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!!

Specializes in Med/Surg, Ortho, ASC.
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.

Unless you manage to get the BON to state, in writing, that you are absolved of any risk (:roflmao:) your call/their answer means nothing.

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Well, just like that you burst my bubble. You're completely right though, lol

The pt dx does somewhat affect mobility, but not in a way that pt needs complete dependence on a lift. In fact, I feel that this lift is hurting as pt isn't having to use what capabilities they do have left. As a matter of fact, PT is coming to the home trying to strengthen the pt and has requested that we help pt walk as often as possible....but now we're told that we can't allow them to be up without the Hoyer. Here's another fun fact...we can't even get the Hoyer in the bathroom at all, making proper company approved transfer into the shower impossible. :lol2:

My honest opinion? This all boils down to not wanting to pay workman's comp.

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Specializes in LTC, assisted living, med-surg, psych.

Sounds to me you're literally being set up to fail. I know we often say "you should quit" on this forum, but in your case you should seriously consider it. Your agency doesn't give a rodent's rump about you OR their client. Find another job STAT and report this company to the state, complete with documentation of conversations you've had with your management, charting on the patient, discussions with family etc.

Wishing you the best in whatever you decide to do. You are between a rock and a hard place and IMHO there's nothing else you can do at this point. Please keep us posted.

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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.

If the mat is over carpet, you are still using the lift on carpet even though a mat is on top. You would still be torn about in court over doing this. You have no defense for doing it this way and you *will* lose any lawsuits related to the lifts use.

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Apparently regulations in home health are different than in a facility and so I can use it on a mat. That's what I was told. But at this point I'm so nervous about it that I want to actually read the regulation for it myself. It still just goes against my judgement, and makes no sense to me at all. I was taught to always follow safety guidelines.

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Well, I'm now looking at nearky 3 hours on the phone with BON. Everytime they transfer me to a nursing consultant, the line dies and I get cut off. Why is it impossible to find Home Health Regulations online?!??

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At the end of the day the patient needs to be transferred using the lift in a safe manner and the patient needs to be fully informed of the risks and benefits of using the lift on the carpet. Ask the patient if they are aware that manufacturer recommendations state that the lift should not be used on a carpet or a raised or uneven surface, as it can cause the lift to tip over and may cause the patient to sustain a serious injury. Inform the patient that the safest way to use the lift is on a hard surface. The carpet should be replaced with a hard surface, it's just carpet, it can be removed and replaced, whereas the patient's head, neck or back cannot be replaced if they are irreparably injured from the lift falling over.

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Sooo. . . I'm going to weigh in from the context of my background as a former legal nurse consultant: your biggest risk exposure is to the courts, not the BON. If your patient is a competent decision maker and you tell your patient that the manufacturer says its unsafe to use the Hoyer on carpet (of course you would have the conversation witnessed and documented) and the patient says to do it any way, your patient has given informed consent to a dangerous practice. It's VERY unlikely any BON would censure you because patients are generally determined to have a right to do unsafe things and you are acting as the patient's agent. BONs are not likely to take action against your license unless they find gross negligence or incompetence, like intentionally harming or abusing a patient or repeated med errors, or practicing impaired or diverting drugs. Possible in your Hoyer case, yes, but extremely unlikely.

Your real exposure is to the legal system. That's where a professional gets sued for malpractice, and that's where the money gets paid out. And even if your patient consents to an unsafe practice and gets hurt, a sympathetic jury could find you guilty and award big damages. And that's what is there to help with.

But I don't think that's what you're really about anyway. It sounds to me and of course I could be wrong that you're asking if your employer can really force you to do this unsafe thing, and you're upset they are trying to. The answer to that is of course they can't force you, but if you practice in a right to work state they can fire you for refusing in the proverbial New York minute. The reality of nursing is that your employer answers the phones in order to yes, provide care, but also to make money, and nurses who insist on practicing in a safe manner can be a thorn in their side. They're going to be annoyed with you for being a stickler. How annoyed only you can judge and time will tell. But that's why we take ethics in nursing courses in school, because being an ethical nurse sometimes requires sacrifice.

And by the way, I love the thick plastic mat idea. I've had that heart stopping feeling when using a Hoyer on carpet when the wheels stop and the patient swings forward. The mat will keep the wheels from getting stuck in the carpet. Of course the Hoyer people won't sign off on it because then THEY are liable if it doesn't work. But I'd use that as a reasonable work around, because that's what the courts and the BONs predicate their judgment on - what would a reasonable person do.

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I have no problem at all using the mat, as long as I'm not going to be thrown under the bus if something goes wrong. I was just concerned because I was taught from CNA class on up that the safety guidelines have to be followed or the caregiver is responsible for all injuries, so being told that as a nurse there are times that I can't follow guidelines raised red flags for me. I agree that they can't force me to do anything, especially given the fact that I'm stubborn. If I were put in a situation where I'm given the option to either do my job correctly or be out of a job, I'll update my resume and find another job. Better that than being under investigation, I remember having to watch an NP go in front of the board...Not something I ever want to experience lol.

I honestly hope that I am able to use the mat in the home, my back would be so grateful for it. Really, this entire fiasco could have been avoided had the case manager informed me of regulation rather than telling me in so many words that she asked her husband if the mat would work and he assured her it would. I outright refuse to use it on just the carpet though, the device nearly tipped with the patient a few days ago on the carpet, and I'm not risking that.

I'm finished with this apparent novel I'm writing right now!! I really appreciate all the help and advice!!! I've only been a nurse for 2 years, and sometimes I feel like a fumbling mess, lol. Would much rather work in a facility of some sort....but alas, I birthed nearly an entire baseball team of children and the pay in home health is better.

Oh, forgot to mention, the patient is not capable of making an informed decision, no real understanding of potential safety hazards. is most definitely something I am going to be getting within the next week or two!!

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I have no problem at all using the mat, as long as I'm not going to be thrown under the bus if something goes wrong. I was just concerned because I was taught from CNA class on up that the safety guidelines have to be followed or the caregiver is responsible for all injuries, so being told that as a nurse there are times that I can't follow guidelines raised red flags for me

I honestly hope that I am able to use the mat in the home, my back would be so grateful for it. Really, this entire fiasco could have been avoided had the case manager informed me of regulation rather than telling me in so many words that she asked her husband if the mat would work and he assured her it would. I outright refuse to use it on just the carpet though, the device nearly tipped with the patient a few days ago on the carpet, and I'm not risking that.

Oh, forgot to mention, the patient is not capable of making an informed decision, no real understanding of potential safety hazards. Malpractice Insurance is most definitely something I am going to be getting within the next week or two!!

Call a provider today, not in the next week or two. Tell them about your patient lift/carpet situation and that you plan to use the lift by placing a mat over the carpet, even though the manufacturer specifically states in the instruction booklet not to use the lift on carpet. Recognize that you will be modifying the lift from it's intended use, ask the insurer if you will be held liable if the patient is injured. Also, ask them how the case manager's husband's verbal assurance that "the mat will work" will be viewed in a court case.

If the patient is not capable of making an informed decision, the situation needs to be discussed with their substitute decision maker, neither you, nor the case manager can make the decision for him.

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There is a note in the home today they want us all to sign stating that we have been trained by PT on gait belt use in the restroom since the Hoyer won't fit in restroom....thats fine....except we arent allowed to transfer him with a gait belt, and even then I haven't laid eyes on PT (we don't have PT with this company) and I'm not signing a paper saying I have. This entire situation is a joke.

The mat is a HUGE hazard. It may have worked in other situations, but in this case the wheels are sticking to it, it's sliding when we move on it, the edges are bubbling up and the mat itself is still sinking down into this caroet (I can't even describe how plush this carpet is, the only thing I can compare it to is memory foam) The aid put me in the lift and tried to move me in it, and it took everything she had....Patient outweighs me by no less that 100 pounds. There isn't a mat in the living room, so they still expect us to transfer over carpet in there. Nope. At this point, I admit defeat....and by defeat I mean they can find some other poor sap that doesn't value their license and the patient's safety. I'm finding another job and turning in my notice. I'll go for a job at an actual facility where I can actually find and read (and FOLLOW) safety guidelines.

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