Module 2 patient transfers


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Module 2 patient transfers

  1. 1. Moving from one location to another
  2. 2.  A transfer is the safe movement of a person from one surface to another.  Planning and organization are required before a patient attempts a transfer.   All safety precautions associated with the transfer need to be observed. SAFETY…SAFETY…SAFETY…SAFETY
  3. 3. Transfers are identified in different ways:  Number of persons performing transfer  1-person, 2-person, 3-person  Description of transfer  Standing, sitting, recumbent, sliding board  Manual or mechanical method  stand pivot, step pivot, NDT, sliding board, Hoyer lift, etc.  Amount of assistance client requires  Transfer or lift, dependent, max/mod/min assist, supervision  Location of transfer  Bed, Gurney, Chair, W/C, Mat, Floor, Car
  4. 4.  Independent  Indirect supervision  Direct Supervision  Verbal Cues, Gestural Cues, Written Cues  Contact Guard Assist, Standby Assist  Min assist  Mod assist  Max assist  Dependent or Total assist
  5. 5.  The OT/OTA/team collaborate with other disciplines to determine the transfer goal  The OT/OTA teaches pt./ staff/caregiver to perform lift as safely as possible  The OT/OTA teaches the pt. to transfer as independently and as safely as possible.  The OT/OTAs’ primary responsibility during a transfer is to guard and protect the pt to avoid injury to the pt or the themselves.  Transfers occur frequently during OT intervention
  6. 6.  Know patients’ sensory, physical, cognitive, and behavioral status.  Be aware of any medical precautions.  Know your own abilities and limitations  Use good body mechanics.  Recognize when and how much mechanical or human assistance is needed for a safe transfer.
  7. 7.  Mechanical devices can keep pts dependent so recommend only if the pt and/or caregiver can not perform the transfer safely without them.  Hoyer or other form of hydraulic, or electrical lifts  Cumbersome  Dangerous if incorrectly used  Costly  BUT - May be only safe method to transfer dependent person  MUST know/observe weight limits for specific device
  8. 8. State of TN mandates specific number of persons to perform lift based on client weight.  1 person = < 50 lbs  2 person = > 50 lbs and < 100 lbs  3 person = >100 lbs and < 150 lbs  Mechanical lift = >150 lbs
  9. 9. Term transfer may be used for both  Transfer - Client performs all, part, or none of transfer with assistance provided as needed for safety. No lifting of client occurs.  Lift – Client is dependent for entire movement and is physically lifted from one surface to another.
  10. 10.  Transfers involve close personal contact.  Many clients are fearful of transfers/potential of falling/experience pain when held/moved  Introduce yourself, explain what you are going to do in simple terms  Have the client repeat back to you what you are going to do, or give non-verbal consent  Tell client before touching their trunk, leg or buttocks.  Stay in contact guard with the client
  11. 11. Use a safety belt, which is also called a gait, guard, ambulation, or transfer belt.  Always request pt’s permission to use belt if cognizant  Fasten as snugly as possible at or just above patient’s hips  IF belt slides upwards, it is too loose  IF patient is obese, pregnant, or has an abdominal or lower spine incision, fasten belt just beneath rib cage  Belt remains on until patient is in a safe, stable position It is possible to safely transfer a client without a safety belt, however belts are mandated by most facilities/agencies
  12. 12.  When giving instructions—  Be concise  Be direct  Use gestures  Use simple, action-oriented verbs  Demonstrate  Encourage pt. to participate mentally and physically as much as possible.  If using someone to assist, tell them exactly what you need/want them to do or not do
  13. 13.  OTA - Make sure long hair is tied back, no dangling or sharp jewelry , name tag will not be in the way, nails are short, and you are wearing non-skid footwear.  Client - Make sure all tubes (catheter, O2,IV, etc.), leads (EKG, BP, etc.), and other items (sheets, bandages, etc.) are properly positioned so as not to become caught or tangled during transfer, and that non-skid surface is on or under feet.  Environment - Make sure transfer area is dry, without trip or fall hazards, moveable surfaces locked.
  14. 14. Patient/client:  Hips scooted ½ way towards front of seat  Feet flat on floor  Lean trunk forward (‘nose over toes’) approx 45 degrees  Look in direction of transfer  Use 1-2-3 rocking momentum  Use hand(s) to push on stationary surface to assist movement
  15. 15. OT/OTA:  Make sure W/C front caster, armrest, and leg rest are not in the way  Never allow pt. to grab around your neck during a transfer  Maintain CGA (contact guard assist) throughout the transfer until you are sure that pt is safe performing an independent transfer  Do not move away from the pt until they in a safe position.  Once a transfer is started, be prepared to either complete it or return pt. to original position
  16. 16.  OT/OTA’s role is to safely lower pt. to nearest surface without injury  Bed/Mat – can push patient backwards onto bed  Chair – may be able to gently lower patient to seat to prevent fall  Floor – lower pt. gently to floor – OT/OTA must use good body mechanics, if necessary, cushion pt. with your body/extremity  Wall - If close enough to a wall, may be able to force a ‘lean’ until balance is regained
  17. 17. Factors that impact independence in transfers:  Safety awareness  Cognition – ability to motor plan, sequence, and problem solve  Strength of extremities used during transfer  Balance  Presence of decreased ROM or pain  Endurance  Motivation  Consistency of performance