What should a health care worker do before transferring a patient to a wheelchair?

According to the Agency for Healthcare Research and Quality, up to 1 million hospitalized patients fall each year, with improper transfers being a common cause. Therefore, a health care worker must follow a strict safety protocol before transferring a patient to a wheelchair to prevent falls and protect both the patient and themselves. This includes thorough patient assessment, environmental preparation, and proper equipment setup.

Quick Summary

Healthcare workers must perform a patient assessment, prepare the environment, and securely position the equipment before transferring a patient to a wheelchair. Clear communication and using a gait belt are essential for preventing falls and ensuring a safe, comfortable transfer.

Key Points

• Assess Patient Capability: Before any transfer, evaluate the patient's ability to bear weight, their balance, and check for signs of dizziness to choose the safest method.

• Prepare the Environment: Ensure the pathway is clear of obstacles, the bed is at the correct height, and the wheelchair is correctly positioned and locked.

• Communicate Clearly: Explain the transfer process to the patient step-by-step to gain their trust and cooperation, reducing anxiety and risk.

• Use a Gait Belt: Always use a gait belt fitted snugly around the patient's waist to provide a secure, non-slip grip for support and control.

• Employ Proper Body Mechanics: Bend at your knees, not your back, and use your leg muscles to lift, keeping the patient's weight close to your body to prevent injury.

• Ensure Wheelchair Safety: Position the wheelchair at a 45-degree angle to the bed on the patient's stronger side, with the brakes firmly locked and footrests out of the way.

• Know When to Ask for Help: If a patient is too heavy, unstable, or unable to assist, call for an additional caregiver or use a mechanical lift to ensure everyone's safety.

• Check Equipment: Before using, inspect all equipment, including the wheelchair and gait belt, for any damage or malfunctions.

Essential steps before a wheelchair transfer

Proper preparation is the most critical phase of transferring a patient from a bed to a wheelchair. Healthcare workers must complete a comprehensive checklist before initiating any movement. This phase is vital for mitigating the risk of injury to the patient and preventing musculoskeletal injuries for the caregiver. This process includes a clinical assessment, environmental setup, and patient communication.

Assessing the patient's readiness

Before beginning, the healthcare worker must evaluate the patient's condition to determine the safest and most appropriate transfer method. A patient's physical and cognitive state can change, so a reassessment is needed for each transfer.

• Evaluate weight-bearing capability: Determine how much weight the patient can bear on their legs. This affects whether a stand-and-pivot technique or a mechanical lift is necessary.
• Check for dizziness or vertigo: Allow the patient to sit on the edge of the bed for a few moments to adjust to the position change and reduce the risk of dizziness.
• Note any weaker side: Transfer towards the patient's stronger side when possible.
• Assess cognitive ability: Determine if the patient can understand and follow instructions. For those with impaired cognition, a slide board or mechanical lift may be safer.

Preparing the transfer environment

After assessing the patient, make the area safe and clear of obstacles.

• Clear the pathway: Ensure the path between the bed and the wheelchair is free of clutter.
• Adjust and lock equipment: Adjust the bed height so the patient's feet can rest flat on the floor. Position the wheelchair at a 45-degree angle to the bed on the patient's stronger side and ensure the brakes are locked.
• Relocate movable parts: Swing the wheelchair's footrests out of the way or remove them. If necessary, remove the armrest closest to the bed.

Communicating with the patient

Explaining the process builds trust, reduces anxiety, and encourages participation.

• Explain the steps: Tell the patient what will happen before and during the transfer.
• Count aloud: Initiate movement on a prearranged count to ensure coordinated effort.
• Remind proper form: Instruct the patient to push off with their hands from the bed, avoiding grabbing the caregiver around the neck.

Utilizing a gait belt safely

A gait belt is a crucial piece of equipment used to provide a secure grip on the patient's torso during transfers. It is a tool for support and stabilization, not a lifting device.

1. Placement: Place the belt around the patient's natural waist, just above the hips and over clothing.
2. Fit: Ensure the belt is snug but not too tight, allowing two fingers to slide comfortably between the belt and the patient's body.
3. Grip: Always use an underhand grip on the belt for a stronger hold.

Comparison of Transfer Methods

Feature	Stand-and-Pivot Transfer	Sliding Board Transfer	Mechanical Lift Transfer
Patient Involvement	Requires significant patient strength and cooperation.	Patient can assist but minimal leg strength is needed.	Patient is fully dependent, no strength required.
Cognitive Requirement	Patient must be able to follow verbal instructions.	Patient must be able to follow instructions.	Minimal to no cognitive function needed from the patient.
Equipment Used	Gait belt, non-slip footwear.	Gait belt, transfer board, non-slip footwear.	Full-body sling and mechanical lift device.
Caregiver Effort	Moderate effort using proper body mechanics.	Moderate effort, positioning is key to avoid strain.	Minimal physical effort, primarily operating the lift.
Best For	Patients with partial weight-bearing capability.	Patients with limited lower-body mobility.	Patients who are heavy, unstable, or fully dependent.

Proper body mechanics for healthcare workers

Using proper body mechanics is crucial for protecting the caregiver and ensuring a safe transfer for the patient.

• Use your legs, not your back: Bend your knees and hips to lift with your leg muscles, keeping your back straight.
• Maintain a wide base of support: Stand with your feet shoulder-width apart for stability.
• Keep the patient close: Hold the patient's weight as close to your body's center of gravity as possible.
• Pivot, don't twist: Move your feet to turn your entire body, rather than twisting at the waist.

Conclusion

Before transferring a patient to a wheelchair, a healthcare worker must take deliberate actions to ensure safety and dignity for the patient and protect themselves from injury. A thorough pre-transfer checklist, including patient assessment, equipment preparation, clear communication, and proper body mechanics, is essential. By consistently following these protocols, healthcare workers can significantly reduce the risk of falls and other adverse events. Preparation and precision are the cornerstones of a successful transfer. Healthcare workers should prioritize safety and seek assistance or equipment when needed.

Key considerations for safe transfers

• Assessment First: Always assess the patient's physical and cognitive ability, potential dizziness, and weaker side before every transfer.
• Communicate Clearly: Explain the entire procedure to the patient in simple, clear language to gain their cooperation and reduce anxiety.
• Use a Gait Belt: Apply a gait belt snugly around the patient's waist to provide a secure grip and better control during the transfer.
• Proper Positioning: Position the wheelchair on the patient's stronger side, with wheels locked, and footrests moved out of the way.
• Master Body Mechanics: Bend with your knees, keep your back straight, and pivot with your feet to protect your own back from injury.
• Clear the Environment: Ensure the pathway is free of clutter and potential tripping hazards to facilitate a smooth transfer.
• Know Your Limits: Never lift more than you can comfortably handle. Request assistance or use a mechanical lift if the patient's weight or instability poses a risk.
• Check Equipment: Before using, inspect all equipment, including the wheelchair and gait belt, for any damage or malfunctions.

Additional resources

• Safe Patient Handling and Mobility

Frequently Asked Questions

What is the very first thing a healthcare worker should do before a transfer?

The very first step is to perform a patient assessment, which includes checking their physical condition, cognitive ability, and weight-bearing capability. It is also important to communicate with the patient and explain the upcoming transfer.

Why is it important to lock the wheelchair brakes?

Locking the wheelchair brakes is critical to prevent the chair from shifting or rolling away during the transfer, which could cause the patient to fall and suffer an injury.

How do I use a gait belt properly for a patient transfer?

A gait belt should be placed around the patient's waist over their clothing and fastened snugly, but not too tightly. The caregiver should use an underhand grip on the belt to assist and guide the patient during the transfer.

What should a healthcare worker do if the patient becomes dizzy during the transfer?

If the patient reports feeling dizzy after sitting up, the healthcare worker should immediately help them sit back down on the bed. Allowing the patient to rest for a few minutes can help them stabilize before attempting the transfer again.

How should a healthcare worker position themselves to prevent injury?

A healthcare worker should use proper body mechanics by keeping their back straight, bending their knees, and maintaining a wide base of support. They should lift with their leg muscles and keep the patient's weight close to their body.

When should a mechanical lift be used instead of a manual transfer?

A mechanical lift should be used for patients who are unable to bear weight, are too heavy for a safe manual transfer, or have severely limited mobility. The assessment of the patient will determine the need for a lift.

What is the importance of patient communication during a transfer?

Clear communication helps reduce patient anxiety and increases their cooperation, leading to a smoother and safer transfer. Explaining each step allows the patient to participate and feel more secure throughout the process.