When should you not use a hoist? A guide to safe patient transfers

Approximately 20% of nursing staff injuries in healthcare settings are related to improper patient handling. Knowing when should you not use a hoist is crucial for preventing harm and ensuring a safe, dignified transfer for the individual in your care.

Quick Summary

A hoist is not always the safest choice; avoid using one for agitated patients, those with specific spinal or skin conditions, or when a less intrusive method is more appropriate and empowers the patient. The decision requires a thorough risk assessment.

Key Points

• Patient State: Never use a hoist on an agitated, combative, or severely confused patient who cannot follow instructions, as this can lead to falls or distress.

• Specific Injuries: Avoid hoisting patients with unstable injuries, such as recent spinal surgery, hip fractures, or fragile skin, where pressure from a sling could cause harm.

• Correct Equipment: Do not use a hoist if the sling is damaged, incorrectly sized for the patient, or incompatible with the specific lift, which could result in a fall.

• Unsuitable Environment: A hoist is inappropriate if the transfer path is obstructed, the floor is uneven, or the space is too confined for stable, safe movement.

• Weight Limits: Always verify that the patient’s weight does not exceed the safe working load (SWL) of both the hoist and the sling to prevent equipment failure.

• Proper Training: Hoisting should only be performed by personnel who have received up-to-date and specific training for the equipment being used.

Understanding the purpose of a patient hoist

A patient hoist, or mechanical lift, is a valuable tool to help caregivers move individuals with significant mobility limitations. It reduces manual lifting, which prevents injuries to both caregiver and patient. However, it's not always suitable and improper use can lead to serious injuries such as falls, fractures, and skin trauma.

Key indicators for avoiding hoist use

There are several critical situations where using a hoist is unsafe or inappropriate. Recognizing these contraindications is essential for responsible caregiving.

Physical conditions that contraindicate hoisting

Using a hoist can worsen certain medical conditions or cause injury due to the physical strain and positioning. Always consult a healthcare professional before using a hoist on patients with conditions like unstable spinal or hip injuries, extremely fragile skin or open wounds, severe respiratory compromise, or significant pain.

Behavioral and cognitive considerations

Safe hoisting requires patient cooperation. Avoid using a hoist if the patient is agitated, resistant, combative, unable to follow instructions due to cognitive impairments like advanced dementia, or is fearful of the equipment, as this can lead to struggles and injury.

Environmental and equipment-related constraints

The environment and equipment must be suitable. Do not use a hoist if the equipment is damaged, the wrong sling is used, the floor surface is uneven or heavily carpeted, there is insufficient space for maneuvering, or the patient's weight exceeds the safe working load of the hoist or sling.

Alternatives to mechanical hoists

When a hoist isn't suitable, consider alternative devices and techniques based on the patient's needs and mobility level.

Comparison of transfer aids

Transfer Aid	Best For	Considerations
Sit-to-Stand Lifts	Patients with some weight-bearing ability who can actively participate and have good trunk control.	Requires the patient to be cooperative. Not for those with poor leg strength or balance.
Transfer Belt (Gait Belt)	Patients who can bear weight and need minimal assistance with balance during a stand pivot transfer.	Requires the caregiver to have a secure grip and good body mechanics. Unsafe for heavier patients or those requiring substantial support.
Sliding Board (Transfer Board)	Patients with good upper body strength who are unable to bear weight on their legs (e.g., lower limb amputation).	Requires a smooth surface and clearance. Not for those with poor trunk control or who cannot follow commands.
Slide Sheets	Repositioning dependent patients in bed or facilitating lateral transfers between flat surfaces.	Not a lifting device. Requires multiple caregivers for safety and effectiveness.

The crucial role of training and assessment

A thorough risk assessment is vital before any patient transfer, considering the patient's condition, the environment, and equipment suitability. Caregivers need proper training not only on how to use a hoist but also on when to choose alternative methods. Resources like the FDA Patient Lifts Safety Guide offer valuable guidelines, including matching slings and regular equipment checks. Neglecting these steps increases injury risk and can have legal consequences in professional settings.

Conclusion: Prioritizing safety and dignity

A patient hoist is a valuable tool, but knowing when should you not use a hoist is fundamental to safe patient handling. By assessing the patient's condition, ensuring appropriate equipment and environment, and being skilled in alternative techniques, caregivers can prevent serious accidents. Informed decisions, proper training, and adherence to safety protocols are essential for safe and compassionate care.

Frequently Asked Questions

When should you not use a hoist for a patient with dementia?

A hoist should not be used for a patient with dementia if they become agitated, resistant, or frightened by the process. Their confusion may prevent them from following instructions, making the transfer unsafe for both the patient and caregiver.

Is it ever safe to use a hoist alone?

Using a hoist alone can be unsafe, especially for heavier or more complex transfers where two or more trained caregivers are often required to ensure stability and proper positioning. While not always illegal, it may violate specific safety protocols and increase the risk of injury.

What are the risks of using the wrong sling size with a hoist?

Using a sling that is too small can cause discomfort and worsen a patient's condition, while a sling that is too large increases the risk of the patient slipping out and falling, potentially causing serious injury or death.

Can you use a hoist to lift someone who has fallen on the floor?

Yes, specialized floor lifts are designed for this purpose. However, a standard mobile hoist may not be suitable. It's crucial to assess the patient for injuries before lifting and to use the correct equipment.

What should I do if the hoist's battery dies mid-transfer?

Electric hoists are equipped with an emergency manual release feature to slowly and safely lower the patient. It is vital to know the location and function of this feature before use.

When is a slide board a better option than a hoist?

A slide board is a better option for a patient with good upper body strength who is unable to bear weight on their legs but can assist with the transfer, such as someone with paraplegia or a lower limb amputation.

How often should hoist equipment be checked for safety?

For safety and legal compliance, hoists should undergo regular maintenance checks by a trained technician, typically annually. Additionally, a visual inspection of the hoist and sling should be performed before every single use to check for any signs of wear or damage.