SAFE PATIENT HANDLING

The most important aspect of the TLB (Total Lift Bed) for Safe Patient Handling is the elimination of many of the transfers in the first place.

Because the TLB allows a patient to be placed in EVERY position the need to transfer is reduced significantly. You can put a patient in lying, seated and STANDING position which is something you cannot do with any other bed. In all these positions the patient is secure on the bed with the specialty surface they require.

When you do need to transfer a patient, the TLB makes traditional transfer methods easier and safer...

Minimal Assist:

In some settings this could also be called a one person assist. Or it should only take one caregiver to assist in transferring this patient. A lot of the time a person is minimal assist for balance or blood pressure problems. The real danger is this level of transfer is not the lifting of the caregiver but for the potential for a fall where the caregiver could be hurt in trying to catch the person.

The TLB allows you to slowly and gradually raise someone to a standing position with the feet planted firmly on the force plate. On the TLB if the blood pressure would fall then you can simply lay back down safely.

Moderate Assist:

In some settings this could be referred to as a two person assist. Or it should take 2 caregivers to assist in transferring this patient. This patient may have poor lower extremity strength and commonly will use a walker or other assisted walking devices. This patient will also often require other medical devices to help in the transfer.

With the TLB you can easily apply these devises by first standing the patient in a safe environment on the footboard while strapped in. This allows the caregiver adequate time in an ergonomic position to apply gait belts, turntables, repositioning aids, and walking devices thus eliminating the potential for user error from hurrying. Also the TLB gives you clear and close contact to all areas of the body while also allowing you to take pressure off those areas to easily apply devices.

Maximum Assist:

In some settings this could be referred to as sit-to-stand assist or the transfer of this patient requires the assistance of a powered stand aid or sit-to-stand lift device. For this type of patient there might be the potential for them to be more mobile. If so the TLB is perfect for this patient because it gives them more time in the standing position during the day. While you still need to use the sit-to-stand lift device, the TLB makes the hardest parts of the transfer easier.

All caregivers know the single hardest part of using a sit-to-stand lift is putting the support vest on. The TLB allows you to stand or sit the patient first to put the vest on and secure it at the right place before attaching it to the lift. The second hardest and most dangerous part is getting them from sitting to standing. Some patient's body types, poor lift design, or lack of training can cause the back belt to slide up on the patient under their arms or even neck.

The TLB can allow you to start the patient at the standing position allowing the lift to be used just for support while transferring. This type of patient might also be utilizing a ceiling lift to help with mobility by gait training. The most difficult part of doing this is always getting the special walking harness adjusted appropriately for walking while at a seated or laying position. This causes the caregiver the potential for exertion trying to hold the patient in a particular position while trying to adjust it or apply more straps. It also makes the gait training more comfortable for the patient if the device is applied and adjusted correctly. Especially considering the majority of the weight in these devices is being applied between the legs.

Total Assist:

In some settings this could be referred to as a total body lift. The transfer of this patient requires a full body, sling style, or total mechanical lift. This type of lift can be mobile or ceiling mounted in design. For this type of patient typically the need to try to mobilize the patient is far past. However they will still benefit from the ability to be tilted at certain degrees. This is especially true if they cannot be bent or put in a seated position.

Again with this type of transfer the hardest part is applying the accessories used. The TLB allows you to stand a patient with straps on and lean them into the straps temporarily eliminating contact with the support surface. This allows you to easily apply patient slings, slide sheets, repositioning slings, turn sheets, and even change bedding. Also you can use the moving footboard on the TLB to reposition some patients back up in bed.

Review of Literature:

Over one million patients who require mechanical ventilation are admitted to Intensive Care Units each year. (Cox) It has been customary that mechanically ventilated patients are sedated, restrained and kept on bed rest. Staff turns these patients every two hours, monitor vital signs with monitors and probes and keep the patient medicated to reduce signs of pain and anxiety. Getting these patients up to a chair requires numerous staff working in a confined space, anxiety about accidental dislodgement of IV lines and breathing tubes, concerns over potential patient instability, and physical stress of lifting patients unable to stand by themselves. Therefore, many patients remain in bed.

Bed rest of even one week can decrease muscle strength by 20%, with each additional week decreasing muscle strength by an additional 20%. (Perme) In a study of patients with ARDS, Herridge reported weight loss of 18% of total body weight by discharge. Patients who remain in bed have neuromuscular complications, co-morbidities, and weakness that further increase their hospital stay and delay ventilator liberation. It is reported that this weakness may persist for months to years after discharge, (Needham).

A study from Wake Forest University School of Medicine found that early mobilization of ICU ventilated patients' decreased ICU length of stay from 6.9 to 5.5 days, as well as the overall length of stay in the hospital from 14.5 days to 11.2 days. De-conditioning of a patient on bed rest in an ICU starts to happen within a few days and often takes significant time to reverse. The study advocates that exercise be viewed and prescribed as any other therapy needed for a patient to progress through the healthcare continuum.

Another study from John Hopkins University found that early mobility research shows potential benefits for patients by lessening symptoms of neuromuscular dysfunction. In fact, bed rest may a contributing factor of the dysfunction.

There are also numerous complications associated with immobility. Acquiring these complications may lead to increased morbidity and mortality. These include pneumonia, pulmonary embolism, postural hypotension, muscle atrophy, D.V.T., pressure ulcers, constipation, and depression. The VitalGo Tota-Lift Bed allows for easy implementation of the "Best Practice" guidelines for Ventilator Associated Pneumonia that recommend raising the head of the bed to 45 degrees or as close as possible. It also plays an important part in pressure ulcer prevention and treatment through use of its pressure reducing mattress and patient repositioning and early ambulation capabilities.

Contraindications to early mobility include certain diagnoses such as spinal cord injury, unstable intracranial pressure, certain devices such as traction, and hemodynamic instability such as: decreased 02 sat; decreased BP; increased HR. However, orthostatic intolerance may be improved with slow, gradual, monitored tilting of patients.

Additionally, NIOSH (National Institute of Occupational Safety and health) has established a 35 pound safe lifting standard for health care workers. Dr. Marras, a leading researcher in the field of safe patient handling, states there is no safe way to manually lift a patient, even with two caregivers. Patient lifting and moving exceed caregivers biomechanical limits. The Vital Go Total-lift bed helps achieve positive outcomes for patients by providing the opportunity for early ambulation and protects health care workers from musculoskeletal injuries related to direct care in non-tilting, non-height adjustable beds.

References

  • Cox, CE, et al (2007) An Economic Evaluation of Prolonged Mechanical Ventilation. Critical Care Medicine, 35(8), 1918-1927.
  • Herridge MS, (2003) One Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 348(8), 683-693.
  • Kubo A. (2007) Progressive Upright Mobility- Self Directed Study. University of Kansas Nursing Policy.
  • Marras, W.S. et al (1999) A Comprehensive Analysis of Low Back Disorder Risk and Spinal Loading during the Transfer and Repositioning of Patients Using Different Techniques. Ergonomics, 42(7), 904-926.
  • Morris PE (2007) Moving Our Critically Ill Patients: Mobility Barriers and Benefits. Critical Care Clinics, 23(1), 1-20.
  • Needham D. et al (2009) Early Mobilization of Critically Ill Patients: Reducing Neuromuscular Complications after Intensive Care. Contemporary Critical Care, 6(9), 1-12.
  • Needham D. (2008) Mobilizing Patients in the Intensive Care Unit. JAMA, 300(14), 1685-1690.
  • Perme, C. (2009) Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care. American Journal of Critical Care, 18(3), 212-221.
  • Vollman K (2005) Progressive Mobility Guidelines for Critically Ill Patients (electronic version). Website: Kathleen Vollman Advancing Nursing.

Testimonials

Just getting patients up and out of bed is not a simple task, we risk injuring a caregiver and a patient fall, which can have traumatic effects. The VitalGo bed offers the patient a natural progression through the phases of mobility.

Amber Perez - LPN, CSPHA, Safe Patient Handling Specialist

Products

  • Total Lift Bed
    425LB/192KG Weight Capacity Tilts a patient from a 0° flat position to an 82° fully upright position, and any degree in-between.
  • Total Lift Bed Bariatric
    1,000LB/453KG Weight Capacity You can begin weight bearing at any stage and progressively enable bariatric patients to weight bear.