Standing Hoists: To stand or not to stand?
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Standing hoists are great resources in the manual handling industry for people who inconsistently or partially weight bear. However they are prescribed incorrectly all the time placing client and care giver at risk. There are limited clinical guidelines available to assist therapists with prescribing standing hoists. This research sought to start filling this gap. We asked a group of experts what skills a care giver needs to display to safely use a standing hoist for both care giver and receiver to be safe. This research was presented at the Australian Association for the Manual Handling of People (AAMHP) in May 2016.
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Standing Hoists: To stand or not to stand?
- 1. STANDING HOISTS To Stand or Not to Stand AIDEEN GALLAGHER AND EMMA SMALL Š Risk Managed Pty Ltd 2016 AAMHP â 7TH BIENNIAL CONFERENCE, FREMANTLE, WA 23 MAY 2016
- 2. ACTIVE TRANSFER EASE DRESSING, TOILETING REDUCED TIME REDUCED MANUAL HANDLING REDUCED COST OF CARE
- 3. 15FALLS in 4 years (HSE, 2015) Some due to Standing hoists
- 4. ALLIED HEALTH CULTURE (Darragh, Campo and Olson, 2009) GOAL REHABILITATION â CHALLENGING PARTICIPANT (Darragh, Campo and Olson, 2009) WEANING OFF EQUIPMENT HEALTH PROFESSIONAL NOT EQUIPMENT
- 5. INJURY AVOIDANCE â GOOD BIOMECHANICS? (Darragh, Campo and Olson, 2009) MANY TECHNIQUES ABOVE SAFETY THRESHOLD (Marras, Davis, Kirking and Bertsche, 1999) SUPPORT WORKER FILLING THE GAP
- 7. BACKGROUND DARK DAY WHEN WE HAVE TO TAKE THE HOIST AWAY
- 8. WHAT SKILLS DOES A CARE RECEIVER NEED TO DISPLAY, FOR THE USE OF A STANDING HOIST TO BE SAFE FOR THE CARE RECEIVER AND CARE GIVER? OUR RESEARCH QUESTION
- 9. DELPHI STYLE STUDY EXPERT PANEL â DEFINE AND DIFFERENTIATE VIEWS (Crisp, Pelletier, Duffield, Adams & Nagy, 1997) DECLARATION OF HELSINKI - Ethics Open Ended Exploratory Explore Range Explore Importance
- 10. Open Ended Exploratory Identify all the skills you feel a care receiver needs in standing hoist transfers ensuring the health and safety of the care giver and receiver. Identify all the skill deficits a care receiver would display for you to conclude standing hoist transfers are unsafe for care giver and receiver STAGE 1
- 11. ANALYSIS QUALITATIVE METHODS DEFINITION-themes and subthemes 29 CRITERIA STAGE 1 Open Ended Exploratory
- 12. Explore Range EXAMPLE: âWEIGHT BEARINGâ MINIMUM TIME MINIMUM PERCENTAGE MINIMUM NUMBER OF LEGS STAGE 2
- 14. Explore Importance 29 CRITERIA ESSENTIAL SKILLS DESIRABLE SKILLS STAGE 3
- 15. RESULTS 18 PARTICIPANTS â STAGE 1 83% ALLIED HEALTH (n=15) 11% NURSING (n=2) 6% WHS PROFESSIONAL (n=1)
- 16. RESULTS 83% OVER 11 YEARS EXPERIENCE(n=15) 94% FEMALE (n=17) 29 CRITERIA
- 17. RESULTS 29 CRITERIA MINIMUM REQUIRMENT FOR CARE RECEIVER TO DISPLAY FOR BOTH CARE RECEIVER AND GIVER TO BE SAFE
- 18. Minimum assistance from care giver (CG) Moderate assistance from CG SUPINE TO SITTING ON THE BED
- 19. MAINTAINED SITTING ON THE SIDE OF THE BED - SKILL LEVEL AND TIME 2 minutes 5 minutes Other
- 20. WEIGHT BEARING CAPACITY SKILL LEVEL AND TIME 60-100 MINUTES 1.5-5
- 21. SECURE SLING UNDER ARM Independent Minimum assistance by CG MAINTAIN HANDS ON GRIP
- 22. MAINTAIN FEET ON FOOTREST Independently Minimum assistance from SW
- 23. MINIMAL TO UNIMPAIRED RECEPTIVE COMMUNICATION CAPACITY TO FOLLOW INSTRUCTIONS LEVEL OF UNDERSTANDING CO-OPERATION ALERTNESS PREDICTABILITY
- 24. DISCUSSION LYING TO SITTING TRANSFER MATTERS Roll and sit 171.0 â 263.2N 30 degree raise 111.2 â 151N (Fray & Hignett, 2015)
- 25. DISCUSSION 1.5-5 MINUTES WHEN IS IT REHABILITATION?
- 26. 25%ASSISTANCE WITH FEET KEY POSITION OF SUPPORT? 50%ASSISTANCE WITH HANDS 63%ASSISTANCE WITH SLING
- 27. INFORMED CONSENT
- 29. LIMITATIONS LOW RESPONSE RATE FUTURE RESEARCH
- 30. CONTACTS EMMA SMALL emmas@occupationalservices.com.au AIDEEN GALLAGHER aideengallagher@riskmanaged.com.au Š Risk Managed Pty Ltd 2016
- 31. REFERENCES ď˝ Fray, M. & Hignett, S. (2015). An evaluation of the biomechanical risks for a range of methods to raise a patient from supine lying to sitting in a hospital bed. Proceedings 19th Triennial Congress of the IEA, Melbourne 9-14 August 2015. ď˝ Crisp, J., Pelletier, D., Duffeild, C., Adams, A. & Nagy, S. (1997). The Delphi Method? Nursing Research, 46, 116-118. ď˝ National Health Service (2015). Patient Safety Alert: Risk of death and serious harm by falling from hoists. Alert reference number: NHS/PSA/W/2015/010. Retrieved from: ww.england.nhs.uk/patientsafety. ď˝ Depoy, E. & Gitlin, L.N. (1998). Introduction to Research: Understanding and Applying Multiple Strategies (2nd ed.). USA: Mosby.
- 32. ď˝ Marras, W. S., Davis, K. G., Kirking, B. C., & Bertsche, P. K. (1999). A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics, 42, 904â926. ď˝ McGrath, M., Taaffe, C. & Gallagher, A. (2015). An exploration of knowledge and practice of patient handling among undergraduate occupational therapy students. Disability Rehabilitation. Mar 4:1-7 ď˝ Darragh AR, Campo M, Olsen D. Therapy practice within a minimal lift environ- ment: perceptions of therapy staff. Work. 2009;33:241â253. REFERENCES
- 33. MEDIA Hoist 1 By Allegro Concepts Copyright Re-produced with permisson Hoist 2 By Allegro Concepts Copyright Re-produced with permission Occupational Therapist by Isle of Man Government https://creativecommons.org/li censes/by/2.0/ Addition of box with text Care Giver By Istock Re-produced with permission Stand off #2 by Nilah https://creativecommons.org/li censes/by-sa/2.0/ Addition of text â stand off A dark sky, dead tree. by cjcazel https://creativecommons.org/li censes/by-sa/2.0/ Books By Istock Re-produced with permission Shopping! by joe jukes Is licenced under CC by 2.0 Addition of text box measuring tape by Sean MacEntee https://creativecommons.org/li censes/by/2.0/ Addition of text box Marking Pile 1/X by Sam https://creativecommons.org/li censes/by-sa/2.0/ Books for Cooks by Sela Yair https://creativecommons.org/li censes/by/2.0/
- 34. Rest your head by Jason Trbovich Is licenced under CC by 2.0 Addition of text box Feet by Arnoooo is licenced by CC sa 2.0 Addition of text Hand modeling by Nate Steiner is licenced by CC zero Addition of text 34 by Namu Lim Is licenced under CC by 2.0 Additio of text Intrigued by Nicolas Alejandro Is licenced under CC by 2.0 Addition of text Opportunity by Quinn Dombrowski https://creativecomm ons.org/licenses/by- sa/2.0/ Addition of text Contracts by Government of Alberta https://creativecomm ons.org/publicdomain /zero/1.0/ Addition of text Classroom by Victor BjĂśrkund https://creativecommons.org /licenses/by/2.0/ Addition of text MEDIA
Hinweis der Redaktion
- How many of you listening today are not a fan of standing hoists, having seen one too many times the horrendous use of this item of equipment? How many of you are emotionally scarred, having had to take a standing hoist away from a care receiver resulting in a complete fracturing of your relationship with the them? How many of you have found by removing that hoist, you solved a manual handling problem and replaced it with a stress problem, used a significant amount of time and felt emotionally drained afterwards. We have and this has been our motivation for doing this study. Our goal is to actually increase the use of standing hoists in the manual handling sector, recognising the signiifcant benefits they have to offer a participant, family and support worker. My name is Aideen Gallagher and I have developed HoistED, a programme that aims to provide therapists with the skills to efficiently and effectively prescribe Hoists managing the social, emotional and physical considerations. With Emma Small from Occupational Services, we want the situation that every prescriber of standing hoists does so with a plan where the care receiver, support worker and family are clear on the skills a care receiver needs to use the standing and a agreement point at which the care receiver on longer demonstrates these skills. This study that we are going to present to you today is step one in the process towards this goal. It was presented at the Australian Association for the Manual Handling of People (AAMHP) 7th Biennnial Conference in Fremantle WA on 23 May 2016. _____ every participant who experiences the removal of a standing hoist from their manual handling routine when they are unsafe for support worker or participant does so with a plan and agreement they knew about before the standing hoist was ever recommended. Every therapist?
- Standing Hoist/Active Hoist Lifting device where the care receiver is weight-bearing Handles, shin rest and foot rest Locking castors, body Sling fitted around the torso and under the arms Standing hoists are a popular item of equipment in the manual handling of people within the health sector. They are favoured by care receivers as they enable them to continue to use their capabilities in standing, remain engaged in the transfer process and therefore there is less of a focus on disability. They are also popular amongst care givers and family members. Standing hoists facilitate dressing and undressing in standing, simplifying tasks such as toileting, as they eliminate the need for a care receiver to be moved onto a bed for these tasks. This versatility, efficiency and reduction in manual handling make them an attractive option as opposed to the full lifting hoist alternative.
- Whilst standing hoists have significant advantages, they do present risks when used inappropriately. A report by the National Health Service (NHS) in the United Kingdom reported 15 falls from hoists within a four year period, some of which were attributed to standing hoists (NHS, 2015). I was not able to get the data specifically for Australia but I suspect this has been under-reported.
- Standing hoists are regularly recommended in the rehabilitation setting when a participant has not just not quite reached the rehabilitation goal of sit to standing independently. A standing hoist involves certain skills the participant needs to bring to the table and when they donât have those skills a support worker assists. What is interesting is what happens in that rehabilitation setting in relation to this assistance as it is usually provided by allied health professionals. Darragh, Campo and Olson [3](2009) describe a different culture amongst allied health professionals from nursing in terms of manual handling and subsequent musculoskeletal injury. Within these therapies,, the goal of treatment is essentially to rehabilitate and promote independence. This can mean challenging patients to stretch beyond their capabilities with an aim to restore function. A component of this can involve weaning patients off equipment as soon as possible. Transfers supported by a health professional as oppose to using equipment may be perceived as more rehabilitation focused and so more patient focused. In this case a standing hoist being a lesser marker of disability than a full lifting hoist. ------------- What is interesting about this is research by Cromie et al in 2002 with allied health professionals in relation to manual handling. The allied health professionals in their study perceived themselves as unlikely to sustain an injury as a result of people handling because of knowledge, abilities and perceived level of fitness and conclude that cultural perceptions about vulnerability may impede the use of protective equipment. There have been a number of key studies that have confirmed that relatively simple manual handling manoevures are over the threshold of pressure on the back for the worker not to be susceptible to injury. Standing hoists are prescribed in hospital with the allied health professional being the support worker. It then goes out in the community with the expectation that the support worker will continue this intervention. . Â and Cromie et al 2002 found a culture amongst therapists where an injury sustained during therapy was the fault of the therapist and a culture of altruism resulted in admitting an injury was caused by patient care was difficult. [4] reported that the majority of injuries sustained by therapists are self-managed and injury was considered the fault of the therapist (Cromie et al, 2002). Fewer than half of therapists reported injuries to their employers (Waldrop, 2004 in Darragh, Huddleston and King, 2009) However, a systematic review (Tullar et al., 2010) found that training alone did not reduce occupational musculoskeletal injuries. Cromie et al (2002) report that physiotherapists perceive themselves as unlikely to sustain an injury because of knowledge, abilities and perceived level of fitness and conclude that cultural perceptions about vulnerability may impede the use of protective equipment. Â
- Allied Health professionals are often responsible for training staff in good body mechanics to avoid injury [3] therefore there was a perception that good body mechanics alone can avoid injury although this assumption has been refuted in the literature (Marras, Davis, Kirking and Bertsche, 1999). [2] conclude that the patient is still considered the prime focus on therapists as opposed care giver self-care and maintenance of health. Standing hoists are prescribed in hospital with the allied health professional being the support worker. It then goes out in the community with the expectation that the support worker will continue this intervention. Without someone specifically advocating for the client this help a support worker is required to give can represent a bottomless pit. Picture bottomless pit
- With usually a therapist involved advocating for the client with the rights and dignity for the participant at the fore, the use of a standing hoist can often result in this stand off between treating therapist and manual handling advisor. The debate bounces between rights of the support worker to remain safe at work and the right of the participant to continue to exercise their right to rehabilitation to use a standing hoist. What can happen is there is not clear line for when a standing hoist is unsafe for not only the participant, but for the support worker.
- The result â an exceptionally emotional day for the participant, support worker and therapist that goes well beyond that day. Therapists coming to my workshops describe being traumatized at times from the process of removing a standing hoist from a client or some having sleepless nights wondering are they going to get a call about the client who fell from an item of equipment they prescribed . They are therefore polarized going from hating standing hoists and refusing to prescribe them to loving them but dreading that day where they need to say no. There is a significant lack of guidelines on using standing hoists keeping the support worker and participant safe. In facts it is almost impossible to get anything written on standing hoists in the literature. It is an area starved of any research. Emma and I decided we had talked about it enough and lets try and do something about it.
- So we wanted to ask the question, what skills does a care receiver need to be able to display for the use of a standing hoist to be safe for the care receiver and the care giver? We felt it was important to come from that angle as when a care receiver cant do something. The care giver is required to act or fill the gap for loss of function.
- Participants â members of the Australian Association for the Manual Handling of People (AAMHP) Online survey Permission sought from the chair person and committee of the AAMHP
- We used qualitative analysis to identify key components within the data. We then had to map the component with the skill you might see underlying that component. We reviewed independently and compared results Deleted duplicates and these were cross referenced to ensure we were not deleting a key component The concept of reflexivity  (Denscombe, 2003; DePoy & Gitlin, 2005) was used to control for research bias throughout the data collection process.  How did you do this? (Mu: Yuo might have some insights Aideen?!)
- 18 participants responded to the first stage of the research. Of them 83% were allied health, 11% nursing and 6% identified themselves at WHS professionals
- 83% of participants had over 11 years experience in manual handling and it is the quality of you participants knowledge that matters in qualitative research. In this case we were confident we were getting good information.
- From stage 1 we analyzed that there was 29 criteria for use of a standing hoist. In stage 2, we wanted to present these criteria and ask the AAMHP professionals what the MINIMUM REQUIREMENT for function was on behalf of the care receiver for both care giver and receiver to be safe. That is, what was that line in the sand. We recognise this is contextual and we wanted to form a line over which it was definitively a no go area.
- We are not going to present the 29 criteria but have just selected 8 In the transfer from lying to sitting on the side of the bed, 75% felt minimal assistance could be provided and 25% needing moderate assistance
- In terms of sitting on the side of the bed, the study looked at the minimum leve lof skillthe care receiver needed to display in and the amount of time sitting needed to be maintained. 50% felt the cohort that the care receiver needs to be independent in this task whilst 50% argued that this should be with minimal assistance. In terms of maintaining sitting on the side of the bed, the figures range from 2 to 20 minutes. ½ of the cohort felt that sitting on the side of the bed for 2 minutes was appropriate and a further 1/4 of cohort increasing it up to 5 minutes. A justification for the he 20 minute suggestion was that, âupright sitting position would indicate a degree of stability without fatigue.
- In termsof weightbearing capacity participants range varied from 60 to 100%. A no. of partiicpants elt this variation was in relation to the task yu have to perform. For eg. 1 participant felt that if pivoting form chair to chair you need 75% compared to if need to stand require 100%
- In terms of maintain the upper limb position to secure sling under the arms - 37.5% felt this should be independent and 62.5% requiring minimal assistance. Similarly when maintaining the hands on the handgrip from the duration of the transfer 50% independent and 50% minimal assistance. We dont have time to look at this point in the discussion but its interesting about what the care giver actually is during the transfer. They cant be everywhere at once
- 75% felt independence in this skill was needed whilst 25% felt minimal assistance was appropriate
- With cognition the study sought the opinion of participants in terms of receptive communication, capacity to follow instructions, level of understanding, co-operation, alertness and predictability. All responses were within the un impairment to minimal impairment range
- Our study sought to start the conversation on some guidelines as to the skills a care receiver needs to display for a standing hoist to be safe for care receiver and care giver. There was a couple of results that we felt were worth discussing the level of data we have now. Firstly, the lying to sitting transfer matters and is part of the standing hoist transfer. 75% participants feeling the support worker should only give minimum assistance during this transfer. Fray and Hignett (2015), discuss the lying to sitting transfer as something that can be perceived as needing minimal assistance by the care giver but is in fact quite hazardous. They found that a traditional roll and sit up on the bed transfer applied between 171.9 and 263.2N on the spine between small and larger clients. They found the addition of a 30 degree raise on the bed reduced this to 111.2 â 151N again with a range of smaller to larger clients. This study points to the fact that abilities either in the form of care receiver capabilities or a mechanical for that first 30 degrees can reduce that pressure on the back extensively
- Another interesting finding is that participants felt that between 2 and 5 minutes of standing was needed on behalf of the care receiver to be able to use a standing hoist safely. I am not a physiotherapist by background but I am unsure if two minutes four times per day is considered above the threshold for meaningful rehabilitation? In my workshops I tend to tell advise therapists to aim for double the amount of time it would be needed to do the functional task at hand.
- COGNITIVE
- Add reference
- As I discussed at the beginning, our aim is that the prescription of standing hoists increases but with clear guidelines as to when they are safe and unsafe. We feel the end results of this study offers an opportunity to therapists to paint a picture for a participants, family member and support worker as to what safe and unsafe in a standing hoist actually is. These guidelines are not only for the prescribing therapist but for the care receiver, family and care giver who are all equal partners in this relationship. These guidelines could provide realistic expectations for people that are objective as regards the function they need to use a standing hoist and be used to manage both the falls risk and emotional and stress risk that using standing hoists involves. _____ We feel there is an opportunity here to continue to use standing hoists with participants and putting guidelines around them managing the risk of falls, emotional fall out from removing it and X. We feel that this study could provide some guidance for therapists to paint a picture for a participants, family member and support worker as to what safe and unsafe in a standing hoist actually is. This could perhaps allow for a agreement amongst parties to be created upon prescription recognising the skills a client needs to display for the standing hoist to be safe for support worker and participant. This could therefore be referred to if and when a standing hoist becomes unsafe and can provide an objective measure as to the appropriateness of the device.
- There were a number of limitations to our study We started with a Delphi style which may not have suited the style of the study. Delphi is a predominantly a qualitative method we felt we needed to go into quantitative research quite early in the study â that is stage two Whilst we got what we feel was a quality response rate to the first stage, this was poor in the second stage limiting the extent to which we could make any statistical conclusion on the findings. With the style of study we choose, we were unable to put the questionnaire out beyond the group that we initially asked, hence the small numbers In conclusion, our study sought to determine the skills a care receiver needs to display for a standing hoist to be safe for care giver and receiver. We feel the research we have done has created a list of criteria that can be discussed and developed. We feel it provides a framework by which to continue the research and ask other professional groups to contribute their thoughts so we can get robust data. We feel there are some great opportunities to create some key partnerships with industry to further enhance the quality prescription of standing hoists.
- If any of you require any further information