Help! I need some advice!

[Shirl57]

Last week I had to lower a patient to the floor to avoid a fall. This patient is recovering from a fx hip and has severe dementia. The patient is also a 1:1 through out the evening shift (sundowners too). While I had her in my care, I had to turn to pull a narcotic PRN for another resident, while still looking back to watch her. When she stood up from her wheel chair I could tell she was about to fall and I caught her. She was pushing away the w/c so I had no choice but to lower her to the floor. Now - I also knew that if I used the Hoyer lift to pick her up from the floor she would not understand, be frightened, fight it, and possibly harming herself, me and another staff member whom I asked to help. But I also knew that guiding her to stand using her 'good leg' and the gait belt, we could safely place her back in her chair. She had the strength to stand up easily. Our facility is a 'No Lift' facility. However, she is a two assist transfer. Here is the question: Was I wrong in NOT using the Hoyer? I had just gotten written up for not doing so. Sorry this so lengthy - I really need some advice!

[systoly]

What was her activity or weight bearing status? How did you assure non weight bearing to the affected extremity? How did you indeed know what the pt was going to do during a lift transfer, this being the weak point in your rationale. I cannot tell you what the best procedure was for this particular situation, but my take on events like this is: I'm the charge nurse so I decide how. I'm also responsible for my decisions and prepared to back them up. If you feel your decision was the best choice, write it down on the written warning, explaining the rationale. Given the limited amount of info available to me about this particular event, I opt for the lift as the safer choice.

[tyvin, BSN, RN]

Why didn't she have a seat belt? Anyway.....hoyers are designed to be able to have one person work them; I've never seen a hoyer that needed two people to operate it. It's true that in facility staff feel more secure with more bodies when using the hoyer but in home health we use them all the time with only one person operating it. Also true; most facilities have a policy that the hoyer is to be operated by at least two people. That might be an area you could pursue; see if your place has a policy regarding how many bodies are required to lift one person.

I can't see how it would be dangerous to put the lift jacket on by yourself; as I said before in home health they do it all the time. I myself had to learn real fast with one case where the guy was active and always ending up on the ground somehow. I know this is not what you want to hear but that's the reality. Also you could have called out or waited for other staff. The bottom line is facility policy will always rule.

Sounds like it time for an in-service for the hoyer and to investigate hoyer policy.

[CoffeeRTC, BSN, RN]

Seat belt? LOLOLOLOLOL They are self releasing seatbelts if you have them at all and that only takes 2 seconds for them to unbuckle.

Yes, one person should be able to do a lift using a hoyer, but I've seen some policies that state 2 staff must be present. Defeats the purpose of time saving if you need two people.

OP...How would have putting her in the hoyer caused more harm? I would thing transfering her and not being able to maintain NWB status would be the issue with not using the lift and also going against the policy.

[Shirl57]

I so appreciate everyone's input. I wanted to hear the positive and the negative to weigh things out. I will still stand my ground regarding her dementia, her quick movements, her fears and the safety of her transfer. . . Had it been someone else, there is no doubt in my mind that I would have used a Hoyer - this really wasn't the right situation for her. Heck, maybe I'm still wrong - but in my heart, I still feel using my nursing judgement was actually the safest.