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!!

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.

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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.

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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.

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

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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.

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Specializes in LTC, Rehab.

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

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It is listed on pt 485 that skilled nursing is needed in home to promote safety and identify safety risks, I'm going to just chart it as an identified risk and that it has been reported. Pt has refused the lift in the past, I'll just get a verbal refusal again today and chart that as well. As far as an order for the lift I don't have an order in the book for lift use in this home, so I wouldn't even be able to chart it as per MD order anyway. I'm sure the manufacturer would back me up since the warning is included in the safety guidelines on the first page of the book.

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I could easily request another case, that's true. However, I enjoy my patient and don't want to request another case. Again, the issue isn't with the patient or even the work I have to do here and I never implied that it was. Not every problem in a home requires transferring to another home. The intention of my post was to find out from more experienced nurses advice on charting the problem as well as questios about liability. I never asked for advice on transferring the patient, as I am more than capable of doing that. There are numerous ways I could transfer him....but that doesn't mean the majority of them would be considered safe. I prefer to do my job correctly.

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The handbook for the Hoyer very clearly states that the device is not to be used on carpet due to risk of tipping". That's your answer right there. It says not to use it on carpeting and if you do that against manufacturer's recommendations you will be crucified in court for it and you *will* be found liable if it goes bad. You will also lose any associated lawsuits. The manual is very clearly warning you of the danger of using it on carpet, this is not a point to be negotiated with anyone for any reason.

Your supervisor has made it clear to you that they don't give a crap about the situation or you either for that matter. Since you can't use the Hoyer on carpet, you refuse to use the lift and tell your managers you won't be using it. Period, this is a statement, it is not up for discussion or negotiation and do NOT engage in either one because they will most likely try to draw you into one. Personally I would not even be willing to see that same patient again. Then look for a new job, one who employs professionals with critical thinking skills.

Last of all "No" is a complete sentence by itself and the responses of "it's not a matter up for discussion" or "that's not possible" are all valid, polite responses.

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How do patients obtain hoyer/mechanical lifts in the US? is it by prescription? if so which health professional is responsible for writing the prescription? Where I am (Ontario) occupational therapists are responsible for prescribing mechanical lifts and before writing the prescription they conduct an assessment of the patient's home. If there is carpet in the patient's home, the OT informs the patient that the lift can not be used safely on carpet and it must be replaced with a hard surface floor before the lift can be ordered.

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We have to have a letter of medical necessity writen by an MD, that letter is then sent to the pt's insurance company and they pay for the lift. That's how it works with this particular type of insurance, it may be different depending on that.

The new plan is to tape a garage mat to the floor and use it that way. I'm just going to call the BON tommorow and find out if that would still be a liability for me.

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Specializes in Short Term/Skilled.

Ok, so aside from all that...what's the patients dx? Are you sure you can't transfer them without the lift?

Sometimes lifts are truly needed, but I've noticed they'll often be ordered for family members to use who don't have experience working with patients, many times I can transfer a patient safely without needing the hoyer.

Just an idea.

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