What are some considerations to be made in transferring a client?
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Transferring is the client’s movement from one surface to another. The process involves the pre-transfer, transfer, and post-transfer. As the client has some physical or cognitive limitations, they require the physical assistance, cues, or supervision of the OT, caregiver, or staff. As each client, OT, their strengths/weaknesses, environment, and situation are different, each transfer must be adapted to fit the client’s needs. Whether you have done a type of transfer 1000x, 10x, 1x, or never, you should always ensure the safety of yourself, your co-workers, and the client. Proper lifting technique is crucial because you need to protect your most important asset to your career – yourself. You might be able to get away with an improper lifting technique once, but compounded over the many times you perform it incorrectly over your career may result in injury. Rushing to do a transfer without necessary precautions may also result in an injury or fall to the client. My facility started requiring staff members to enroll in safe patient handling courses. This is a great asset because many staff, including nurses, have been getting injured on the job transferring patients. I hope that this post provides information for everyone to take away from, whether you are an experienced OT or just starting out as a new grad. Even students should learn proper technique before getting into the workforce. I hope that you learn some new proper and safe skills/techniques or become inspired as you reflect and gain insight into how you are lifting and transfer clients. There is always some room for improvement because new technologies and research are being developed or shared to make the OT, caregiver, and client’s life easier. Risks to InjuryVertical – lifting, e.g. dependent transfers Lateral – between flat surfaces, e.g. bed to gurney Repositioning – e.g., turning or repositioning in bed Ambulation – e.g., assisting to walk Bariatric – more than 200# Common Transfers LocationsConsider these types of transfers when preparing clients for discharge, especially when training caregivers so that they are comfortable with all these types.
Safety Tips
Body MechanicsPrinciplesThe OT must understand the biomechanics of movement prior to transferring their client to maximize the success and facilitate movement while preventing injury or a fall.
“APPLAUSE”Approach – get close to the client. Plan – plan ahead with your client how you will perform the transfer. Pivot – pivot your legs, do NOT twist or rotate your spine or back. Legs – use your legs, not your back, arms, or shoulders Apart – keep your feet shoulder-width apart for increased back support. Up – keep your head up to ensure correct spinal curve Stomach (suck it in) – increase your inner abdominal pressure to serve as a splint to your spine Easy – take your time, do not rush Falls/Loss of balance during transfer
The Setup & TransferI like to say that my transfer is “90% set up and 10% transfer”. The set up is very important and can reduce the amount of effort and problems that can arise. This list is very comprehensive and while each step does not apply to every transfer, they are important to consider depending on your situation.
Equipment for TransfersBedThe best beds are ones that can elevate and lower electrically. Manual crank-style beds are also common. Some hospital beds are not considered “low beds” and cannot lower enough to match the height of other surfaces such as wheelchairs or commodes, making various transfers more difficult. Another consideration is the type of bed that the client will actually have at home. If a hospital bed will not be available at home, the client should be trained to simulate their bed height at home or resources should be provided to them to modify their bed or overcome this barrier. To make getting into higher beds easier, a flat wooden platform can be installed or a commercial bed rail can be purchased. Wheelchairs
WalkersFront wheeled, Platform, Four Wheeled
Slide BoardSee above for transfer sequence. Beasy BoardSlide SheetsSLIPP
Sit to Stand Devices
Hover Mattress
HoverJack
Backboards
Grab bars
Trapeze bar
Gait Belt
Canes
Hand Hold Assist
Types of TransfersBed MobilityRolling
Side-lying to sit
Scooting to the edge
Sliding / Boosting to Head of Bed (2 Person Assist)
Bridging to the Head of Bed (1 Person Assist)
Sit to Stand
Stand Pivot
Stand StepA stand step pivot is a sit-to-stand combined with sidestepping (instead of feet pivoting at an axis) towards the destination surface, then coming from stand to a sit. The OT assists in the same manner for setup, cues, hand placement, and client hand placement. Consider the client’s cognitive and physical ability as stand step with some clients may be risky, especially the client with a hemiparetic lower extremity which may have difficulty lifting off the ground as opposed to just pivoting. Squat (Bent) Pivot
Slide Board (between surfaces)Ideal for when clients cannot bear weight through their lower extremities or with bilateral lower extremity weakness, paralysis. Clients should have safe trunk control and good sitting balance for a safe sliding board transfer, especially onto/off a commode.
Weight Shifting to SlideThe client leans to one side laterally to shift weight onto that side (unweighting the bottom of their opposite side), while the therapist assists in sliding the opposite side (usually the hip) anteriorly or posteriorly. This is much easier if the client is on a pad or sheet than just with pants on a surface, but is often still very physically demanding on the OT. Remember friction is your enemy, but sometimes in small spaces like on a wheelchair, you do not have much room to work. Call for assistance if needed – 1 person to assist with the lower extremities and the 2nd at the torso. Airplane (Depression Scoot)
Dependent (One-Person Assist)
Ground or Fall RecoveryMechanical LiftSit to Stand devicesHoyer lifts (Electric & Manual)Vanderlift, Vera Lift
Overhead lifts
Further Reading
What safety considerations should be taken when transferring a client?What do I need to do before I transfer the person?. Check the person for pain or other problems. A transfer can cause pain or make pain worse. ... . Gather extra pillows. ... . Look around the room. ... . Check that equipment will not move during a transfer. ... . Secure all medical equipment on or near the person.. What should you assess before transferring a patient?Ensure patient's privacy and dignity. Assess ABCCS/suction/oxygen/safety. Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal. A slider board and full-size sheet or friction-reducing sheet is required for the transfer.
What are the techniques used in transferring a client?Use proper body mechanics:. Keep the patient close to you.. Keep the patient facing you.. Keep your knees bent.. Use your leg muscles instead of back muscles as much as possible.. Keep a straight, neutral spine (not arched or curved forwards or backwards).. Place feet shoulders width apart.. When transferring a client the best thing to do is?The client's feet should be flat on the floor approximately 12 inches apart. When transferring a client who has a weak side, position the chair on his strong side. For a client who is weak, you must have control of the shoulders and hips during a transfer. Never transfer a client by lifting him under the arms!
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