SPECIFIC
- DO NOT PULL FROM HEAD OF BED. Manual patient repositioning is dangerous.
- Discourage and remove draw sheets from beds and replace them with full body slings for repositioning. Using draw sheets on beds gives conflicting messages and makes the transition to technology use more difficult.
- The repositioning sling should be placed before a dependent patient is transferred to the surface.
- Inflate mattress of low air loss beds to maximum setting to assist in repositioning.
- Although some specialty beds turn and/or rotate the patient, most specialists confirm that bed rotations are not sufficient to off load pressure off patient and recommend that use of a repositioning sling is the best option for full turns. Confirm with Wound Care that off-loading pressure is accomplished appropriately.
- When using bed repositioning option, caregiver must assess skin integrity, support the turn, adjust limbs and provide pillow supports.
- For patients with delicate skin or pressure ulcers, care must be taken to avoid shearing force.
- Working height should be appropriate for staff safety, at about elbow height.
- For patients that can assist in moving up in bed, to encourage them to help, ask the patient to hold on the side rails above head, to help pull themselves up in bed, then to flex knees and push on the count of three.
- Verify equipment is locked prior to transfer/movement.
- If using seated sling, air assisted lateral transfer device or friction reducing device, obtain facility direction for leaving under patient.
- The force required to logroll a patient is about 32% of the patient’s body weight
- The force required to pull a dependent patient on a draw sheet is about 72.6% of the patient’s body weight
- Caregivers should avoid push or pull forces greater than 20% of their own weight.
GENERAL
- NEVER lift patients manually except under emergency situations such as during an active patient code.
- NEVER catch a falling patient! A caregiver probably cannot stop a patient from falling. Quickly remove obstacles out of the way that may injure the patient’s head.
- Prior to starting task, CONFIRM patient handling equipment, slings, and destination locations (bed, commode, wheelchair, etc.) meet WEIGHT, WIDTH, AND HEIGHT requirements of patient.
- Do not allow patient to lean or pull/grab on caregiver for support in movements.
- Allow and encourage patients to move on their own as much as it is safe to do so.
- Ask patient what steps can be taken to facilitate ease and comfort in their movement and mobility as they typically understand their strengths and weaknesses.
- Avoid shearing forces especially for patients with delicate skin or pressure ulcers.
- Increase ease in inserting slings by using friction reducing device or lateral transfer device.
- During any patient task, under the best of circumstances (no lines, tubes, contractures, etc.), a caregiver may lift no more than 35 pounds of a patient’s weight (body, head, appendages). If tubes, lines and other patient items or conditions influencing patient handling are present, or staff must bend, twist or reach, the permissible lifting weight is decreased. If weight limit is exceeded, assistive devices must be used if possible.
- Conditions likely to affect transfer/repositioning techniques.
- Hip/Knee/Shoulder Replacements
- Respiratory/Cardiac Compromise
- Fractures
- History of Falls
- Wounds Affecting Transfer/Positioning
- Splints/Traction
- Paralysis/Paresis
- Amputation
- Severe Osteoporosis
- Unstable Spine
- Urinary/Fecal Stoma
- Severe Pain/Discomfort
- Severe Edema
- Contractures/Spasms
- Postural Hypotension
- Very Fragile Skin
- Tubes (IV, Chest, etc.)
BARIATRIC
- For patient handling purposes, any patient that weighs more than 300 pounds, or 100 pounds over ideal weight, or who has a BMI or over 40 is considered a patient that increases the risk for caregivers while performing patient handling. Waist circumference is also used to identify bariatric patients. Weight, height, waist diameter, waist circumference should be collected on these patients in order to provide safe care and select appropriate equipment, beds, stretchers, wheelchairs, lifts, and other devices.
- Most bariatric patients have to have the head of the bed elevated at all times to facilitate ease in breathing during repositioning tasks.
- Encourage patient to move as much as possible independently to minimize caregiver handling tasks and foster patient independence and worsening of functional abilities.
- Use foam mattresses for patients who have some functional ability if the patient’s condition permits. Self-mobilization is easier on a foam mattress than a Low Air Loss Mattress.
- Use a sealed, high-density foam wedge or similar device to assist in maintaining positioning
- Some patients have poor tolerance for turns greater than 30 degrees
- Keep repositioning sling under patient at all times to minimize high risk handling tasks, if possible.
- When Low air loss mattress is required the patient is likely to slide down in bed frequently due to slippery mattress cover, use of a repositioning sling under patient facilitates routine movement will offer patient comfort.
- Consider use of 2 padded twin turners or bariatric limb slings, one over upper torso/back one over buttocks area to turn and reposition patient when there is a need to access the back for wound care. Utilize friction reducing devices to insert twin turner or limb holders.
- Expanded capacity turning, limb holding, and repositioning slings may help with repositioning patients during bathing.
- Bariatric patients require more caregivers. Identify a leader when performing tasks with multiple caregivers in order to synchronize efforts and increase safety.
- Abdominal binder/pannus sling may be necessary to prevent abdominal area from interfering with patient handling task/transfer.
- A friction reducing device will facilitate insertion and removal of a sling under a bariatric patient.
- Inserting sling or friction reducing device from head to toe or toe to head rather than log rolling may make sling placement easier.
- Suggest applying a sticker to all bariatric equipment with ‘EC’ (expanded capacity) and the weight capacity of the equipment.
- A multidisciplinary team should problem solve these tasks, communicate to all caregivers, refine as needed and perform consistently.