Transferring Bariatric

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More of a vent than a question but I promise one is there somewhere!

I am employed at a "no lift facility" please advise on what the alternative would be if the pt is refusing to use a hoyer lift?

This individual is well over 500lbs. Refusing to use hoyer lift (will not leave AMA, even though this person has threatened to do so) and constantly saying they will send their self out 911 (never calls btw). Mind you in the morning shift he can transfer independently, but at night he's asked us to document how "difficult" it is to transfer him to bed. Oh & he says if he got a new one (10k bariatric bed, although he currently has a bari-bed......it's just not the brand he wants) he'd be able to do it independently as well.

My supervisors resolution: get non urgent ambulance to transfer if he is refusing hoyer lift and so they did......here are my concerns:

1. No MD gave the order to call an ambulance

2. Is this going to be a daily thing?

3. Is it wrong to refuse to lift him (our policy says we are a NO lift, my back is precious and also bc my supervisor said if we get injured that's on us for not using the hoyer lift)

4. The ambulance staff realized they bit off more than they can chew, they ended up asking for help in transferring him. Helllllooooooo if we were able to do it we would not have called you! Here's the problem, if there's no order and IF he would have fallen who's liable?

5. They placed the gurney parallel to his motor scooter (immediately after they realized he couldn't bare his weight to pivot over to the gurney) and wanted to use 3 sheets to transfer him. THREE SHEETS for a bariatric patient. Walk me through this bc I couldn't wrap my head around it. How do you plan to transfer a pt that's well over 500lbs with three sheets!!!

My charge nurse was upset with me bc I refused to help transfer, ummmmm but in my defense, there was no order and I did not think the sheets were a SAFE method to transfer him so of course I don't want my name on that potential incident-lawsuit.

What would you have done? How would you approach a situation like this?

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

I think it's really stupid for your supervisor to want you to call an ambulance company to transfer a patient to bed every single night because he refuses a Hoyer lift. What on Earth is she thinking? The patient needs to use the Hoyer or your facility needs to give him an advance written notice of discharge, because it cannot safely meet his needs.

What is his reasoning for refusing the Hoyer lift? Is he just trying to be difficult? If so, I'd notify the manager and the Dr. that we are unable to transfer the patient due to his refusal of the lift. Then I'd educate the patient on the complications related to non-movement, such as pressure sores, etc. and I'd document it all like h***. Then I guess he'd just sit there until he got fed up with it and allowed the Hoyer transfer.

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"Patient in motorized chair. Patient refuses to be transferred to bed as patient refuses Hoyer lift."

Nuh-uh. This gal's not wretching her back because a patient refuses a safe method of transfer. And what in the name of Grinch does a different bed have to do with patient getting from chair to bed? "I could ambulate with a different bed." What does that even mean?

What a waste of EMS time. Basically they have to show up because your patient is throwing a hissy fit. I totally would have refused to help with that transfer too. Sounds like someone at your facility needs to lay it down with this patient instead of letting the patient walk all over the staff.

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Specializes in retired LTC.

Also, I'd make sure all family members are on the same page with family care plan meetings.

(And to let you know, there is a denim-y canvas strapped 'lift' sheet with grips that is made commercially so EMS squads can use it for lifts. My local squad used it when I fell some time ago. I believe this should be avail for use for this guy and to be kept in supply for future uses. Ii's like plastic covered so it can be cleansed down. I'd keep it for single pt use. Thinking about it now, maybe all facilities should have them in their repertoire of avail equip needed for heavy lifting.)

I don't know how well the threat of a discharge would fly in some places. The DOH/Ombudsman offices might be all over you.

Just to ask - is he OOB all day after getting out in the AM?? He really might just be weaker in the evening if he's been in his chair all day. He sounds like he's trying to manipulate y'all, but there just might be a little iota of truth in his story.

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Specializes in Critical Care, Education.

Wow. I'm with OP all the way. Manual lifting is never safe -- incredibly unsafe with patients this large.

What's the physician's role in all of this? S/he needs to step in and get involved with that discussion - either comply with facility policy or be discharged. I'd also advise getting your risk management dept involved. This situation seems to be leading up to a huge liability risk for the organization.

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I wouldn't transfer him. I'd leave him in the chair. I'd give him his choices, we can either transfer you safely with the hoyer or you can stay in the chair. I'd ask him why he didn't want to transfer in the hoyer. If he said he was anxious I'd see if I could get something on board for anxiety. I'd get the doctor involved. If the doc put in an order for ambulance help then maybe. Honest if this was my shift I'd chart pt refused hoyer lift. Unable to transfer pt at this time. Discussed safety risks with pt including x, y, z... Pt verbalized understanding risks of staying chair. Reported to MD (insert name) and supervisor (insert name). Heck no would I be trying to move a 500 lb pt without a lift. No thank you.

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I have to agree, he is probably weaker in the evenings and requires more assistance.

How is he being taken care of when he is OOB all day?

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Specializes in retired LTC.
I have to agree, he is probably weaker in the evenings and requires more assistance.

How is he being taken care of when he is OOB all day?

My guess is foley cath and he can prob shift himself a bit while in his whch. But then later in the evening he's prob leg-weak from so much sitting.

We acknowledge this with LOLs and LOM in the NH. We freq care-plan them "to return to bed after lunch for a nap" and then again "OOB for supper". Common nsg intervention for increased fatigue.

His baloney demands for the other specialized bed is just that - baloney. That's just manipulation. But I do think there might really be increased fatigue after prolonged sitting. (Any dependent pitting edema?)

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I worked in a no lift facility. A patient refused a lift. DON called and instructed us to do a lift manually with 3 people. Patient fell on one of the three. Workers comp for months. Personally, my back is not a hoyer lift. I can not send it in to be fixed or replaced. If you don't want to use a lift, I'm out. I will try education and relaxation techniques, if appropriate. But, I'm not doing a manual lift with a 500 lb patient. I doubt I'd get fired, but if I did, I would be glad to get out of a facility that cares so little for its staff. That's right up there with staying close to a patient in case they start to fall. Maybe for a little old lady, but 500 lb? Nope. I'm not breaking that fall.

And it's on you if you get injured because you didn't use the lift but then the DON got mad because you refused? Yeah, can't have your cake and eat it too.

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Specializes in retired LTC.

Can you picture going to Unemployment and explaining to them WHY you were terminated? Your failure to manually lift a 500 lb pt!!

This just cracks me up.

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He gets OOB independently in the morning.

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Thank you all for the feedback.

I'm not sure what my supervisor was thinking. My supervisor and charge nurse were upset that I refused to lift, I felt I was in the right. I have to make sure the pt is safe as well as me and my CNAs.

We are being told "if you get injured for not using the hoyer lift that's your fault not the XXXX" but they haven't decided on what to do when he refuses.

Dr. Clueless hasn't been much help, saying the pt already has a bariatric bed and ordering another brand name one will not be different. It's a battle of which party pays for the bed. The facility unwilling is unwilling to pay for another one and the pt is also unwilling to fork over 10K. í ½í¸©í ½í¸©í ½í¸©í ½í¸–

I agree. I believe he is being manipulative. He has been able to get in and oob by himself up until a week or two ago and has been that way for most of the time he's been there. Since he got the bari-bed and it's not the one he wanted, he suddenly can't stand up.

Sidenote, after being put to bed by EMS 3 hours later he got up...solo. I was incredibly frustrated that night .

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