Moving, Transferring, & Repositioning Patients

Hydraulic or Mechanical Lift

1) 2 basic designs are the floor model and ceiling suspension. The latter is becoming more popular due to ease of use. 2) Patients can be moved in a sitting position or supine (laying position). 3) Always visually inspect the system for signs of wear, such as fraying, cuts or tears in the material of the body or straps. 4) Certain contraindications may exist for transferring patients with injuries (i.e. using lift with a spine board put underneath patients with spine or other injuries)

Stretcher

1) Some have foot controls, and manual controls to move stretcher up and down and tilt head or foot end. 2) Side rail operations are also different, depending on the manufacturer. 3) Most will accommodate an I.V. pole. 4) Always push from patient's head. 5) Push into elevators. 6) When going around corners or through doorways, check for oncoming traffic and maneuver from the foot end. 7) When not in use, always put the brake on.

General guidelines when moving any wheeled equipment (wheelchairs, beds, carts and stretchers)

1) Unlock the brakes. 2) Adjust the height of the equipment to waist height where possible. So it's more comfortable for you and your back can be kept straight, and body weight is used to push. 3) Make sure wheels are functioning properly by pushing the object. 4) Keep your back straight thus reducing the stress on your lower back. 5) Face forward and push the equipment, if possible. Avoid pulling the equipment. Pushing allows you to use body weight, momentum and the long leg muscles to assist. 6) Grasp the object with both hands therefore avoiding twisting of your spine. 7) Know your physical capabilities. To move heavy equipment, get help especially if you are moving up or down a ramp. Seeking assistance provides a more controlled movement and shares the load. 8) When using an elevator, make sure that the elevator and the floor are level before moving the equipment into or out of the elevator. 9) PUSH stretchers into the elevator. PULL wheelchairs into elevators. 10) Always look first before going through doors or around corners when using wheeled equipment. Some facilities have mirrors located at hallway corners to visualize oncoming traffic.

Sitting a Patient Up and On the Edge of the Bed

1) Use gravity to pull the patient's feet down towards the floor, thereby pulling the body up. Have pt use side rail to help, if possible. Allow pt to do what they can for themselves ALWAYS. If they don't use it, they will lose it. 2) At the same time, pivot on the balls of your feet. Remember, this is an assist and NOT a lift. 3) If your patient cannot help, call for additional help from a coworker.

Footstool

1) Used to assist patients to get on or off a table, bed or stretcher; gives the patient support. 2) Rectangular stool, approximately 11 x 15 and 9 high. 3) Have a looped handle that permits patient support when climbing on and off a bed.

Determining Pt's Mental Status Before Beginning to Move Pt

1). Has your patient had a stroke and have residual weakness or paralysis? 2). Do they have dementia? 3). Assess your patient's ability to understand directions. 4) Look directly into their eyes and ensure they understand your directions. Have them repeat them back to you before beginning the move, if not sure of comprehension.

Procedure to transfer using the One-Person Pivot from bed to wheelchair

Do not attempt this transfer if the patient is much larger than you. Explain the procedure to the patient. Place the chair as close to the bed as possible so that the chair is on the patients stronger side. (Always move towards the patient's stronger side. If a wheelchair is used, lock the wheels and remove the foot rests. Note: If the patient has trouble walking, place the wheelchair at a 45 degree angle to the bed. If appropriate, place a transfer belt and slippers on the patient. Adjust the height of the bed to facilitate good body mechanics and to allow the patient's feet to touch the floor. Assist the patient to sitting on the edge of the bed. Check for dizziness. Adjust IV Pole and/or any drainage bags and oxygen tubing. Instruct the patient to: lean forward slightly from the hips; place both feet firmly on the floor and slightly apart; place the hands on the bed surface or on your shoulders (not around your neck) Stand directly in front of the patient: assume a broad stance, place your feet slightly in front of your patient's feet. This will prevent your patient from slipping. (Note in the video the patient's feet are between the technologist's feet. Should the patient slip, she could slide between the technologist's legs! Something to remember) Stabilize the patients knees by supporting them with your knees. bend your knees Depending on the abilities of the patient, encircle the patients waist with your arms and: grasp the transfer belt towards the back or place your hands against the sides of the patients chest While rocking back and forth and on the count of 1-2-3-go, assist the patient to a standing position by: the patient pushing up with their hands and you straightening your knees as you stand up. Support the patient in an upright standing position for a few moments. This allows time for you to check the patient is O.K. and allows your joints to extend.You will be standing very close to your patient in a "bear hug" type of position. While in the same position, pivot or shuffling towards the chair. Instruct the patient to: back up to the chair and place their legs against the seat. place both hands on the arms of the chair. Instruct the patient to sit in the chair. Lower the foot plates and place patient's feet onto them. Note: If the patient has an injured lower extremity, move towards the patients stronger side. For example if the right leg is injured, position the wheel chair on the patients left side.

Sim's Position

Often used for rectal exam and using a thermometer.

Fowler's Position

Patient head is raised. In the high Fowler's position the patient is sitting at 90 degrees. In the low Fowler's the patient is sitting at about 45 degrees. All Fowler's positions promote lung expansion. Gravity allows the diaphragm to drop down therefore increase the lung capacity. In the Fowler's position the knees should be elevated to assist the patient from sliding down in the bed. N.B.: Ensure the patient is well up in the bed prior to putting in a Fowlers position. You may need to re-position the patient up in the bed first.

Lateral Position

Patient is laying on their side.

Prone Position

Patient is laying on their stomach

Supine Position

Patient is lying face up

Transferring & Repositioning Patients

Prior to transferring or re-positioning any patient you must assess the patient and the situation first. Trend today is toward a no lift policy There are 5 areas which you should assess. They are the patient's: 1) Physical Condition 2) Medical Condition 3) Mental Status 4) Ability to Communicate and 5) Environment

Semi Fowler's Position

The head of the bed is partially elevated to 15 to 30 degrees. Patients are often more comfortable in this position than lying supine.

Trendelenburg Position

The patient's head is lower than their feet. In this position the head of the bed is lowered. This promotes circulation. This is also a useful when re-positioning (or sliding the patient up in the bed), by making use of gravity.

Communication Before Beginning a Pt Move/Transfer

Always tell the patient before beginning the move: 1). what you are going to do and 2). how they can participate and assist. 3). Give the explanation before you start to do anything and then ... 4). continue explaining as you do the transfer.

Determining Patient's Medical Condition Before Beginning Moving

1) Is your patient on any medication? Does this medication make them light headed? 2) Any incisions or c/o pain or painful joints, etc.? Check for pain or tenderness. 3) Does Pt's infection require special precautions? 4) Check for IVs, oxygen tubing, wound drainage bags, chest tubes, and catheters.

Procedure to Move Patient to a Sitting Position On the Edge of a Bed

1) Adjust bed height to allow patient's feet to touch the floor. 2) Explain the procedure to the patient and how she/he can assist. 3) Raise the head of the bed (or table) as high as it will go. 4) Assist patient to a lateral position. 5) Put feet and lower legs at the edge of the bed. 6) Stand beside the patient's hips and face the far corner of the bottom of the bed. Assume a broad stance. Toe pointing towards the foot of the bed. 7) Bend your knees and keep your back straight. 8) Place one arm around the patient's shoulders and the other arm beneath both of the patients thighs near the knees. 9) Tighten your abdominal, gluteal, leg and arm muscles. 10) Instruct patient to push on the bed with their arms. Rock back and on the count of three, pivot on the balls of your feet in the desired direction (facing the foot of the bed) while pulling the patient's legs and feet off the bed. 11) As the legs come off the bed the patient's upper torso will come up. 12) Remain with the patient, providing support until the patient is well balanced and comfortable before ambulating or transferring.

Gait Belt

1) Aka a "walking" or "transfer" belt. 2) 2" wide belt that is placed around a patient's waist and fastened with velcro 3) Used to ensure a good grip of unstable patients; provides stability when transferring patients by giving health care workers something firm and stable to hold while transferring a patient. 4) Results in less strain for the health care worker

Determining Physical Condition Before Moving Patients

1) Always check you have the correct patient (wrist ID, name, birthday) 2) Is patient on any medication that would make them light headed or faint? 3) Patients who are weight bearing must wear safe footwear (rubber-soled shoes or non-skid/non-slip socks) when being transferred. (It is usually easier to put footwear on any patient when they are laying because the bed/table is at your hip or waist level.) 4) Apply any necessary slings, braces, elastic stockings before you position the patient on the side of the bed/table. Transfer belts/Gait belts are put on in the dangling position (sitting up on bedside). 5) Always protect patient's modesty and privacy. Ensure they're fully clothed or gown is tied.

Procedure to Apply a Transfer Belt

1) Apply belt over gown or clothes, NOT against skin. This maintains medical asepsis and patient comfort. 2) Apply belt while pt is lying down, preferably. This allows you to position the belt more easily. When patients are sitting they sometimes slump and/or lose their balance. If they are not wearing a belt you have nothing to hold to prevent this. 3) Place belt around the patients waist, above the pelvis and below the rib cage. Belt should not ride up or down. 4) Apply belt firmly allowing only enough room to fit your hands around it. The belt must be stable so that you can hold the patient securely and firmly. 5) Velcro fastening surface s/b at the front, over the patient's abdomen, not at his or her back. Easier to apply and remove the belt when the patient is sitting against the back of a chair.

Wheelchair

1) Arm rests are often removable so the patient can easily slide onto another surface. Ensure patient's arms are in the wheelchair, especially when passing through doors. 2) Foot rests can be adjusted or removed for the patient's comfort or convenience. 3) Must always be pushed from behind. . 4) Avoid collisions 5) When entering an elevator, back the wheelchair into the elevator so the wheelchair won't tip

Ambulation

1) Assist patient with robe and slippers. 2) Clear surrounding area of any obstacles. 3) Collect an IV pole if needed and re-arrange any drainage bags. 4) Apply a gait belt snuggly around the patient's waist, if required and available. 5) Place IV pole on the same side as the insertion site of the infusion and have the patient push the pole while ambulating. Secure any drainage bags below the level they are draining. 6) Walk on the patient's weaker or affected side, (leaving their good arm to hold the IV pole or their cane). 7) If patient is very weak or has poor balance, stand next to their stronger side. Do not support the patient from their axilla. 8) Walk slightly behind your patient in the event he or she might feel faint, so they can slide against your body onto the floor, if they do. 9) Walk slowly and position the patient between yourself and the wall. If the patient is unsteady or feels faint have them sit, immediately.

Assisting a Patient from bed or table, with the aid of a footstool

1) Assist the patient to sit up and on the edge of the bed. 2) Lower the bed to position the patient's feet as close to the footstool as possible. 3) Place the footstool square to the bed and allow the patient to stand onto the broadest width of the footstool and to walk down and forward. If the footstool has a handle, place the handle on the patients stronger side and perpendicular to the bed. 4) Look into the patient's eyes and ask if they feel faint or dizzy. Ensure they can move their legs. 5) Assist the patient to stand up onto the footstool. Ensure the patient is steady and balanced before proceeding. Encourage the patient to place their hand(s) onto the top of your shoulders or your flexed arms for support. 6) Assist the patient to step down from the footstool by walking forward off the footstool.

Procedure to transfer using a lateral transfer board

1) Explain procedure to patient. 2) Prepare area 3) Lock bed brakes 4) Lower bed rails 5) Position wheelchair close to or at 45 degrees to bed so transfer board can be placed in a stable position in front of wheel and diagonal to bed. 6) Where possible, adjust height of bed so transfer board slopes downward slightly in direction of transfer. This makes use of gravity to assist with transfer. 7) Remove/adjust footrests and remove armrest nearest bed. (This removes potential hazards). 8) Lock wheelchair brakes. 9) Position one end of transfer board under patient and other end on chair. 10) Clothing or talcum powder on board will make slide easier 11) Using their upper body strength, stand by as patient maneuvers into chair. 12) Replace foot and arm rests 13) Disinfect transfer board if it is not patient's personal property

Equipment Used to Transfer or Re-Position Patients

1) Gait or Transfer belt 2) Lateral Transfer or Sliding Board 3) Slider Board or Smooth Mover 4) Wheelchair 5) Stretcher 6) Bed 7) Hydraulic or Mechanical Lift: Hoyer or Sit-to-Stand 8) Footstool

Re-position a patient in a Wheelchair

1) Lock the wheelchair brakes 2) Explain procedure to patient and how he/she can be of assistance. 3) If appropriate, place transfer belt around patient's waist. 4) Bend patient's knees and place their feet flat on floor, slightly apart and directly below knees. 5) Instruct patient to bend their elbows and to hold arms across the chest. 6) Stand behind wheelchair with a broad stance and in a lunge position. Brace knee of the forward foot against back of wheelchair. 7) Place your arms under patient's arms and with palms up, grasp transfer belt in front with both hands. (This brings the load close to the centre of gravity) OR 8) Place your arms over patient's arms and, with the palms towards the patient's body, firmly grasp the middle of the patient's right forearm with your right hand and the middle of the left forearm with your left hand. Be careful to avoid grasping over an IV insertion site. 9) Bend your knees and tighten your abdominal and gluteal muscles. (This keeps your back straight.) 10) Instruct the patient to lean as far forward as possible and to push with their feet on the count of three (if they can). 11) Rock back and forth in the lunge position to gain momentum. 12) On count of 1-2-3 (cueing) and while straightening your knees and slide patient back in chair. (This stabilizes the shoulder joints and uses the large leg muscles for slide.) 13) If necessary, remove transfer belt. If the wheelchair does not have an IV pole attachment, then lift foot rests and place IV pole in front of wheel chair with patient's feet resting on poles wheel base. Ask patient to hold pole with one hand. This will allow you to push from behind wheelchair with both hands.

Bed

1) Most have electric motors to operate the moveable parts. 2) Ensure it is plugged in to an electrical outlet to activate the motor. 3) Divided into 3 sections, so the head and foot can be elevated separately. 4) IV poles may be attached to most beds. 5) Controls may be located on side rails and/or at end of bed.

Assisting a Patient to the Floor in an Emergency

1) Move behind the patient and grasp transfer belt. This provides a means for grasping a patient securely for a controlled descent. 2) Stand with feet wide apart as a broad base for support. Extend one leg between the patient's legs and pull the patient close to you. 3) While keeping your back straight, bend your knees while assisting the patient to the floor. Let the patient slide down your body and your outstretched leg. This ensures that the leg muscles take the strain and decreases the risk of injury by using proper body mechanics. 4) Protect the patient's head. 5) Position the patient comfortably on the floor and assess for injury before attempting to move the patient. Call for assistance. 6) DO NOT ATTEMPT TO HOLD OR CATCH A PATIENT. The safest action you can take is to control the patient's fall and assist him/her to a comfortable position on the floor. This is a useful skill to know as any patient may faint regardless of their well-being or whether diagnostic treatment is received in a hospital or private office.

Environment Before & After Moving/Transferring Pt

1) Organize the work environment before you position the patient. Remove any unnecessary equipment clutter. 2) Keep your patient warm and comfortable; offer pillows, cushions, warm blankets. 3) Always replace wet sheets with dry linen. Damp or wrinkled sheets will lead to pressure ulcers, as will immobility of 1-2 hours. 4) Call for assistance once transfer plan in place and environment is good and pt is ready. 5) When you are finished with the transfer, wash the slider board and your table with a disinfectant. 6). Wash your hands. 7). If using a bed or stretcher with sheets, change the linen in preparation for the next patient.

Assisting a Patient onto a bed or examining table with the aid of a Footstool

1) Position the wheelchair square to the bed (table) so the patient can walk beside the length of the bed and step onto the broadest width of the footstool. 2) Apply the brakes and remove the foot rests from the wheelchair. 3) If the footstool has a handle, position the handle parallel to and away from the bed or table. 4) Look into the patient's eyes and ask if they feel faint or dizzy. Ensure they can move their legs. 5) Assist the patient to step onto the footstool by providing your arm for support. If the footstool has a handle, place it so the patient's stronger hand can grasp it. The patients other arm can be placed on the mattress for additional support. 6) Assist the patient to turn 90 degrees so his/her back is towards the bed or table. 7) Once the patient can feel the bed or table at the back of their legs, assist the patient to sit down on the bed.

Purpose of using a turn sheet or draw sheet to turn the patient

1) Reduces friction 2) Evenly distributes patient's weight 3) Reduces shearing effect and... 4) Promotes a slide rather than a lift.

Lateral Transfer or Sliding Board

1) Short wooden or polyethylene board measuring about 35 inches long 2) Used when patient can lift their weight off their buttocks 3) Pt uses his/her upper body strength to maneuver across the board, into a wheelchair or from a wheelchair to another seat, like a chair, car, or bed. 4) Often used by paraplegics confined to a wheelchair

Body Positions

1. Supine 2. Prone 3. Lateral 4. Sim's Position 5. Trendelenburg 6. Fowler's 7. Semi Fowler's