Transfer Techniques Planning plays a major role in safe effective client transfers. You must determine to what extent the client is able to help with the transfer. If the client is totally dependent or is heavy, the caregiver will need other staff members to help.

LISTS OF POTENTIAL HAZARDS IN CLIENT TRANSFERS AND PREVENTIVE MEASURES

FALLING Assess client’s size and ability to assist Ask for help from other staff members if needed If client starts to fall, lower gently to the floor while protecting the head If client has fallen, assess thoroughly for signs of injury

SKIN DAMAGE Use a transfer board or draw sheet Lift client instead of sliding across surfaces Pad surfaces that may cause injury (e.g., bed rails)

FOOT INJURY Place nonskid slippers on client Do not tuck sheets/blankets tightly over feet Ensure that feet do not become tangled in side rails, chair legs, or other equipment

DISLODGING CLIENT Assess for presence of all tubes and care equipment lines (e.g., catheters, IV lines) Determine if equipment must be temporarily disconnected during the transfer Reconnect equipment promptly when transfer is completed Keep the urinary drainage bag at a level lower than the bladder

A. Transferring from Bed to ChairA client may need to be moved from the bed to a chair, commode, or wheelchair.A wheelchair is a means of transportation for clients unable to support their weight while standing. Safety instructions for use of a wheelchair include the need to keep the wheels locked when not deliberately moving and to move the footrests out of the way when getting in and out of the wheelchair.

Wheelchair Technique When pushing a wheelchair, back into and out of elevators. Back slowly down wheelchair ramps. Push the wheelchair ahead of you when going up ramps. If going through a self-closing door, back the wheelchair out of the room. You can keep the door

open by backing against the door. The wheelchair can then be guided out of the room. Lock brakes when the wheelchair is standing still. Intravenous infusion bags can be placed on portable IV poles attached to the wheelchair during

transport. Urinary drainage bags can be placed on the lower body of the wheelchair during transport. Coil the drainage tubing so the catheter is not tugged during transport. Empty urinary drainage bag prior to wheelchair transfer. Keep the urinary drainage bag below the level of the client’s urinary bladder.

B. Transferring from Bed to StretcherSome clients (e.g., those who are too weak to sit upright, those who are unconscious, or those with injuries prohibiting the erect position) must lie flat during transfers.In such situations, a stretcher (gurney) is used to facilitate client transfer. Stretchers have several safety features, including side rails, safety belts/straps, and locking wheels. You should caution clients to move carefully while on the stretcher as it is narrower than the bed. Reassure the client that side rails will be used to prevent falls.

Assistive DevicesThere are several devices available for helping with client transfers. Slide boards or transfer boards assist the bed-wheelchair transfer by bridging the same level space between the bed and the wheelchair. Note that specialized wheelchairs with removable armrests are used with slide boards. As the client becomes more independent, the slide board can be used to transfer from wheelchair to car.

Other transfer appliances include stretchers (gurneys) and hydraulic lifts. The hydraulic (Hoyer, mechanical) lift is used for moving immobile clients who are obese. A client may be transferred to a chair, wheelchair, bedside commode, stretcher, or scale using a hydraulic lift.

The manufacturer’s equipment instructions should be followed and the weight limits must not exceed the manufacturer’s specifications. Two staff members are needed to safely operate a hydraulic lift. Hydraulic lifts are not for use with clients who have spinal cord injury as spinal alignment is not maintained during use of the lift.

Action RationaleTransferring a Client from Bed to Chair

Equipment Bed Wheelchair/commode/chair

1. Inform client about desired purpose and destination.

1. Reduces client anxiety and increases cooperation.

2. Assess client’s ability to assist with the transfer and for presence of cognitive or sensory deficits.

2. Promotes safety.

3. Lower the bed. 3. Reduces distance client has to step down, thus decreasing risk of injury.

4. Allow client to dangle for a few minutes. 4. Allows time for assessing client’s response to sitting; reduces possibility of orthostatic hypotension.

5. Bring wheelchair close to the side of the bed, toward the foot of the bed.

5. Minimizes transfer distance.

6. Lock wheelchair brakes and elevate the foot pedals.

6. Provides stability.

7. Assist client to side of bed until feet touch the floor.

7. Provides guidance and helps client maintain balance.

8. Assess client for dizziness. Remain in front of client until dizziness has subsided. Apply gait belt if necessary.

8. Reduces risk of falling.Reduces risk of falling by maintaining client stability during transfer.

9. Reach under client’s axillae and place hands on client’s scapulae (or grasp gait belt).

9. Maintains client stability and reduces pressure on axillae.

10. Assist the client to a standing position and provide support.

10. Helps client stand safely and gives time to assess status.

11. Pivot client so client’s back is toward the wheelchair.

11. Moves client into proper position to be seated.

12. Instruct client to place hands on the arm supports of the wheelchair.

12. Allows client to gain balance and judge distance to seat.

13. Bend at the knees, easing the client into a sitting position.

13. Increases stability and minimizes strain on back.

14. Assist client to maintain proper posture. 14. Broadest, and therefore safest, base of support is with client seated as far back on the seat as possible.

15. Secure the safety belt, place client’s feet on 15. Ensures client safety; prepares client for

feet pedals, and release brakes. movement.

Transferring a Client from Bed to Stretcher with Minimum AssistanceEquipment

Bed Stretcher

1. Inform client about desired purpose and destination.

1. Reduces client anxiety and increases cooperation.

2. Raise the height of bed and lock brakes of bed..

2. Reduces distance caregiver must bend, thus preventing back strain; prevents bed from moving.

3. Instruct client to move to side of bed close to stretcher. Have client use trapeze bar if available.Lower side rails of bed and stretcher.

3. Decreases risk of client falling.

4. Stand at outer side of stretcher and push it toward bed. Lock wheels of stretcher.

4. Diminishes the gap between bed and stretcher; secures the stretcher position.

5. Instruct client to move onto stretcher with assistance as needed.

5. Promotes client independence.

6. Cover client with sheet or bath blanket. 6. Promotes comfort; protects privacy.7. Elevate side rails on stretcher and secure safety belts about client. Release brakes of stretcher.

7. Prevents falls.

8. Stand at head of stretcher to guide it when pushing.

8. Pushing ensures proper body mechanics (if client are in large assistive devices)

Transferring a Client from Bed to Stretcher with Maximum AssistanceEquipment

Bed Stretcher Pillows Lift sheet

1. Inform client about desired purpose and destination.

1. Reduces client anxiety and increases cooperation.

2. Elevate height of bed. 2. Decreases amount of bending for caregiver, thus reducing risk of back injury.

3. Assess amount of assistance required for transfer. Usually two to four staff members are required for the maximum assisted transfer.

3. Promotes client independence; assures that enough staff is present before beginning transfer.

4. Lock wheels of bed and stretcher. 4. Prevents falls.5. Have one caregiver stand close to client’s head. 5. Supports client’s head during the move.6. Logroll the client and place a lift sheet under the client’s back, trunk, and upper legs. The lift sheet can extend under the head if client lacks head control abilities.

6. Prevents flexion and rotation of client’s hips and spine; maintains correct body alignment.

7. If urinary drainage bag is present, empty it and move it to side of bed closest to stretcher.

7. Prevents risk of urinary infection.

8. Move client to edge of bed near stretcher. 8. Prevents dragging, which causes shearing force.9. Caregiver on non-stretcher side of bed holds the lift sheet across the client’s chest.

9. Protects the client from falling.

10. Place pillow overlapping the bed and stretcher. 10. Protects head from injury.11. Position client on stretcher and cover with a sheet or bath blanket.

11. Promotes comfort and provides for privacy.

12. Secure safety belts and elevate side rails of stretcher.

12. Prevents falls.

13. If IV pole is present, move it from bed IV pole to stretcher IV pole after client transfer.

13. Prevents tubing from being pulled and IV from being dislodged.

Wheelchair Techniques1. Pushing a wheelchair into and out of elevators 4. Transporting patients with:

a. Urinary bagb. IV infusion bag

2. Going up/down on ramps.3. Getting in/out of a self closing door

SCORE SHEET – TRANSFER TECHNIQUESNAME: DATE:

Transferring a Client from Bed to Chair 5 3 01. Inform client about desired purpose and destination.2. Assess client’s ability to assist with the transfer and for presence of cognitive or sensory deficits.3. Lower the bed.4. Allow client to dangle for a few minutes.5. Bring wheelchair close to the side of the bed, toward the foot of the bed.6. Lock wheelchair brakes and elevate the foot pedals.7. Assist client to side of bed until feet touch the floor.8. Assess client for dizziness. Remain in front of client until dizziness has subsided. Apply gait belt if necessary.9. Reach under client’s axillae and place hands on client’s scapulae.10. Assist the client to a standing position and provide support.11. Pivot client so client’s back is toward the wheelchair.12. Instruct client to place hands on the arm supports of the wheelchair.13. Bend at the knees, easing the client into a sitting position.14. Assist client to maintain proper posture.15. Secure the safety belt, place client’s feet on feet pedals, and release brakes.

Transferring a Client from Bed to Stretcher with Minimum Assistance 5 3 01. Inform client about desired purpose and destination.2. Raise the height of bed and lock brakes of bed.3. Instruct client to move to side of bed close to stretcher. Have client use trapeze bar if available. Lower side rails of bed and stretcher. 4. Stand at outer side of stretcher and push it toward bed. Lock wheels of stretcher.5. Instruct client to move onto stretcher with assistance as needed.6. Cover client with sheet or bath blanket.7. Elevate side rails on stretcher and secure safety belts about client. Release brakes of stretcher.8. Stand at head of stretcher to guide it when pushing.

Transferring a Client from Bed to Stretcher with Maximum Assistance 5 3 01. Inform client about desired purpose and destination.2. Elevate height of bed.3. Assess amount of assistance required for transfer. Usually two to four staff members are required for the maximum assisted transfer.4. Lock wheels of bed and stretcher.5. Have one caregiver stand close to client’s head.6. Logroll the client and place a lift sheet under the client’s back, trunk, and upper legs. The lift sheet can extend under the head if client lacks head control abilities.7. If urinary drainage bag is present, empty it and move it to side of bed closest to stretcher.8. Move client to edge of bed near stretcher.9. Caregiver on non-stretcher side of bed holds the lift sheet across the client’s chest.10. Place pillow overlapping the bed and stretcher.11. Position client on stretcher and cover with a sheet or bath blanket.12. Secure safety belts and elevate side rails of stretcher.13. If IV pole is present, move it from bed IV pole to stretcher IV pole after client transfer.

Wheelchair Techniques 5 3 01. Pushing a wheelchair into and out of elevators2. Going up/down on ramps.3. Getting in/out of a self closing door4. Transporting patients with:

a. Urinary bagb. IV infusion bag