AGING & DISABLED HOME HEALTH CARE AFFORDABLE HOME CARE TRANSFER TRAINING

AGING & DISABLED HOME HEALTH CARE AFFORDABLE HOME CARE TRANSFER TRAINING

HHA & PCA TRAINING

Target Audience: Personal Care Attendant & Home Health Aides

TOPIC: BASIC PRINCIPLES OF PROPER PATIENT TRANSFER TECHNIQUES

• Use lifts,transfer boards,adjustable beds, and gait belts

• Medicare may cover the coast of a lift or hosipatl bed for a bed-bound patient in the home setting. A 2002 study, An ergonomic comparison between mechanical and manual patient transfer techniques found that manual patient transfer and repositioning techniques are a signifiacnt cause of low back injuries, and showed that using lifts placed less stress on the low back than manual patient transfer techniques.

• Promote patient independence during transfer. In Evience-Based practices for safe patient Handing and movement, Registered Nurse Audrey Nelson and Medical Assistant Andrea Bapiste state, Patient should be encouraged to assist in their own transfer and handing aides and should be used whenever possible.

• Some patient are capable for performing their own transfer using a mechanical lift.

• Learn proper body mechanics. It will lower the risk of injury prevention.

GENERAL TRANSFER TECHNIQUES

• It is bed to lift with 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 feet and shoulder width apart is a good general rule to follow when attempting to lift patient.

• Never lift at the waist.

• Try to get the weight as close to the body as possible to make carrying it easier on the back.

Always explain to the patient what you plan to do.

• The healthcare worker should steer clear of any twisting motion.

• If the patient starts to fall,ease the pateint down onto the closest surface.Then reposition yourself and the patient before continuing the transfer.

• Keep your back straight because dics can tolerate compressive loads when the back is straight; dics are weaker when you lift in a flexed position.

o Maintain the neutral curves of the spine and keep the spine aligned,moving smoothly as you complete the transfer process.

o Keep stress off of the spine and keep an imaginary line to maintain the curves in your balance.

• Prior the actual transfer prepare the transfer method and determine the patients ability to assist.

TYPES OF TRANSFERS

1. Complete Independence

a. If walking,patient safely approaches,site down on a regular chair,and gets up to a standing position from a regular chair. Patient also safely transfer from bed to chair. (No helper)

b. If in a wheelchair,patient approaches a bed or chair,locks brakes,loft foot rests,removes arm rest if necessary,and performs either a standing pivot or sliding transfer (w/o a board) and returns. The patient performs this activity safely. (No helper)

2. Modified Independence

a. The patient requires an AD such as a sliding board lift,grab bars,or a special seat/chair/brace/crutches;or the activity takes more than a reasonalbe amount of time; or there are safely considerations. In this case, a prosthesis or oethesis is considered an AD if used for the transfer (Helper)

3. Supervision or Setup

a. The patient requries supervision (e.g. standby,cueing,coaxing) or setup (positioning sliding borad,moving foot rests,etc.) (Helper)

4. Minimal Contact Assist

a. The patient requires no more help than touching and performing 75% or more of transferring tasks. (Helper)

5. Moderate Assistance

a. The patient requires more help than touching or performs 50-74% of transferring tasks. (Helper)

6. Maximal Assistance

a.The patient performs 25-49% of transferring tasks. (Helper)

7. Total Assistance

a. The patient performs less than 25% of transferring tasks. (Helper)

TRANSFER TECHNIQUES

1. 4 types of wheelchair transfers

a. Standby assist
b. Assisted standing pivot
c. 2-person lift
d. Hydraulic lift

2. Assisted standing pivot transfer

a. For those with limited mobility
b. Use transfer belt
c. Move wheelchair to a 45-degree to bed or chair on the patients strong side.
d. You will:
i. Move footrests out of the way
ii. Be sure that the wheels are locked
iii. Have patient sit on the edge of the wheelchair seat
iv. Have patient push down on the arms to assist in rising
v. Bend knees,grasping transfer belt with both hands.
vi. Rise with the patient close to you
vii. Make sure patient is not dizzy.
viii. Pivot toward the chair until patient can feel table behind thighs
ix. Ask patient to reach out and hold onto the chair with both hands.
x. Assist patient to sit down

3. Base of support

a. Foundation on which a body rests or stands;when a person is standing,the feet and the space between them define the base of support.Standing with feet wide apart enlarges the base of support. Narrow bases are unstable-like standing on one foot. its important for both staff and patients.Wide bases of support create stability.

4. Lifting

a. Done by bending and straightening the knees with a straight back.

5. Principles of lifting:

a. Let the patient do as much as possible-this will minimize the trauma to the patient and avoid stress on the employee.
b. Stand with feet apart creating a wide base of support.
c. Patients center of gravity should be held close to the employees center of gravity.
d. Use transfer belt around patients wasit.
e. Let the legs do all the lifting.
f. Avoid trunk twisting.
g. Have patient stand slowly to reduce chance of orthostatic hypotension.
h. Ask the patient if they are doing Ok?
i. Ask t he patient to take is slow deep breaths.

6. Rolling patients

a. Always roll patient toward you.
b. Provide positioning wedges to support patient comfortably

PATIENT/CAREGIVER SAFETY IS THE #1 GOAL

Patients often requires assistance with transferring in and out of bed and from one surface to another. Health care workers are at risk of injury if proper body mechanics are not used during these transfers.

BED MOBILITY

Patient Grouping: This is for patient who spend a lot of time in bed and cannot get in and out of bed without assistance.

Procedure:

• If the patient has a hospital bed, raise the height of the bed to your waist height to avoid bending over and placing a strain on your back.If the patient does not have a hospital bed there needs to be a recommendation for the rental or purchase of a hosiptal bed.

• Assist the patient move to the side of the bed by rolling him/her toward you.

• Support the patient at the shoulder and buttocks area.

•To transfer from laying down to siting,instruct the patient to puch off the bed with his elbow while you reach underneath his knees and assist him with bringing his feet over the edge of the bed.

• Squat down as you lower his feet toward the floor.

PERSON BED MOBILITY

Patient Grouping: For patients who spend a lot of time in a hospital bed with their heads elevated.This position causes patient to slide down over time and assistance is required to re-position them. Bed mobility maneuvers should be performed with two peopple whenever possible.It is also necessary when providing care for every debilitated patients who do not have the strenght to reposition themselves in the bed and require the assistance of 2 healthcare workers.

Procedure:

• Lower the head of the bed until the patient is lying flat.

• Raise the height of the bed to your waist height to avoid bending over.

• Ask the patient to help,if possible,by bending his/her legs and pushing or by pulling on the sides rails.

• Every involved in the lift should work in unison.

• There should be one person on either side of the bed.

• With a straight back and bent knees,the healthcare workers get as close to the patient as possible.

• The healthcare workerd grasp the sheet edge positioned under the patient at his/her shoulders and hips.

• Count to 3 and lift and slide the patient up in bed to reposition the patient.

• The healthcare worker should shift their weight from one foot to another instead of twisting with the back.

SIT TO STAND TRANSFER

Patient Grouping: This is for patient who requrie human assistance to transfer from a sitting to standing position.

Equioment needed: Gait Belt

Procedure:

• Place a gait belt around the patients waist to provide somethings for you to hold onto.

• Do not hold the patient by the armpit as this can cause damage to his/her shoulder.

• Instruct the patient to scoot forward toward the edge of the seat until his/her feet are flat on the floor then place his/her hands on the armrests of the chair or next to his/her sides on the bed.

• Stand facing the patient,bend your knees and hold each side to the gait belt.

• Rock the patient back and forth three time (counting 1,2,3) then,on three,instruct the patient to push up with his/her arms as you pull him/her close to your body move into a standing position.

STAND PIVOT

Patient Grouping: Patient who need assistance to rise from a sitting to standing position.It is approprirate for patients who can support 75% of their weight but need physical assistance for balance,or have difficulty picking their feet up to take steps to transfer from on surface to another.

Equipment Needed: Gait Belt

Procedure:

• Perform the sit to stand transfer.

• Continue to hold each side of the gait belt and hold the patient close to your body.

• Take small steps and rotate your body until the patients back is facing the seat he/she is moving to.

• Slowly squat and lower him/her into a seated position.

SLIDING BOARD TRANSFER

Patient Grouping: The sliding board transfer is used for patient who are unable to bear weight on their legs.

Equipment Needed: Sliding Board,Wheelchair,Gait Belt

Procedure:

• The patient is in a sitting position on the bed.

• Position the wheelchair close to the bed at an angle off 30-45 degrees

• Lock the wheels and remove the nearest armrest and move the footrest out of the way.

• Raise or lower the bed to level of the wheelchair.

• Instruct the patient to lean to the side and place a sliding board (smooth side up) under the patients buttocks on the stronger side of his/her body

• Position the opposite end of the slide borad on the seat surface of the wheelchair pointing toward the opposite back corner.Rest the edge of the against the front of the large chair wheel closest to you.

• Push downward on the board to prevent pinching when the patient returns to an upright sitting position with his hip and thigh on the board.

• Place a gait belt around the patients waist id needed for added stability.

• Be sure the patient has both feet on the floor befor you start,and explain each step to him.

• Assist the patient with shifting his/her weight from side to side by squatting in front of the patient and holding each side of the belt as he/she scoots sideways along the sliding borad.

• If you need to assist,stand with one foot between the patients 2 feet and put your arms around him.Bend at the knees and hips,then push while lifting to gradually side him across the board.

• Make the transfer slowly,through a series of leaning and sliding movements.

• Once the patient is in the wheelchair,help the patient shift his/her body weight to the side and remove the sliding board from underneath his/her buttocks.

TRANSFER TO A CHAIR

Patient Grouping: Patients who need the assistance of one healthcare worker with transfer from bed to chair.wheelchair to toilet,etc.; and the patient is able to walk with assistance of one healthcare worker.

Equipment Needed: Gait belt,chair

Procedure:

• Place the chair facing the bed or at a 45 degree angle to the bed.

• Remove everything from the transfer area to prevent slips or falls.

• Position the chair at the same height as the bed or wheelchair you are transferring the patient to.

• If the transfer is to a wheelchair remember to locl the wheels of the chair and make sure the footrests are moved out of the way.

• Make sure the side rails of the bed are lowered.

• Raise the head of the bed to the highest position the patient will tolerate.

• If availble secure a gait belt around the patients waist while lying on their back.

• Assist the patient turn toward you to lie on their side (in a modified fetal position) with knees bent.

• The employee places one arm underneath the patients torso and the other arm over the patients legs,Behind the knees.

• The employee instruct the patient to help lift up at the count of 3.

• On 3, the employee will swing the patients legs over the edge of the bed while at the same time lifting the torso. The momentum built up from the legs will assist the employee in safely bringing the patient to a sitting position.

• Once the patient is upright (sitting on the edge of the bed) have the patient set there for at least 10 seconds to ensure the patient is not dizzy.

• Put your arms around the patients torso and help him move to the edge of the bed.

• If possible,have the patient place both feet flat on the floor.

• The employee position one foot in front of the patients toes and brace their knee in front of the patients leg.

• If the patient is able,ask him/her hands over your shoulder.

• Ask the patient to place his/her hands on edge of the bed and push off.

• Keep your knees slightly bent. As the patient puches off, straighten your knees and hips, lifting the patient.

• Once upright,the patient will grab the healthcare worker around the shoulders and the healthcare worker will reach around the patients waist,firmly grasping the gait belt.

• With both patient and healthcare workers legs positioned a shoulder-length apart,they pivot their bodies using small steps until standing directly in front of the chair keeping your back as straight as possible

• Keep your back straight and flex your knees as you lower the patient into the chair bending at the knees and using your legs for support.

• Make sure the wheels of the new patient destination are locked,if transferring from a chair to wheelchair.

o ALTERNATE METHODS

* Use a transfer belt (also called a gait belt) around the patients torso to assist with the transfer.

* For large patient or for added stability, 2 people may assist with this transfer.in this case, one person assists the patient swing his/her legs over the side of the bed while the other helps raise him/her into a sitting position.

* The 2 caregivers support the patient between them as they lift and piovt him/her until his/her back is to the chair,then both assist the patient to lower into the chair.

Transfer of The Patient from a Chair To a Toilet

Patient Group: Patients who are unable to complete toilet transfer independently

Equipment Needed: Gait Belt

As important as the actual lifting technique is the earning of the trust and cooperation of the patient in the chair and ensuring that his or her dignity is preserved at all times. If a person is able to rise with only partial assistance,this ways the best option

Procedure:

• Maneuver the wheelchair so that the patient is facing the toilet. Position the persons feet under his or her body.

• Stand in front of the wheelchair,facing the patient,with your back to the toilet. Grabbing the back of the pants or belt, lift the person to his or her feet.

• Keeping the patients weaker knee between your legs,pivot him or her around in front of the toilet.

• Always transfer the patients weight towards his or her stronger side.

• Gently lower the patient onto the toilet seat and help remove his or her clothing.

Safe Patient Lifting

Patient who cannot transfer themeselves with assist and need the full assist of the employee.

Equipment Needed: Gait Belt

Procedure:

• Support the patient when attaching the gait belt.

• Have the patient sit up and as close to the edge of the chair or bed as possible and lean the patient forward.

• Transfer any special padding or equipment from the chair to the patients new destination.

• Cross the patients arms across his/her chest.

• Place your arms under the patients upper arms and hold onto his wrists.

• Ask the patient to assist you by flexing his knees and pushing on the count of three,if the patient is able to do so.

• Place your feet against the patients feet prevent any slipping by you or the patient.

• Gently lift the patients torso and firmly press your knees agianst the patients knees,keeping the patient close to your body.

• Position the patient in the chair or bed and replace the armest,if applicable.

• Center the patient on the bed or chair and reposition the padding and gait belt as necessary.

• Straighten the tubing of any urine-collecting devices and place the bag below the level of the bladder.

• Lock the wheels in place,if the patient is being transferred to a wheelchair

o Replace the footrests if applicable.

o Make sure the patient is comfortable before leaving the room or continuing with what you were doing.

PEDIATRIC PATIENTS

Patient Grouping: Pediatric pateints

• Health care worker who work with the pediatric population frequently lift patient to mover them from one surface to another.

• To lift a child who is lying in bed, raise the height of the bed to waist-height.

• Place one arm under the childs shoulders and the other under his/her hips.Slide the child close to your body.

• Hold the child against your body as you lift and move.

• Squat as you lay the child onto the other surface.

WHEELCHAIR TO VEHICLE

Patient Grouping: Pateint requiring transfer assistance into a vehicle

Equipment Needed: Wheelchair and Gait Belt and the potential for the need of a 2nd healthcare worker.

• Recline the back of the car seat as far as it will go.

• Position the wheelchair at an angle to the car.

• Lock the wheelchair brakes and remove the armrest.

• Place the transfer board under patients thigh,with the other solidly resting on the car seat and angled toward the center of the seat.

• If able,the patient slides himself across the transfer board to the car. Once there,the patient leans on the back of the seat while positioning his/her legs.

• Use a gait belt for stability and security.

• The healthcare worker may need an assistant to help the patient complete the transfer.

o The 2nd healthcare worker lifts both of the legs and swings them together into the vehicle, positioning the patients feet on the floor.

o Fasten the seat belt before returning the seat back to an upright position.

EQUIPMENT TRANSFERS

• Health care workers often have to transport and lift equipment through out the work day.

• Injury can occur from improper body mechanics during these lifts.

• Store equipment at waist height as much as possible to reduce stresses on the lower back from bending over or backwards to reach up.

• Lift equipment by using your forearms around the sides of the machine and bring as close to your body as possible.

• If the equipment is not at waist height,use a step ladder or squat down rather than bending at the waist.

• If equipment must be moved across long distance,use a wheeled cart for transport.

Reference: Mayo Clinic,OSHA, Therapist Contribution at eHow.

COMPETENCY CHECK OFF ON TRANSFER TECHNIQUES IN THE HOME SETTING




















































USE OF GAIT BELT