Patient Transfer for Health Care

Professional

Objectives

Discuss safety pertaining to patient transferDiscuss levels of transfer and assistanceDiscuss proper body mechanicsDiscuss examination before patient transferReview of main transfer equipmentReview procedure of care to treatment table

transferReview procedure of three person carryReview 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 compromisedNever select method of transfer by easeWhen in doubt always obtain helpAlways stabilize equipment (lock..)Secure all lines when transferringUse proper body mechanics

Levels of Transfer

Independent 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 uprightBend at kneesBe 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 bedsHelpful 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 engagedSliding board is placed under patient

buttocks to the chairPatient 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 patientSides of sheet are rolled and grasped close to patientLeader should be near patient’s headIt 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 sideSupport head and UE, midsection and LEUpon command patient is moved to the edge of the cartFlex patient’s elbows – roll on his side, facing personnelUpon command patient is liftedUpon command personnel walks backward to pivot 90

degrees or until patient is aligned with treatment tableUpon 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 priorityGait belts, sliding boards, hydraulic lift, wheel

chairs, and carts are main transfer equipmentKnowledge level of transfers and assistances will

aid staff to evaluate appropriate transfer techniqueProper body mechanics must be adhered toAppropriate steps should be taken based on the

type of transfer

Question 1

Body mechanics ensures the safety of the _________?

A. PatientB. Staff membersC. EquipmentD. Both A and B

Answer (Question 1)

Both A and B

Which is NOT an important factor for safe transfers?

A. Safety must never be compromisedB. Always select method of transfer by easeC. When in doubt always use an assistantD. 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.

A. 15%B. 25%C. 50%D. 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.comwww.meiresearch.orgwww.okcareertech.orgDuesterhaus Minor, M.A. and Duesterhaus

Minor, S. (2006). Patient Care Skills, 5th ed. Upper Saddle River, NJ: Pearson