What is an important safety measure when transferring a resident from bed to wheelchair?
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If your loved one will use a wheelchair, you need to know about transfers. For safety’s sake, learn how to help your loved one in and out of the wheelchair. One basic method is shown here. Lock the wheelchair. Help the patient turn over onto his or her side, facing you. Put an arm under the patient’s upper back with your hand
supporting the shoulder. Put your other hand behind the knees. Swing legs over the edge of the bed, helping the patient to sit up. Have the patient scoot to the edge of the bed. Put your arms around the patient’s chest and clasp your hands behind his or her back. Support the leg farthest from the wheelchair between your legs, lean back, shift your weight, and lift. Have the patient pivot toward the chair, as you continue to hold on. Always transfer toward the person’s stronger side. As the patient bends toward you, bend your knees and lower the patient into the back of the chair. Lifting a patient can be hard on your back. To reduce the risk of a back injury, remember to do the following: Organize the steps in your head
before you move. Explain the steps of the move and ask the patient when he or she is ready to move. Keep your knees bent and your back straight. You may use a transfer belt to provide a firm hold, rather than clasping your hands behind his or her back. Get help when you need it. Ask to practice with supervision. Definition/IntroductionPatient care transfer can be defined as moving a patient from one flat surface to another. The most common patient transfers are from a bed to a stretcher and from a bed to a wheelchair. While seemingly intuitive, successful patient transfers rely on understanding each patient’s specific needs while simultaneously adhering to evidence-based guidelines. Patient care transfer can also be defined as transferring patients within the same facility and between facilities.[1][2] Patient care transfers are an essential yet often neglected aspect of patient care. Patient care transfers are an indispensable aspect of patient care, requiring rigorous adherence to clinical guidelines.[2] Proper transfers are based on the concept that focuses on maintaining continuity of care both during and after the transfer. Depending on the complexity, patients often receive care in multiple settings during and after hospitalization. While some aspects of patient transport vary depending on the patient’s status, intrahospital transports are inevitable, particularly in critically ill patients. Poorly organized patient transfers can result in increased morbidity and mortality and should be performed with careful attention. Issues of ConcernWhile each hospital will likely have its policy, several safety concerns should precede patient transfers.[2] These include:
Clinical SignificanceTransfers from a Bed to a Stretcher [3] [4] [5] After the pre-transfer checklist is complete, the transfer from a bed to a stretcher may be performed according to the following steps:
Transfer from a Bed to a Wheelchair [6] [7] [8] [9] Transferring patients from a bed to a wheelchair requires understanding the needs of the patient. Always communicate with the person being transferred so that assistance is being given at the appropriate time, allowing for coordination of efforts between the assistant and the patient. If the patient can bear weight on both lower extremities and predictably take small steps, a one-person assist may be performed. If these criteria are not met, a two-person transfer or a mechanical lift may be necessary to safely transfer the patient. If transferring a patient from a bed to a wheelchair, first complete the pre-transfer checklist and proceed according to the following steps:
Slide Boards Transfer [9] [10] Clinicians and patients most preferred the slide board technique for comfort and safety after becoming familiar with it. A sliding transfer board can benefit patients with paraplegia, lower-extremity amputation, and decreased balance or strength at the lower extremities. A patient with quadriplegia would not have the postural support or upper extremity strength to use a slide transfer board. A patient who can do a stand pivot transfer would not need a slide transfer board. A patient that cannot follow commands will not benefit from a slide transfer board.
Log-rolling Procedure [11] [12]
Nursing, Allied Health, and Interprofessional Team InterventionsProviders who assist in patient transfers should be trained, competent, and experienced. Patient transfers induce many physiologic changes that may be associated with increased risk to the patient. Adverse events that should be considered include: losing the patient wristband/identification, disconnected/obstructed lines, decreased/increased systolic blood pressure, loosened/kinked tubes, fractures, and change in mental status. Many guidelines exist to help providers transfer patients with the utmost care, and specific training is often recommended. As mentioned, pre-transport checklists help decrease the risk of adverse events that may arise, and proper technique will improve the transfer’s safety.[21][22][23] Unexpected events during transfers of critically ill intensive care unit patients can be reduced when an intensivist or medically qualified personnel accompanies the patient.[24][25] The use of standardization of procedures, checklists, and good team training reduces the risk of unexpected events, improving the patient’s safety, and lowering the complications.[25][26][27][28] A nurse with post-registration qualification in critical care is recommended to accompany the transfer of critically ill intensive care unit patients.[29] Depending on the setting, nurses are frequently involved in patient transfers. Transferring a patient may be considered a high-risk maneuver because of the potential harm posed to the patient and the provider. While there is no consistent method used to teach proper transfer techniques, simulation-based or hands-on training is encouraged in teaching these advanced patient handling methods.[30] Patient-handling tasks such as transfers, lifting, and repositioning patients are physically demanding and often require strenuous movements and awkward positioning for the provider. Using assistive devices such as gait belts, walking belts, and multi-person teams may reduce the burden placed on providers who routinely perform patient transfers. Attention to proper ergonomics may reduce the risk of musculoskeletal injuries to healthcare personnel.[3][31][32] Paraplegic patients are taught how to improve the upper extremities' strength and upper back muscles to improve transfers. A realistic goal for paraplegic patients is to become independent with transfers using a slide transfer board. While at a nursing home or a rehabilitation center, the occupational therapy the patient receives should include practicing transfers under various conditions. This will help the patient to adjust to different situations outside the nursing home. Review QuestionsReferences1.Dunn MJ, Gwinnutt CL, Gray AJ. Critical care in the emergency department: patient transfer. Emerg Med J. 2007 Jan;24(1):40-4. [PMC free article: PMC2658153] [PubMed: 17183043] 2.Warren J, Fromm RE, Orr RA, Rotello LC, Horst HM., American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004 Jan;32(1):256-62. [PubMed: 14707589] 3.de Ruiter HP, Liaschenko J. To lift or not to lift: patient-handling practices. AAOHN J. 2011 Aug;59(8):337-43. [PubMed: 21780736] 4.Barbareschi G, Cheng TJ, Holloway C. Effect of technique and transfer board use on the performance of wheelchair transfers. Healthc Technol Lett. 2018 Apr;5(2):76-80. [PMC free article: PMC5933366] [PubMed: 29750117] 5.Waters T, Baptiste A, Short M, Plante-Mallon L, Nelson A. AORN ergonomic tool 1: Lateral transfer of a patient from a stretcher to an OR bed. AORN J. 2011 Mar;93(3):334-9. [PubMed: 21353805] 6.Baird JM, Raina KD, Rogers JC, O'Donnell J, Holm MB. Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning. Am J Occup Ther. 2015 Sep-Oct;69 Suppl 2:6912185020p1-8. [PubMed: 26539675] 7.Cheung K, Dai J, Cheung CL, Cho HK, Chow YL, Fung KY, Lam WS, Calvin Li HL, Ying Ng S, Ngan MY, Szeto G. The biomechanical evaluation of patient transfer tasks by female nursing students: With and without a transfer belt. Appl Ergon. 2020 Jan;82:102940. [PubMed: 31473499] 8.Tang R, Holland M, Milbauer M, Olson E, Skora J, Kapellusch JM, Garg A. Biomechanical Evaluations of Bed-to-Wheelchair Transfer: Gait Belt Versus Walking Belt. Workplace Health Saf. 2018 Aug;66(8):384-392. [PubMed: 29426267] 9.Hess JA, Kincl LD, Mandeville DS. Comparison of three single-person manual patient techniques for bed-to-wheelchair transfers. Home Healthc Nurse. 2007 Oct;25(9):577-9. [PubMed: 18049253] 10.Sun C, Buchholz B, Quinn M, Punnett L, Galligan C, Gore R. Ergonomic evaluation of slide boards used by home care aides to assist client transfers. Ergonomics. 2018 Jul;61(7):913-922. [PubMed: 29265925] 11.Conrad BP, Rossi GD, Horodyski MB, Prasarn ML, Alemi Y, Rechtine GR. Eliminating log rolling as a spine trauma order. Surg Neurol Int. 2012;3(Suppl 3):S188-97. [PMC free article: PMC3422095] [PubMed: 22905325] 12.Chandran KV, Abraham SV. Basic Life Support: Need of the Hour-A Study on the Knowledge of Basic Life Support among Young Doctors in India. Indian J Crit Care Med. 2020 May;24(5):332-335. [PMC free article: PMC7358858] [PubMed: 32728324] 13.McGuire RA, Neville S, Green BA, Watts C. Spinal instability and the log-rolling maneuver. J Trauma. 1987 May;27(5):525-31. [PubMed: 3573109] 14.Conrad BP, Horodyski M, Wright J, Ruetz P, Rechtine GR. Log-rolling technique producing unacceptable motion during body position changes in patients with traumatic spinal cord injury. J Neurosurg Spine. 2007 Jun;6(6):540-3. [PubMed: 17561742] 15.Del Rossi G, Horodyski MH, Conrad BP, Di Paola CP, Di Paola MJ, Rechtine GR. The 6-plus-person lift transfer technique compared with other methods of spine boarding. J Athl Train. 2008 Jan-Mar;43(1):6-13. [PMC free article: PMC2231400] [PubMed: 18335007] 16.Rowell W. When emergency nurses should drop the log-rolling manoeuvre. Emerg Nurse. 2014 Jul;22(4):32-3. [PubMed: 24984742] 17.Leech C, Porter K, Bosanko C. Log-rolling a blunt major trauma patient is inappropriate in the primary survey. Emerg Med J. 2014 Jan;31(1):86. [PubMed: 24136122] 18.Horodyski M, Conrad BP, Del Rossi G, DiPaola CP, Rechtine GR. Removing a patient from the spine board: is the lift and slide safer than the log roll? J Trauma. 2011 May;70(5):1282-5; discussion 1285. [PubMed: 21610441] 19.Prasarn ML, Horodyski M, DiPaola MJ, DiPaola CP, Del Rossi G, Conrad BP, Rechtine GR. Controlled Laboratory Comparison Study of Motion With Football Equipment in a Destabilized Cervical Spine: Three Spine-Board Transfer Techniques. Orthop J Sports Med. 2015 Sep;3(9):2325967115601853. [PMC free article: PMC4622296] [PubMed: 26535397] 20.Prasarn ML, Horodyski M, Behrend C, Del Rossi G, Dubose D, Rechtine GR. Is it safe to use a kinetic therapy bed for care of patients with cervical spine injuries? Injury. 2015 Feb;46(2):388-91. [PubMed: 25457336] 21.Jarden RJ, Quirke S. Improving safety and documentation in intrahospital transport: development of an intrahospital transport tool for critically ill patients. Intensive Crit Care Nurs. 2010 Apr;26(2):101-7. [PubMed: 20089403] 22.Choi HK, Shin SD, Ro YS, Kim DK, Shin SH, Kwak YH. A before- and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients. Am J Emerg Med. 2012 Oct;30(8):1433-40. [PubMed: 22205013] 23.Papson JP, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007 Jun;14(6):574-7. [PubMed: 17535981] 24.Venkategowda PM, Rao SM, Mutkule DP, Taggu AN. Unexpected events occurring during the intra-hospital transport of critically ill ICU patients. Indian J Crit Care Med. 2014 Jun;18(6):354-7. [PMC free article: PMC4071678] [PubMed: 24987233] 25.Kumari S, Kumar S. Patient safety and prevention of unexpected events occurring during the intra-hospital transport of critically ill ICU patients. Indian J Crit Care Med. 2014 Sep;18(9):636. [PMC free article: PMC4166880] [PubMed: 25249749] 26.Jones HM, Zychowicz ME, Champagne M, Thornlow DK. Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan. Dimens Crit Care Nurs. 2016 May-Jun;35(3):133-46. [PubMed: 27043399] 27.Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study. Aust Crit Care. 2020 Jan;33(1):12-19. [PubMed: 30674422] 28.Salt O, Akpınar M, Sayhan MB, Örs FB, Durukan P, Baykan N, Kavalcı C. Intrahospital critical patient transport from the emergency department. Arch Med Sci. 2020;16(2):337-344. [PMC free article: PMC7069436] [PubMed: 32190144] 29.Mackintosh M. Transporting critically ill patients: new opportunities for nurses. Nurs Stand. 2006 May 17-23;20(36):46-8. [PubMed: 16755893] 30.Kjellberg K, Lagerström M, Hagberg M. Patient safety and comfort during transfers in relation to nurses' work technique. J Adv Nurs. 2004 Aug;47(3):251-9. [PubMed: 15238119] 31.Belbeck A, Cudlip AC, Dickerson CR. Assessing the interplay between the shoulders and low back during manual patient handling techniques in a nursing setting. Int J Occup Saf Ergon. 2014;20(1):127-37. [PubMed: 24629874] 32.Garg A, Kapellusch JM. Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel. Hum Factors. 2012 Aug;54(4):608-25. [PubMed: 22908684] What safety precautions must be taken when transferring from bed to wheelchair?Position and lock the wheelchair close to the bed. Remove the armrest nearest to the bed, and swing away both leg rests. Help the patient turn onto his or her side, facing the wheelchair. Put an arm under the patient's neck with your hand supporting the shoulder blade; put your other hand under the knees.
What should you consider before transferring a patient from the bed to a wheelchair?The patient should help support their weight on their good leg during the transfer. Pivot towards the wheelchair, moving your feet so your back is aligned with your hips. Once the patient's legs are touching the seat of the wheelchair, bend your knees to lower the patient into the seat.
What safety measures would you follow when transferring a resident?It is important to protect your lower back when you transfer a person. Do not stretch your back or turn at your waist during a transfer. Keep your body in a straight line, with a straight back and bent knees. Your head and chest should be up and straight.
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