Transferring Patients

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The Occupations Safety and Health Administration (OSHA) has guidelines in place regarding the transfer of patients. These guidelines are aimed at helping to reduce the risk of employee injury and to make the transfer as safe as possible not just for the employee, but also for the patient. Below are different types of patient transfer situations that employees need to be aware of how to handle.

When transferring a patient from the bed to a chair, chair to a toilet, chair to a chair, or from a car to a chair, OSHA suggests the following steps:

• If the patient can fully bear weight, no assistance should be required. However, stay nearby for safety in case help is needed.
• If the patient can only partially bear weight, and the patient is cooperative, use a gait/transfer belt using a stand and pivot technique or use a powered standing assist lift.
• If the patient can only partially bear weight but is not cooperative, use a full-body sling lift and two caregivers.
• If the patient cannot bear weight, but is cooperative and has upper extremity strength, use a seated transfer aid. You can use a gait/transfer belt if the patient can independently complete the transfer.
• If the patient cannot bear weight, is cooperative, but does not have upper extremity strength, use a full-body sling lift with the assistance of two caregivers.
• If the patient cannot bear weight and is uncooperative, use a full-body sling lift with the assistance of two caregivers.
• Some additional points to consider:
  • If you are using a seated transfer aid, the chair must have arms that lower or are removable.
  • If transferring to or from a car using a full-body sling lift, use a lift that is specifically designed to access a patient from the car.
  • If the patient is partial weight-bearing, it is best to transfer the patient toward the stronger side.
  • If toileting a patient, there are toileting slings available.
  • If bathing a patient, there are mesh slings available.

When transferring a patient laterally to and from a bed to a stretcher or trolley, OSHA suggests the following steps:

• If the patient can assist, caregiver assistance is not required. However, stay nearby for safety in case help is needed.
• If the patient is partially able or not able to assist, use a lateral sliding aid and two assisting caregivers if the patient is less than 100 lbs.
• If the patient is partially able or not able to assist, use a lateral sliding aid or a friction-reducing device and two assisting caregivers if the patient weighs 100-200 lbs.
• If the patient is partially able or not able to assist, use a lateral sling aid and three assisting caregivers or a friction-reducing device or a lateral transfer device and two caregivers or a mechanical lateral transfer device.

When transferring a patient to and from a chair to a stretcher, OSHA suggests the following steps:

• If the patient is not cooperative, use a full-body sling lift and two or more assisting caregivers.
• If the patient is cooperative and can fully bear weight, assistance is not necessary. However, stay nearby for safety in case help is needed.
• If the patient is cooperative and can only partially bear weight, place an exam table, or stretcher to a low level, use a non-powered stand-assist aid. Otherwise, use a full-body sling lift.
• If the patient is cooperative, but cannot bear weight, use a full-body sling lift and two or more assisting caregivers.

When repositioning a patient in the bed side-to-side or up in bed, OSHA suggests the following steps:

• If the patient cannot assist, use a full-body sling lift or a friction-reducing device with two or more assisting caregivers.
• If the patient can only partially assist, encourage the patient to use a positioning aid or cues. If the patient is less than 200 lbs., use a friction-reducing device and two or three assisting caregivers. If the patient is over 200 lbs., use a friction-reducing device and at least three assisting caregivers.
• If the patient can fully assist, help should not be necessary. However, the patient may/may not use a positioning aid.
• Additional points to consider:
  • It is important not to pull from the head of the bed. This task is not intended for just one person.
  • If pulling a patient up in the bed, the bed should be flat or in a Trendelenburg position.
  • If patients have pressure ulcers, avoid shearing forces during the transfer.
  • Ensure the bed height is at the caregiver’s elbow height.
  • If the patient can help when assisting up in bed, have the patient bend his/her knees, and push on the count of three.

When repositioning patients in a chair, wheelchair, and dependency chair, OSHA suggests the following steps:

• If the patient can fully assist, help is not necessary. However, stay nearby for safety in case help is needed.
• If the patient can partially assist and has upper extremity strength in both arms, have the patient lift up while the caregiver pushes their knees to reposition. However, if the patient does not have sensation, cues may be necessary to remind the patient to reposition.
• If the patient cannot assist and their chair reclines, then recline the chair and use a friction-reducing device and two assisting caregivers.
• If the patient cannot assist, their chair does not recline, but they are cooperative, use a full-body sling lift or a non-powered stand assist aid, and one to two assisting caregivers.
• If the patient cannot assist, their chair does not recline, and they are not cooperative, use a full-body sling lift, and two or more assisting caregivers.
• Additional points to consider:
  • You should not pull the patient from behind the chair, it is not a one-person task.
  • Use the chair to your advantage as some chairs recline or have armrests.
  • Always make sure chair wheels are locked and cannot roll.

When transferring a patient up from the floor, OSHA suggests the following steps:

• If the patient is not injured but is not independent, use a full-body sling lift with two or more assisting caregivers.
• If the patient is not injured and is independent, assistance should not be necessary. However, stay nearby for safety in case help is needed.
• If the patient was injured and it is not a minor injury, the transfer technique will depend upon the type and severity of injury (follow your company’s standard operating procedures).
• If the patient was injured, the injury was minor, and the patient is independent, assistance should not be necessary. However, stay nearby in case help is needed.
• If the patient was injured, the injury was minor, but the patient is not independent, use a full-body sling lift with two or more assisting caregivers.

 

Source:

United States Department of Labor.  Occupational Safety & Health Administration.  Guidelines for Nursing Homes.  Section III.  Identifying Problems and Implementing Solutions for Resident Lifting and Repositioning.  Retrieved from:

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

 

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