MENDOCINO COAST DISTRICT HOSPITAL
HUMAN RESOURCES POLICY AND PROCEDURE STATEMENT
NUMBER: 130.3020
PAGE: 6 OF 6
TITLE: Patient Lifting and Transferring
PURPOSE: To establish consistent patient lifting and transfer method that insures safety of both patient and healthcare worker. (HCW)
POLICY:
Principles:
1. Patient cooperation, functional ability and goals/outcome are to be considered when establishing a plan for lifting and transferring.
2. Safe patient lifts and transfers involve a planned, systemic, deliberate approach that solicits the patient’s assistance as much as possible. The HCW should give only the assistance necessary to aid the patient.
3. Assure adequate number of personnel available to assist with lifting /transferring of patients
4. Patient positioning, bed height, and side rail use are to be considered when assisting patients to move and/or transfer.
5. Beds, wheelchairs and gurneys are to be locked prior to patient lifts and/or transfers.
6. Eliminate environmental hazards prior to patient lifting/transfers.
7. Appropriate size wheelchairs, commodes and lifts are to be used on patients of size
8. Patient Care conference with all appropriate Health Care Workers will be held as soon as possible for any patient with lifting, transferring or ambulation challenges.
a. Supervisor / Charge Nurse
b. Physical / Occupational Therapy
c. Employee Health
Devices to Assist
1. Secure footwear is to be worn by the patient when transferring ambulatory patients.
2. Walkers/Canes are to be used for ambulation as needed or recommended by Physical Therapy Department.
3. Unless there is a contraindication, a gait belt is to be used when assisting patients to transfer bed/chair and back, as well as during ambulation.
4. A pull sheet is to be used on all patients requiring assistance in bed.
5. A frame trapeze on the bed is recommended for immobile patients to increase patient participation.
6. A slide board is to be used when assisting patients to transfer bed/gurney and back when the patient is immobile and unable to assist.
7. A mechanical lift is to be used for transferring immobile patients when cooperation, ability, and/or goals would compromise patient and/or HCW safety.
8. Appropriate size wheelchairs, commodes and lifts are to be used on patients of size.
PROCEDURE:
Department Specific Guidelines:
1. Pre Hospital (Ambulance)
Patient lifting and transfers in the pre-hospital setting.
a. On scene responsibilities of EMT’s and Paramedics often require additional resources for lifting and transferring patients. Partners should never be encouraged to lift beyond their own individual capabilities. The assistance from other resources, such as personnel from law enforcement or fire department is encouraged.
b. When a patient is to be moved down a flight of stairs, the gurney wheels will be “locked’ in the “up” position, with safety belts securely fastened around the patient. Whenever possible, a four person carry/lift will be used. Consider use of the “stairpro” if patient is able to sit upright.
2. Surgery
Preoperative Transfer – POS to OR suite, Nursing Unit to OR suite
Ambulatory
a. Promote patient autonomy by assisting the ambulatory patient to the OR bed
b. Secure the locks on both the gurney and OR bed. Assist the patient in moving to the OR bed. Staff should assist the patient by placing themselves on the opposite side of the OR bed.
Non-Ambulatory Patient
d. Defined by inability to move self from gurney or patient bed due to physical or mental limitations. (i.e. hip fracture patients, paraplegic patients, or unconscious patient)
e. Secure the locks on both the gurney and OR bed.
i. Short roller: Utilized when 4 lifting personnel are present. Obese patients require additional lifting personnel + 2 staff members or more if indicated.
ii. Long roller: Utilized when 3 lifting personnel are present. Obese patients require additional lifting personnel + 2 staff members or more if indicated.
f. Remove the patient gurney or patient bed only after patient is secure on the OR bed utilizing the safety strap(s)
Postoperative Transfer – OR Suite to the PACU
*Note: The post op patient will be transferred to a gurney. The patient bed will be for the following patient types: Total Joint (hips, knees, shoulders), Hip Fracture, and Critical Care patients.
Ambulatory Patient (local, conscious sedation or very awake MAC patients)
a. Promote patient autonomy by assisting the patient from the OR bed to the gurney.
b. Secure locks of the gurney and the OR bed. Assist the patient from the OR bed to the gurney. Staff should assist the patient by placing themselves on the opposite side of the gurney.
Non-Ambulatory Patient
a. Defined by inability to move self from gurney or patient bed due to physical or mental limitations. (i.e. Hip fracture patients, paraplegic patients, unconscious patients)
b. Secure the locks on both the gurney and the OR bed.
i. Short roller: Utilized when 4 lifting personnel are present. Obese patients require additional lifting personnel + 2 staff members or more if indicated.
ii. Long roller: Utilized when 3 lifting personnel are present. Obese patients require additional lifting personnel + 2 staff members or more if indicated
Note: On call crew may need to ask surgeon, EMT/Paramedics or house Supervisor to assist in transfer in the Surgical Suite. Request for additional help should never be ignored due to the restrictive area. Additional help is expected to don surgical attire and assist in the transfer. On Call crew must be proactive in requesting additional assistance, both for the patient safety and staff safety.
Post Operative Transfers – PACU to Nursing Units
a. Assistance (more than 1 staff) will be by patient type / acuity Guidelines
i. Gurney & IV without IV/PCA pump 1 staff RN
ii Gurney & IV with IV/PCA pump 1 –2 staff (1RN)
iii. Patient bed & IV with or without IV/PCA pump 2 staff (1RN)
iv. Patient Bed Critical Care Patient 2-3 staff (1RN, may include anesthesia provider)
b. Transfer form gurney to the patient bed.
Note: The expectation is that the postoperative patient can participate in the transfer, taking into consideration physical and/or mental limitations from the surgical procedure.
Ambulatory Patient (Conscious Sedation, MAC, General Anesthesia including Spinal Anesthesia which is no longer intact.)
a. Promote patient autonomy by assisting the patient from the gurney to the patient bed.
b. Secure the locks of the gurney and the patient bed. Assist the patient in moving to the bed. Staff should assist the patient by placing themselves on the opposite side of the gurney.
c. Instruct the patient to utilize the trapeze bar in their move
Non-Ambulatory Patient
a. Secure locks on the gurney and patient bed.
b. Utilize the slider board
c. Minimum staff present for transfer will be 3
d. Obese patients will require 3 + staff during the transfer.
3. Home Health
a. Home Health staff determines a patient’s eligibility/appropriateness for admission using a variety of criteria, including, but not limited to:
i. Reasonable expectation that the patient’s medical, personal and social needs can be met adequately in his/her residence, including a plan to meet medical emergencies.
ii. The availability of appropriately skilled MCDH Home Health personnel and the resources to provide the services required by the patient’s care needed
Note: A more detailed list can be found in the MCDH Home Health Administrative Policy and Procedure manual.
b. In homes where HCW’s may require additional resources for moving patients in order to perform prescribed care, the assistance from caregivers or family members is necessary. If a patient has fallen and there are not enough resources available in the home, additional personnel fro the ambulance or fire department may also be necessary.
4. In patient Care
a. Ambulatory
i. Promote patient autonomy and independence by assisting the ambulatory patient.
ii. Independent ambulatory patients may be assisted by 1 staff employee
.
b. Ambulatory with Assist
i. Promote patient autonomy and independence by assisting the ambulatory patient
ii. Patients requiring assistance with ambulation or transfer (walker, cane,) must be accompanied by at least 2 staff employees.
iii. Obese patients, with any ambulatory or transfer needs (assistive devises, weak, or post surgical) must be accompanied by 3 staff employees. Two on either side of patient and one with a wheelchair.
iv. Bariatric Patients:
A. Any patient weighing 300 pounds or more and has Impaired Mobility, or Altered Mentation
B. Notify a manager or supervisor to hold a Patient care conference ASAP. (See above for appropriate personnel)
C. Follow the minimum staffing requirements to safely care for this individual.
D. Attempt to determine their pre-hospital ability to ambulate.
Note: To determine the number of hospital staff required to:
A. Turn a patient side to side.
B. Transfer a patient up in bed or move them in any manner
C. Help transfer them out of bed or chair for any reason
Please divide the patient’s weight by 75 to determine the number of staff needed.
5. Education and Training
a. General body mechanics will be taught to all employees upon hire during general orientation. All New Hires will be given instructions on the use of all transfer equipment. All employees involved in lifting and transferring patients are oriented to correct methods by their department manager/designee upon hire. Reviews are conducted annually, with any change in any policy/procedure and as a need is identified by the department manager or Environment of Care Committee.
6, Documentation
a. Specific methods established for patient lifting an transferring, including plan developed by the Physical Therapy Department personnel are to be documented on the Nursing Care Plan and on the Patient Kardex and communicated to other direct care providers as necessary. (i.e. Radiology, EEG, Emergency Dept.) And updated as condition changes
b. Follow-up on patient and employee incidents involving lifts and transfers is to include compliance to this policy.
Attachments: MCDH Bariatric Guide
New: May 2004 Revised: 1/15/08
Approval Signatures:
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Employee Health Coordinator Date
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Chief, Human Resources Date
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Chief Executive Officer Date
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President, Board of Directors Date
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Chief Nursing Executive Date