Mobility for Nonambulatory
or Bed-bound Patients
The NoLiftingTM Patient Transfer System is a combination mobile chair, lateral transfer device, and gurney for transferring and transporting highly dependent patients. It is currently a prototype device and is not yet available for purchase. The system provides a fast, safe, virtually painless, cost effective way for a single caregiver to transfer most patients with minimal disturbance of the patient and no lifting or dragging by the caregiver.
In homes, following transfer from the bed, patients can use commodes and showers while remaining in the mobile chair thus reducing falls. In institutions, patients can be transferred from the mobile chair to other patient support surfaces such as height-adjustable examining tables.
The comfort, dignity, and safety of the patient, and the health and safety of the caregiver are two primary concerns of the health care industry.
Dependent patients who must be dragged, twisted, lifted, or raised in a sling to transfer them from their beds are subject to unnecessary pain and anxiety, and in rare cases additional injury.
Professional caregivers who must do the dragging and lifting have the highest incidence of occupational injuries leading to lost days of work of any industry. ¹ The 2.7 million member American Nursing Association's web site states, "Every day nurses suffer debilitating and often career-ending and life-altering injuries from repeatedly lifting, moving, transferring, and repositioning patients" It also states that "repeated lifting and forceful movements associated with patient care activities" are why 52% of nurses complain of chronic back pain and "back injuries affect up to 38% of all nurses". ² While there is a serious nursing shortage in the United Sates, one study concluded that 12 percent of nurses were "leaving for good" with back pain as the main contributory factor. ³ The average nurse lifts 1.8 tons per shift. 4 The resulting disability and workmen’s compensation costs for health care institutions have been very high.
The patented NoLiftingTM System uses a common wheeled base in combination with a newly-developed lateral transfer mechanism to create a moderately-priced patient transfer system. It provides a way to transfer patients by gently raising them off the bed so there can be liftless, low friction, transfer of patients from hospital beds to convertible reclining mobile chairs/gurneys. Optionally, the transfer process does not require a change in position of a supine or prone patient. In the alternate approach, the patient must be rolled onto a transfer sheet. It also occurs with no discomfort due to bending, twisting, or hoisting the patient above the bed. It will therefore help disabled patients with and without chronic painful conditions gain mobility. In addition, the system will also encourage the early mobilization of patients with acute pain following surgery or injury.
Most importantly for medical institutions, the system avoids caregiver occupational injuries because there is no lifting or dragging of patients required of the caregiver. In addition, the system reduces liability because the patient cannot fall or be dropped during transfer. Also, the danger of using slings which exert friction and shear forces that can lead to skin breakdown is eliminated. The system, unlike most transfer devices, requires only one caregiver for patient transfer which improves efficiency and reduces personnel costs for healthcare institutions.
The NoLiftingTM system does not use slings, boards, belts, sliding sheets, or air-assisted low friction sliding aids, many of which have serious drawbacks for both caregivers and patients. It also does not require any secondary transfer equipment, which may be bulky and require storage. Instead, it uses a patented lateral transfer mechanism to create a versatile patient transfer, mobility, showering, and toileting system.
In a normal eight hour shift, a caregiver might transfer a patient to a wheelchair from the bed, to a shower chair once, and to a commode four times. A sling-lift would require the patient to be transferred eleven times (transfers: bed to WC [wheelchair] to shower chair to WC to commode to WC to commode to WC to commode to WC to commode to WC). That is eleven opportunities for a patient fall. The NoLifting TMsystem would require only one transfer in this situation since the patient could stay in the mobile chair for all of these activities.
The system provides a patient transfer method which from the patient's point of view is comparable to "levitating" him or her out of bed. The effort required to move the patient laterally is minimal because such movement creates little resistance. A crank inclines or reclines the back-rest once the patient has been transferred to the chair allowing smaller caretakers to reposition (sit up and recline) patients who are heavier and larger than the caregiver. Using the NoLiftingTM system could all but eliminate patient transfer-related occupational injuries for caregivers of nonbariatric patients, and it could do it cost-effectively.
As with a transport mobile chair, once transferred, the patient is fully mobile. The transfer system also allows the use a high quality seat cushion to avoid skin damage when using the transfer device as a mobile chair instead of a gurney. If a powered base were used instead of the less expensive, manual wheeled base, the transfer system would allow for independent mobility.
Mobility is a key element in the health of the over one million nonambulatory people living in the US today. The ability to sit upright (partially or fully) in a mobile chair, or stand up without first undergoing the twisting, bending, or dragging that is normally required to leave the bed, can greatly improve the health of normally bed-bound patients. This is because such mobility helps prevent health problems as diverse as blood clots, poor circulation, urinary tract infections, kidney stones, pressure ulcers, excess fluid in the airway, hypostatic pneumonia, loss of range of motion in the limbs, osteoporosis, and even depression. 5 Sitting in a mobile chair puts pressure on different areas of the body than lying in bed. Transfer to a mobile chair is therefore helpful in avoiding the development of pressure sores by eliminating or shifting pressure on virtually all of the areas of the body negatively affected by bed rest.
Enhanced mobility also increases the variety of treatment options available to nonambulatory or dependent patients. Once the patient is mobile, the system can be used to safely transfer patients from the reclining mobile chair to "hi-lo" examining tables, radiology tables, and other patient support structures. A portable, inexpensive attachment allows the system to be used as a shower chair or for toileting without moving the patient from the mobile chair. These common transfer activities can take a fraction of the time it takes to make such transfers using a floor sling-lift. They are also less dangerous than the common "stand and pivot" transfer.
Because the transfer system has few environmental requirements for use, it permits some patients who would normally require nursing home care to stay at home. The inherent safe design of the system means it can be used by less experienced caregivers which also encourages patients to stay at home.
The issue of pain in patient transfer is important for a number of reasons. When most of the pain and anxiety of transfer are eliminated, fewer pain-killing drugs are required and the patient's blood pressure remains stable. Patients are therefore more relaxed and have better concentration as they begin rehabilitation, or undergo other remote medical procedures. With fewer drugs, diagnostic procedures are more effective because patients are more alert. Such patients can give more accurate information to physicians about their condition during examinations. Patients also sometimes become agitated or combative because they experience pain while being moved. 6 Such patients tend to make quick and unpredictable movements which make them a danger to both themselves and the caregiver. Forceful unexpected movements by patients during transfer are directly responsible for many caregiver occupational injuries. Reducing the patient's pain is also psychologically beneficial to nurses who see their role as helpers, and find it difficult to repeatedly do things that cause their patients pain.
Patients who normally must wait days or weeks to begin physical therapy at remote therapy centers can often begin limited therapy shortly after accidents or surgery before they become seriously debilitated. As the proportion of mobile patients increases, the need for expensive technologies to avoid skin breakdown such as low air loss and alternating pressure mattresses decreases which provides additional savings for hospitals.
The psychological benefits of being mobile so patients can eat with others at a dining table, attend recreational activities, or visit the outdoors also cannot be overstated. Some transfer systems which rely on gurneys or transfer chairs that have limited functionality and mobility cannot provide access to such common activities. True transport mobile chair mobility can increase social and environmental interaction, and reduce the incidence of the "failure to thrive" diagnosis which is often used to describe the deteriorating condition of bed-bound patients.
Being bed-bound is especially dangerous for the elderly following an accident or surgery. A five year Yale study looked at 754 people seventy years of age and older, and examined how hospitalization can lead to permanent disability (defined as needing assistance in bathing, dressing, and walking inside the house). In order to avoid permanent disability following a period of hospitalization, the study first emphasizes the importance of "minimizing the number of things that keeps someone almost chained to a bed" (such as use of catheters or consciousness-impairing drugs) and second, the importance of making "intensive efforts to maintain mobility by getting people out of bed onto a chair or walking in the corridor". 7
The NoLiftingTM system is of greatest benefit to quadriplegics, burn patients, patients with painful spinal conditions, patients with painful cancers such as bone cancer, patients with multi-trauma resulting from war injuries or other serious accidents, patients with difficult to stabilize fractures such as broken hips, patients with auto-immune diseases such as advanced rheumatoid arthritis that cause pain in the joints, and patients with many other common disabling conditions which make it difficult to leave the bed. It is especially good for quadriplegics because it prevents the orthostatic hypotension (fainting and dizziness due to a sudden drop in blood pressure) which sometimes occurs when transferring quadriplegic patients using sling-based transfer devices. Late stage Alzheimers (stage 6 and 7) patients who sometimes lose their ability to follow directions and move from the bed may also benefit from the use of the NoLiftingTM device.
Also, patients who are required to lie on their stomachs, patients who cannot bend at the hips or knees, and patients with partial or full body casts can be transferred with the system. These patients cannot be transferred with devices that commonly use flexible slings.
Though the NoLiftingTM system is most helpful in the above situations, it is intended for general use. It offers a concrete alternative to other transfer mechanisms. It also permits caregivers to completely conform to a no lift policy (or zero lift policy) which are policies being adopted by many medical institutions. Ten states including Texas and California have all passed "safe patient handling" laws with "no lift" requirements for nurses. Most competing transfer systems may technically be described as "no lift" systems but in daily use, they often require caretakers to perform a wide variety of strenuous activities including lifting. Such activities can lead to the very musculoskeletal injuries these systems were designed to avoid.
The NoLiftingTM system is moderately priced, relatively light weight, and compact so it can be used in a variety of environments where other more expensive or larger transfer systems are not practical. It also has many advantages over standard sling-based transfer systems.
The patented NoLiftingTM Patient Transfer System is a revolution in patient care, comfort, and freedom.
1. de Castro, A.B. (September 30, 2004) "Handle With Care®: The American Nurses Association’s Campaign to Address Work-Related Musculoskeletal Disorders", Online Journal of Issues in Nursing. Vol. #9 No. #3, Online article.
2. "Safe Patient Handling and Movement page", ANA Nursing World - The official Web Site of the American Nurses Association, Online Source: ANA Handle With Care main page.
3. Stubbs, D.A., Buckle, P.W., Hudson, M.P., Rivers, P.M., & Baty, D. (1986). Backing out: Nurse wastage associated with back pain. International Journal of Nursing Studies, 23 (4), 325-336
4. Tuohy-Main, K. (1997). Why manual handling should be eliminated for resident and carer safety. Geriaction, 15, 10-14. Online article.
5. Stolov, W., & Clowers, M. (1981). Handbook of Severe Disability. Washington, DC: U.S. Government Printing Office, pp. 55-62
6. de Castro, A.B, Ibid
7. Thomas M. Gill (2004). "Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons", Journal of the American Medical Association, 292:2115-2124. Online source: Online web article.