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Hoyer Lift Issue

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I work in home health and my patient has a Hoyer Lift that us supposed to be used in the home. I don't have an official MD order for its use in the home, but pt's MD wrote the letter of medical necessity for it to be approved through pt insurance. Now, my concern is that his house is carpeted with very thick/plush carpet. The handbook for the Hoyer very clearly states that the device is not to be used on carpet due to risk of tipping. I talked to the case manager about my concerns about both pt safety and the possibilty of me being liable if pt is injured while using the lift against safety guidelines. I was met with very ugly responses and was asked if I was more worried about using the lift as I was ordered to do or not using the lift because the manufacturer says not to use it on carpet. This was said in a voice absolutely dripping woth disgust and contempt. In my mind, the two are exactly the same. If I were investigated I feel like state would nail me either way. I can either defy this as of now missing order and not use the lift or I can break safety guidelines by using the lift improperly. We've also been told we will face disciplinary action if we document a lift without Hoyer being used...so I suppose I'm supposed to lie or face trouble if I chart honestly. I was taught that I'm responsible for any injury that occurs due to bad nursing on my part....is breaking safety guidelines not considered bad nursing? I'm at a loss as to what to do. One of the other nurses attempted to use the lift and the lift itself nearly tipped over. I've tried googling this, but cant find much of anything other than the guidelines for two person assist. I feel like I'm being told to do something that could potentially land me in a lot of trouble. Help!!

VANurse2010

Has 6 years experience.

I work in home health and my patient has a Hoyer Lift that us supposed to be used in the home. I don't have an official MD order for its use in the home, but pt's MD wrote the letter of medical necessity for it to be approved through pt insurance. Now, my concern is that his house is carpeted with very thick/plush carpet. The handbook for the Hoyer very clearly states that the device is not to be used on carpet due to risk of tipping. I talked to the case manager about my concerns about both pt safety and the possibilty of me being liable if pt is injured while using the lift against safety guidelines. I was met with very ugly responses and was asked if I was more worried about using the lift as I was ordered to do or not using the lift because the manufacturer says not to use it on carpet. This was said in a voice absolutely dripping woth disgust and contempt. In my mind, the two are exactly the same. If I were investigated I feel like state would nail me either way. I can either defy this as of now missing order and not use the lift or I can break safety guidelines by using the lift improperly. We've also been told we will face disciplinary action if we document a lift without Hoyer being used...so I suppose I'm supposed to lie or face trouble if I chart honestly. I was taught that I'm responsible for any injury that occurs due to bad nursing on my part....is breaking safety guidelines not considered bad nursing? I'm at a loss as to what to do. One of the other nurses attempted to use the lift and the lift itself nearly tipped over. I've tried googling this, but cant find much of anything other than the guidelines for two person assist. I feel like I'm being told to do something that could potentially land me in a lot of trouble. Help!!

Inform

them that an order to use equipment against safety guidelines is not a valid order and you won't be doing it. Document the date and time of the conversation. You'll get nailed if you lie in your charting just as quick as if a patient gets hurt from a tipped Hoyer (which could obviously be serious). I hate using the cliche "find another job" because that's casually thrown around this forum like it's nothing, but if your story is accurate then your management clearly has zero regard for your license.

My supervisor has apparently told one of the other nurse s that if we aren't comfortable using the lift to chart it as pt refused due to fear for safety...which still isn't true because I haven't even attempted to use the Hoyer because using it puts both pt and myselfmyself at risk. The issue is with this particular case manager. I have every intention of going to my supervisor with this tommorow morning. In the meantime, I'll do what you said and chart it in my papers. I didn't report it until about 6:30 last night, so I'm not sure how to chart the previous transfers during the day...should I document it as something along the lines of "Hoyer not used due to manufacters safety guidelines ....Good grief I don't even know what to write. This is all ridiculous.

Overlook my terrible typos...apparently proofreading isn't something I value very much :b

Send a communication note to the office requesting that the Hoyer lift be added to the DME section and the orders section of the 485. I have used the lift on carpet before. It is not easy but it is better than not using it and injuring myself. Do not chart that the patient refused. That is bad advice from the supervisor and she knows it. If I were you, I would look for a new agency and hope that this supervisor does not move to that agency. She is not easy to work with. Needs an attitude adjustment.

My concern is that if the lift tips over (Which it nearly did the other day on another nurse) I will be held liable because I willingly used the Hoyer lift in violation of manufacturers guidelines which clearly states that it isn't to be used on carpet due to risk of tipping. It isn't the fact that it is hard to use that worries me, it's that if he falls in it and I have used it incorrectly it's going to be my rump on the line. The way it stands now, if I hurt myself transfering pt the company can refuse workmans comp because there is a lift in the home, but if I use said lift and injure my pt bc the lift flips the company can throw me under the bus for using the lift unsafely in the event the family filed a lawsuit.

The best solution is for the patient to have the carpet removed and if there isn't already a hard surface under the carpet, a hard surface should be installed, it will be safer and more hygienic than keeping the carpet in the room. Do not use the lift on carpet, if the lift tips over and the patient and/or you are injured, you are liable.

The lift never tipped over on me. But then, I never found it easy to use on carpet either. You might suggest to the family that they invest on a plastic mat like is used under chairs in offices to place around the bed area where the lift is to be used, to provide a surface for traction. Inconvenient for carpet cleaning but solves the problem with the lift. If you find the situation untenable, then you should request a different patient. The agency is not going to go any further in fixing the problem for you, I can guarantee that. When I have brought this problem up with my agencies in the past, I got the "oh well" response.

The plastic mat over the carpet still poses a risk of the lift tipping and the liability will remain on the user for not following manufacturers instructions.

My other suggestion is to obtain that documentation from the manufacturer -- I'm sure you can find it online-- and give a copy to the family and to your organization risk manager (and another to the nursing management).

The plastic mats as used under chairs in office is brilliant. They're quite rigid and not expensive.

Edited by AliNajaCat

Very true, the manual never specifically says anything about mats, but us very clear about using it on anything that is raised or creates an uneven surface.

I have seen the plastic mat idea used successfully. In one of those cases, the parent told me they thought of the idea themselves. You just can't get everyone, in every case, to agree to try it, like any other idea.

This is extremely plush carpet. Very thick, you can barely roll the wheelchair on it. The risk of tipping pt is very very high in this house, not to mention pt's disorientation and the fact that pt tends to be combative at times. One wrong move in that lift while on the carpet and pt is tipping, and we'll be falling with the pt.

I wouldn't be opposed to trying this mat idea if not for the fact that if something were to happen, the liability would fall to me, I could lose my license and spend who knows how long paying penalties to the nursing board for malpractice and whatever other things they decided to level against me, lol.

I have seen the plastic mat idea used successfully. In one of those cases, the parent told me they thought of the idea themselves. You just can't get everyone, in every case, to agree to try it, like any other idea.

In the event of a lawsuit, a nurse's anecdotal testimony will not hold up against the manufacturer's researched based recommendations or the expert witness's testimony.

This is extremely plush carpet. Very thick, you can barely roll the wheelchair on it. The risk of tipping pt is very very high in this house, not to mention pt's disorientation and the fact that pt tends to be combative at times. One wrong move in that lift while on the carpet and pt is tipping, and we'll be falling with the pt.

I wouldn't be opposed to trying this mat idea if not for the fact that if something were to happen, the liability would fall to me, I could lose my license and spend who knows how long paying penalties to the nursing board for malpractice and whatever other things they decided to level against me, lol.

See if the manufacturer will back you up. And whatever else happens, you still get to exercise your nursing judgment.

In the event of a lawsuit, a nurse's anecdotal testimony will not hold up against the manufacturer's researched based recommendations or the expert witness's testimony.

Much ado about something the OP can correct by requesting another case. Nobody is holding a gun to her head to work in that home. Tongue in cheek.

djh123

Specializes in LTC, Rehab. Has 5 years experience.

I wish I had some advice, but I don't - but your case manager sounds like a typical moron.