Practical Guides #9. How to do an environmental assessment for a mobile hoist and a profiling bed

This post will cover:

• What is a mobile hoist
• Why they are needed
• What to do and look for on your environmental assessment

Disclaimer: assessing for a hoist is complex. Always consult with your supervisor throughout this process and do not simply rely on this article

So today I thought that I would write about how to do an environmental assessment for a hoist and hospital bed. I remember during my community rotation being very nervous about doing these as I’d not had much experience with hoists. I worried that if I got the assessment wrong, the implications could be great. If  there isn’t enough room for a hoist to manouvre then the patient would be discharged bed bound. It’s a lot of responsibility.

In order to improve my skills, I took some measurements of a nearby hoist and I shadowed more experienced OT’s doing hoist environmental assessments. I then made myself a checklist of things to consider when doing my assessment. Please also see my guide for doing a standard environmental assessment.  On my last rotation (elderly rehab) I was dealing with more complex discharges and often sending people home with hoists, so I built upon this knowledge from an inpatient perspective. I would also like to credit my last band 7 who also added a few things to my checklist to consider. Thanks Helen Mc!

http://www.jacksonsleisure.co.uk/disability-aids/hoists/lifts.htm

What is a mobile hoist?

For the purposes of this blog post I will be talking about a mobile hoist (not a gantry, track or stand-aid hoist). Hoists enable the carer to transfer a person with limited function without putting unnecessary strain on the carer. The person is lifted in a sling attached to the hoist and transferred on and off commode/bed/chair/wheelchair/shower chair. This means that the person being hoisted is completely passive during the process.

Why am I doing a hoist environmental assessment?

Because you, another OT or physiotherapist has assessed that the patient needs a hoist on discharge and you need to check whether there is going to be enough room at home for the full hoist set-up.  When you’re putting in a hoist, a hospital bed is usually ordered to enable the carers to assist with their manual handling and you’ll usually also issue a glide about commode.

So, at a basic level, you will be assessing.

• Is there room for a bed and commode? Where?
• Is there room for the hoist to manoeuvre?
• Will the hoist go round/under the chair or will they need a different chair?
• Advise on the environment and placement of equipment.

 

OK, so come with me. Picture yourself outside someone’s house, about to do your environmental assessment and I’ll walk you through it.

Access

OK, you’re stood outside the house looking at the front door. The first thing that you’ll need to consider is how will the patient get through the front door on arrival to property. Can you see if there is sufficient room to get a wheelchair or stretcher into the property? If not, are there any alternate entrances they can use like a back door or patio doors?

Next you’ll need to see if there is enough room to get the hoist through the door. Measure the door width from the edge of the door near the hinges door to door jam. Sounds a bit technical but you’re just checking if the door was wide open as much as it could be (without removing the door), would you get the hoist through?  You’ll need about 27” for a standard mobile hoist.  FYI your standard door width is usually 28”. If the door is too small, you’ll need to advise that the hoist will need to be disassembled by your local equipment stores to fit through the door and reassembled inside. Consider if there is any tight access points on entrance like tiny porches or narrow hallways.

You’ll also need to measure in the same way all door widths that the hoist will be going through.

Steps outside front access

Are there any steps or stairs up to the property? Again, will a wheelchair or stretcher get up them?  Will you be able to get the hoist up the steps into the property?  Can you get the hoist in?

• Measure height of steps (including any lips on the doorway)
• tread
• threshold into hallway.
• Are there any ramps or lifts?
• Note number of steps

 

Rooms

You’ll need to ask the patients family member or representative what rooms the patient will be using. Will they be using one room or multiple rooms? Mobile hoists are for use in one room at a time. Clients are only hoisted and transported for a very short distance (ideally only  a 90 degree turn). If a person wishes to use another room they need to be hoisted into a wheelchair, shower chair or glide about commode and transported to another room and the hoist will need to be wheeled into that room separately by a carer. Then the client is hoisted in the second room (more on this later) onto another bed/chair etc.

Sounds a bit overly complicated? Let me bring it to life a little;  here are some examples of single or multiple room living that I have seen are:

• Staying in one room. Chair/bed/commode all in one room. Hoist stays in this room (single room living).
• Patient is sleeping in the front room and using the back room as their living room. They are hoisted onto glide about commode in front room and  wheeled into back room and then the hoist is wheeled through to the back room and then hoisted from commode onto armchair.
• Patient sleeping in front room, hoisted in to electric wheelchair and takes self into kitchen and dining room in their wheelchair.
•  Living and sleeping in the living room and using the bathroom (on the same level). Client is hoisted onto shower chair/ or commode in living room and wheeled into level access shower for wash/toileting and then wheeled back into living room and then hoisted onto bed or armchair.

 

So consider how this person will be transported to the other room and what transfers they will have to do in that room. Think about whether the corridor is wide enough for the hoist or commode if it has to go into other rooms, especially when turning a corner.

Look at the flooring in these rooms, you’ll probably be recommending that a smooth floor is best for the wheels of the hoist to glide. Check the floor is level and free from trip  hazards. Advise to take up the little rugs, squares of carpet. Check there’s no holes or tears in flooring. Be aware of any deep pile carpets as this can make it extremely difficult to  move the hoist.

The room that is being used with the hoist needs to be empty as possible. Advise on specific furniture that may need to be removed or relocated.

Tasks

Consider what  the patient be hoisted to and from. What will be the transfers?

Bed

You need to advise on the placement of bed.

Measure the rooms identified to see if there is enough space for a hospital bed. Ideally away from the wall to allow carer access either side. Or if the bed is going into a corner ensure that bed can be pulled away with adequate space either side for carer access. You need approx 190×90 cm for a hospital bed. You’ll need to check that there are enough plug points for the hoist, the hospital bed and you’ll need another plug if the patient is having a dynamic mattress (e.g Air Flow).

Although not specifically part of the environmental assessment, a hospital bed can be set up on 2 different settings:  ultra-low or standard. Consider the ultra-low setting when reducing the falls risk if cot sides are not appropriate (You’ll also want to look at bed wedges or crash mats if this is the case). Tell equipment stores if you want the bed set at ultra low on your equipment form.

If you are having cot sides, please bear in mind that community equipment stores’ cot sides cover the whole of the bed length and come in either 2 bar or 3 bar models. You need to select 3 bars if patient is having dynamic/pressure mattress. You’ll also need to order slide sheets to enable to carers to position the patient in bed.

Chair

Is the chair suitable for the patient to be hoisted into?  You’ll need to take measurements of the height.  If it’s got a recline on the chair or it’s a slouchy armchair it can be difficult to get the patient in a good position in the chair from the hoist. Check if the hoist can get it’s legs underneath the armchair. Take measurements of the gap below the seat to the floor.  You’ll need approx 11-15cm to get those legs in. If there’s no room for the hoist legs to go under the chair, look at whether the hoist legs will be able to go around the chair. You’ll need approx 76cm, as this is the mid point of the legs where the boom is.

Chair and bed should be at 90 degrees to each other to minimise time in hoist. You may want to advise on placement of these items.

Shower chair/wheelchair/Commode/Toilet

Check if there is adequate room for this equipment. In the hoist set-up I would usually order a glide about commode. As the commode has wheels and can be manoeuvred into the best position for transfers. In addition a glide about commode and has brakes so it doesn’t need to be positioned against the wall like the static commode so reduces time using the hoist. Also providing if there is room, a glide about can be put over a normal toilet so people can feel a bit more dignified about their toileting. Mostly downstairs toilets are tiny, so often this can’t be done.

Don’t forget the little things too. Just because someone is going home on a hoist, they may still want to be able to do things for themselves. So think whether they will be able to turn on their lamp, see their TV, Turn on their radio or alarm clock from their bed. Consider if there is room for an over bed table. We only issue these in very particular situations. I would advise that the client purchases one themselves and can be picked up cheaply from Argos. Or think about whether there is room for a bedside table.

Space

Is there adequate space to carry out the transfers?  Hoist legs are about 110cm length, a pretty basic way of seeing if you’ve got enough space is to get your tape measure, fix it at 110cm. Imagine where the bed is going to be. Imagine the legs going under the bed, coming out and turning onto a chair.   This is difficult, especially if you have rubbish spatial awareness like me. Take a more experienced OT with you the first few times to see if they agree with you.    A mobile hoist needs min turning space of 1.20 m2.  The recommended turning space of mobile hoist by a bed is 3.6 m, according to Invacare.

Advise if there is there anything in the way that can be moved to make room for the hoist to manouvre.

If the hoist is to be used in multiple rooms, can the hoist fit down the corridor?

Safety

How are the rooms heated?  Is there a fire in the room? If someone is in a room with a gas fire , check it has been safety checked and recommend a carbon monoxide alarm. How will the persons heating come on? Is it on timer or is there someone available to put it on? You may need to ask carers to put the heating on if there is no one available to do this.  Another option is the Hive system if the client is au fait with technology, where the heating can be controlled by an app on a smartphone.

Ask where the smoke alarms are and when they were last checked.

If someone will be upstairs living advise that they will need to call the local fire service to let them know. The fire service has a database and need to know for rescue purposes.

Note if  there a Lifeline/falls alarm system in the house

If a loved one is upstairs sleeping, how will the client get that persons attention if they need something? You may want to advise a wireless doorbell or baby monitor.

On discharge

Lastly on discharge, a home visit is required with the patient to check the hoist and transfers to check everything is OK moving forward and any problems can be sorted. Before the patient comes home advise the relative to put the hoist on charge.

I hope this has been useful. This will probably be my last physical health post for a while as I leave the physical health world and go into mental health. I hope my practical guides have been useful to you all out there. I may even revisit some of them adding extra insights from the mental health perspective.

Take care and thanks for reading

Helen