifts are safe. Since January 2005, 198 severe adverse events involving mechanical patient handling devices have been reported to the FDA, five of them involving the death of the patient. The following report (verbatim) made to the FDA illustrates the potential seriousness of injuries resulting from the use-and misuse-of lifting equipment:
The resident was bathed and removed from the tub using the lift. The resident and lift were parked without the brakes engaged approximately 12 inches from the end of the tub. The resident was then dried in this location. The caregiver turned around to "lower the tub and open the drain to empty the tub." When the caregiver turned around, the resident was face down on the floor, attached to the lift. The caregiver did not see the lift and resident fall over. The safety belt was applied "from the front, between the resident's legs" with the tightening mechanism at the back of the resident (at about the lower spine). The resident incurred bruises on both knees, fractures of one femur, and a head injury (bruising). The resident was placed under sedation. The resident passed away the next day.
The FDA considers patient lifts to be "low-risk" equipment and thus does not require any evaluation before they're used. In the literature, no mention is made of lifting equipment posing significant risks to patients. The ANA fact sheet on safe patient handling, "Handle with Care," while it mentions five benefits to patients of the use of lifting equipment, makes no mention of risks to patients associated with its use.
Mechanical lifts should be seen as high-risk equipment. Nurses should be made aware of safe practices for both patients and staff, and should collaborate with patients when deciding the most appropriate method.
At a recent conference focusing on safe patient handling, a case was made for mandating that all nurses use lifting equipment. Administrators were encouraged to discipline nurses who did not use equipment after a no-lift policy had been introduced in their facility. Punishments could include suspension and termination.
Before legislation is passed and no-lift policies are implemented, policymakers and nurses should look at the risks to patients. Even when lifting equipment is properly maintained and operated, some patients may experience pain, anxiety, or even terror. Lifting and moving patients is a complex process with many variables; laws restricting manual lifting to emergency situations leave nurses little flexibility in making informed choices. Nurses should be given the autonomy to provide care in a manner that is best for both themselves and patients.