Safe Patient Transfers – It’s Not What You Do, It’s How You Do It
One of the top occupational hazards for a healthcare professional might surprise you. If you guessed, “what is, broken bones due to ‘sticks and stones’?” then you just lost your turn at Jeopardy. Other than some of the more obvious hazards like biological, or stress, or chemical; healthcare workers often face ergonomic hazards due to improper and unsafe patient transfers.
Transferring a person in and out of a wheelchair, or gurney, or bed, or MRI table can put undue stress on your back, arms, and shoulders; and it can quite possibly put the patient in danger as well.
If you learn the correct way to transfer a patient, you will prevent undue wear and tear on your body and will keep your patient as safe and comfortable as possible.
Trainings in safe patient handling do exist, and it is highly encouraged. However, we will discuss best practices here, so if you do take part in a training, you’ll have a much stronger knowledge base going in.
Where do transfers commonly occur? In and out of bed, wheelchair, chair, bathtub, car, and toilet.
What is some helpful equipment for transfers? Various types of lifts, walkers, grab bars, a trapeze bar, and sliding boards.
Before we get into technique, we’ll start off with a few helpful bits of common sense and basic body mechanics.
1) Transfer your patient only when necessary. The more you transfer, the more opportunities there are for mishaps.
2) Get as close as possible to wherever plan on making the transfer.
3) Get your center of mass as close as possible to your patient’s center of mass. It’s important to start by standing up straight with good posture, making sure you aren’t too stiff, and your knees aren’t locked. Make sure your feet are spread slightly wider than shoulder width so that you have a broad base of support. You want to keep your center of gravity as low as possible.
4) If and when at all possible, try to transfer “downhill,” rather than “uphill,” and do so at a modest height (adjusting the height of the bed or chair as needed).
5) Maintain the natural curves of your back and only bend at your knees and hips. Do not put unnecessary pressure on your back.
6) Move or pivot your feet when turning. Do not twist at your back.
7) Patient collaboration is always a great idea and have the patient assist as much as possible.
8) If more than one person is making the transfer, then make sure to communicate.
9) Make sure to maintain “modesty,” meaning if the patient is wearing a hospital gown, then see to it that the gown stays on or over certain body parts.
10) Watch out for any potential dizziness or hypotension and communicate with the patient to make sure they’re doing okay.
More on technique…
If you’re transferring from a wheelchair or anything else with wheels, make sure you lock the wheels. You don’t want your patient to be, “the one who got away.”
If your patient is in a wheelchair, have them scoot to the edge of the chair, and if they are able, have them put their feet on the floor. If there is a rotating or movable arm rest on the chair, move it or remove it on the side that you will be making the transfer.
Next, have your patient lean their trunk forward. Pop artist Shakira said, “the hips don’t lie,” and she couldn’t have been more right. When transferring, your patient’s head should move in the opposite direction of their hips. This will help with movement and clearing any obstacles during the transfer.
As a precaution to protect the patient’s shoulders, have them keep their arms as close to their body as possible (somewhere in the range of 30-45 degrees). This helps keep the patient’s weight centralized, making it easier to lift them. To protect the patient’s wrists, have them grab a bar or grip an edge. You don’t want to them to lay their hands flat and put weight on their palms. This is a dangerous position for them to be in and can even lead to carpal tunnel syndrome.
Before and during lift off, coach your patient making sure they are working with you to clear any obstacles, taking great care that they not bump or rub against anything. You want them to avoid shearing or the development of bed sores.
If you and the patient feel like you can’t make the transfer in one smooth movement, then perform the transfer is small, calculated steps. You can also use a transfer board if needed. Just be sure to take extra precaution sliding the patient to the transfer board because this kind of movement can damage a person’s skin. You’ll want to use a towel or pad on the board if you think bare skin will come in contact with the board during the transfer.
There is equipment to make transfers safer, but you must use them properly so as not to injure yourself with improper technique.
If you’re going to use a mechanical lift to transfer someone, know that lifts are meant to move in a straight front and back motion. If you have to turn, do not make yourself the center of gravity by planting your feet and twisting your body. Rather make the lift the center of gravity by coming to one side, pinning your elbows inward. Then hold one handle and walk with the mechanical lift to turn it, and then drive the empty wheelchair or other chair to the lift. Do not drive the lift around with someone in it (as fun as it may look, it’s very dangerous).
For transferring to shower chairs, it’s important to know the difference between regular shower benches and the swivel, sliding bench. Here is a short video that explains more:
For car transfers, get the patient as close as possible to the car seat they’ll be moving to while still leaving enough room for the two of you to move. You, the person making the transfer, should stand inside the open door. Do not work against gravity, and make sure the transfer isn’t being made uphill or on an incline. Angle the wheelchair 45-90 degrees toward the car and lock the brakes on the wheelchair. From here you can use a sliding board or go back to the technique as was described earlier.
No matter where you transfer, communication and preparation are the two most important factors to consider. Communication leads to collaboration and ultimately you need the help of your patient to make a transfer that’s both safe for the patient and for you. Preparation is also crucial because you don’t want to make a transfer without having the support of a colleague or equipment or proper body placement.
With proper preparation and communication, you’ll ensure your own safety and the safety of your patient when making a transfer.