Safe Transfers and Positioning
When transferring a resident, it is important to use safe techniques and to follow the resident’s individualized plan of care. While you may think it’s quicker to have them wrap their arms around your neck rather than to get an extra person, it is dangerous for you as well as the resident.
There are multiple benefits from having a safe transfer program:
Improved quality of care
Improved resident safety and comfort
Reduced risk of falls
Reduced risk of skin tears and bruising
Reduced risk of injury to staff
Types of transfers
One person- Appropriate when a resident can bear weight and assist with the transfer. Use a transfer or gait belt per your facility policy and the resident’s care plan. Make sure to use proper body mechanics- bend at the knees, not at the back.
Two person- When a resident is able to bear weight but may be too heavy for one person to safely transfer alone, or when a resident isn’t able to bear as much weight or when a resident has a deficit on one side. If a resident has been determined to require two staff for transfers it is never appropriate to try and transfer that person on your own. This places risk to resident and to you.
Always use a gait or transfer belt.
Sit to stand Lift- This can be used when a resident is able to bear weight but may require more weight bearing assistance than is staff for staff alone to provide. There are several different models- make sure you feel comfortable in how to operate the lift at whatever nursing home or hospital you are working. Most lifts require 2 staff to operate. If you’re not sure how to use the lift stop and ask for help- never try to figure it out on your own, as this can lead to injury of you and the resident. If a resident has been deemed to need a sit to stand lift for transfers, never attempt to transfer them with staff only.
Full body lift- This is used for residents who are not able to bear weight. Always requires two staff to operate this lift- no exceptions. If you’re not sure how to use the lift stop and ask for help- never try to figure it out on your own, as this can lead to injury of you and the resident. If a resident has been deemed to need a full body lift for transfers, never attempt to transfer them with staff only.
If you are caring for a resident and feel that they would benefit from additional support with transfers, always report this to your charge nurse and ask for help. This resident may have had a decline that the nurse isn’t aware of yet.
Refer to the resident’s plan of care to determine how frequently he or she needs to be assisted with repositioning. If there is a support surface that should be used, such as a cushion, make sure you are using it at all times. If you’re not sure for the positioning specifics for a resident-stop and ask your charge nurse for guidance and look at the care plan.
Having a good supportive surface in the resident’s wheelchair or on their bed is great and very important but does not take the place of repositioning. When assisting with repositioning, it is important to pay special attention to heels and elbows, as they are more prone to damage due to it being difficult to redistribute pressure in these areas.
Make sure you pay attention to heels and ischial tuberosities (sit bones) for residents who are in a wheelchair all the time. These are the two most common areas for pressure injuries to occur.
When positioning someone in bed, pay special attention to make sure their heels are floated off the mattress. If you are using some kind of heel protector, make sure it relieves pressure from the heels, as some of the older models don’t and are not effective in preventing pressure injuries.
If you have a resident who has contractures or prefers to lay on his or her side, make sure you put some cushion between the knees to prevent pressure in that area.