SPECIFIC
- Confirm destination surfaces (bed, stretcher, exam table, etc.) and patient handling equipment MEET WEIGHT, WIDTH, and HEIGHT REQUIREMENTS of patient
- If patient needs to be pulled up in bed prior to transfer, see Repositioning in Bed (Algorithm 3).
- High/low beds, adjustable exam tables and stretchers are ideal for making transfers easier.
- Lock all wheeled equipment before transfer.
- When using air assisted lateral transfer device, ALWAYS move feet first, followed by upper torso and head, to determine if is safe to continue the move and to prevent patient from falling through the space between sending and receiving surfaces.
- Destination surface should be ½” lower than sending surface for all lateral patient moves.
- Ensure that at least one caregiver is on the destination side.
- For patients with delicate skin or pressure ulcers, care must be taken to avoid shearing force by dragging patient against surfaces.
- Friction reducing devices vary greatly in design and efficiency. Sometimes a combination of a slide board and another type can reduce forces more than either one alone.
- The force required to logroll a patient is about 32% 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.
- Increase ease in inserting seated slings by using friction reducing device or lateral transfer device.
- If using seated sling, air assisted lateral transfer device or friction reducing device, obtain facility direction for leaving under patient.
- Working height should be appropriate for staff safety, at about elbow height.
- 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.
- 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.
- 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.