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A Hoyer lift

A sling lift, patient lift, patient hoist, hydraulic lift, or Hoyer Lift (a brand name) is an assistive device that allows patients in hospitals and nursing homes and those receiving home health care to be transferred between a bed and a chair or other similar resting places, using hydraulic power. Hoyer lifts are used for patients whose mobility is limited, and who are too heavy for nursing staff to lift[1][2].

The widely-used term "Hoyer Lift" refers to the best-known brand name. When manufactured by another company, it is known under a different name[3]. The basic design for the sling lift or Hoyer lift was patented in 1955 by R.R. Stratton, and titled "Floor Crane with Adjustable Legs" (US patent 2706120). According to the patent, the lift's design was based on a similar device used in "automotive repair shops" which is described as a "floor crane available for lifting engines and other heavy parts".

The Hoyer lift has several advantages, in that it allows patients who would otherwise be too heavy to be lifted to be transferred more easily, it allows a reduced number of nursing staff members to move a patient as would be needed without the device, and that it reduces the chances of orthopedic injury from lifting among nursing staff members[4][5]. Patients who have medical conditions that do not allow them to be bent and compressed by the sling as they are hoisted (i.e., cannot withstand "vertical transfer") generally use other assistive devices for transfer. The two other types of transfer device which allow for lateral or supine (supine position) transfer are stretcher chairs (also called transfer or convertible chairs) that allow patients to be slid or dragged from the bed onto a mobile stretcher that then converts to a mobile chair, and inflatable sliding mats which use air bearing technology to reduce friction during lateral transfer.

Use of the Hoyer lift involves placing a special piece of fabric under the patient (usually made of woven nylon, cotton, or a similar material to a modern hammock) which can hold the weight of the patient while suspended in air. The fabric is attached to a series of hooks and chains, which are raised or lowered using the manually operated or electric hydraulic lift or hoist.

Some variations of the Hoyer lift's sling involve the placement of three separate pieces of thick foam pads under the patient. When the patient is elevated, these pads hold the patient in place. These, according to some, can be easier for a lone home health aide to use. Other kinds of specialized slings are toileting slings, amputee slings, quadriplegic slings (contain additional head support), repositioning slings (for turning or sliding patients in bed), disposable slings (for enhanced infection control), and stretcher slings (for supine transfer). It is important that medical staff do an assessment of the patient's size, weight, and medical condition in order to select the proper sling to avoid injuring the patient during transfer

Another kind of sling lift, called a Guldmann Lift or ceiling lift, can be permanently installed on the ceiling of a room in order to save space[6]. Floor sling lifts usually have a wide wheeled base that requires considerable space to horizontally maneuver the patient into a wheelchair or onto a bedside commode after they are hoisted from the bed. The ceiling lift eliminates this space issue because the patient is supported by ceiling tracks instead of by the wheeled base. Ceiling lifts use the same sling technology as floor sling lifts. However, they usually have a "track system" attached to the ceiling for horizontal movement of the patient within the patient's room and often into an adjoining bathroom. Ceiling lifts also use an overhead electric motor (i.e., they are not hydraulic) controlled by a hand-held set of push buttons to raise and lower the patient. In most cases, the same overhead motor is used to move the patient horizontally, but such movement is limited by the placement of the overhead ceiling track system.

Another form of overhead lift is the free-standing or A-frame lift. This form of lift consists of an inverted U-shaped structure which has two vertical members that rest on the floor on either side of the patient's bed. These vertical members support a horizontal track that runs over the patient's bed. This kind of modular track system avoids the expensive and time-consuming installation of permanent ceiling tracks while providing the space advantages of an overhead patient lift system.

Bed scales used to weigh patients who cannot get out of bed easily use the same principles as the hoyer lift. The patient is placed on a pad that is elevated by a hydraulic system, similar to that of a Hoyer lift. When the patient is completely suspended above the bed, the scale provides an accurate weight.

The role of Sling Lifts in Safe Patient Handling Programs

There has been considerable effort put forth by nursing advocacy groups (see the American Nursing Association's "Handle With Care" program at http://www.Nursingworld.org) to encourage hospitals and nursing homes to adopt "zero-lift" or "no-lift" programs in order to prevent orthopedic injuries in healthcare workers. However such programs, which require the use of mechanical lifting aids such as Hoyer lifts, are difficult to implement and sometimes fail. This is in part due to the time and effort required to safely use lift equipment. Once the sling lift is in the patient's room, moving the patient from a bed to a wheelchair normally takes between 3 and 6 minutes (considerably longer than moving the patient manually). This time difference and the complexity of the transfer process can result in caregivers resisting the adoption of the sling lift as a normal mode of patient transfer. Lifts are then used only to move obese patients who are far too heavy to move manually.

To use a floor lift, the lift must first be brought to the patients room, the proper sling must be selected and available, the nurse must be trained in the use of the particular lift device and sling, there must be sufficient space in the patient's room for the lift and the wheelchair or gurney, the patient must usually be "log rolled" onto the sling, the lift must be in good working order and its battery must be charged (for electric lifts), and the patient must be prepared and understand the lift process to avoid undue fear and agitation. Additional pain medication may also be necessary if the patient has a painful medical condition. Though it is well known that manual lifting of patients is unsafe and often leads to caregiver musculoskeletal injuries, the cost and complexity of using floor lifts makes implementation of safe patient handling and movement (SPH&M) programs challenging. These issues with floor lifts are some of the reasons why more expensive ceiling lifts which are permanently installed in the room and require less space are becoming popular.

One approach that has been used successfully with floor lifts is to create a facility "lift team" that is on call (usually 12 hours a day), and specializes in moving patients. This eliminates a number of issues mentioned above since the lift team brings the lift with them to the patient's room, maintains it in proper working order, is knowledgeable in the use of the lift, has special expertise in sling selection, and can move patients quickly and safely. The down side of the lift team is that the team(s) may be busy when needed, and patients who need to be mobilized quickly to meet schedules must wait for a team to become available. Most lift teams seek to guarantee that they will arrive in the patient's room and begin transfer in less than 20 minutes after the nurse makes a request for service.

Legal issues

While Hoyer lifts are often used by only one health care worker without assistance, most manufacturers require that two caregivers be present. However, the single caregiver approach makes the Hoyer lift more usable in home care settings where there is often only one caregiver per patient. In either case, Hoyer lifts require special care in their use, as any mistakes made may result in serious injury. Some injuries that have been caused by improper use or malfunction of Hoyer lifts have led to civil lawsuits[7][8]

In 1999, a lawsuit was filed after two women were injured in falls at a Massachusetts Sunrise Senior Living facility[9].

In January 2008, the family of an elderly Naples, Florida woman sued the nursing home where the woman was residing after she died from a fall off a Hoyer lift. The lawsuit alleges that the nursing home did not take X-rays following her fall[10].

In October of 2006, Linda Ober, a resident of the Gateway nursing home in Oregon was dropped during transfer from a wheelchair to her bed while using a sling lift for transfer. The fall occurred because of an improperly positioned sling. The fall broke both of her legs. The nursing home failed to give her treatment following the fall for five days which resulted in the filing of criminal charges against two nursing employees and a 5.3 million dollar law suit [11] against the nursing home. Ms. Ober later died of medical complications resulting from the fall.

References

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