SPECIFIC
- Prior to transport, determine if bathroom doorway can accommodate entry of lift and/or wheelchair, staff, and patient.
- Thresholds may present a problem. Consult with Engineering Service to lower if problematic.
- If using seated transfer aid, chair arms must recess or be removable.
- If patient has partial weight-bearing capacity, transfer toward stronger side.
- Use of powered toilet lift seat facilitates a safer process.
- Toileting slings (bariatric and non-bariatric) are available for toileting.
- Verify equipment is locked prior to transfer onto or off of commode.
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.
- 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.
- ip/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, and 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.
- Check toilet weight capacity. A bariatric patient may need an expanded capacity commode chair, steel toilet, or toilet with enhanced weight support. A standard porcelain toilet typically has a weight limit of 350 pounds. Even a floor-bearing toilet may shear under weight.
- A standard bathroom toilet often does not provide adequate space for the body of a bariatric patient; use of an expanded capacity commode over a toilet provides safety and privacy for the patient.
- Place bariatric patient in a room where there is full access to ceiling lift throughout the room, into the shower and over the toilet using one move if available.
- Use correct size and padded hygiene slings for toileting and showering tasks.
- Use bariatric standing assist device, if appropriate, to facilitate independence in toileting and preserve as much function as possible.
- Consider bariatric powered lift toilets if appropriate.
- 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 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.