1. Patient Transfer for Health Care Professional

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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”

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

13. 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

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

15. 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

16. 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

17. 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)

18. 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

19. 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

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

21. Answer (Question 1)
Both A and B

22. 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

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

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

25. Answer (Question 3)
False

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

27. Answer (Question 4)
C. 50%

28. 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?

29. Answer (Question 5)
False

30. 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