Safe Patient Transfers: What Should You Do with the Footplates When Transferring the Resident in out of the Chair?

Improper transfers are a leading cause of falls among wheelchair users in long-term care facilities [1.4.6]. A key question for caregivers is: what should you do with the footplates when transferring the resident in out of the chair? The answer is critical for safety.

Quick Summary

For a safe transfer, always move the wheelchair footplates out of the way. They should be swung away, flipped up, or removed entirely to prevent a serious trip hazard for both the resident and the caregiver [1.3.5, 1.6.6].

Key Points

• Clear the Path: Always swing away, flip up, or remove wheelchair footplates before a transfer to eliminate a primary trip hazard [1.7.2].

• Lock the Brakes: Before any movement, ensure both wheelchair brakes are securely locked to prevent the chair from rolling [1.6.3].

• Communicate Clearly: Explain each step of the transfer process to the resident to ensure their cooperation and reduce anxiety [1.6.6].

• Use Proper Body Mechanics: Caregivers must bend at the knees and lift with their legs, not their back, to prevent personal injury [1.7.5].

• Position for Success: Place the wheelchair at a 30-45 degree angle to the destination surface to minimize the distance and difficulty of the pivot [1.2.6].

• Feet on the Floor: Ensure the resident's feet are firmly on the floor before they attempt to stand [1.2.6].

The Critical Importance of Managing Footplates During Transfers

Incorrect transfers are a primary cause of falls for residents in long-term care, with research showing that improper body weight shifts contribute to over 70% of falls from wheelchairs [1.4.6]. A frequently overlooked but vital step in this process is managing the wheelchair's footplates. Leaving footplates in place creates a significant obstruction and tripping hazard [1.7.2]. Before any movement begins, the footplates must be moved. Depending on the wheelchair's design, this means they should be swung out to the sides, flipped up, or detached completely [1.3.5, 1.6.6]. This simple action clears the path between the chair and the transfer surface, allowing the resident to place their feet firmly on the floor and reducing the risk of stumbles, trips, and falls for everyone involved.

Step-by-Step Guide to a Safe Wheelchair Transfer

Executing a safe transfer requires preparation, clear communication, and proper body mechanics. Following a consistent process minimizes risk for both the resident and the caregiver. The Occupational Safety and Health Administration (OSHA) emphasizes using safe patient handling programs to reduce musculoskeletal disorders among healthcare staff [1.5.1, 1.5.3].

1. Communicate and Prepare: Explain the entire transfer process to the resident before you begin [1.6.6]. Let them know what they can do to assist. Ensure the destination surface (bed, toilet, car seat) is stable, at the correct height, and as close to the wheelchair as possible [1.3.3].
2. Position the Wheelchair: Place the wheelchair at a 30 to 45-degree angle to the destination surface [1.2.6]. This minimizes the distance the resident needs to pivot.
3. Lock the Brakes: Securely lock the brakes on both wheelchair wheels. This is a non-negotiable step to prevent the chair from moving unexpectedly [1.6.3, 1.7.4].
4. Move the Footplates: This is the crucial step. Swing away, flip up, or remove the footplates to create a clear path [1.7.2]. Forgetting this is a common and dangerous mistake [1.6.3].
5. Prepare the Resident: Have the resident scoot to the edge of the seat until their feet are flat on the floor, shoulder-width apart [1.2.6]. Their knees should be bent at roughly a 90-degree angle [1.3.5]. If using a gait belt, secure it snugly around the resident's waist [1.6.3].
6. Use Proper Body Mechanics: As the caregiver, stand facing the resident with your feet shoulder-width apart. Bend at your knees and hips, keeping your back straight [1.6.4, 1.7.5]. You can brace the resident's knees with your own for added stability.
7. Initiate the Transfer: Instruct the resident to lean forward and push off the armrests if they are able. On a count of three, assist them into a standing position, lifting with your legs, not your back [1.3.1].
8. Pivot and Sit: Guide the resident to pivot slowly towards the destination surface until they can feel it against the back of their legs [1.2.5]. Have them reach back for the surface and slowly lower themselves into a seated position.

For more in-depth guidelines on safe patient handling, you can refer to resources from OSHA [1.5.1].

Comparison Table: Transfer Do's and Don'ts

Action	Do (Safe Technique)	Don't (Unsafe Mistake)
Wheelchair Position	Place chair at a 30-45 degree angle, close to the destination [1.2.6].	Leaving a large gap between surfaces [1.3.1].
Brakes	Lock both wheels securely before any movement [1.7.4].	Forgetting to lock the brakes, causing the chair to slide [1.6.1].
Footplates	Swing them away, flip them up, or remove them completely [1.7.2].	Leaving footplates down, creating a trip hazard [1.7.1].
Communication	Explain every step to the resident before and during the transfer [1.6.6].	Moving the resident without warning or explanation [1.3.1].
Body Mechanics	Bend at the knees, keep your back straight, and lift with your legs [1.7.5].	Twisting your torso or lifting with your back muscles [1.3.1].
Resident's Feet	Ensure feet are flat on the floor before standing [1.2.6].	Attempting to transfer while feet are still on the footplates.

Common Mistakes to Avoid

Even experienced caregivers can make mistakes. Being aware of common errors is key to preventing them.

• Forgetting to Lock the Brakes: This is a leading cause of transfer accidents, as the chair can easily roll away [1.6.2].
• Not Moving Obstructions: Besides the footplates, ensure armrests are moved if they impede the transfer [1.6.3]. The path should be clear of clutter and rugs [1.7.3].
• Poor Communication: Failing to communicate can cause anxiety and resistance from the resident, making the transfer less safe [1.6.2].
• Rushing the Process: Take your time. Rushing increases the risk of mistakes and falls for both you and the resident [1.6.3].
• Improper Lifting: Never pull on the resident's arms or clothing. Use a gait belt for a secure grip and always lift with your leg muscles [1.3.1].

Conclusion: Safety First, Always

Mastering safe wheelchair transfers is a fundamental skill in senior care. The simple act of moving the footplates out of the way is a cornerstone of this process, directly preventing one of the most common transfer hazards. By combining this critical step with clear communication, proper preparation, and correct body mechanics, caregivers can protect residents from falls and injury while also safeguarding their own physical well-being. Always prioritize a safe, methodical approach over speed.

Frequently Asked Questions

Why is it important to move the footplates before a transfer?

Moving the footplates is crucial because they create a significant trip hazard. Leaving them in place can cause the resident or caregiver to fall during the transfer. Removing them clears the path for the resident's feet to be placed securely on the floor [1.7.1, 1.7.2].

What is the very first step before beginning a wheelchair transfer?

The first step is to communicate with the resident, explaining what you are about to do. Then, you should ensure the environment is safe and position the wheelchair correctly next to the destination surface before locking the brakes [1.6.6, 1.7.6].

What angle should the wheelchair be at for an easy transfer?

The wheelchair should be positioned at a 30 to 45-degree angle relative to the bed, chair, or toilet you are transferring to. This angle makes the pivot motion shorter and easier [1.2.6].

What should I do if a resident starts to fall during a transfer?

Do not try to stop the fall, as this can injure both of you. Instead, use proper body mechanics (bend your knees) to guide the resident slowly and safely to the nearest surface, such as the floor or a chair [1.3.5].

Should I use a gait belt for every transfer?

Using a gait belt is highly recommended as it provides a secure place to hold onto the resident, reducing the risk of injury to their arms or shoulders and giving you better control during the lift and pivot [1.6.3].

How do I transfer a resident who is weaker on one side?

When transferring a resident with a weaker side, always position the wheelchair on their stronger side. This allows them to use their stronger limbs to push off and support their weight during the transfer [1.2.4, 1.3.5].

After the transfer is complete, when do I put the footplates back?

Once the resident is seated comfortably and securely in the wheelchair with their buttocks against the back of the seat, you can then reposition the footplates and place their feet on them [1.3.5].