Patients safety transfers and lifting

PATIENTS SAFETY TRANSFERS AND LIFTING

Taking the pain out ofPatient handlingThe healthcare industry is getting serious about avoiding caregiver/nurses injuries caused by patient lifts and transfers. FOR DECADES, nurses and otherhealthcare providers have suffereddebilitating musculoskeletal injurieswhen lifting, transferring, and repositioningpatients manually. Today, the healthcare industry acknowledgesthat manual patient handling isn’t safe. We’re so devoted to protecting our patients that we don’t focus enoughon protecting ourselves .

What is the proper approach to the patient transfer or lift?•Proper documentation and communication should inform the nurse of the client's abilities, transfer needs, physical stability, and tendency if any, towards aggressive acts.

•The nurse should anticipate what actions would be necessary if the client loses balance or falls.

•The procedure for the transfer should be clearly communicated and understood by any other staff assisting and the patient or resident.

•The nurse should assess the client, even briefly, before every transfer.

In transfers, tighten your abdominal muscles, keep your back straight, and use your leg muscles to avoid injury.

Do not rotate or twist the spine. Move your entire body in the direction of the transfer.Never grab the client under his or her armpits as this could injure the client.

Position yourself close to the client and assure footing is stable.

Try to maintain eye contact with the client and communicate while the transfer is in progress.

Never allow the client to grasp you around the neck as this could result in injury.The client should be transported the shortest possible distance by the lifting device.Agree on the timing of the transfer with the client and other caregiver(s) and count together.

Assure that the path of the transfer or lift is clear from obstructions and that furniture and aids that the client is being transferred to are properly placed and secure.

If the weight of the person is more than one-fourth of your body weight, you should get someone to help you. Also, get assistance if lifting the person is awkward.

If assistance is needed, find out the person's strengths and weaknesses. Often one side of the body is stronger. The stronger side should be transferred first.

Do not attempt to transfer anyone if you feel unable to lift their full weight.

Never leave a person unattended on a bedside commode

Proper Body Mechanics Safety Precautions

• Using specific methods to lift large weights without injury• Safety Precautions

• Use legs, not back to lift• Largest bone/muscle

group• Keep weight close to

body• Shifts center of gravity

to patient• More leverage

Body MechanicsCondiserations

• Guidelines for lifting/carrying • Consider pt weight• Know your limitations• Lift without twisting• Position feet one in front of

the other• Communicate with partner• Keep back locked and don’t

twist• Flex at hips (not at waist)• Bend at knees• Keep elbows bent with arms

close to sides• Don’t hyperextend your back • Avoid reaching more than

15”-20” in front of your body• Push rather than pull• Keep line of pull through

midline

Proper lifting technique

Avoid reaching more than 15-20" in front of your body.Avoid reaching and strenuous activity for more than 1 minute.

Keep your back in locked-in position.Avoid stretching or overreaching when reaching overhead.

Transfers - Safety

Safety is a major concern when transferring. Falls are a common hazard. If a patient starts to fall – do not try to stop the fall, instead assist the patient to the floor while protecting the head from injury. This will reduce the risk of patient as well as staff injury.

Complete a thorough nursing assessment before you move the patient to determine if she/he has suffered any injuries.

Prevention of injury is the key, be aware of the client’s motor deficit, ability to support their body weight and use effective body mechanics & lifting techniques.

When in doubt regarding the patient’s ability -GET ASSISTANCE

GENERAL MOVING AND/OR LIFTING PATIENTRECOMMENDATIONS

i. Ensure the patient's privacy is maintained 

ii. If a patient arrives on a trolley or wheelchair, ascertain how ambulant they are by asking the doctor or nurse, in this instance, do not depend on the patient's comments as they may be confused or too helpful etc. It is best that when in doubt, then lift the patients so as to avoid accidents. 

iii. Remove jewellery from your hands and wrists as this may cause skin damage to the patient. 

iv. Support/splint areas as needed e.g. fractured limbs, cervical spine etc 

v. Ensure the patient's arms and legs are in a suitable position. 

vi. Ensure there is nothing restrictive to the patient's movement e.g.. bedclothes 

vii. Ensure that tubes are free moving e.g. urinary catheters, IV drips, NG tubes, drains etc 

viii. Do not rush the patient. If you do you will find that the patient won't be helping and you will have to support the whole weight. 

ix. Whenever possible have an assistant, preferably of the same frame and height as yourself. Use a count down to effectively work as a team. When holding onto an assistant, grab his/her wrist in preference to the hand, so if one looses his/her grip then that support is still retained by the other. 

x. Lift, don't drag the patient otherwise you may cause skin tearing. 

xi. If one person is aiding the patient then be on the patient's weaker side so that they may assist you with their better side.

Patient safety:

• Patients who are at risk for falling must receive diligent care to prevent falls. • Always return the bed to the height that is safe for the patient, which is usually the lowest position.• Always ensure bedrails are up when the patient is in bed, if required.• Never leave a patient unattended on the edge of a bed, unless she can fully support herself and is able to walk. • Gather all needed supplies ahead of time, prior to beginning care, so the patient is not left unattended.• Better to be safe—using a lift and having the help of a colleague—than sorry.• If you are helping a patient to walk or stand and he starts to fall, do not attempt to stop him from falling. Instead, guide and support his fall and protect his head.

Before you begin, make sure you have put up the foot pedals or swung them out of the way. Place your arm around the person under his or her arm at the armpit. Place your other arm under the person's knees. Or face the person in the chair. Secure a hold under each arm, and lift the person out of the chair.

Draw Sheet

• Loosen sheets from bed

• Place stretcher next to bed

• Reach across and firmly grasp sheet• Head• Chest• Hips• Knees

• Slide pt gently onto stretcher

WARM UP EXERCISES BEFORE YOU START WORK

Stand with knees slightly bent and feet apart, place palms onlower back, fingers pointing downward. Gently push your palms forward and gently bend your back backwards. Hold for 5-10 seconds. Repeat 3-5 times.Then bend the knees and lower the body forward as far ascomfortable. Relax the neck, shoulders and arms. Hold 5seconds.

Keep knees bent and slowly uncurl to an upright position.Slowly roll your shoulders backward five times in a circularmotion. Slowly roll your shoulders forward 5X in a circular motion.

Interlace fingers. Turn palm upwards above your head as youstraighten your arms. Stretch and hold for 5-10 seconds.Repeat 3-5 times.

Fingers interlaced behind your back. Slowly turn your elbow outward while straightening your arms. Hold for 5-10 seconds.Repeat 3-5 times.

Interlace fingers. With palms facing out, straighten arms out tothe front of you. Hold for 5-10 seconds. Repeat 3-5 times.

Hold left elbow with right hand. Gently pull elbow behind head until you feel a stretch. Hold for 5-10 seconds. Repeat 3-5 times. Repeat with other arm.

Gently pull your left elbow across your chest towards your right shoulder until you feel a stretch. Hold for 5-10 seconds. Repeat 3-5 times. Repeat with other arm.

Sit or stand upright. Interlace fingers and lift armsoverhead. Keeping the elbows straight, press arms as far back as you can. Slowly bend to the left side until you feel a stretch. Hold for 5-10 seconds. Slowly bend to the right side until you feel a stretch. Hold for 5-10 seconds. Repeat 3-5 times.

Sit with left leg across right leg. Rest elbow or forearm of right arm on the outside of the left upper thigh. Gently apply pressure with right elbow or forearm towards the right. As you apply pressure, look over your left shoulder. Hold for 5-

Stand upright with right hand supported on a wall or the back of a stationary chair. Grab your left ankle with your left hand. Keep left knee pointed towards the ground. Slowly pull the left leg towards the buttock until you feel a stretch in the front of the thigh. Hold for 5-10 seconds. Repeat 3-5 times. Repeat with the other leg.

Stand arms length from a wall or other support, feet facingforward. Place right foot forward and keep the left leg straight and the heel on the ground. Lean your body towards the wall until you feel a stretch in the left calf. Hold for 5-10 seconds.Repeat 3-5 times. Repeat with the other side

END

THANK YOU!

As you go about your daily work, remember to push, pull or roll heavy objects rather than lifting them—whenever possible.Don’t ever lift or transfer a client if you feel dizzy or lightheaded.  You could both be in for a spill!

Encourage your clients to practice good posture, too.   They may experience fewer aches and pains...and have a better quality of life!Ask your supervisor to review safe transfer procedures with you anytime you feel the need.

Exercise regularly to keepyour back and abdominalmuscles strong.  Rememberthat thesemuscles actlike a natural“girdle” toprotect yourback.

Exercise regularly to keep your back and abdominal muscles strong.  Remember that these muscles act like a natural "girdle” to protect your back.If you’ve felt pain or discomfort while moving a particular client , then DON’T DO IT AGAIN IN THESAME WAY!  Change your technique or get help when it’s time to move that client again.Don’t ever lift or transfer a client if you feel

dizzy or lightheaded.  You could both be in for a spill!Just because a client is small doesn't mean that she will be easy to transfer.   Be sure to think about the client’s flexibility, range of motion and overall strength.  All these things together affect how easy a client is to transfer

V. WHEELCHAIRS:A. Make sure the chair is locked when removing or seating the person.B. Pull the wheelchair backwards up steps or curbs.C. Adjust the height of the foot pedals so the person is sitting at a 90 degree angle at the hip and knee.D. When removing or seating the person, the following procedure is suggested as easy for you and most comfortable for the person: VI. LIFTING AND MOVING(from bed to wheelchair):A. Always begin the lifting procedure by moving the person to the edge of the bed. First, move the upper trunk, then the legs one at a time. Repeat this until the person is near the edge of the bed. Repeated movement of the trunk and legs is easier than lifting the person as a whole all at once.B. Remember, bend from your knees, not from your waist. If you must bend from the waist, tighten your stomach muscles while bending and lifting. This reduces pull on the back muscles. Keep your back straight at all times. The following are step-by-step procedures which will make lifting and transferring safer and easier.

Other Tips For Safe Lifting & Transferring Try to stretch and loosen your

muscles every day before work. Even five minutes of stretching can help save your back!Just because a client is small doesn't mean that she will be easy to transfer.   Be sure to think about the client's flexibility, range of motion and overall strength.  All these things together affect how easy a client is to transfer. If appropriate, use an assistive device to

move a client.  This may include a transfer belt, sliding board or draw sheetA back injury can change your life.  It can keep you from being able to do your job...and from doing the things you love.  A back injury can also give you a lifetime of chronic pain

Guidelines for ReachingAvoid twisting.Keep your back straight when leaning over patients.Lean from the hips.Use shoulder muscles with log rolls.

Guidelines for Pushing and PullingPush whenever possible rather than pull.Keep your back locked-in.Keep elbows bent with arms close to sides.Keep the line of pull through the center of your body by bending your knees.Keep weight close to body.Push at a level between your waist and shoulders.Use kneeling position if weight is below waist level.Avoid pushing and pulling from overhead position.

VII. THE ONE-PATIENT TRANSFER:A. Prepare for the lift.1. Place a belt around the person's waist.2. Place wheelchair at a slight angle to the side of the person's bed.3. Lock both brakes on the wheelchair.4. Remove the armrest of the wheelchair on the side next to bed, if possible. This helps prevent bumping the person's hips or buttocks and allows for lifting without lifting too high.5. Swing away the legrests of the chair. If legrests will not swing away, lift the pedals to avoid interference during the transfer.6. If the person has a catheter, be sure the bag is lower than the bladder and that both bag and tubing are out of the way. (This applies equally to transfers from a wheelchair to a surface and from a surface to a wheelchair.)7. Stabilize the bed, so it will not move

B. Steps in the one-person transfer.1. Place the person's legs over the side of the bed with the knees near the bed's edge.2. Place the person's hands in his or her lap.3. Place your arms under the person's armpits and around the back.4. Raise the person to a sitting position on the side of the bed. Do not let go unless the person can sit alone without support.5. Gradually slide the person forward until the person's feet are flat on the floor. Place your feet in a "v" on both sides of the person's feet for support. Have your feet far enough apart to give you a good base of support. Your knees should be on each side of the person's knees.6. Have the person lean forward. If possible, place the person's arms around your shoulders. Allow the person to reach with an outside arm for the far wheelchair arm.7. Bend your hips and knees while keeping your back straight. Place your arms around the person's waist. Grip the person's belt on both sides toward the back with your hands. (If the person is not wearing a belt, a safety belt may be put on during the preparation stage.)8. Keep the person's knees stabilized. Count 1-2-3, then pull forward on the belt to lift the person.9. When the person is high enough to clear the armrest or chair surface, turn by taking small steps. Be sure to keep the person's knees blocked with your own knees.10. When turned, bend your hips to squat and lower the person to the chair's seat.11. Replace the footrests, then the armrest.12. Remove the belt, if necessary.13. Fasten the seat belt on the chair.14. Repeat the procedure from steps 5 to 11 when transferring from a chair to the bed or other areas. Remember to move any catheter bags or tubes out of the way prior to lifting.

C. Alternate lifts: use only to lift a very small person.1. Prepare for the lift by following the same procedure as outlined in steps 1-6 in the one-person transfer. 2. If the individual is totally incapable of assisting you and you are alone without another's assistance, follow the procedure listed below. (If the person is more than one-fourth of your body weight, try not to lift the person by yourself.)a. Move the person to the side of the bed in a lying pohition.b. Fold the person's arms across his or her chest.c. Place your feet far enough apart to give you a good base of support.d. Bend your knees slightly.e. Place one of your arms under the person's neck.f. Place the other arm under the person's knees.g. Using the strength in your legs, draw the person close to your body and lift up while keeping your back straight.h. Take small steps to the wheelchair. Remember to keep your knees bent. Carefully place the person in the seat of the chair.i. Check on the person's sitting position and adjust the wheelchair seat belt.j. Fasten the seat belt.k. Repeat the procedure to lift an individual from a wheelchair to another area (e.g., to a bed or couch).

VIII. THE TWO-PERSON TRANSFER:A. Prepare for the transfer.1. Know where you are going to move the person.2. Prepare the wheelchair, tub, or bed prior to starting to lift the person.3. Be sure the wheelchair brakes are locked.4. Remove the wheelchair's armrest which is closest to the destination point.5. Swing away or remove the legrests or lift pedals, if possible.6. If the person has a catheter, be sure the bag is lower than the bladder and that both bag and tubing are out of the way. (This applies equally to transfers from a wheelchair to a surface and from a surface to a wheelchair.)7. Stabilize the surface from which you are lifting the person.

B. Steps in a two-person transfer.1. The taller lifter should stand at the back of the person.2. The shorter person should stand on one side of the person.3. The lifter at the back should put his or her arms under the person's shoulders and around the person's chest with arms folded across the person's chest.4. The taller lifter at the back should then widen the base of support by spreading feet apart and bending slightly at the hips and knees. (Remember to not bend the back, but to use the strength in the hips and knees.)5. The shorter lifter at the side places both arms under the person's thighs in order to support the buttocks and lower legs. Clasp one hand to wrist for firm grip.6. The shorter lifter should also widen the base of support by spreading feet apart.7. Bend knees and hips slightly before lifting.8. Be sure the person being lifted keeps elbows next to the body or place arms and elbows in that position, if necessary.9. The taller lifter counts to three after which both lifters should straighten their hips and knees to lift the person in unison. Both lifters step to the transfer surface and place the person there. If the individual is being put in bed, repositioning for comfort may be necessary.

BACK CARE 101 LIFTING MECHANICS AND SAFETYLifting mechanics:• Keep your back in balance and maintain good posture. Maintain the three naturalcurves of your spine.• Always lift with your quads. These are long and strong. If you bend at your waistand extend your upper body to lift an object, you upset your back’s alignment andyour center of balance. You also force your spine to support the weight of yourbody and the weight of the object you're lifting. Your lower back lifts 7-10 timesthe weight of an object. For example, if you bend over to pick up a 10 lb. box,your back is lifting 70-100 lbs., plus the weight of your upper body. This situationis called "overload". You can avoid overloading your back by using good liftingtechniques.• Maintain a wide base of support by keeping your feet apart.

• Avoid twisting your back. Twisting can overload your spine and lead to serious injury. Make sure your feet, knees, shoulders and hips are pointed in the same direction when lifting or transferring.• Do not lift heavy objects above shoulder level. Avoid reaching.• Tuck your pelvis. By tightening your stomach you can tuck your pelvis which will helpyour back stay in balance while you lift.• Bend at your knees instead of at your waist. This helps you keep your centre of balance and lets the strong muscles in your legs do the lifting. Lift with your legs.• Hold the patient or object close to you and in line with your centre of gravity. If necessary, hop onto a patient’s bed if you need to be closer to him for a move.• Never work over a bedrail. Always lower it prior to providing any patient care.• Always raise the bed to a good working level. Make sure you lower it once you aredone so your patient can safely get out of bed, or so if she falls, she will not fall asfar.• Whenever possible, utilize gravity instead of fighting against it. For example, if transferring a patient from a bed to a chair, make sure the bed is slightly higher thanthe chair.• Pushing is easier than pulling, as the body weight can be used to help move theobject or person. When pushing, get close to the object/person, push with your legs,arms should be lock in a bent position, the back should be straight, and pushhorizontally.• When pulling, keep the back and arms straight, and use your legs and body weightto pull.

Steps for transferring from Bed to WheelchairRemove clutter from area, including all scatter rugsDiscuss with the transferee, the process before and during the transferThe amount of room available for transfer will dictate which side of the bed you will be transferring from.Determine if the transferee has a stronger side, as he/she will be better able to scoot to the edge of the bed on that side prior to transfer.Position wheelchair on the transferee’s strongest side (for example if the right side is strongest, you will be transferring from the right side of the bed.)Assist person to be transferred to edge of bed and to sitting position first with feet dangling and then with feet on floorFor ease of transfer, position the wheelchair next to the knee on his/her strongest sidePull wheelchair within a foot of the person’s knee and lock the wheelchair brakesExplain the sequence of lifting and pivoting into the wheelchair (example: on the count of 3, I am going to help you stand up and turn to your strong side; eg right side as in above example; and sit in the wheelchair)Using the bear hug technique, ask the person to place his/her arms on your shoulders as you place your arms around his/her trunkBracket their feet with your feet to prevent slippingUsing your leg muscles, stand up and bring the person upward in a slow steady rising motionIf transferee is capable, have him/her reach for the furthest wheelchair armrestPivot towards wheelchair seat, and lower slowlyAttach or swing foot rests of wheelchair into placePlace person’s feet onto foot rests of wheelchair

Steps for transferring from Wheelchair to Bed

Have the bed at the lowest level.Park the wheelchair with the person’s strongest side next to the bed.Lock the wheelchair brakes and remove feet from foot rests.Swing or remove foot rests from wheelchair.Explain the sequence of lifting and pivoting into the wheelchair (example: on the count of 3, I am going to help you stand up and turn to your strong side; eg right side as in above example; and sit in the wheelchair).Using the bear hug technique, ask the person to place his/her arms on your shoulders as you place your arms around his/her trunk.Bracket their feet with your feet to prevent slipping.Using your leg muscles, stand up and bring the person upward in a slow steady rising motion.Seat the person on the bedAssist in bring the person’s legs up onto the bed.Position for comfort.

Patient Positioning • Unresponsive pt (non traumatic)

• Rolled into recovery position (Left side)• Pt with dyspnea or chest pain

• Position of comfort• As long as hypotension doesn’t occur

• Suspected spine injury• Immobilized to long backboard

• Pregnant Pt• Left lateral recumbent• Supine= Fetus on vena cava

• Shock• Elevated legs 8”-12”

• Nausea/Vomiting • Position of comfort• EMT in position to control airway

Bed to StandingPosition the wheelchair close to the side of the bed, and lock the wheels. It should be on the side that the patient feels the strongest. Ideally, the bed should be slightly higher than the wheelchair. Assist the patient to a sitting position by gently grasping under the legs and swinging them over the edge of the bed. Use the electric bed to assist the patient to sitting or assist the patient to sitting by grasping her hands. Secure a gait belt around the patient's waist. The nurse should keep her feet shoulder width apart, her back straight and her knees bent. Place the patient's hands on the bed or on the arms of the wheelchair. Hold the patient close, and lift with the knees until the patient is in a standing position.Standing to SittingPivot the patient toward the wheelchair. Be sure that the patient reaches back to feel for the chair and does not fall into the chair as this can be dangerous. Slowly bend at the knees and lower the patient into the chair while keeping the back straight.

Read more: Proper Lifting Techniques for Nurses | eHow.com http://www.ehow.com/info_8221747_proper-lifting-techniques-nurses.html#ixzz1o04Dw600

Position in BedMany times, a patient will need to be repositioned in bed. This requires assistance from another person. Be sure there is a draw sheet under the patient for lifting and turning. The bed should also be locked with the rails up and the height at waist level to avoid stooping. Ask the patient to help, if possible, by bending his legs and pushing or by pulling on the side rails. Everyone involved in the lift should work in unison, usually on a count of three. With a straight back and bent knees, get as close to the patient as possible, and slide him up in the bed to reposition him. Shift weight from one foot to another instead of twisting with the back.General TechniquesIn general, it is best to lift with the knees and avoid twisting the back. Although it is sometimes impossible to avoid lifting, it helps to get as many people as possible to help with the bigger lifts that sometimes are necessary. Keeping the neck and back in alignment with the feet shoulder width apart is a good general rule to follow when attempting to lift patients. Never lift at the waist, and always try to get the weight as close to the body as possible to make carrying it easier on the back.

Lifting & Moving PatientsBACK   Thousands of patients are lifted and moved by EMTs and many EMTs are injured because they attempt to lift or move a patient improperly. A wide variety of patient conditions as well as circumstances affect how the patient is "packaged" for transport.   The expression "Lift with your legs and not your back." is a very important part of proper body mechanics. Always get as close to the patient as you can when lifting. Keep your arms and patient as close to your body as you can to help create leverage and maintain balance. Bend at the knees while keeping your back as straight as possible. Recognize your limitations and call for back-up when needed to lift patient.

Guidelines for Carrying Patients and EquipmentWhenever possible, move patients on devices that can be rolled.Minimize the distance needed to carry patientsKnow the weight to be carried.Work in a coordinated manner with your partner.Keep the weight as close to your body as possible.Keep your back in a locked-in position and refrain from twisting.Flex at the hips, NOT the waist, and bend at the knees.Do not hyperextend your back (do not lean back from the waist).Try to lift with a partner that has similar height and strength.Guidelines for Safe Carrying on Stairs    One of the most difficult carries an EMT must do is carry a patient backwards up a stairway. Try to carry heavy patients up a stairway with two people at the top, shoulder to shoulder, and two at the bottom of the stretcher.Always carry patients head first up the stairs and feet first down the stairs.Try to use a stair chair if the patient's condition allows it. If a stair chair is not available, use a light but sturdy kitchen chair. If neither are available, use the extremity lift.Keep you back in the locked-in position.Flex at the hips, NOT the waist, and bend at the knees.Keep the weight and your arms as close to your body as possible.

Clothing Drag1. Tie the patient's wrists together if you have something quickly available. If nothing is available, tuck the hands into the waist band to prevent them from being pulled upwards.2. Clutch the patient's clothing on both sides of the neck to provide a support for the head.3. Pull the patient towards you as you back up, watching the patient at all times. The pulling force should be concentrated under the armpits and NOT the neck.Sheet Drag1. Fold or twist a sheet or large towel lengthwise.2. Place the narrowed sheet across the chest at the level of the armpits.3. Tuck the sheet ends under the armpits and behind the patient's head.4. Grasp the two ends behind the head to form a support and a means for pulling.5. Pull the patient toward you while observing the patient at all times.Blanket Drag1. Lay a blanket lengthwise beside the patient.2. Kneel on the opposite side of the patient and roll the patient toward you.3. As the patient lies on their side while resting against you, reach across and grab the blanket.4. Tightly tuck half of the blanket lengthwise under the patient and leave the other half lying flat.5. Gently roll the patient onto their back.6. Pull the tucked portion of the blanket out from under the patient and wrap it around the body.7. Grasp the blanket under the patient's head to form a support and means for pulling.8. Pull while backing up and while observing the patient at all times.Bent Arm Drag1. Reach under the patient's armpits from behind and grasp the forearms or wrists.2. Use your arms as a cradle for the patient's head and keep the arms locked in a bent position by your grasp.3. Drag the patient towards you as you walk backwards, observing the patient at all times.