Safely Moving & Transferring Persons

1. Chapter 17: Safely Moving & Transferring the Person

2. Safely Moving and Transferring Persons • During these and other tasks, you must use your body correctly. • Turning and repositioning persons • Moving persons in bed • Transferring persons to and from beds, chairs, wheelchairs, stretchers, and toilets

3. Preventing Work-Related Injuries • You must prevent work-related injuries when moving and transferring patients and residents. • The Occupational Safety and Health Administration (OSHA) recommends: • Minimizing manual lifting in all cases • Eliminating manual lifting when possible

4. Preventing Work-Related Injuries (cont’d) • To safely move and transfer the person, the nurse and health team determine: • The person’s dependence level • The amount of assistance needed • What procedure to use • The equipment needed

5. Moving Persons in Bed • Those who are weak, unconscious, paralyzed, or in casts need help moving in bed. • Total Dependence—mechanical lift or friction-reducing device and at least 2 staff members • Extensive Assistance—mechanical lift or friction-reducing device and at least 2 staff members • The person weighs less than 200 pounds—2 to 3 staff members and a friction-reducing device • The person weighs more than 200 pounds—at least 3 staff members and a friction-reducing device

6. Moving Persons in Bed (cont’d) • Protecting the skin • Protect the person’s skin during moving and transfer procedures. • Friction is the rubbing of one surface against another. • Shearing is when the skin sticks to a surface while muscles slide in the direction the body is moving. • Reduce friction and shearing when moving the person in bed by: • Rolling the person • Using friction-reducing devices

7. Moving Persons in Bed (cont’d) • Raising the person’s head and shoulders • You can raise the person’s head and shoulders easily and safely by locking arms with the person. • Do not pull on the person’s arm or shoulder. • It is best to have help with older persons and with those who are heavy or hard to move.

8. Moving Persons in Bed (cont’d) • Moving the person up in bed • The person is moved up in bed for good alignment and comfort. • You can sometimes move lightweight adults up in bed alone if they can assist using a trapeze. • It is best to have help and to use an assist device. • Two or more staff members are needed to move heavy, weak, and very old persons up in bed. • Always protect the person and yourself from injury.

9. Moving Persons in Bed (cont’d) • Moving the person up in bed with an assist device • The person is moved more evenly. • Shearing and friction are reduced. • At least two staff members are needed. • This procedure is used for: • Most patients and residents • Persons recovering from spinal cord surgery or spinal cord injuries • Older persons

10. Moving Persons in Bed (cont’d) • Moving the person to the side of the bed • The person is moved to the side of the bed: • For repositioning and care procedures • Before turning • To limit the need to reach over the person • One method involves moving the person in segments. • With at least co-worker, use a mechanical lift or an assist device: • Following guidelines • For older persons • For persons with arthritis • For persons recovering from spinal cord injuries or spinal cord surgery

11. Turning Persons • Persons are turned onto their sides: • To help prevent complications from bed rest • For certain procedures and care measures • The person is turned toward you or away from you. • The direction depends on the person’s condition and the situation. • After turning the person, position him or her in good alignment. • Use pillows to support the person in the side-lying position.

12. Turning Persons (cont’d) • Logrolling is turning the person as a unit, in alignment, with one motion. • The spine is kept straight. • The procedure is used to turn: • Older persons with arthritic spines or knees • Persons recovering from hip fractures • Persons with spinal cord injuries • Persons recovering from spinal surgery

13. Sitting on the Side of the Bed (Dangling) • Patients and residents sit on the side of the bed (dangle) for many reasons. • While dangling the legs, the person: • Coughs and deep breathes • Moves the legs back and forth in circles • Two staff members may be needed. • Persons with balance and coordination problems need support. • If dizziness or fainting occurs, lay the person down.

14. Transferring Persons • The amount of help needed and the method used vary with the person’s dependency level. • For a safe transfer, the: • Room must be arranged so there is enough space. • Chair, wheelchair, or other device must be placed correctly. • Transfer belts/gait belts are used to: • Support patients and residents during transfers. • Reposition persons in chairs and wheelchairs.

15. Transferring Persons (cont’d) • Bed to chair or wheelchair transfers • Help the person out of bed on his or her strong side. • In transferring, the strong side moves first. • Stand and pivot transfers are used if the: • Person’s legs are strong enough to bear some or all of his or her weight • Person is cooperative and can follow directions • Person can assist with the transfer • Chair or wheelchair to bed transfers have the same rules as bed to chair transfers.

16. D&S Skill: Pivot Transfer a Weight Bearing, Non-Ambulatory Resident from Bed to W/C using a Gait Belt

17. D&S Skill: Pivot Transfer a Weight Bearing, Non-Ambulatory Resident from W/C to Bed using a Gait Belt

18. Transferring Persons (cont’d) • Mechanical lifts • Mechanical lifts are used to transfer persons who: • Cannot help themselves • Are too heavy for the staff to transfer • Slings • The type of sling used depends on the person’s size, condition, and other needs. • Follow agency policy and the manufacturer’s instructions for washing slings. • Follow agency policy for handling and washing contaminated slings.

19. Transferring Persons (cont’d) • Before using a mechanical lift: • You must be trained in its use. • It must work. • The sling, straps, hooks, and chains must be in good repair. • The person’s weight must not exceed the lift’s capacity. • At least two staff members are needed. • Always follow the manufacturer’s instructions.

20. Transferring Persons (cont’d) • Transferring the person to and from the toilet • Transfers involving wheelchairs and toilets are often hard. • Falls and work-related injuries are risks. • Sometimes mechanical lifts are used. • A sliding board may be used if: • The wheelchair armrests can be removed. • The person has upper body strength. • The person has good sitting balance. • There is enough room to position the wheelchair next to the toilet.

21. Transferring Persons (cont’d) • Moving the person to a stretcher • Stretchers (gurneys) are used to transport persons to other areas who: • Cannot sit up • Must stay in a lying position • Are seriously ill • The stretcher is covered with a folded flat sheet or bath blanket. • A drawsheet, turning pad, large incontinence underpad, slide sheet, or lateral transfer device with slide board is used. • At least 2 or 3 staff members are needed for a safe transfer.

22. Transferring Persons (cont’d) • OSHA recommends the following: • If the person weighs less than 100 pounds, use a lateral sliding aid and 2 staff members. • If the person weighs 100 to 200 pounds, use a lateral sliding aid or a friction-reducing device and 2 staff members. • If the person weighs more than 200 pounds, use one of the following: • A lateral sliding aid and 3 staff members • A friction-reducing device or lateral transfer device and 2 staff members • A mechanical lateral transfer device with a built-in slide board

23. Transferring Persons (cont’d) • When the person is on the stretcher: • Safety straps are used. • The stretcher side rails are kept up during the transport. • The stretcher is moved feet first. The staff member at the head of the stretcher can watch the person’s breathing and color during the transport. • Never leave the person alone.

24. Re-Positioning in a Chair or Wheelchair • For good alignment and safety, the person’s back and buttocks must be against the back of the chair. • Follow the nurse’s directions and the care plan for the best way to re-position a person in a chair or wheelchair. • Do not pull the person from behind the chair or wheelchair.