17. Safe resident handling, moving, and transfers


Safe resident handling, moving, and transfers


Objectives



Key terms


friction  The rubbing of one surface against another


logrolling  Turning the person as a unit, in alignment, with one motion


shearing  When skin sticks to a surface while muscles slide in the direction the body is moving


transfer  Moving the person from one place to another


KEY ABBREVIATIONS











ID Identification
OSHA Occupational Safety and Health Administration

You will turn and re-position persons often. You move them in bed. You transfer them to and from beds, chairs, wheelchairs, stretchers, and toilets. To transfer a person means moving the person from one place to another. During these and other tasks, you must use your body correctly. This protects you and the person from injury.


See Focus on Communication: Safe Resident Handling, Moving, and Transfers.



FOCUS ON COMMUNICATION


Safe Resident Handling, Moving, and Transfers


Handling, moving, and transfers can be very painful following an injury or surgery. Many older persons have painful joints. The fears of pain and falling are common. Always explain what you are going to do before starting the procedure. Then explain what you are doing step-by-step. This promotes comfort. When giving step-by-step directions:



You must make sure the person is comfortable and that you are not causing pain. You can say:



See Promoting Safety and Comfort: Safe Resident Handling, Moving, and Transfers.



See Teamwork and Time Management: Safe Resident Handling, Moving, and Transfers.




TEAMWORK AND TIME MANAGEMENT


Safe Resident Handling, Moving, and Transfers


Residents need to be moved, turned, transferred, and re-positioned. These tasks and procedures are best done by at least 2 staff members.


Friendships are common among co-workers. And some working relationships are better than others. Do not just ask your friends or those with whom you work well to help you. Include all co-workers. Do not just help your friends or those with whom you work well. Assist anyone who asks for your help. This includes new staff members and those from other units.


Preventing work-related injuries


You must prevent work-related injuries when handling, moving, and transferring residents. Follow the rules in Box 17-1. The Occupational Safety and Health Administration (OSHA) recommends that:




Box 17-1


Preventing Work-Related Injuries


General guidelines



• Wear shoes that provide good traction. Avoid shoes with worn-down soles. Good traction can help prevent slips or falls.


• Use assist equipment and devices whenever possible instead of lifting and moving the person manually. Follow the person’s care plan.


• Get help from other staff. The nurse and care plan tell you how many staff members are needed to complete the task.


• Plan and prepare for the task. For example, know what equipment you will need, where to place chairs or wheelchairs, and what side of the bed to work on.


• Schedule harder tasks early in your shift.


• Balance lighter and harder tasks. Plan your work so that you can complete a lighter task after a harder one.


• Lock bed wheels and wheelchair or stretcher wheels.


• Tell the person what he or she can do to help. Give clear, simple instructions. Give the person time to respond.


• Do not hold or grab the person under the underarms.


• Do not let the person hold or grasp you around your neck.


Manual lifting



• Use good body mechanics.


• Stand with good posture. Keep your back straight.


• Bend your legs, not your back.


• Use your legs to do the work.


• Face the person.


• Do not twist or turn. Pick up your feet, and pivot your whole body in the direction of the move.


• Try to keep what you are moving close to you—the person, equipment, or supplies.


• Move the person toward you, not away from you.


• Use slides and lateral transfers instead of manual lifting.


• Use a wide, balanced base of support. Stand with one foot slightly ahead of the other.


• Lower the person slowly by bending your legs. Do not bend your back. Return to an erect position as soon as possible.


• Use smooth, even movements. Avoid jerking movements.


• Lift on the “count of 3” when lifting with others. Everyone should lift at the same time.


Lateral transfers



• Position surfaces as close as possible to each other (bed and chair; bed and stretcher).


• Adjust surfaces so that they are at about waist height. The receiving surface should be slightly lower to take advantage of gravity. For example, when transferring the person from bed to a chair, the chair surface is lower than the bed.


• Make sure bed rails are down. Make sure side rails on stretchers are down.


• Use drawsheets, turning pads, large incontinence pads, or other friction-reducing devices. Such devices include slide boards, slide sheets, and low-friction mattress covers.


• Get a good hand-hold. Roll up drawsheets, turning pads, and incontinence pads. Or use assist devices with handles.


• Kneel on the bed or stretcher. This helps prevent extended reaches and bending the back.


• Have staff on both sides of the bed or other surface. Move the person on the “count of 3.” Use a smooth, push-pull motion. Do not reach across the person.


Gait/transfer belts



Stand-pivot transfers



• Use assist devices as directed. Follow the care plan.


• Use a gait/transfer belt with handles.


• Keep your feet at least shoulder-width apart.


• Lower the bed so the person can place his or her feet on the floor.


• Plan the transfer so that the person moves his or her strong side first.


• Get the person close to the edge of the bed or the chair. Ask the person to lean forward as he or she stands.


• Block the person’s weak leg with your legs or knees. If the position is awkward, do the following:


• Use a transfer belt with handles.


• Straddle your legs around the person’s weak leg.


• Bend your legs. Do not bend your back.


• Pivot with your feet to turn.


• Use a gentle rocking motion to assist the person to stand. The rocking motion gives strength and force as you pull the person to a standing position.


Lifting or moving the person in bed



Transporting residents and equipment



Transferring the person from the floor



Modified from Cal/OSHA: A back injury prevention guide for health care providers, Sacramento, Calif, revised November 1997, and referenced in Ergonomics: guidelines for nursing homes, Occupational Safety and Health Administration, revised March 2009.


To safely handle, move, and transfer the person, the nurse and health team determine:



• The person’s dependence level. Dependence levels relate to the ability to move without help. Some persons do not need help moving. Others totally depend on the staff. You need to know the person’s dependence level before you handle, move, or transfer a person. See Box 17-2, p. 222.


• The amount of assistance needed. This depends on the person’s height, weight, cognitive function, and dependence level. Some persons only need help from one staff member. Others need help from at least 2 or 3 staff members.


• What procedure to use. This chapter includes handling, moving, and transfer procedures. The nurse and care plan tell you what procedure to use.


• The equipment needed. Assist equipment and devices are useful to safely handle, move, and transfer persons. They are presented throughout this chapter. The nurse and care plan tell you what to use. Always follow the manufacturer’s instructions. Ask for any needed training to use the equipment and devices safely.



Box 17-2


Levels of Dependence



Code 4: Total Dependence. The person cannot help with the transfer. The task or procedure is done by the staff.


• The person should be lifted and transferred using a full-sling mechanical lift (Fig. 17-1). The mechanical lift is used for transfers between beds, chairs, and toilets. It is also used for transfers to and from bathtubs and weighing scales.


Code 3: Extensive Assistance. The person can bear some weight, can sit up with help, and may be able to pivot to transfer.


• The person should be lifted and transferred using a mechanical lift. The mechanical lift is used for transfers between beds, chairs, and toilets. It is also used for transfers to and from bathtubs and weighing scales. The type of lift to use is noted on the person’s care plan—full-sling mechanical lift or stand-assist lift (Fig. 17-2).


Code 2: Limited Assistance. The person is highly involved in the moving or transfer procedure. He or she needs some help moving the legs. The person can stand (bear weight). The person has upper body strength and can sit up. He or she is able to pivot to transfer.


• Stand-assist devices may be needed. These can be attached to the bed or chair (Fig. 17-3). Other stand-assist devices include walkers (Chapter 26) and gait/transfer belts with handles.


• Sliding boards are useful for transfers to and from beds and chairs (Fig. 17-4).


Code 1: Supervision. The staff needs to look after, encourage, or cue the person. To cue means to remind the person what to do.


• The devices for Code 2 may be needed.


Code 0: Independent. The person can walk without help. Sometimes the person may need limited assistance.


• Mechanical assistance is not normally required for transfers, lifting, or re-positioning.






Modified from Nelson AL: Patient care ergonomics resource guide: safe patient handling and movement, Patient Safety Center of Inquiry (Tampa, Fla), Veterans Health Administration and Department of Defense, August 2005.


See Residents With Dementia: Preventing Work-Related Injuries, p. 224.



RESIDENTS WITH DEMENTIA


Preventing Work-Related Injuries


Some older persons have dementia. They may not understand what you are doing. They may resist your handling, moving, and transfer efforts. The person may shout at you, grab you, or try to hit you. Always get a co-worker to help you. Do not force the person. The rules and guidelines in Box 17-1 apply. The person’s care plan also has measures for providing safe care. For example:



Tell the nurse at once if you have problems handling, moving, or transferring the person.


See Teamwork and Time Management: Preventing Work-Related Injuries, p. 224.



TEAMWORK AND TIME MANAGEMENT


Preventing Work-Related Injuries


Some centers have “lift teams.” These teams perform most of the lifting, moving, and transfer procedures. They use assist equipment and do not manually lift or move residents unless necessary.


The nurse advises the lift team of scheduled procedures. The team is called by beeper, pager, wireless phone, or other device for unscheduled transfers.


Do not assume that the lift team will lift, move, or transfer your assigned residents. Follow center policy for checking or adding to the lift team’s schedule. Do not neglect or omit a procedure because the center has a lift team. If the person is on the team’s schedule, always check to make sure that the procedure was done. Sometimes the team can get delayed because of unscheduled or unexpected events. Always thank the team for the work that they do. Their work protects residents and you from injury.


See Delegation Guidelines: Preventing Work-Related Injuries, p. 224.



See Promoting Safety and Comfort: Preventing Work-Related Injuries, p. 224.



Moving persons in bed


Some persons can move and turn in bed. Others need help from at least one person. Those who are weak, unconscious, paralyzed, or in casts need help. Sometimes 2 or 3 people or a mechanical lift is needed.



See Delegation Guidelines: Moving Persons in Bed.



Protecting the skin


Older persons have fragile skin that is easily damaged. Protect their skin during handling, moving, and transfer procedures. Friction and shearing injure the skin. Both cause infection and pressure ulcers (Chapter 36).




Reduce friction and shearing when moving the person in bed. Do so by:



• Rolling the person.


• Using friction-reducing devices. Such devices include a lift sheet (turning sheet). A cotton drawsheet (Chapter 19) serves as a lift sheet (turning sheet). Turning pads, large incontinence products, slide boards, and slide sheets are other friction-reducing devices.


imageRaising the person’s head and shoulders


You may have to raise the person’s head and shoulders to give care. Simply turning or removing a pillow requires this procedure. 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. This protects the person and you from injury.




imageRAISING THE PERSON’S HEAD AND SHOULDERS


Quality of life


Remember to:



Pre-procedure



Procedure



8 Ask your co-worker to stand on the other side of the bed. Lower the bed rails if up.


9 Ask the person to put the near arm under your near arm and behind your shoulder. His or her hand rests on top of your shoulder. If you are standing on the right side, the person’s right hand rests on your right shoulder (Fig. 17-6, A). The person does the same with your co-worker. The person’s left hand rests on your co-worker’s left shoulder (Fig. 17-7, A).


10 Put your arm nearest to the person under his or her arm. Your hand is on the person’s shoulder. Your co-worker does the same.


11 Put your free arm under the person’s neck and shoulders (Fig. 17-6, B). Your co-worker does the same (Fig. 17-7, B). Support the neck.


12 Help the person raise to a sitting or semi-sitting position on the “count of 3” (Figs. 17-6, C, and 17-7, C).


13 Use the arm and hand that supported the person’s neck and shoulders to give care (Fig. 17-6, D). Your co-worker supports the person (Fig. 17-7, D).


14 Help the person lie down. Provide support with your locked arm. Support the person’s neck and shoulders with your other arm. Your co-worker does the same.



Post-procedure



imageMoving the person up in bed


When the head of the bed is raised, it is easy to slide down toward the middle and foot of the bed (Fig. 17-8). The person is moved up in bed for good alignment and comfort.




imageMOVING THE PERSON UP IN BEDimage


Quality of life


Remember to:



Pre-procedure



Procedure



8 Lower the head of the bed to a level appropriate for the person. It is as flat as possible.


9 Stand on one side of the bed. Your co-worker stands on the other side.


10 Lower the bed rails if up.


11 Remove pillows as directed by the nurse. Place a pillow upright against the head-board if the person can be without it.


12 Stand with a wide base of support. Point the foot near the head of the bed toward the head of the bed. Face the head of the bed.


13 Bend your hips and knees. Keep your back straight.


14 Place one arm under the person’s shoulder and one arm under the thighs. Your co-worker does the same. Grasp each other’s forearms (Fig. 17-9).


15 Ask the person to grasp the trapeze.


16 Have the person flex both knees.


17 Explain the following:


a You will count “1, 2, 3.”


b The move will be on “3.”


c On “3,” the person pushes against the bed with the feet if able. And the person pulls up with the trapeze.


18 Move the person to the head of the bed on the count of “3.” Shift your weight from your rear leg to your front leg (see Fig. 17-9). Your co-worker does the same.


19 Repeat steps 12 through 18 if necessary.



Post-procedure



You can sometimes move lightweight adults up in bed alone if they can assist and use a trapeze. However, it is best to have help and to use an assist device—lift sheet, large incontinence product, slide sheet (p. 229). 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.


See Promoting Safety and Comfort: Moving the Person Up in Bed.



imageMoving the person up in bed with an assist device


Assist devices are used to move some persons up in bed. Such assist devices include a drawsheet (lift sheet), flat sheet folded in half, turning pad (Fig. 17-10), slide sheet (Fig. 17-11), and large incontinence product. With these devices, the person is moved more evenly. And the devices reduce shearing and friction.


image
Fig. 17-10 Turning pad.


The device is placed under the person from the head to above the knees or lower. At least two staff members are needed. This procedure is used for most residents. It is used:



See Promoting Safety and Comfort: Moving the Person Up in Bed With an Assist Device.



imageMoving the person to the side of the bed


Re-positioning and care procedures require moving the person to the side of the bed. The person is moved to the side of the bed before turning. Otherwise, after turning, the person lies on the side of the bed—not in the middle.


Sometimes you have to reach over the person. Giving a bed bath is an example. You reach less if the person is close to you.


One method involves moving the person in segments (Fig. 17-13). Sometimes one person can do this. Use a mechanical lift (p. 244) or the assist device method:






Assist devices for this procedure include a drawsheet (lift sheet), flat sheet folded in half, turning pad, slide sheet, slide board, and large incontinence product. Using an assist device helps prevent pain and skin damage. It also helps prevent injury to the bones, joints, and spinal cord.


See Promoting Safety and Comfort: Moving the Person to the Side of the Bed.



imageTurning persons


Turning persons onto their sides helps prevent complications from bedrest (Chapter 26). Certain procedures and care measures also require the side-lying position. The person is turned toward you or away from you. The direction depends on the person’s condition and the situation.


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Nov 5, 2016 | Posted by in MEDICAL ASSISSTANT | Comments Off on 17. Safe resident handling, moving, and transfers

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