Why would the nurse lower the arms of a full-body sling lift when attempting to transfer a client?

Issued: 8 March 2010
Last Updated: 24 October 2013

Purpose

This safety alert aims to:

• inform people of the risk of patients falling out of patient lifting slings attached to patient hoists while the hoist is being moved
• provide guidance on ways to control the risk of a patient falling from a patient lifting sling/hoist and to ensure a safe system of work is followed.

Background

Workplace Health and Safety Queensland investigated an incident involving an elderly person who fell from a sling that was attached to a patient lifting hoist. The patient sustained injuries including a broken leg.

Contributing factors

The investigation highlighted the need for the regular reassessment of the patient to ensure a safe method of transfer, as well as a reliable system for sling selection, maintenance and use of slings.

Action required

Patient assessment

Assess the patient to determine the appropriate sling, hoist and transfer method to use.

Reassess the patient on a regular basis or when there is a notable change to their physical and/or mental status and use the most appropriate sling, hoist and transfer method.

Where the risk of a patient injury from transfer is high and the risk cannot be adequately controlled, eliminate it by providing an alternate care plan (e.g. sponge bath in bed).

Communicate any changes in the patient's transfer requirements to all staff that are responsible for the care of the patient (e.g. document in the patient care plan, update at staff changeover).

Proper sling selection

Selecting the type and size of sling should be based on the patient assessment and their transfer requirements.

Use slings that provide sufficient leg support to prevent patients slipping through slings.

Check the selected sling has the appropriate safe work load (SWL) for the patient and is compatible with the hoist being used.

Note: Sling sizes are not consistent across manufacturers. This variation in sizing/fit results in different patient positioning.

Sling availability and integrity/condition

Ensure a range of sling types and sizes are available in order to meet the wide range of patient needs.

Follow the manufacturer's specifications regarding checking sling and hoist integrity and condition.
As a minimum:

• inspect the condition of the sling and hoist to ensure good working order prior to each use. A sling is unsafe to use if the sling (particularly the attachment points, seams and other fragile areas) is frayed or torn, has holes, broken clips or failing components.
• implement a proactive maintenance program for slings and hoists.

Training in correct sling selection and use

Trained workers should be able to:

• choose appropriate slings including sling type, size and weight limits, application of slings
• understand the consequences of incorrect sling selection and application
• inspect slings for damage prior to use
• manage infection control, hygiene, laundering and maintenance.

Other administrative controls

• Do not lift patients higher than is necessary during the transfer.
• Ensure a clear path between the two transfer surfaces.
• Provide adequate number of staff to safely perform hoist transfers.

Manufacturers and suppliers of lifting slings

Manufacturers and suppliers of lifting slings must:

• provide sufficient information to assist with the selection of the appropriate type and size of sling for individual patients including the patient's physical measurements and medical condition
• place caution labels on slings stating the importance of ensuring a patient sling is the correct size for a patient prior to lifting.
• provide information with the slings on the most secure method and configuration for attaching the patient lifting slings to the hoist in order to ensure patient safety.

Legislative requirements

The Work Health and Safety Act 2011 sets out the laws about health and safety requirements affecting most workplaces, work activities and high risk plant in Queensland. It seeks to protect the health and safety of everyone at a workplace. Duty holders should pay particular attention to sections 19 (2), 21, 25 and 26.

Further information

The procedure for using a mobile sling hoist to move a patient

Authors
Sue Thompson, RGN, is moving/handling coordinator; Phil Jevon, PGCE, BSc, RN, is resuscitation officer/clinical skills lead; both at Manor Hospital, Walsall, West Midlands.

Introduction

Using a hoist to move a patient can be a hazardous manoeuvre for both nurses and patients. It is paramount that nurses undertake this procedure safely following best-practice guidelines (NMC, 2008).

Procedure

The procedure described here involves using a mobile sling hoist to move a patient. It is important to receive training on how to use the hoist. For guidance on preparing for any manual-handling procedure, see part 1.

Perform a risk assessment. Assess the patient for using a hoist - check their mobility care plan and consult colleagues. Determine how many staff (usually two) will be required and ascertain which hoist to use. Mobility care plans should document the hoist and sling type, including the sling size.

• Explain the procedure to the patient. Advise them that staff will use the hoist to lift them safely and without hurting them, and that they may be asked, if they are able, to carry out simple instructions such as holding their arms crossed over their chest.
• Ensure the environment is safe (see part 3).
• Wash and dry hands; don a plastic apron and gloves.
• Reassure the patient. Some patients may fear being dropped when lifted in a hoist.
• Prepare equipment. Always check the hoist before use (Fig 1). Check it has been maintained; there should be a sticker on the hoist indicating the date of the last maintenance check - this should be every six months. Check that the slings are the correct ones for the particular hoist. Inspect them for wear and tear, and the attachments. Check any maintenance stickers or labels on the slings - these should also be checked every six months. Do not use slings that
  are incompatible with the hoist.
• Check the hoist’s weight limit. This will be indicated on the hoist, usually on the main boom. Ensure the hoist is suitable
  for the patient’s height and weight.
• Select the correct sling for the patient, taking into account their body shape.
• Ensure the patient’s privacy and dignity.
• If the patient is in a chair or on a bed, ensure the brakes are on. If they are being moved to another chair or bed, check the brakes of these items are on.
• Insert the sling. If the patient is on the floor or on a bed, assist them to roll over. If they are on a bed, raise it to an acceptable height so you can roll and insert the sling under them. If the patient is on the floor, staff may be required to kneel.
• Insert the sling alongside the patient’s back and as far under as possible (Fig 2). It is important the bottom edge of the sling is as far as possible under the hip. Bunch the sling slightly before moving the patient on to their back, then ease the patient the other way to pull the sling through. Ensure that the leg slats are under the patient’s thighs (Fig 3). Care should be taken if they have a urinary catheter in situ.
• If the patient cannot roll, two flat slide sheets can be concertinaed and eased into position under them and the hoist sling slid between the two slide sheets.
• Once the sling is in place, check that the lower edge of the back of the sling is under the patient’s hips. If the sling is of the correct size, the crown of the patient’s head should be on the sling, if a high-back sling is being used. Follow manufacturers’ instructions for each sling type used.
• Attach the leg and chest attachments to the hoist’s spread bar. Some attachments are passed through each other and crossed before they are attached to the spread bar.
• Hoist the patient up a small distance, then check the sling attachments are secure, before continuing with the full hoisting action (Fig 4). If using a sling hoist, do not have the hoist brakes on when hoisting, except when hoisting a patient on a sloped surface or from the floor. The hoist will balance and find its own centre of gravity when the brakes are off. Do not hoist patients from an angle. This may cause the hoist to tilt, especially if the patient’s weight is close
  to the hoist’s limit.
• Raise the patient for clearance, not to the hoist’s height capacity unless necessary (the patient may find it more fearful if raised to the highest position) (Fig 5).
• Observe the patient at all times while hoisting and provide encouragement and reassurance. Some patients may become distressed and staff should ease anxieties by talking to them and keeping close while they are in the hoist.
• Manoeuvre the hoist and patient to the desired position, then lower (Fig 6).
• Once the patient is in position, unhook or unclip the attachments and move the hoist away from them. Then remove the sling.
• Ensure the patient is comfortable and has the nurse call system close by.
• Remove the hoist to its storage place.
• Ensure the hoist is clean and on charge (some hoists have battery chargers and one of these should always be on charge).
• Follow local laundry procedures for hoist slings after use.
• Wash and dry hands according to local policy (BackCare, 2005).
• Disposable (one-person slings) are useful as they can be allocated to a patient for their hospital stay and disposed of on discharge. This reduces infection risk.
• Generally, slings are not left underneath a patient. Any decision to do this must be based on assessment and documented. Staff should seek advice on choice of sling in such cases and should try to resolve reasons for leaving a sling in situ, for example by a change of chair type.

BackCare (2005) Guide to Patient Handling. Teddington: BackCare.

NMC (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC.