transfers (week 7)

Definition of Transfer

Safe movement of a person from one surface, location, or position to another

Independent 06

pt can perform the transfer/gt without any verbal or manual assistance

Modified Independent

pt can perform an activity without physical assistance from you but requires an assistive device or adaptive equipment (ie. walker, bed rail, grab bars, furniture)

05-Setup or clean-up assistance

pt needs someone else to set up or clean-up an activity but does not need any asst physically

Supervision

pt can perform the task without set-up, cues, or physical assistance; however, pt is not independent or safe doing the task alone

standby assist

pt needs verbal cues and/or instructions in order to complete a task but does not need any physical assistance from you to be safe and efficient; you need to be close but not touching the pt (book says tactile cues also but I don’t agree)

04-Supervision or touching asst

you give vc and/or touching (CGA) in order for pt to complete the task

CGA

you are making contact with the pt by holding onto the gait belt or the pt but does not need more help than a touch or close guarding

GG codes

06-Independent

05-Setup or clean-up asst

04-Supervision or touching asst

03-Partial/mod asst

02-Substantial/max asst

01-Dependent

Levels of Assistance

Minimal asst

03-Moderate asst or Partial asst

02-Maximum asst or Substantial asst

01-Dependent (Total) asst

Minimal asst

pt performs 75% or more of the activity (you are doing 25 % of the work)

03-Moderate asst or Partial asst

pt performs 50-74% of the activity (you are doing less than half the work)

02-Maximum asst or Substantial asst

pt performs 25-49% of the activity (you are doing almost all the work; more than half)

01-Dependent (Total) asst

pt is not able to assist with the activity at all (you are doing ALL the work) and/or you need additional assist from someone else or equipment to complete the task

Required Documentation

Amount of assistance required

Amount of time to complete transfer

Amount of people to complete transfer

Level of safety demonstrated

Weight bearing status

Level of consistency of performance

Equipment or devices used

gait belt

An adjustable belt or strap that is secured around a person’s waist and is used to protect and control the person

´Used to increase pt safety during mobility and with balance activities

´May be used to prevent falls but also to lower pt to the ground slowly to avoid injury

´Should be used with ALL pts in the hospital and long term care settings

´Used often in Rehab setting

´Used rarely in OP and HH settings

when to use gait belt

Applied in sitting position

Applied around the pt’s waist and adjusted snuggly

May need to be tightened once standing due to slipping down

In some instances, the belt may be secured around the chest

Therapist’s hand holds from under the belt

For bariatric pts, 2 belts may need to be joined prior to putting on pt.

gait belt and falling

A fall is considered to be the pt’s knees touching the floor even though you descend slowly with a soft landing

The belt can be used to slowly lower someone to the ground instead of holding them up

If you have a bariatric pt, you will NOT be able to hold them up and will HAVE to lower them to the floor

Preparation for Transfers

Proper footwear (shoes with rubber soles, socks with grips on the bottom)

Safety or gt belt

Be alert to the unexpected

Apply the gt belt from in front or slightly from the side of the pt

Secure gait belt, bedrail, or other protective devices

Instruct the pt to push up from what they are sitting on when coming to std and to reach back for chair/bed before sitting on it; Do NOT allow pt to put their arms around your neck

Environment free of unnecessary equipment

before the transfer

Analyze transfer into component parts

Prepare the environment

Prepare patient

Prepare yourself and other persons involved

Analyze transfer into component parts

position of equipment- make sure pt’s assistive device is within reach and the correct heighth

pt’s ability to use the equipment

position of patient’s body – poor balance, hemiplegia

movements required – pt’s ability to assist

Prepare the environment

position chair perpendicular to the bed so that pt will be moving towards his strong side during transfer

lock the wheels if applicable

Prepare patient

tell the pt the plan

what they need to do

apply proper footwear

apply the gait belt

Prepare yourself and other persons involved

decide who will be the leader if more than 1 person is helping and give the instructions

Sit to Stand

Move forward in chair positioning COG near BOS

Position feet (stronger leg in back)

Lean forward

Use arms simultaneously to push up from what the patient is sitting on-----“Nose over toes”

Stand up

Reverse process for stand to sit

During the Transfer

Be alert to devices or external factors that may interfere (curtains, IV poles, catheters)

Stabilize patient’s knees, pelvis, and upper thorax for control

Remain close to and guard patient properly

Use proper body mechanics

Use concise statements while guiding the patient and others through the transfer

Conditions Requiring Special Precautions

Total hip replacement

Low back trauma or discomfort

Spinal cord injury

Burns

Hemiplegia

Total hip replacement

usually avoid hip adduction, flexion more than 90 degrees, internal rotation

usually for 3 months but depends on physician

Low back trauma or discomfort

avoid lumbar rotation, trunk side bending, and trunk flexion)

acronym is no BLT w/pickles (no bending, lifting, twisting, or pulling)

usually avoid any lifting more than 10 lbs

no pulling

“logrolling” technique

“hooklying” position

Spinal cord injury

if acute, may have an external appliance (brace or halo device) and/or an internal fixation ( bone graft, metal rods or wires)

if an old injury, prone to osteoporosis (esp. long bones and vertebra)

avoid distraction and rotational forces

protective positioning in side-lying or sitting

prone to syncope when transferring from supine to sitting due to orthostatic hypotension

Autonomic dysreflexia

Burns

avoid creating shear forces across the burn, graft site, or area where the graft was taken due to impaired healing

ensure that you lift the burned area when moving to avoid shearing

Hemiplegia

avoid pulling the affected limbs when moving the patient due to tendency to have shoulder subluxation

pain/discomfort when rolling or lying on the affected shoulder

Weight Bearing Status

Non–weight bearing (NWB)

Partial weight bearing (PWB)

Toe-touch weight bearing (TTWB)

Full weight bearing (FWB)

Weight bearing as tolerated (WBAT)

Different types of transfers

sit pivot

stand pivot

recumbent

sit pivot

pt remains in a sitting or squatting position during the transfer

1. Independent

2. Assisted

3. Dependent

stand pivot

pt remains upright during transfer

1. Independent

2. Assisted

3. Dependent

recumbent

pt is lying down during transfer

1. Dependent

Transfer Activities

Bed <-> chair

Two-person dependent: bed<->chair, chair <-> floor

Three-person dependent: bed <-> stretcher

Wheelchair/chair <-> floor

Standing dependent pivot from bed to wheelchair

Diagnosis specific such as total hip replacement, hemiplegia, weight bearing restriction, spinal cord injury (SCI)

Bariatric – using a draw sheet and doing a 2 man pivot

Sliding board

Mechanical lift

Bed <-> chair

Position chair so that the patient is moving towards their strong side

Have patient move to edge of the bed

Ensure proper foot wear

Apply gait belt

Instruct patient to push up using arms and non-affected leg

Instruct patient to pivot so that buttocks moves toward chair and to sit on the chair

Instruct patient to scoot back in the chair and assist if needed

Position patient for comfort

Reverse procedure for going back to bed

Transfer for a patient with a THR

Follow the steps for bed <->chair transfers but add the following:

1. Instruct patient to move to edge of bed using noninvolved (unaffected) extremities and assist with moving the involved (affected) limb

2. Follow specific hip replacement guidelines as involved lower extremity is moved off the bed and positioned with feet on the floor

3. Push up from bed with hands, stand, and grasp hand grips of walker

Transfer for a patient with back pain

Follow the steps for bed <->chair transfers but add the following:

1. Lift one leg up at a time to get feet flat on bed

2. Log roll to sidelying then sit up on edge of bed (assist when needed)

3. Push up from bed with arms, stand, and grasp hand grips on assistive device if used

Transfer Equipment and Devices

Transfer board

Hydraulic or pneumatic lift

Electric hoist

Bedrail

Over-the-bed or trapeze bar

sliding boards

Used to do a lateral transfer from one fairly even surface to another

Bridges the gap btn two surfaces

Used when a pt is unable to bear weight on LEs or too weak to stand on legs

sit to stand with crutches

sit to stand with a cane