Patient Transfer for Health Professional

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

Generalizability and Examination The goal to 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 by some examinations:  Strength  Range of motion  Pain  Cognitive abilities  Movement dysfunctions

Safety First Safety must never be compromised Never select method of transfer by ease When in doubt always use an assistant Always stabilize equipment (use wheel locks) Secure all lines when transferring Use proper body mechanics

Levels of Transfer Independent transfer: patient is able to perform all aspect of transfer without assistance by additional personnel Assisted transfer: patient participate actively with some assistance form personnel Dependent transfer: patient does not participate actively or participate on minimal basis

Levels of Assistance Standby assistance – patient 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 have a likelihood for needing physical assistance such as balance or support Contact guarding – patient is able to perform transfer with minimal assistance; constant contact should be used to insure safety Minimal assistance – patients who 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 condition changes When more than one person is required for transfer chart will indicate  Example: Moderate x2

Body Mechanics Create a good base by keeping feet at shoulder width Keep back upright Bend at knees Attention to center of mass and base of support reduces strain on staff member(s) back and upper extremities Control appropriate aspect of patient’s anatomy to provide support  Under buttocks for lifting  Behind the 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 a patient’s confidence) Personnel performing transfer should avoid wearing jewelry that can entangle or scratch patients during patient care All equipment should be ready before transfer begin  Example: Speak to floor nurse to prepare

Instructions and Verbal Cues Clear and define instruction should be verbalized clearly to patient and assistance(s) Patients feel comfortable knowing what is about to take place Never move patient on a number instead use action words example: 1. “ I will count to three and then give the command to lift” 2. “When I say ‘lift,’ we will lift.” 3. The leader should visually and verbally check to make sure that patient and assistance are ready 4. The leader says “ One, two, three, lift”

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

Hydraulic Lift Use to transfer patients to chairs and beds Helpful in moving difficult transfer patients (Especially with overweight patients) 450 pounds capacity on average

Gait Belts Gait/transfer belts can wrap around the waist of a patient providing handles for a worker to grasp when assisting or transferring a partially dependent patient Small hand-held slings that go around the patient can aid in transfer by providing handles Handles improves the grasp opportunity for the worker and thereby reduces the risk of accidents Gait/transfer belts can wrap around the waist of a patient providing handles for a worker to grasp when assisting or transferring a partially dependent patient Small hand-held slings that go around the patient can aid in transfer by providing handles Handles improves the grasp opportunity for the worker and thereby reduces the risk of accidents

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 Wheel locks are engaged Sliding board is placed under patient buttocks to the chair Patient does a series on push ups, with guidance from the technician, 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 the patient Sides of sheet is rolled and grasped close to the patient Leader should be near patients head If patient is unable to control their head and neck, then leader should one arm under the patient’s shoulders 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 controlling lower extremities, and other assistant on the other side On leaders command move patient (may kneel on table if can not reach across.)

Three Person Carry Tallest, if strong enough, at the head All three movers on the same side Support the head and upper extremities, midsection, and lower extremities Upon command patient is moved to the edge of the cart By flexing elbows patient is rolled on to his side, facing personnel Upon command patient is lifted Upon command personnel walk backward to pivot 90 degrees or until patient is aligned with treatment table Upon command personnel flex their legs until elbows rest on the edge on the table then uncradle slowly and align patient

Summary Before transferring examine patient strength, range of motion, pain, cognitive abilities, and movement dysfunction Safety of patient and staff should be prioritized Gait belts, sliding boards, hydraulic lift, wheel chairs, and carts are main transfer equipment Knowledge levels of transfer and assistances will aid staff evaluate transfer Proper body mechanics should always be used in transfers Steps should be followed when transferring patient from cart to treatment table Steps should be followed when transferring patient by means of three person carry Steps should be followed when transferring patient to wheelchair using a sliding board

Question 1 Body mechanics ensures the safety of the_______. A. Patient B. Staff member C. Equipment D. Both A and B

Answer (Question 1) D. Both A and B

Question 2 Which is not an important factor in safe transfers? A. Safety must never be compromised B. Always select method of transfer by ease C. When in doubt always use an assistant D. Always stabilize equipment E. Use proper body mechanics

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

Question 3 True or False? 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 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 presents of patient because it brings anxiety to the patient

Answer (Question 5) False

References Duesterhaus Minor, M.A. and Duesterhaus Minor, S. (2006).Patient Care Skills fifth edition. Upper Saddle River, NJ: Pearson