Transcript 517 kB 25th Aug 2014 Patient Transfers:CNA

Patient Transfer
for Health Care Professional
Objectives
 Discuss safety pertaining to patient transfer
 Discuss levels of transfer and assistance
 Discuss proper body mechanics
 Discuss examination before patient transfer
 Review of main transfer equipment
 Review procedure of care to treatment table transfer
 Review procedure of three person carry
 Review procedure of sliding board and wheel chair
transfer
Generalizability and Examination
 The goal of transfer training is generalizability
 Generalizability means that some skills learned for
one transfer can be used for other transfers
 Patients should be accessed for function capabilities
before transfer as noted below:
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Strength
Range of Motion
Pain
Cognitive abilities
Movement dysfunction
Safety First
 Safety must never be compromised
 Never select method of transfer by ease
 When in doubt always obtain help
 Always stabilize equipment (lock..)
 Secure all lines when transferring
 Use proper body mechanics
Levels of Transfer
 Independent Transfer:
 Patient is able to perform All aspects of transfer WITHOUT
assistance by additional personnel
 Assisted Transfer:
 Patient participates actively with some assistance from
personnel
 Dependent Transfer:
 Patient DOES NOT participate actively or participate in
transfer
Levels of Assistance
 Standby Assistance: - patient is able to perform
transfer on their own, but may require some verbal
cues
 Close guarding: patient is able to perform transfer
on their own, but may be limited by their balance
and limited strength
 Contact guarding: patient is able to perform
transfer with minimal assistance – constant contact
should be used to insure safety
Level of Assistance Continued
 Minimal assistance: patient can perform at least
75% of the activity
 Moderate assistance: patient can perform at
least 50% of the activity
 Maximum assistance: patient can perform less
than 25% of the activity
Amount of Assistance
 Level of assistance changes as patient’s condition
changes
 When more than one person is required for transfer
utilize moderate x2 assist (for example)
Body Mechanics
 Create a good base by keeping feet at shoulder width
 Keep back upright
 Bend at knees
 Be attentive to center of mass and base of support –
reduces strain on back and upper extremities
 Control appropriate aspect of patient’s anatomy to
provide support
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Under buttocks for lifting
Behind hips for moving patient into your base of support
Preparing the Environment
 Consideration of direction of transfer from LEFT to
RIGHT or RIGHT to LEFT
 Moving patient to their STRONGER SIDE is the
easiest (also bolster’s patient’s confidence level)
 Personnel performing transfer should avoid wearing
jewelry that can entangle or scratch patients during
patient care
 All equipment should be ready BEFORE transfer
begins
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Example: coordinate with floor nurse prior to transfer
Instructions and Verbal Cues
 Clear and define instruction should be verbalized
clearly to patient and assistant(s)
 Patients feel comfortable knowing what is about to
take place
 Never move patient on a number INSTEAD use
actions words as noted below:
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“I will count to three and then give the command to lift”
“When I say “lift”, we will “lift”
The lead should visually and verbally check to make sure the
patient and assistant are ready
The leader says “One, two, three, lift”
Equipment
 Some equipment used in patient transfers:
 Wheelchairs
 Cart or trolley
 Hydraulic lift
 Gait belts
 Sliding board
Gait Belts
 Gait, transfer belts can wrap around the waist of the
patient providing handles for the personnel to grasp
when assisting or transferring a minimal assist
patient
 Small hand-hold slings that go around the patient
can aid in transfer by providing handles
 Handles improves the grasp opportunity for
personnel and thereby reduces accidents and
possible skin shearing…tearing
Hydraulic Lift
 Used to transfer patients to chairs and beds
 Helpful in moving difficult transfer patients (obese)
 450 pound capacity on average
Sliding Board
 Sliding boards are usually made of a smooth rigid
material
 Sliding boards vary in shape and material
 Boards act as a supporting bridge when seated slide
transfers are performed
Sliding Board with Wheel Chair
 Wheelchair and table are parallel, or at a slight angle
 Wheels locks are engaged
 Sliding board is placed under patient buttocks to the
chair
 Patient DOES a series of push ups, with guidance
from personnel, sliding into the wheelchair
 Patient leans AWAY from the wheel chair and board
is removed
 Vise-versus from chair to table
Sliding Transfer (Cart to Treatment Table)
 Draw sheet is placed under patient
 Sides of sheet are rolled and grasped close to patient
 Leader should be near patient’s head
 It patient is unable to control their head and neck, then the
leader should place one arm under the patient’s should while
cradling the patient’s head
 If movement cannot be controlled or if a patient is agitated, a
sheet may be wrapped around patient for better control
 Place cart and table side by side with leader at head, assistant
controls LE, and other assistant control other side
 On leaders command move patient (may kneel on table if
cannot reach across)
Three person carry
 Tallest person (if strong enough) is at the head
 All three movers on the same side
 Support head and UE, midsection and LE
 Upon command patient is moved to the edge of the cart
 Flex patient’s elbows – roll on his side, facing personnel
 Upon command patient is lifted
 Upon command personnel walks backward to pivot 90
degrees or until patient is aligned with treatment table
 Upon command personnel flex their legs until elbows
rest on edge of table then uncradle slowly and align
patient
Summary
 Before transferring patient, examine patient strength,
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ROM, pain cognitive abilities, skin integrity, and
movement dysfunction
Safety of patient and staff is priority
Gait belts, sliding boards, hydraulic lift, wheel chairs, and
carts are main transfer equipment
Knowledge level of transfers and assistances will aid staff
to evaluate appropriate transfer technique
Proper body mechanics must be adhered to
Appropriate steps should be taken based on the type of
transfer
Question 1
 Body mechanics ensures the safety of the
_________?
A. Patient
B. Staff members
C. Equipment
D. Both A and B
Answer (Question 1)
 Both A and B
Which is NOT an important factor for safe
transfers?
A. Safety must never be compromised
B. Always select method of transfer by ease
C. When in doubt always use an assistant
D. Use proper body mechanics
Answer (Question 2)
B. Always select method of transfer by ease
Question 3
 Never consider the direction of transfer (Left to
Right or Right to Left).
Answer (Question 3)
 False
Question 4
 Moderate assistance refers to the patient’s being able
to perform at least _______ of the activity.
A. 15%
B. 25%
C. 50%
D. 75%
Answer (Question 4)
 C. 50%
Question 5
 True or False:
Staff should never discuss plan of transfer in the
presence of patient because it increases the patient’s
anxiety level?
Answer (Question 5)
 False
References
 www.gendronine.com
 www.meiresearch.org
 www.okcareertech.org
 Duesterhaus Minor, M.A. and Duesterhaus Minor, S.
(2006). Patient Care Skills, 5th ed. Upper Saddle
River, NJ: Pearson