Medline MDS400EL User Manual download pdf (Page 11)

Assessment Tools

Assess your incoming patients

to ensure you have the proper

lifting protocols in place.

Consider all physical and

cognitive factors to ensure

you make the right decision –

maximizing patient care and

employee safety.

Safe 'n Easy Lift Assessment

Safe 'n Easy Assessment Tool and Care Plan

General Information

Patient's Name

Assessment Date

Your Name

Your Signature (sign after printing)

I. Patient's Level of Assistance (check one)

Independent

- Patient performs task safely, with or without staff assistance, with or without assistive devices.

Partial Assist

- Patient requires no more help than stand-by, cueing, or coaxing, or caregiver is required to lift no more than 35 lbs of a patient's weight.

Dependent

- Patient requires nurse to lift more than 35 lbs. of the patient's weight, or is unpredictable in the amount of assistance offered. In this case, assistive devices should be used.

II. Weight Bearing Capability (check one)

III. Bi-Lateral Upper Extremity Strength (check one)

Full

Yes

Partial

None

IV. Patient's Level of Cooperation and Comprehension (check one)

Cooperative

- may need prompting; able to follow simply commands

Unpredictable or varies

(patient whose behavior changes frequently should be considered as "unpredictable"), not cooperative, or unable to follow simple commands

V. Weight, Height, BMI

Weight (lbs)

Height (inches)

Calculated Body Mass Index (BMI)

VI. Applicable conditions likely to affect the transfer/repositioning techniques (check all that apply)

Hip / Knee / Shoulder Replacements

Respiratory / Cardiac Compromise

Fractures

History of Falls

Wounds Affecting Transfer / Positioning

Splints / Traction

Paralysis / Paresis

Amputation

Severe Osteoporosis

Unstable Spine

Urinary / Fecal Stoma

Severe Pain / Discomfort

Severe Edema

Contractures / Spasms

Postural Hypotension

Very Fragile Skin

Tubes (IV, Chest, etc.)

Other Comments:

VII. Care Plan

Transfer To and From: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair

Lateral Transfer to and From: Bed to Stretcher, Trolley

Transfer To and From: Chair to Stretcher, or Chair to Exam Table

Reposition in Bed: Side-to-Side, Up in Bed

Reposition in Chair: Wheelchair and Dependency Chair

Transfer Patient Up from the Floor

Bariatric 1

Bariatric Transfer To and From: Bed to Chair, Chair to Toilet, or Chair to Chair

Bariatric 2

Bariatric Lateral Transfer To and From: Bed to Stretcher or Trolley

Bariatric 3

Bariatric Reposition in Bed: Side to Side, Up in Bed

Bariatric 4

Bariatric Reposition in Chair: Wheelchair, Chair, or Dependency Chair

Bariatric 5

Patient Handling Tasks Requiring Access to Body Parts (e.g., Limb, Abdominal Mass, Gluteal Area)

Bariatric 6

Bariatric Transporting (Stretcher)

Bariatric 7

Bariatric Toileting Tasks

Sling Type:

Seated

Seated (amputation)

Standing

Supine

Ambulation

Limb Support

Sling Size (XS, S, M, L, XL)

Additional data needed for determining slings:

Circumference Around Hips

Distance from Top of Head to Just Above Kneecap

Distance from Shoulder Blade to Just Above Kneecap

Note

: An assessment should be made prior to each task if the patient has varying level of ability to assist due to medical reasons, fatigue, medications, etc. When in doubt, assume the patient cannot assist with the transfer/repositioning.

Note

: if patient has a BMI of 50 or more, transfer care plan will be based on bariatric algorithms.

Note:

The presence of the following conditions are likely to affect the transfer/repositioning process and should be considered when identifying equipment and techniques needed to move the patient.

Algorithm

# Staff

Equipment /

Assistive Device

Task

1-800-MEDLINE | www.medline.com

Lifting Program

Safe

Patient Handling

and Movement

Algorithms

Developed By:

VISN 8 Patient Safety Center

11605 N. Nebraska Avenue 673/118M

Tampa, FL 33612-5738

http://www.visn8.med.va.gov/patientsafetycenter/

Center Director:

Audrey Nelson, PhD, RN, FAAN

Phone: 813-558-3902

Safe ‘n Easy

Lift Policy

Safe resident/patient lifting policy is one part of a comprehensive program to reduce musculoskeletal injuries to

frontline caregivers, one of our most valuable resources. The policy recommends guidelines to ensure that the

transferring needs of all patients/residents are assessed.

All healthcare personnel responsible for transferring patients shall be aware and trained on the correct

procedures for lifting and moving patients. Adherence to this policy ensures that patients/residents are being

liftedand transferred safely while encouraging patient mobility and independence. Safe resident/patient lifting

policy is one part of a comprehensive program to reduce musculoskeletal injuries to frontline caregivers,

one of our most valuable resources. The policy recommends guidelines to ensure that the transferring needs

of all patients/residents are assessed.

All healthcare personnel responsible for transferring patients shall be aware and trained on the correct procedures

for lifting and moving patients. Adherence to this policy ensures that patients/residents are being liftedand

transferred safely while encouraging patient mobility and independence.

Safe resident/patient lifting policy is one part of a comprehensive program to reduce musculoskeletal injuries to

frontline caregivers, one of our most valuable resources. The policy recommends guidelines to ensure that the

transferring needs of all patients/residents are assessed.

All healthcare personnel responsible for transferring patients shall be aware and trained on the correct procedures

for lifting and moving patients. Adherence to this policy ensures that patients/residents are being liftedand

transferred safely while encouraging patient mobility and independence.

Customizable Lift Policy

Ensures you have a thorough

policy on record, covering

all aspects of your lift

program. Responsibilities,

equipment requirements,

and maintenance procedures

are all addressed in this

customizable policy.

Implementation Plan

Manage implementation

of your formal lifting

program through an

easy-to-use checklist.

You can designate who

is responsible and stay

on track.

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Medline MDS400EL User Manual Page 11

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