Evaluation of ceiling lifts: Transfer time, patient comfort and staff perceptions
Introduction
Mechanical lifting devices have been introduced in the healthcare setting in an effort to curb occupational injuries associated with patient handling. The majority of healthcare workers injuries are musculoskeletal in nature and incurred during patient handling.17 Patient handling, in particular the lifting involved, is considered hazardous due to high physical demands and unexpected conditions that may arise possibly due to the patient's diagnosis.6, 9, 12 Consequently, in British Columbia, Canada a Memorandum of Understanding was signed between healthcare employers and unions to introduce a “no-unsafe manual lifting” policy.16 In order to comply with this policy, mechanical lifting devices such as floor lifts and ceiling lifts have been implemented and advocated. Originally, floor lifts were introduced to reduce the risks associated with patient transfer.6, 22 However, this method has been reported to require more time and space than manual methods.18 According to Garg et al.,6, 7 patients perceived this method of transfer to be more uncomfortable and less secure than manual methods.
More recently ceiling lifts have been introduced as an alternative to floor lifts. The ceiling lift consists of a ceiling mounted track, electric motor and a patient sling.5 This allows for minimal physical effort and more maneuverability. Ceiling lifts require less force to operate during transfer than floor lifts.24 Previous literature has proven ceiling lifts to be effective in reducing injury rates and cost-effective.3, 5, 20, 23
Staff perceptions have been used to evaluate the acceptance of mechanical lifting devices as an effective intervention to reduce patient handling related injuries. The majority of recent research suggests that healthcare workers’ perceptions toward mechanical lifting devices are favourable. According to Nelson et al.,15 equipment was deemed to be the most effective component of a safe patient handling program by staff. Yassi et al.25 performed a randomised controlled trial with mechanical lifting equipment that resulted in decreased staff perceptions of how physically demanding their work was and their self-perceived fatigue. It has also been demonstrated that staff perceptions improve with repeated usage of lifting devices. Engst et al.5 found that staff preferred ceiling lifts for bed to chair transfers and that healthcare workers perceived their risk of injury, pain and discomfort to decrease with increased ceiling lift usage. Miller et al.13 reported that staff perceived that ceiling lifts made their job easier and that they preferred to use them over floor lifts and manual methods.
Healthcare workers frequently note increased time to transfer as a concern associated with the use of mechanical lifts.4, 8 Efficiency is important for healthcare workers. According to Yassi et al.,25 this increase in transfer time is not only an inconvenience to extremely busy workers; it may also increase the amount of time staff spent in injury inducing forward flexed position. Despite the suggestion that time involved is a barrier to ceiling lift use, there is limited evidence comparing the duration of various transfer methods and tasks. There is evidence to suggest that floor lifts require more time than manual methods.4 Keir and MacDonell11 found that manual methods required the least time followed by ceiling lifts and that floor lifts required the most time. They also observed that experienced workers required less time than inexperienced workers to transfer patients using mechanical lifting devices. However, their results were only descriptive. To the best of our knowledge, there have been no studies comparing the time to reposition patients with ceiling lifts and manual techniques.
An advantage of ceiling lifts is the additional feature of the repositioning sling. Repositioning or boosting patients in bed is a very physically demanding task.10 However, the effectiveness of ceiling lifts for repositioning has been questioned by researchers. Studies by both Engst et al.5 and Ronald et al.20 failed to show a reduction in compensation costs related to injuries incurred during repositioning tasks with the implementation of ceiling lifts. Furthermore, staff perceptions of the risk of injury, pain or discomfort when repositioning patients did not improve with the addition of ceiling lifts.5
Another concern in patient handling is the comfort of the patient/resident. As mentioned earlier floor lifts were not perceived as comfortable or secure by patients.6, 7 More recently, Pellino et al.19 found that for lateral transfers mechanical lifting devices were more comfortable than manual methods. There have only been a few studies that have looked at patient comfort during ceiling lift transfers. Zhuang et al.26 compared the comfort and security for floor lifts, ceiling lifts and manual methods and found no difference between the different methods.
Current evidence clearly supports the use of ceiling lifts for injury prevention in staff. This paper introduces new information to the field of injury research by examining the impact of ceiling lifts on transfer time, patient comfort and staff perceptions. The specific objectives of this research were: (1) to measure and compare the time spent to perform various patient transfer tasks using ceiling lifts or floor lifts, (2) to determine the impact of ceiling lifts on patient comfort levels compared to floor lifts in long-term facility. In respect to staff perceptions, the objectives were (3) to determine healthcare workers’ perceptions on patient handling by identifying key barriers and achieved successes in the optimal use of patient transfer devices in facilities with varying levels of ceiling lift coverage.
Section snippets
Materials and methods
A two part investigation into the use of ceiling lifts was conducted at three long-term care facilities in different stages of patient handling equipment implementation in British Columbia, Canada. The study took place in the later half of 2007. The ceiling lift coverage rates were 100% for facility 1, 33% for facility 2 and no coverage for facility 3. The ceiling lifts available in the facilities were permanent and from the same manufacturer. The floor lifts used in the facilities were all
Transfer time
A total of 119 patient transfers were observed in the three long-term care facilities (59 transfers were observed at facility 1, 16 at facility 2 and 44 at facility 3). Of these transfers 78 were from chair to bed (Fig. 1, Fig. 2), 32 were from bed to chair and 28 were repositioning/boosting tasks.
The mean time (preparation time, actual transfer time and total time) for bed to chair (Fig. 3) and chair to bed transfers (Fig. 2) were found to be longer for those transfers involving floor lifts
Discussion
Injuries related to patient handling are prevalent amongst direct care healthcare workers and effective strategies to decrease the inherent risk to healthcare workers are essential.17 There is evidence to suggest that for patient handling tasks, ceiling lifts are a more acceptable mechanical lifting device than floor lifts. Both observational and survey data obtained in this investigation support this conclusion.
Transfer time has been cited as a concern for healthcare workers.4 Patient
Conclusion
This study provides a close examination of ceiling lifts by addressing potential perceived barriers and facilitators to their effective use amongst healthcare workers. The results are concurrent with previous literature and the healthcare workers surveyed seem to recognise the advantages of ceiling lifts. More information is required on the use of ceiling lifts for repositioning tasks and possible strategies to overcome the additional barrier of time are needed. It is important to ensure that
Conflict of interest statement
There is no conflict of interest to disclose.
Acknowledgement
Role of funding source: There was no external funding for this project. All funding was provided by the Occupational Health and Safety Agency for Healthcare (OHSAH) in BC.
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