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PTA Blog Talk

Skilled Mechanical Lifts

Published October 18, 2013 8:18 PM by Jason Marketti

Apparently a mechanical lift is not a skilled source of treatment. Maybe that's why there are therapists out there who have no idea how some of the lifts work. If they did, they would realize there is a skilled component to ensure the patient is safe, not to mention the patient, family and caregiver training involved.

I guess the argument against a lift being part of skilled treatment is that anyone with minimal training can do it and the patient isn't actively moving, kind of like supine passive range of motion lower-extremity exercises. But wait, we bill for PROM exercises, don't we? So that's not a good example. What about a tilt table? No, we bill for that too and the patient is lying supine, not actively involved in the process. Maybe the skilled portion of the tilt table is taking the patient's blood pressure, but don't CNAs do that and not bill insurance companies for their time?

Using a lift requires skill, professional judgment of the patient's response to the lift and most of all, technique for a safe transfer. There's positioning involved in the sling as well as in a chair as the lift descends into it. If all straps aren't adequately secured, the patient could get injured. This is something home care givers and family could easily miss if they're not instructed in safe and secure transfer techniques.

Aren't patient, family and caregiver education and safety with transfers part of a skilled session of therapy? How has it been determined that a mechanical lift doesn't fit that scenario but other forms of passive activity do? Can someone explain this to me please?

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If you are consistently using a Hoyer type lift to routinely place the patient in the chair...no it is not skilled. That could be done by nursing or restorative aides. HOWEVER, IF you are educating the family or caregiver in HOW to use a Hoyer lift OR using a lift for the 1st time to determine the pt's response to tx or to set up a maintenance program for the pt, then YES IT IS SKILLED!!!! The facility I work in has Restorative aides who are very adept at performing PROM and using lifts to MAINTAIN the pt's current Level of function.

Remember the RPT needs to JUSTIFY in their evaluation the Skilled Need and then we as PTA's need to JUSTIFY it in our daily note.

Ex: Family educated in proper placement and use of Hoyer lift for safe transfers to reclining w/c. Good return demo w/ verbal and visual cues for sling alignment. Also required cues to open base of lift to promote pt safety. Requires cont'd training to ensure safe, independent operation of lift and sling.

The above describes the SKILL required and demonstrates that in this instance NOT anyone could do this.  Maybe the pt has a trach tube (vent dependent or t-bar) or has a complex medical condition that would preclude the pt being able to be transferred to a chair w/ lift by anyone BUT a therapist.

We really can't justify PROM but if we state that we are performing PROM w/ passive stretching to decrease contracture in a LE to "decrease burden of care" that is Skilled need. OR if you are performing PROM but using tapping/stroking etc to attempt to facilitate neuromuscular response post CVA...again documenting that is SKILLED.

Hope this helps!!

Veronica November 7, 2013 1:27 AM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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