Comprehensive UCI Health Guide for Safe Bed-to-Wheelchair Patient Transfers

Prior to moving any patient, it is essential to prepare both the room and the transfer surface to ensure maximum safety for both the patient and the caregiver.
All unnecessary materials that may pose a potential trip hazard must be cleared from the area.
The transfer surface must be flat and clean to reduce any risk of slipping or tripping during the procedure.
It is highly recommended that rugs be removed throughout the household to prevent tripping accidents for patients with mobility issues.
All sheets, blankets, and excess clothing should be moved away from the patient's immediate vicinity to ensure clear space for movement and to avoid interference during bed mobility or the physical transfer.

The transfer surface, such as a wheelchair, should be positioned as close to the bed as possible. This proximity reduces the falling risk by minimizing the travel distance and the physical effort required.
Positioning: An ideal angle of $45$ degrees should be maintained between the edge of the bed and the wheelchair to minimize the distance between the two surfaces.
Strong Side Orientation: If the patient has a designated weak side, always position the wheelchair on the patient's strong side to facilitate a safer transition.
Brakes: Ensure that the wheelchair brakes are fully applied so the device does not roll away during the transfer.
Casters: Rotate the wheelchair's casters backward so they do not protrude as a tripping hazard.
Accessibility: Remove the armrest from the wheelchair on the side closest to the bed to provide an unobstructed path for the patient.

Preparation for Rolling: Bend the patient's knees up while they are lying on their back. This leg position assists in the roll by using the momentum from moving the legs to the side to help turn the torso.
Caregiver Positioning: The caregiver must position themselves on the side of the bed toward which the patient is moving. This placement allows the caregiver to assist the patient directly and prevent them from accidentally falling off the bed edge.
Body Mechanics: Caregivers must keep their back locked in an upright, straight position at all times. To reach lower heights, the caregiver should bend at the knees and lower their hips toward the ground to prevent back injury.
Manual Assistance: Assist the rolling motion by placing one hand on the patient's shoulder and the other hand on the patient's hip.
Patient Contribution: The patient can facilitate the roll by reaching across their body toward the edge of the bed using the arm opposite the side they are rolling toward.

Leg Maneuver: Assist the patient in lowering their legs off the edge of the bed.
Sitting Up: If the patient is physically capable, they should push off the bed with both arms to reach a seated position.
Supported Sitting: If the patient requires assistance to sit up, the caregiver should stabilize the patient's hip while simultaneously lifting at the shoulder. The caregiver must maintain a straight back and bend at the knees throughout this motion.
Positioning at the Edge: Once seated, the patient should lean forward and move their hips closer to the edge of the bed. If they cannot do this independently, the caregiver can facilitate the movement by shifting the patient's hips one at a time.
Foot Placement: Continue shifting the patient forward until their feet are placed firmly on the floor for stability.

Gait Belt Application: A gait belt should be placed low and tight around the patient's hips. Any excess slack on the belt should be tucked in to prevent it from getting caught during the transfer process.
Footwear Requirements: Both the patient and the caregiver must wear proper footwear. Footwear should provide stable support and have sufficient tread to limit the risk of slipping.

Leg Blocking: The caregiver should position one of the patient's legs between their own legs. Squeezing the patient's leg between the caregiver's legs provides an additional point of control and stability.
Hand Placement and Leverage:
- The patient should lean forward to shift their weight.
- If capable, the patient reaches for the nearest wheelchair armrest with one hand while pushing off the bed with the other.
- The caregiver must hold onto the gait belt at both sides of the patient's hips for leverage and control.
- Warning: The patient should avoid holding onto the caregiver, as this could cause injury to both parties.
The Lift: As the patient leans forward, the caregiver holds the gait belt and leans backward, leveraging the patient up off the edge of the bed.
Stance: The caregiver should stagger their feet, with one behind the other, to receive the patient's weight and maintain balance.
The Pivot: As the patient clears the bed, pivot them toward the wheelchair seat by guiding their hips with the gait belt. The caregiver must pivot their entire body; do not twist at the waist, as this is a high-risk movement for spinal injury.

Seating Alignment: Before lowering the patient, ensure the back of their legs are in contact with the wheelchair seat. This ensures they are seated far enough back and are not at risk of falling off the front edge.
Lowering: Once aligned, the caregiver should bend their knees into a squat to lower the patient into the seat, continuing to guide the hips with the gait belt.
Application Variation: While demonstrated for bed-to-wheelchair, these procedures apply to transfers involving chairs, commodes, cars, showers, or tub benches.
Contact Details: For more information on UCI Health Rehabilitation Services, visit ucihealth.org/rehab or call $714$ .