SPECIFIC
- Take full advantage of chair functions, such as a chair that reclines.
- May use arm rest to facilitate repositioning.
- Make sure chair wheels are locked.
- Friction reducing devices for seated repositioning vary greatly. One way slides, slide sheets, or thin, small slide boards may be appropriate.
- Do NOT push on knees without friction reduction or manually lift a patient up in a chair.
- NEVER use a gait belt to lift, transfer, or catch a patient.
- Caregivers should avoid push or pull forces greater than 20% of their own weight.
- Avoid shearing forces.
- Always be aware of and use stronger side, if appropriate.
GENERAL
- NEVER manually lift patients 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
- If using seated sling, air assisted lateral transfer device or friction reducing device, obtain facility direction for leaving under patient.
- Utilize one way slide cushion as much as possible to minimize repositioning needs in chair.
- 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 are unable to sit upright in seated position due to large abdomen obstructing sitting, so facilitate seating in modified recline for patient comfort and ease in breathing.
- Verify the bariatric chair meets patient’s weight and width at widest part of body, and facilitate ability of patients’ feet to reach the floor for safety and comfort.
- Utilize the seated full body sling that fits the patient’s size to position patient during repositioning of patient in chair. Avoid having patient sit on the sling for prolonged periods in a way that would create pressure points.
- Most bariatric patients require padded slings during positioning in chair.
- Encourage patient to reposition self as much as possible independently.
- Often bariatric patients have swelling and poor circulation in the legs, so consider keeping legs elevated on pillows, using limb sling to reposition legs as needed.
- Bariatric patients require more caregivers. Identify a leader when performing tasks with multiple caregivers in order to synchronize efforts and increase safety.
- A friction reducing device will facilitate insertion and removal of a sling under a bariatric patient.
- 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.