Tips for Safe Patient Transfers

Patient transfers are common ways that health care professionals and patient caregivers harm themselves. It’s important to know proper transfer techniques to protect yourself, so that you can continue providing the best care possible to your patient.

What is a transfer?

A transfer is a method of moving a patient from one surface to another, where the patient is capable of helping with the transfer and is able to bear weight on at least one of his or her legs.

Common places transfers occur:

• Onto/ off toilet
• Into/ out of bed
• Into/ out of wheelchair
• Into/ out of chair
• Into/ out of bathtub
• Into/ out of car

Types of transfers:

• Stand Pivot
• Stand Step
• Sliding
• Bent Pivot
• Dependent
• Mechanical Lift

Common causes of injury:

• Sudden changes in patient alertness
• Lack of preparation before transfer
• Using improper body mechanics, such as twisting of the trunk
• Environmental complications (ie. slick floors, inappropriate shoes)
• Patient’s fear of falling
• Not asking for help when it’s needed
• Being in a hurry

Helpful equipment for transfers:

• Sliding boards
• Walkers
• Grab bars
• Trapeze bar
• Various types of lifts

Guidelines and Tips for Using Proper Body Mechanics:

• Set up is key. Have the surfaces you’re transferring to and from as close as you can. Have everything you’ll need before and during the transfer within arms reach.
• Give clear, concise, and short directions before and during the transfer for the patient.
• Demonstrate to the patient what you would like for them to do before performing the transfer.
• Agree on timing of transfer with patient. Counting to three before trying to transfer the patient may be helpful.
• When the patient is changing positions to/ from lying, sitting, or standing, let him or her remain in the new position for a few seconds to allow their blood pressure to stabilize before you instruct them to start moving.
• Use a gait belt at all times if you have access to one. If you don’t have access to one, use the patient’s pants or belt.
  • Always check to see if patient has a colostomy bag or feeding tube before putting on a gait belt.
• Verbalize any postural observations that can be fixed and will be problematic for the transfer. For example, if the patient is slumped over, ask him or her to sit straight up.
• Never let a patient hold onto your neck when transferring.
• Never put a gait belt or your arms/ hands under a patients arms (in the armpit) during transfers, because this could damage the cluster of nerves located there, called the “brachial plexus”.
• When possible, have a client move towards his or her strong side of their body.
• Use proper body mechanics:
  • Keep the patient close to you.
  • Keep the patient facing you.
  • Keep your knees bent.
  • Use your leg muscles instead of back muscles as much as possible.
  • Keep a straight, neutral spine (not arched or curved forwards or backwards).
  • Place feet shoulders width apart.
  • Keep heels firmly planted on the ground.
  • Consider patient’s weight and assistance level needed. Don’t attempt more than you can handle.
  • Avoid twisting or rotating your trunk. Use pivots or steps instead of rotating and twisting.
  • Avoid combining movements, such as rotating and bending at the same time.
• Consider the following before doing the transfer:
  • Patient’s medical precautions
  • Number of people needed for a safe transfer
  • Time needed for a safe transfer
  • Client’s ability to understand you and your directions
  • Environmental barriers or opportunities (remove all clutter, and leave enough room for the two of you to move freely)
    

Stand Pivot Transfer

1. Get the surface the patient is moving to and the surface the patient is moving from as close as you can while still leaving enough room for the two of you to move freely.
2. If possible, situate the chair in the appropriate position for the patient to move towards his or her strong side.
3. Have the client move from a higher surface to a lower surface if you have control over surface heights. (ie. If patient is transferring from the edge of his or her bed to his or her wheelchair, raise the bed so that it’s somewhat higher than the wheelchair.)
4. Angle the chair 45^O-90^o to the surface you’re moving towards.
5. Lock the brakes on wheelchair.
6. Have the patient scoot as close to the edge of his or her chair as is safely possible.
7. The patient’s heels should be angled to the surface you’re moving towards.
8. Instruct the patient to position his or her feet directly under his or her knees or a tiny bit behind the knees. (Injury could happen if the feet are too far back or too far forward.)
9. With your knees and feet, straddle the patient’s leg that is farthest from the surface you’re transferring towards. (ie. if you’re having the patient move from bed to a wheelchair, then the order of feet would be bed, your foot, their foot, your foot, their foot, then the wheelchair.)
10. Communicate timing of the transfer. Count to three then rock the patient’s hips and buttocks towards you, then gently move them forward away from you into his or her chair. Instruct the patient to push up from the first surface in order to help you get them up.
11. During the transfer, the patient should reach his or her hands to their corresponding arm rests on the chair to help them guide their body’s movements. This will help to promote confidence in the patient with the transfer and to promote safety during transfers with no falls.

Resource:

Youtube video

 

Sliding Board Transfer

1. Get the surface the patient is moving to and the surface the patient is moving from as close as you can while still leaving enough room for the two of you to move freely.
2. If possible, situate the chair in the appropriate position for the patient to move towards his or her strong side.
3. Have the client move from a higher surface to a lower surface if you have control over surface heights. (ie. If patient is transferring from the edge of his or her bed to his or her wheelchair, raise the bed so that it’s somewhat higher than the wheelchair.)
4. Angle the chair 45^O-90^o to the surface you’re moving towards.
5. Lock the brakes on wheelchair.
6. Remove the arm rests on the chair, bedside commode, and/ or bed.
7. Lift the leg closest to the transfer surface and place the sliding board under the leg (mid thigh between the buttocks and the knee, angled toward the opposite hip).
8. The board must be firmly under the thigh and firmly on the surface that the client is transferring towards.
9. Block the client’s knees with your own knees.
10. Instruct the client to place one hand on the edge of the board (don’t let them put any part of their hands under the sliding board) and the other hand on the surface he or she is transferring to.
11. Instruct the client to lean forward and slightly away from the surface they are transferring towards.
12. The client should then transfer his or her upper body weight in the direction opposite of the surface they are transferring. The client should use both arms to lift or slide the buttocks along the board.
13. Assist the client when they need help shifting weight and supporting the trunk while he or she is moving.
14. A pillowcase can be placed on the sliding board if the patient is sliding on bare skin to prevent skin shearing or tears and to make the transfers easier. Use this instead of powder, because powder can end up on the floor causing the patient to slip.

Resource:

Youtube video

http://www.youtube.com/watch?v=0RXvkJFzppc&list=UUmY1FzEEDRdhjMqfPoxZa_w&index=4&feature=plcp

Bent Pivot Transfer

1. Get the surface the patient is moving to and the surface the patient is moving from as close as you can while still leaving enough room for the two of you to move freely.
2. If possible, situate the chair in the appropriate position for the patient to move towards his or her strong side.
3. Remove the arm rest located between the surfaces that the patient is transferring to and from if possible.
4. Have the client move from a higher surface to a lower surface if you have control over surface heights. (ie. If patient is transferring from the edge of his or her bed to his or her wheelchair, raise the bed so that it’s somewhat higher than the wheelchair.)
5. Angle the chair 45^O-90^o to the surface you’re moving towards.
6. Lock the brakes on wheelchair.
7. Assist the client to scoot to the edge of the surface they are sitting on until both feet are firmly planted on the ground. Grasp the client around the waist, hips, or under his or her buttocks.
8. Instruct the patient on moving their body to midline or sitting as straight up as possible.
9. Shift their weight forward from the waist, hips, or buttocks toward and over the client’s feet.
10. Have the client either reach toward the surface he or she is transferring to or push from the surface he or she is transferring from.
11. Assist the patient by guiding and pivoting the patient around toward the transfer surface.

One- Person Dependent Transfer

1. Get the surface the patient is moving to and the surface the patient is moving from as close as you can while still leaving enough room for the two of you to move freely.
2. If possible, situate the chair in the appropriate position for the patient to move towards his or her strong side.
3. Have the client move from a higher surface to a lower surface if you have control over surface heights. (ie. If patient is transferring from the edge of his or her bed to his or her wheelchair, raise the bed so that it’s somewhat higher than the wheelchair.)
4. Angle the chair 45^O-90^o to the surface you’re moving towards.
5. Lock the brakes on wheelchair.
6. Position the client’s feet together on the floor, directly under the knees, and swing the footrest away. Grasp the client’s legs from behind the knees, and pull the client slightly forward on the surface the patient is transferring from. Ensure that the patient’s buttocks will clear the large wheel on their wheelchair if they’re transferring to/ from a wheelchair.
7. Place a sliding board under the client’s inside thigh, midway between the buttocks and the knee, to form a bridge from the surface they’re transferring to and transferring from. The sliding board should be angled toward the client’s opposite hip.
8. Stabilize the client’s feet by placing your feet on the outside of the patient’s feet.
9. Stabilize the client’s knees by placing your own knees firmly against the front and side area of the patient’s knees.
10. Help the client lean over the knees by pulling him or her forward from the shoulders. The client’s head and trunk should lean opposite the direction of the transfer. The client’s hands can rest on their lap.
11. Reach under the patient’s outside arm and grasp the waistband of the pants or under the buttock. On the other side, reach over the client’s back and grasp the waistband or under the buttock.
12. After your arms are positioned correctly, lock them to stabilize the client’s trunk. Keep your knees slightly bent and brace them firmly against the patient’s knees.
13. Gently rock with the client to gain some momentum, and prepare to move after the count of three. Count to three aloud with the client. On three, holding your knees tightly against the client’s knees, transfer the client’s weight over his or her feet. You must keep your back straight and you knees bent to maintain good body mechanics. Pivot with the client and move him or her onto the siding board. Reposition yourself and the client’s feet and repeat the pivot until the patient is firmly seated on the bed surface, perpendicular to the edge of the mattress and as far back as possible.
14. You can secure the client on the bed by easing him or her against the back of an elevated bed or on the mattress in a side-lying position, then by lifting the legs onto the bed.

 Car Transfers

1. Get the surface the patient is moving to and the car seat as close as you can while still leaving enough room for the two of you to move.
2. The therapist or caregiver should stand inside the open door where the door meets the car.
3. Make sure that the wheelchair and car are not on an incline, because working against gravity will make this transfer much more difficult. If possible, angle the car and wheelchair so that gravity may be used to assist with the transfer.
4. Angle the chair 45^O-90^o to the car.
5. Lock the brakes on wheelchair.
6. From this point, a stand pivot transfer or sliding board transfer may be used when transferring from a wheelchair into a car seat.

Resource:

Youtube video