Patient Transfer for Health Care Professional

Objectives Discuss safety pertaining to patient transfer Discuss levels of transfer and assistance Discuss proper body mechanics Discuss examination before patient transfer Review of main transfer equipment Review procedure of care to treatment table transfer Review procedure of three person carry Review procedure of sliding board and wheel chair transfer

Generalizability and Examination The goal of transfer training is generalizability Generalizability means that some skills learned for one transfer can be used for other transfers Patients should be accessed for function capabilities before transfer as noted below: Strength Range of Motion Pain Cognitive abilities Movement dysfunction

Safety First Safety must never be compromised Never select method of transfer by ease When in doubt always obtain help Always stabilize equipment (lock..) Secure all lines when transferring Use proper body mechanics

Levels of Transfer Independent Transfer: Assisted Transfer: Patient is able to perform All aspects of transfer WITHOUT assistance by additional personnel Assisted Transfer: Patient participates actively with some assistance from personnel Dependent Transfer: Patient DOES NOT participate actively or participate in transfer

Levels of Assistance Standby Assistance: - patient is able to perform transfer on their own, but may require some verbal cues Close guarding: patient is able to perform transfer on their own, but may be limited by their balance and limited strength Contact guarding: patient is able to perform transfer with minimal assistance – constant contact should be used to insure safety

Level of Assistance Continued Minimal assistance: patient can perform at least 75% of the activity Moderate assistance: patient can perform at least 50% of the activity Maximum assistance: patient can perform less than 25% of the activity

Amount of Assistance Level of assistance changes as patient’s condition changes When more than one person is required for transfer utilize moderate x2 assist (for example)

Body Mechanics Create a good base by keeping feet at shoulder width Keep back upright Bend at knees Be attentive to center of mass and base of support – reduces strain on back and upper extremities Control appropriate aspect of patient’s anatomy to provide support Under buttocks for lifting Behind hips for moving patient into your base of support

Preparing the Environment Consideration of direction of transfer from LEFT to RIGHT or RIGHT to LEFT Moving patient to their STRONGER SIDE is the easiest (also bolster’s patient’s confidence level) Personnel performing transfer should avoid wearing jewelry that can entangle or scratch patients during patient care All equipment should be ready BEFORE transfer begins Example: coordinate with floor nurse prior to transfer

Instructions and Verbal Cues Clear and define instruction should be verbalized clearly to patient and assistant(s) Patients feel comfortable knowing what is about to take place Never move patient on a number INSTEAD use actions words as noted below: “I will count to three and then give the command to lift” “When I say “lift”, we will “lift” The lead should visually and verbally check to make sure the patient and assistant are ready The leader says “One, two, three, lift”

Equipment Some equipment used in patient transfers: Wheelchairs Cart or trolley Hydraulic lift Gait belts Sliding board

Gait Belts Gait, transfer belts can wrap around the waist of the patient providing handles for the personnel to grasp when assisting or transferring a minimal assist patient Small hand-hold slings that go around the patient can aid in transfer by providing handles Handles improves the grasp opportunity for personnel and thereby reduces accidents and possible skin shearing…tearing

Hydraulic Lift Used to transfer patients to chairs and beds Helpful in moving difficult transfer patients (obese) 450 pound capacity on average

Sliding Board Sliding boards are usually made of a smooth rigid material Sliding boards vary in shape and material Boards act as a supporting bridge when seated slide transfers are performed

Sliding Board with Wheel Chair Wheelchair and table are parallel, or at a slight angle Wheels locks are engaged Sliding board is placed under patient buttocks to the chair Patient DOES a series of push ups, with guidance from personnel, sliding into the wheelchair Patient leans AWAY from the wheel chair and board is removed Vise-versus from chair to table

Sliding Transfer (Cart to Treatment Table) Draw sheet is placed under patient Sides of sheet are rolled and grasped close to patient Leader should be near patient’s head It patient is unable to control their head and neck, then the leader should place one arm under the patient’s should while cradling the patient’s head If movement cannot be controlled or if a patient is agitated, a sheet may be wrapped around patient for better control Place cart and table side by side with leader at head, assistant controls LE, and other assistant control other side On leaders command move patient (may kneel on table if cannot reach across)

Three person carry Tallest person (if strong enough) is at the head All three movers on the same side Support head and UE, midsection and LE Upon command patient is moved to the edge of the cart Flex patient’s elbows – roll on his side, facing personnel Upon command patient is lifted Upon command personnel walks backward to pivot 90 degrees or until patient is aligned with treatment table Upon command personnel flex their legs until elbows rest on edge of table then uncradle slowly and align patient

Summary Before transferring patient, examine patient strength, ROM, pain cognitive abilities, skin integrity, and movement dysfunction Safety of patient and staff is priority Gait belts, sliding boards, hydraulic lift, wheel chairs, and carts are main transfer equipment Knowledge level of transfers and assistances will aid staff to evaluate appropriate transfer technique Proper body mechanics must be adhered to Appropriate steps should be taken based on the type of transfer

Question 1 Body mechanics ensures the safety of the _________? Patient Staff members Equipment Both A and B

Answer (Question 1) Both A and B

Which is NOT an important factor for safe transfers? Safety must never be compromised Always select method of transfer by ease When in doubt always use an assistant Use proper body mechanics

Answer (Question 2) B. Always select method of transfer by ease

Question 3 Never consider the direction of transfer (Left to Right or Right to Left).

Answer (Question 3) False

Question 4 Moderate assistance refers to the patient’s being able to perform at least _______ of the activity. 15% 25% 50% 75%

Answer (Question 4) C. 50%

Question 5 True or False: Staff should never discuss plan of transfer in the presence of patient because it increases the patient’s anxiety level?

Answer (Question 5) False

References www.gendronine.com www.meiresearch.org www.okcareertech.org Duesterhaus Minor, M.A. and Duesterhaus Minor, S. (2006). Patient Care Skills, 5th ed. Upper Saddle River, NJ: Pearson