Which nursing intervention would be carried out to prevent a patient from falling when moving from the bed to the stretcher?

Approximately one million patient falls occur in U.S. healthcare facilities annually, with transfers being a high-risk activity. Understanding which nursing intervention would be carried out to prevent a patient from falling when moving from the bed to the stretcher? is therefore fundamental for ensuring patient safety and promoting healthy aging outcomes during a crucial moment of care.

Quick Summary

A primary nursing intervention to prevent a patient from falling during a bed-to-stretcher transfer is to ensure proper equipment readiness, such as locking the wheels of both the bed and the stretcher, and to utilize a coordinated two-person team or a specialized sliding transfer device.

Key Points

• Pre-Transfer Assessment: Before moving a patient, assess their mobility, cognitive status, and any physical limitations to tailor the safest transfer approach.

• Equipment Security is Paramount: The most crucial intervention is to lock the brakes on both the bed and the stretcher firmly before initiating any patient movement.

• Utilize Assistive Devices: Employ specialized equipment like slide boards, draw sheets, or air-assisted devices to reduce friction and minimize strain during the transfer.

• Promote Teamwork and Communication: A coordinated two-person or multi-person transfer team, led by a designated leader, ensures synchronized and safe patient movement.

• Prepare the Patient: Instruct the patient on how they can assist with the transfer, such as folding their arms across their chest, to help maintain their stability.

• Manage the Environment: Keep the transfer area clear of clutter, cords, and spills to eliminate potential tripping hazards for both patient and staff.

Understanding the Risks of Patient Transfers

Patient transfers, particularly from a bed to a stretcher, are high-risk maneuvers that require meticulous planning and execution. Several factors can increase a patient's risk of falling during this process, including physical weakness, impaired balance, cognitive deficits, vision problems, and disorientation. The surface gap and height difference between the bed and stretcher also present significant hazards. Failure to use proper technique or equipment can lead to severe injury for the patient and potential back injuries for healthcare staff. A proactive, evidence-based approach is crucial to mitigate these risks and create a safer environment for everyone involved.

Critical Nursing Interventions for Safe Transfers

For nurses, preventing falls during bed-to-stretcher transfers is a multi-step process that begins with a thorough risk assessment and ends with proper post-transfer positioning. The core of this intervention lies in preparation, teamwork, and the strategic use of assistive devices.

Pre-Transfer Checklist and Preparation

Before any physical movement begins, nurses must complete a series of preparatory steps to ensure a safe transition. This checklist minimizes last-minute errors and ensures all necessary resources are available.

• Patient Assessment: Evaluate the patient's ability to cooperate, physical strength, and balance. Note any cognitive impairments or specific medical conditions that might affect the transfer.
• Environment Check: Ensure the area is clear of clutter, cords, and wet floors. Adequate lighting is essential for visibility.
• Equipment Readiness: Bring the stretcher to the bedside and align it with the bed. The height of the bed and stretcher should be matched as closely as possible to reduce the risk of a gap or trip hazard.
• Lock All Wheels: This is arguably the most fundamental and critical step. A nurse must verbally confirm that the brakes on both the bed and the stretcher are firmly locked before any transfer begins. This prevents the equipment from rolling away and creating a gap during the maneuver.
• Secure IV Lines and Tubing: Any attached lines, drains, or tubes must be managed to prevent entanglement. They should be secured, but with enough slack to accommodate the move.

The Role of Assistive Devices

Assistive devices play a pivotal role in reducing friction and the physical strain on both the patient and the healthcare provider, thereby preventing falls. The choice of device depends on the patient's mobility level and weight.

• Slide Boards: A rigid or flexible board placed under the patient acts as a bridge, allowing the patient to be slid from one surface to another. A draw sheet should be used on top of the board to reduce friction further.
• Air-Assisted Lateral Transfer Devices: These devices use an air cushion to lift and float the patient across a gap, significantly reducing the force required for a transfer. This is especially useful for bariatric patients or those with sensitive skin.
• Draw Sheets: A simple but effective tool. The patient is rolled onto a draw sheet, and the nursing team uses the sheet to pull and guide the patient across the gap, providing controlled movement and minimizing sheer forces.

Teamwork and Communication

Successful transfers rely on synchronized effort and clear communication among the nursing team. A two-person or multi-person transfer technique ensures the patient's weight is evenly distributed and controlled throughout the move.

1. Assign Roles: Designate one team member as the leader who will count and coordinate the transfer. Other members should be positioned at the head, waist, and feet to support the patient evenly.
2. Clear Instructions: Explain the process to the patient, encouraging them to help where possible (e.g., crossing arms over their chest, tucking their chin).
3. Synchronized Movement: On the leader's count of three, the team executes the transfer smoothly and in unison. Avoid jerky or sudden movements that could cause the patient to lose balance.

Safe Transfer Technique: A Step-by-Step Guide

Following a standardized procedure is key to consistency and safety.

1. Assess and Prepare: Complete the pre-transfer checklist, including locking wheels and ensuring height alignment.
2. Position the Patient: Roll the patient onto their side, away from the stretcher, and place the transfer device (e.g., slide board, draw sheet) underneath them.
3. Return to Supine: Gently roll the patient back onto the transfer device, ensuring they are centered.
4. Position the Team: Station two team members on the side of the stretcher to pull, one at the head to guide, and one on the opposite side of the bed to push.
5. Execute the Transfer: The designated leader gives the command. The team pulls and pushes simultaneously, moving the patient to the center of the stretcher.
6. Secure and Conclude: Remove the transfer device, raise the stretcher side rails, and cover the patient. Reassess the patient for comfort and repositioning needs.

Equipment Comparison: Manual vs. Assisted Transfers

Feature	Manual Transfer (with draw sheet)	Assisted Transfer (with slide board/air mattress)
Equipment Required	Draw sheet, team of 2-3 nurses	Slide board or air-assisted device, draw sheet, team of 2-3 nurses
Friction Reduction	Moderate; depends on surface	High; significantly reduces friction
Patient Effort	Minimal cooperation needed	Minimal to no patient effort required
Caregiver Effort	Moderate to high physical strain	Low physical strain, less risk of back injury
Ideal For	Cooperative, lightweight patients	Non-cooperative, heavy, or immobile patients
Risk of Injury	Moderate for both patient and staff	Low; provides a smoother, more controlled transfer

Post-Transfer and Continuous Assessment

After a successful transfer, the nursing intervention does not end. The patient should be continuously monitored and reassessed. This includes checking vital signs, assessing skin integrity, and ensuring proper positioning for comfort and safety. Any changes in the patient's condition or signs of discomfort should be addressed immediately. Implementing a fall prevention protocol consistently, including the use of bed alarms for high-risk patients, can further enhance safety measures.

Conclusion

Preventing a patient from falling during a bed-to-stretcher transfer is a core competency for nursing professionals. By combining careful pre-transfer preparation, the use of appropriate assistive devices like slide boards, and effective teamwork and communication, nurses can significantly reduce the risk of patient falls. Locking the wheels of all equipment is the non-negotiable, foundational step in this process, ensuring a stable and secure transfer surface. The commitment to standardized, evidence-based practices, as outlined in this article, is essential for maintaining patient safety and delivering the highest quality of care in any medical setting.

Frequently Asked Questions

What is the single most important nursing intervention for preventing a fall during a bed-to-stretcher transfer?

The single most important intervention is to ensure the brakes on both the bed and the stretcher are securely locked. This prevents unexpected movement that could cause a fall or injury during the transfer.

Why is using a slide board an effective nursing intervention to prevent a patient from falling?

A slide board reduces the friction and gap between the bed and stretcher, creating a smooth surface for the patient to be moved across. This eliminates the need for lifting, which minimizes the risk of the patient slipping or losing balance.

How does proper communication affect a safe bed-to-stretcher transfer?

Clear and coordinated communication among the nursing team is vital. A designated leader provides a countdown, ensuring that all team members pull and guide the patient at the exact same time, preventing jerky movements and maintaining control.

Can a patient fall during a transfer even if a slide board is used?

Yes, a fall is still possible if proper protocols are not followed. This includes failing to lock equipment, not having enough staff to assist, or moving too quickly. The slide board is an aid, not a guarantee of safety without proper procedure.

What should a nurse do if the patient is uncooperative during the transfer?

If a patient is uncooperative, confused, or physically unable to assist, the nursing team should use alternative methods, such as an air-assisted lateral transfer device or a mechanical lift, which require less patient participation and provide greater stability.

Is it better to have more nurses assisting with a transfer?

For heavier or less mobile patients, a multi-person team (often two or three nurses) is safer than a single nurse. This distributes the patient's weight, provides more points of contact for control, and reduces the risk of injury to both the patient and the healthcare staff.

When should the nurse re-evaluate the patient's fall risk?

The patient's fall risk should be re-evaluated continuously. This includes before the transfer, immediately after the transfer to ensure stability, and throughout their stay as their condition or medications change.