PATIENT TRANSFERS DIAGNOSTIC MEDICAL SONOGRAPHY PROGRAM Dr. Kristin Schroeder, PT, DPT

OBJECTIVES Demonstrate proper techniques in:  Transferring the patient from Wheelchair to Exam Table  Transferring the patient from the Exam table to Wheelchair  Transferring the patient from Stretcher to Exam table  Transferring the patient from Exam table to Stretcher

STATISTICS Top 5 causes of injury among hospital workers: 1.Overexertion and bodily reaction (48%) 2.Slips, trips, and falls (25%) 3.Contact with objects (13%) 4.Violence (9%) 5.Exposure to substances (4%)

BODY MECHANICS Definition: Occupational positioning and use of the body that leads to forces and stresses to body structures Video: g8YAyRp4oTV_0&index=2 g8YAyRp4oTV_0&index=2 Use of proper body mechanics will:  Protect yourself and patient from injury  Reduce physiological and anatomical stress and strain to your body  Provide efficiency for lifting, reaching, pushing, and pulling by reducing the amount of energy expenditure  Allow you to safely manage and move patient patients, equipment, and supplies  Allow you to form good habits to maintain comfort, ease and consistency of movement

PRINCIPLES OF LIFTING AND TRANSFERS  Preventative and planning activities  Take care of your back  Reduce the effect of levers  Improve stability  Instruct assistants or patients PRIOR to the move  Give your full attention to the task

BODY MECHANICS PRINCIPLES FOR LIFTING  Wide base of support  Maintain lumbar neutral  Bends at hips and knees  Uses weight shift for standing transition of weight  Avoids twisting of lumbar spine  Keeps patient/object close to reduce lever arm of weight  Moves in a smooth and controlled manner  KNOW YOUR CAPABILITIES!!! NOT GOOD!

DEFINITION OF A TRANSFER Safe movement of a person from one surface, location, or position to another surface ***Remember, there is always a risk for falls, and no transfer technique is without risk. BUT, learning how to properly transfer patients minimizes the risks.***

THINGS TO REMEMBER WITH PATIENT TRANSFERS  Never leave a patient unattended on the exam table  To protect your back, always uses your legs to lift; not your back  Move your feet during the pivoting process to maintain proper back alignment and balance  For patients with fragile skin, remember to use your hands and not your fingers during transfers  Learn how to attach and detach wheelchair foot rests prior to an actual transfer  Be aware of IVs and Foley catheters when transferring patients. Keep Foley catheter collection units LOWER THAN the Foley insertion site.  If you are uncertain about a patient’s ability to assist with a transfer, CALL FOR HELP!

ASSISTANCE TERMINOLOGY  Dependent = clinician performs 100%  Maximum Assistance = patient 25-50%, clinician > 50%  Moderate Assistance = patient 50-75%, clinician 25-50%  Minimum Assistance = patient 75% or move, clinician < 25%  Contact Guard Assistance = hands on, patient MAY need assistance  Stand by Assistance = verbal/tactile cues, not hands on but clinician is close by  Independent = does not require cues or physical assistance

PREPARATION FOR TRANSFER  Make sure patient is wearing non-skid socks, shoes, or slippers  Explain transfer procedure to patient  Position the wheelchair with stronger lower extremity on side toward transfer (if applicable)  Wheelchair should be placed close to the exam table  LOCK the wheelchair and remove the footrests (if applicable)  If patient cannot use theirs legs or health status has changed since transferring to exam table, use a lift to transfer or send patient back on stretcher.  Log roll when appropriate

LOG ROLL TECHNIQUE Log rolling keeps the spine in alignment to help maintain patient safety and comfort. STEP 1 STEP 2

WHEELCHAIR  EXAM TABLE 1. Position the exam table at the lowest level. 2. Wheelchair placed with patient’s stronger side next to the exam table. 3. Lock the wheelchair brakes. 4. Remove feet from foot rests then remove foot rests from wheelchair. 5. Explain the sequence of the transfer to patient. 6. Apply gait belt. 7. Clinician place hands on gait belt. 8. Bracket their feet with your feet to prevent slipping. 9. Using leg muscles, assist patient with transfer by slowly lifting upward. At the same time, patient should place hands by side and push off support surface to assist with transfer. 10. Take small steps to pivot towards bed. 11. Have patient reach for exam table as you slowly lower them. 12. Log roll technique into supine position. 13. Position for comfort; blanket if needed.

EXAM TABLE  WHEELCHAIR 1. Log roll patient from supine into sitting 2. Let patient sit for a few minutes secondary to dizziness. 3. Lower exam table (if possible). 4. Explain the sequence of the transfer to patient. 5. Place gait belt around patient’s waist. 6. Stand patient at edge of bed using your legs. At the same time, patient should place hands by side and push off support surface to assist with transfer. 7. Take small steps to pivot towards the wheelchair. 8. Have patient reach for arm rests as you slowly lower them into wheelchair. 9. Replace foot rests and lock into place. Assist patient, as needed, with getting feet onto foot rest.

EXAM TABLE  STRETCHER 1. Locks the exam table and stretcher. 2. Position the exam table and stretcher so they are at the same height. 3. Lower the side rails of the exam table and stretcher. 4. Position at least one helper on each side of the exam table and stretcher. 5. Move the patient to the side of the stretcher. 6. Align patient’s legs and head with trunk. 7.Helper on side of stretcher opposite exam table turns patient away from exam table while other helper places transfer board. 8. Use draw sheet to slide patient across transfer board onto exam table. 9. Turn patient away from stretcher and removed board and transfer sheet. 10. Reposition patient on exam table for comfort and alignment, blanket if needed. 12. Raises exam table side rails. (if present)

STRETCHER  EXAM TABLE Reverse steps from above!

REMEMBER… If the patient starts to fall during the transfer, lower them down to the nearest flat surface, bed, chair or floor. Do NOT attempt to stop them from falling. This may cause injury to your back. “GO DOWN WITH YOUR PATIENT.”

Time to practice!!!