When performing a roll with two staff members, the bed height should be at the waist of the shorter person

According to the Centers for Disease Control and Prevention (CDC), back injuries are a leading cause of disability among healthcare workers. When performing a roll with two staff members, the bed height should be carefully adjusted to prevent musculoskeletal strain and ensure patient safety. Correct bed positioning is a critical step in proper body mechanics and is fundamental for safe patient handling.

Quick Summary

The bed must be adjusted to the waist height of the shortest caregiver involved in a two-person roll. This height ensures both staff members can maintain proper body mechanics, use their leg muscles, and avoid straining their backs. Proper positioning and communication are vital for a smooth, safe, and efficient patient roll.

Key Points

• Adjust to the Shorter Person: The bed height should always be set to the waist level of the shortest staff member assisting with the roll to ensure proper body mechanics for everyone.

• Protect Your Back: By adjusting the bed height correctly, caregivers can avoid bending, twisting, or awkward reaching, which are common causes of back injuries.

• Use Leg Muscles: The proper bed height allows caregivers to use their stronger leg muscles for the movement, rather than relying on their back and arms.

• Engage Proper Body Mechanics: Keep your feet wide and staggered, and maintain a straight back. The movement should come from your hips and legs.

• Coordinate the Movement: Both staff members should communicate clearly and work in unison on a count to ensure a smooth and controlled roll.

• Use Equipment: Utilize friction-reducing devices like slide sheets to make the roll easier and reduce strain on both the patient and the caregivers.

• Prioritize Patient Safety: Proper bed height and technique minimize the risk of injury to the patient and allow for better control throughout the repositioning process.

Why is correct bed height crucial for a two-person roll?

Proper bed height is the cornerstone of safe patient handling. When two staff members perform a roll, their combined effort can be compromised if the bed is at an awkward level. The fundamental principle is to minimize physical strain by bringing the task as close to the caregivers' center of gravity as possible. Incorrect height forces staff to bend, twist, or reach awkwardly, placing undue stress on the back and increasing the risk of musculoskeletal injuries.

By setting the bed to the waist height of the shortest person, both caregivers can work comfortably and efficiently. The taller individual can simply bend their knees slightly more to accommodate the height, maintaining a straight back and engaging their powerful leg muscles. This strategy distributes the physical load evenly and reduces the risk of injury for everyone involved.

Step-by-step guide to performing a two-person patient roll

1. Assess and Prepare: Before beginning, assess the patient's condition, mobility, and any special precautions. Explain the procedure to the patient and encourage them to assist as much as possible. Gather all necessary equipment, such as slide sheets or positioning devices, and ensure the bed's brakes are locked securely.
2. Adjust the Bed: Raise the bed to the waist level of the shorter staff member. This is the most important ergonomic step. Lower the side rails on the side you are working from to get closer to the patient. The bed should also be flat to ensure a smooth, even roll.
3. Position the Patient: Move the patient to the side of the bed opposite the direction they will be rolling. This is often done using a slide sheet or draw sheet. Cross the patient's arms over their chest and bend the leg farthest from you at the knee, creating a lever.
4. Initiate the Roll: Stand with your feet shoulder-width apart, with a slight staggered stance for better balance. One staff member should be positioned at the patient's shoulder and the other at the hip. Use the draw sheet or slide sheet for a firm grip.
5. Coordinate the Movement: Agree on a count and work in unison. Use your leg and core muscles to pull the patient toward you, shifting your weight from your front foot to your back foot as you move. The movement should be a controlled roll, not a lift. Pull the sheet rather than the patient's limbs directly.
6. Secure the Position: Once the patient is rolled onto their side, use pillows or wedges to support their back, legs, and arms, ensuring proper alignment. Ensure no bony prominences are resting on each other and that tubing is not pulled. Return the side rail to the raised position for safety.

Comparison of bed heights for different patient handling tasks

Task	Optimal Bed Height Recommendation	Reasoning
Two-Person Roll	Waist height of the shortest staff member	Enables both staff members to maintain a straight back and leverage their body weight effectively, reducing strain.
Assisting with Standing	Low enough for the patient's feet to be flat on the floor	Allows the patient to use their leg muscles to help with the transfer, promoting independence and reducing caregiver effort.
Providing General Care (e.g., changing linen)	Waist level of the caregiver	Minimizes bending and reaching, allowing the caregiver to work efficiently and comfortably.
Transferring Bed to Wheelchair	Level with the wheelchair seat, or slightly higher	Creates a smooth, even transition, reducing the need to lift and decreasing the risk of falls.

Conclusion

When performing a roll with two staff members, the bed height should be adjusted to the waist height of the shortest staff member involved. This practice is not an optional guideline but a fundamental principle of safe patient handling. By adhering to this ergonomic standard, healthcare providers can protect their own musculoskeletal health and ensure a safe, dignified, and efficient repositioning experience for the patient. Combining proper bed height with clear communication and teamwork is essential for preventing injuries and providing the highest quality of care. The seemingly small detail of bed height has a significant impact on caregiver safety and patient outcomes.

Frequently Asked Questions

What is the primary reason for adjusting the bed height to the shorter person's waist?

The primary reason is to protect the staff members' backs from injury. By setting the height to the shorter person's waist, both caregivers can maintain a straight back, bend their knees, and use their leg muscles, which are stronger than their back muscles, for the movement.

What risks are associated with an incorrect bed height during a roll?

Risks include musculoskeletal injuries for the caregiver, such as back strain, sprains, and long-term pain. It also increases the risk of an unsteady or uncontrolled roll, which could harm the patient.

Why shouldn't the bed be set at the tallest person's waist?

If the bed were at the tallest person's waist, the shorter person would have to reach up, forcing them to use poor body mechanics and significantly increasing their risk of back and shoulder injury during the roll.

How can staff ensure coordination during the roll?

Staff should communicate clearly, agree on a count, and coordinate their movements to act in unison. This prevents sudden or jerky motions and ensures a smooth and controlled repositioning of the patient.

Should a draw sheet or slide sheet be used for a two-person roll?

Yes, using a friction-reducing device like a draw sheet or slide sheet is highly recommended. It reduces the effort required by caregivers and minimizes shear forces on the patient's skin, which helps prevent pressure injuries.

What is the proper patient positioning before initiating the roll?

Before rolling, the patient's arms should be crossed over their chest, and the leg farthest from the direction of the roll should be bent at the knee to act as a lever.

What should be done after the patient is successfully rolled onto their side?

After the roll, pillows or positioning wedges should be used to support the patient's back and limbs to ensure proper alignment and comfort. The side rails should be returned to the up position for safety.