Sit to stand lifts

[Nurse2332]

I have a resident that was using a sit to stand lift when I came on. This resident doesn't support her own body weight, cannot sit up unsupported, needs help moving her feet and hands onto the lift and sometimes can't bend her knees without assistance. I was told to do a lift evaluation on this resident and it is a yes or no questionarre that said the resident needed a total mechanical lift. The resident is fighting having to go on the lift but multiple staff members feel unsafe using the sit to stand with the resident. One instance I was trying to get her hooked up and the resident suddenly lost control of holding herself up and fell backwards. Therapy is evaluating the resident saying it's safe to use the sit to stand with her. Our policy says only one person is needed for our facility lifts but no one feels comfortable doing it alone. I've heard that people can lose their license over lifts so my question is, can we be forced to use a sit to stand when we feel it's unsafe? My hesitation is worrying she will slip out of it while transferring to the toilet which she is also incontinent. She will say she's done then we start raising the lift up to wipe her and BM will go everywhere that we end up having to clean all over her and the bathroom floor. The whole thing is a disaster. 

[Mike Hunt]

This is a physical therapy question. First and foremost, your back and health is more important to you than any patient. Do not enter any situation where your well-being is questioned. If you absolutely cannot find someone else to do the job, then do everything you can to promote safety and prevent injury. I'd recommend using a gait belt and doing the egress test to see how mobile the patient actually is before using lifts. If she soils herself then so be it; cleaning her is ultimately up to you. You can probably get a CNA/PCT to deal with that. Hopefully. However you should still encourage the patient to do as much as she can, which might be a foreign concept to her. Help the patient or don't, the choice is yours. Your back and career is infinitely more important to you.

[BeatsPerMinute, BSN, RN]

I had a patient in the ICU who was like this. She was 340-something pounds on a lasix drip and the MD's were anti-foley catheter. Per PT, it was deemed "OK" for single person to assist this patient. At the time, I was a 20-something year old nurse that only weighed approx 125lbs. I was strong though as I worked out a lot and did a lot of weight lifting. I was everyone's favorite turning buddy actually, LOL. However, I was not strong enough to work with a patient who fights me during the whole process of getting them out of bed to the bedside commode and back. In the afternoon while assisting her again to the commode, she was angry, frustrated, ranting about how life is so unfair. She was not listening to my directions while we were mid-way through the process of getting her to the commode. She was flailing around in anger while we were standing and she fell forward onto me. I shouted out for help. Several co-workers rushed in to assist getting this patient off of me, cleaned up, and back to bed. That patient's husband was getting lunch during the incident. When he returned, learned what had happened, and heard ( from the patient) explaining that she was just "mad," but still "sorry" that she fell on me, the husband was absolutely furious with his wife for being like that, and he apologized profusely to me and all of the staff. I had done everything I could with what we had & I was safe, job wise. But it was just one more ding to my back and I was put on light duty for awhile... Not worth it. 

[FolksBtrippin, BSN, RN]

I wouldn't worry about losing your license over a lift. I would worry about getting hurt, like someone else said. If truly no one wants to do this, you need to have a convo with PT, the MD, your sup. 

[Raulthatool]

No, if it's a safety issue, you move to a full body lift. Also, just because policy states 1 person for the Sit to Stand doesn't mean you can't have 2 people for the transfer. Anyways, You notify the supervisor and document. 

I.E "Resident cannot tolerate the sit to stand lift. Their legs give out and they fall back. Resident was transfered with a full body mechanical lift for safety."

Use the full body lift, to bed, to bedpan/bedside commode or shower chair for them to use the bathroom. 

I don't see a problem with helping them get a hold of the handle bars and assisting with bending to sit.(Unless they can't hold on for the duration to complete toileting/transferring). The losing control and falling back is the issue.