Evaluation of the effectiveness of portable ceiling lifts in a new long-term care facility
Introduction
Musculoskeletal injuries (MSI) are a major source of work-related disability within the healthcare industry (Choi et al., 1996; Fragala, 2004; Wasiak et al., 2004). Higher incidence rates of MSI have been observed in healthcare workers compared to the general population (Fuortes et al., 1994; Pheasant and Stubbs, 1992) and to other occupational groups (Ono et al., 1995). In Canada, the evidence is similar (Koehoorn et al., 2002; Yassi et al., 2002) with the injury rate for the healthcare sector from 1996 to 2000 higher than the average for all other industries combined (Engst et al., 2004). In 2001, the injury rate per 100 Full Time Equivalent (FTE) workers for the Acute and Long-term care sectors in British Columbia (BC) were 6.4 and 10.7, respectively, while the injury rate for all other industries in BC was 3.7 (Workers Compensation Board of British Columbia, 2002).
Owen (2004) summarizes the evidence that back injuries are a major problem for those nurses providing direct patient care. Nurses with frequent and direct physical contact with patients have been shown to have a higher incidence of back injuries than those who work with patients infrequently (Jensen, 1990), and nurses who have been injured commonly report patient handling as a major cause of their injury (Bork et al., 1996; Garg and Owen, 1992b; Hollingdale and Warin, 1997; Knibbe and Friele, 1996; Leighton and Reilly, 1995; Ono et al., 1995; Ostry et al., 2003; Smedley et al., 1995; Yassi et al., 1995).
Manual patient handling such as lifting and transfer of patients/residents from one destination to another has been identified as a high-risk activity (Garg et al., 1992c; Hollingdale and Warin, 1997; Nelson and Fragala, 2004). The risk on the musculoskeletal system is due to the weight or required force to lift/transfer or reposition a patient/resident, the horizontal and vertical location of the patient/resident relative to the healthcare worker, the frequency, duration and orientation of lifting, stability of the patient, workplace geometry, and environment (Garg and Moore, 1992a; Marras et al., 1995, Marras et al., 1999; Waters et al., 1993). The potential for injury is not only due to overcoming a heavy patient/resident's body weight, but is further compounded by the patient's size, shape, deformities, level of fatigue, cognitive functioning, cooperation as well as the worker's physical impairments or lower limb function, balance, and coordination (Garg et al., 1992c; Lloyd, 2004). Cognitively impaired patients/residents can be unpredictable and may suddenly become combative, resist efforts, or go limp during a transfer, causing a nurse to lose balance and/or make sudden unexpected movements (Lloyd, 2004). These sudden unexpected movements and resultant muscular contractions can cause high muscular forces within the erector spinae of approximately 145–187% of one's Maximum Voluntary Contraction (MVC) (Anderson, 2001) leading to fatigue and possible failure of the muscles surrounding the lumbar spine (de Looze et al., 1998; Dempsey, 1998; McGill, 2002).
Reducing patient handling injuries can result in considerable economic benefits to employers and prevent significant pain and suffering for workers (de Looze et al., 1998; Gorelick et al., 2003). Many traditional interventions to this problem based on teaching workers proper body mechanics while manual lifting, have not yielded widespread success in reducing injury rates (Fragala, 2004; Keir and MacDonell, 2004). In recent years, ceiling mounted lifting devices have been increasingly promoted as an alternative to conventional floor lifts for lifting and transferring patients from one location to another, and repositioning patients in bed (Engst et al., 2003, Engst et al., 2004, Engst et al., 2005; Gamble, 1998; Holliday et al., 1994; Villeneuve, 1998; Yassi et al., 2001). Ceiling lifts can reduce many of the variables related to unexpected patient/resident behaviors and create a safer situation for healthcare workers (Daynard et al., 2001; Fragala, 2004).
Engst et al. (2003) describe a ceiling lift as consisting of a ceiling mounted track, an electric motor, and a patient sling used to lift and transfer, and reposition patients/residents (Fig. 1). One or more staff members are capable of placing a sling on a patient/resident and hooking them onto the ceiling lift. Ceiling tracks can be configured in numerous arrangements to accommodate many beds within a single room, and possibly multiple rooms. There is generally two different types of ceiling lift motors: portable and fixed. Portable motors are easily attached and detached from the ceiling lift tracks. In a study of overhead ceiling devices in an extended care unit of a hospital, Engst et al. (2005) found a greater proportion of nursing staff used ceiling lifts to lift and transfer residents from bed to chair than manually or with mechanical floor lifts. In addition, perceptions of pain, discomfort and risk of injury were significantly decreased when lifting and transferring with the ceiling lift. It can be seen that ceiling lifts have solved many of the problems associated with mechanical lifts since they require minimal physical effort to move and maneuver, are always available for use since they are stored within a patients’/resident's room, and require less space to operate (Engst et al., 2005). Mechanical lifting devices of any type however have been shown to be far safer for both nurses and patients, than manual methods (Lloyd, 2004; Zhang et al., 2000).
In 2000, the Occupational Health and Safety Agency for Healthcare (OHSAH) in BC, an agency jointly governed by union and employer representatives dedicated to identifying and sharing best practices (Yassi et al., 2002) to reduce injuries and illnesses in healthcare workers, examined the effectiveness of installing ceiling lifts within the design of a new long-term care facility. The objectives of this study were to examine the impact of installing ceiling lifts in a new long-term care facility in relation to (1) staff preferences for patient handling practices and (2) reductions in patient handling injury rates as a result of the ceiling lifts installed within a newly designed care facility.
Section snippets
Research design
The evaluation of the impact of the installation of portable ceiling lifts into a long-term care facility implemented using a quasi-experimental pre-post intervention design with a concurrent control in two long-term care facilities. The intervention facility was a 63-bed long-term care facility that was being moved into a newly constructed facility on the same property in Vancouver, BC, Canada. All of the residents and staff moved into the new facility on August 1st, 2002. This period was the
Questionnaire
A total of 32 respondents completed both the pre- and post-intervention questionnaire, including 17 in the intervention group and 15 in the comparison group. Questionnaire results indicated that 71% of intervention subjects used the ceiling lifts ‘at least once in the prior week’ for bed to chair or chair to bed transfers (“chair includes a commode or wheelchair”). During the post-intervention period, 98% of the comparison group and 59% of the intervention group used floor lifts with the help
Discussion
This study provides the first opportunity to explore the effects of proactively installing portable ceiling lifts in a multi-level care facility, whereas previous studies have only taken place in facilities that were retrofitted with ceiling lifts or in simulated laboratory settings. The results from this study are similar, however, to those reported by Engst et al., 2003, Engst et al., 2004, Engst et al., 2005, Ronald et al. (2002), Spiegel et al. (2002), and Zhang et al. (1999). In these
Conclusion
Introduction of ceiling lifts into long-term care facilities has positive reductions of patient handling injuries. Staff within the intervention facility did not find any significant differences between mechanical floor lifts and ceiling lifts in terms of risk for injury, but preferred to use the ceiling lifts for performing lifts and transfers of residents. When assessing the need for overhead lifting equipment, it is always necessary to assess the physical capabilities of the residents and
Acknowledgments
This research was supported by the Canadian Institutes of Health Research (through its Community Alliance for Health Research funding program). The authors wish to acknowledge the Canada Research Council of Canada, through career support for Dr. Yassi, The Occupational Health and Safety Agency for Healthcare in British Columbia, and the staff, management, and residents that participated in this study.
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