Ask The Back School: Weight Limits for Wheel Chair Transfers
Time for another entry in our Ask The Back School series where our team of instructors and industry experts respond to questions submitted by our former Back Scholars.
We were contacted by a company that wants us to do post offer testing for their new hires. The workers would be doing wheelchair to toilet transfers with a disabled population. A question came up regarding how much lifting weight should be required, e.g. knuckle to waist level to simulate a transfer. I know the DOT usually listed related occupations e.g. nursing, nursing aide as medium level work. But you know the transfers can be much heavier. Any experience with this question?
We asked our resident Physical Demands and Employment Testing Certification instructor, Vic Zuccarello, to field this question and were blown away by his incredibly detailed response. Here’s what Vic had to say:
This question comes up a lot because there is no “easy button” when testing healthcare workers. There are variables in patient weight, level of assistance required, configuration of the load, and coupling patterns to name a few.
Further, there are no state or federal guidelines (other than the DOT which you mention)and no credible testing guidelines have been developed by any test provider, though a few providers will try to “wow” you stating that they have “proprietary” guidelines for testing these populations.
The bottom line is this: to perform a test that is “job-specific and consistent with business necessity” you need to first obtain physical requirements from a Physical Demands Analysis (PDA). Now, some national employers will compel you to use their PDA and expect you to design a test around it — fine if they agree to sign a waiver that indemnifies you of any potential legal entanglements resulting in someone challenging the test.
In the absence of that, you need to go onsite and do you own PDA. In your initial interview with the employer’s supervisor and active employees you will obtain the Job Purpose and Essential Functions. Then you will collect physical demand information on each function. In your example, it is important to find our if they use a mechanical lift anytime in their patient handling and if so, for which scenarios do they use it. Then narrow down the types of scenarios for which they don’t and you are left with the lifts you will need to evaluate both in the PDA and in a new-hire test.
So, transfers. There are a number of ways you can evaluate this in a PDA, but I’ll describe my favorite way. You should be able to find out the average and maximum weight of patients currently onsite as patients by a quick check of the medical records. Then you need to find a few able-bodied nursing personnel around those weights. They will be your simulated patients and they will simulate with you a minimum, moderate, and maximum assist transfer.
I like to use my force gauge and a transfer belt to monitor the force required (tare-weight) to lift them from the origin point to standing in each type of transfer (toilet, bed, wheelchair) for each type of patient (min-mod-max assist). Note your force requirements and divide by ‘2’ which will give you an idea of the dynamic lift requirement. Note your hand-placement pattern during the origin and destination of the lift. What you will find is that you are doing a maximum knee to knuckle lift of between 70-100#. In the past, I have used a requirement of 70# knee to knuckle lift/pivot/knuckle to knee lower movement as a requirement.
I also use my force gauge to assess bed mobility. The static pull requirement for moving a load across a bed can be elicited by placing a backboard on the bed and laying the load (person) on it and pulling until the load moves. That is your pull requirement and can be uses as a isometric pull test in your post-offer. You will find a maximum of between 100-120# pulling force is required and I have used a 100# pull requirement in my tests.
You also need to find out how they move a fallen and unconscious patient from the floor to a bed or stretcher. Find out how many people would be lifting that person, or if they would use a mechanical assist. I have used a floor to waist lifting requirement of 35-50# in the past.
Even though I have some pretty clear ideas on common requirements, I still go through the process of doing the PDA because if your test is ever challenged the attorneys will want to know where your numbers came from. You have to demonstrate that you made the effort to objectively determine them. You will also impress your client by making the effort. As you accurately stated, you can’t blindly use the DOT as that often under-predicts what people really do.
Good luck! Let me know how it turns out.
My first reaction to Vic’s reply to the questioner, is “Great Job” and I’m glad I don’t have to do that!
Now I’d like to make a separate point to healthcare staff educators about the importance of training, since I see too many healthcare workers(hcw) hurting themselves because of inadequate preparation, body mechanics and technique when lifting and transferring pt.s.
Referring to the picture of the proposed lift from the w/c (above) I’d like to offer my own training approach.
Notice in the picture that the pt. is still seated back in the chair. He must be instructed, and or assisted, to be seated on the front edge of the seat prior to attempting any lift. That improves the leverage advantages for both pt. and hcw, as pt’s COG has less distance to travel to get over his BOS. .
Secondly, instruct and assist pt. to incline his trunk forward, as is somewhat occurring in the photo. This insures that the pt.’s COG remains over his BOS and minimizes the risk of increased torque – or pull on the hcw and a guaranteed back injury.
Regarding hcw positioning for supporting and blocking the pt. from “buckling” at the hips and knees during a lift: Ideally, the hcw can position his/her knees directly against the pt.’s and still be able to reach back and hold behind both hips. Any other positioning by the hcw can allow the pt. to slip down – out of the hcw’s control. (Sombody get me an incident report.)
More pre-lift preparation: I teach pt.s and hcws an “ABC”system prior to initiating any transfer (or functional activity) It stands for A=Align (posture awareness and correction)
B= Breathe (consciously maintaining a rhythmic breathing pattern – for relaxation and to avoid holding your breath. Counting slowly out loud facilitates steady breathing; C=Centering – taking a moment to be sure both pt. and hcw have minds and bodies working together to complete the lift, or any task safely and efficiently.
Sorry Vic – I could never do your job – but if anyone wants more ideas about training – I’m available!
I agree with all that you say and would also add that proper instruction in the use of a Gait belt focuses on the patient’s center of gravity and the belt is simply a handle to control the patient’s center of gravity. You instruct the pt. in eye to eye contact what their role will be. A Gait belt should not be mistaken for a lifting belt.
I work at a school that is expecting teacher’s assistants to transfer students (over 50 lbs) with a hoyer without any assistance. I feel this is unsafe and it should be a 2 person transfer. The school is in Illinois. Is there a regulation somewhere that I could reference to inform the school this is not acceptable?